Epidemiology and management of uterine fibroids

Uterine leiomyomas are one of the most common and yet understudied diseases in women. These tumors, commonly known as fibroids, affect women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African ancestry during their lifetime. This disease has a profound impact on health care delivery and costs worldwide. Though most women with fibroids are asymptomatic, approximately 30% of them will present with severe symptoms which can include abnormal uterine bleeding, anemia, pelvic pain and pressure, back pain, urinary frequency, constipation, or infertility, and will require intervention. Furthermore, fibroids have been associated with poor obstetrical outcomes. The current options for symptomatic fibroid treatment include expectant, medical, and surgical management, and interventional radiology procedures. This article reviews the recent progress and available management strategies for uterine fibroids and highlights areas where further research is needed to find new therapeutic targets and better personalize treatments.We provide a review of the management options for uterine fibroids.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154526/1/ijgo13102.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154526/2/ijgo13102_am.pd

WHOI Hawaii Ocean Timeseries Station (WHOTS) : WHOTS-7 2010 mooring turnaround cruise report

The Woods Hole Oceanographic Institution (WHOI) Hawaii Ocean Timeseries (HOT) Site (WHOTS), 100 km north of Oahu, Hawaii, is intended to provide long-term, high-quality air-sea fluxes as a part of the NOAA Climate Observation Program. The WHOTS mooring also serves as a coordinated part of the HOT program, contributing to the goals of observing heat, fresh water and chemical fluxes at a site representative of the oligotrophic North Pacific Ocean. The approach is to maintain a surface mooring outfitted for meteorological and oceanographic measurements at a site near 22.75°N, 158°W by successive mooring turnarounds. These observations will be used to investigate air–sea interaction processes related to climate variability. This report documents recovery of the WHOTS-6 mooring and deployment of the seventh mooring (WHOTS-7). Both moorings used Surlyn foam buoys as the surface element and were outfitted with two Air–Sea Interaction Meteorology (ASIMET) systems. Each ASIMET system measures, records, and transmits via Argos satellite the surface meteorological variables necessary to compute air–sea fluxes of heat, moisture and momentum. The upper 155 m of the moorings were outfitted with oceanographic sensors for the measurement of temperature, conductivity and velocity in a cooperative effort with R. Lukas of the University of Hawaii. A pCO2 system was installed on the WHOTS-7 buoy in a cooperative effort with Chris Sabine at the Pacific Marine Environmental Laboratory. The WHOTS mooring turnaround was done on the University of Hawaii research vessel Kilo Moana, by the Upper Ocean Processes Group of the Woods Hole Oceanographic Institution. The cruise took place between 27 July and 4 August 2010. Operations began with deployment of the WHOTS-7 mooring on 28 July. This was followed by meteorological intercomparisons and CTDs. Recovery of WHOTS-6 took place on 2 Aug 2010. This report describes these cruise operations, as well as some of the in-port operations and pre-cruise buoy preparations.Funding was provided by the National Oceanic and Atmospheric Administration under Grant No. NA09OAR432012

WHOI Hawaii Ocean Timeseries Station (WHOTS) : WHOTS-3 mooring turnaround cruise report

The Woods Hole Oceanographic Institution (WHOI) Hawaii Ocean Timeseries (HOT) Site (WHOTS), 100 km north of Oahu, Hawaii, is intended to provide long-term, high-quality air-sea fluxes as a coordinated part of the HOT program and contribute to the goals of observing heat, fresh water, and chemical fluxes at a site representative of the oligotrophic North Pacific Ocean. The approach is to maintain a surface mooring outfitted for meteorological and oceanographic measurements at a site near 22.75N 158W by successive mooring turnarounds. These observations will be used to investigate air-sea interaction processes related to climate variability. The first WHOTS mooring (WHOTS-1) was deployed in August 2004. WHOTS-1 was recovered and WHOTS-2 deployed in July 2005. This report documents recovery of the WHOTS-2 mooring and deployment of the third mooring (WHOTS-3) at the same site. Both moorings used Surlyn foam buoys as the surface element and were outfitted with two Air-Sea Interaction Meteorology (ASIMET) systems. Each system measures, records, and transmits via Argos satellite, the surface meteorological variables necessary to compute air-sea fluxes of heat, moisture, and momentum. WHOTS-2 was equipped with one Iridium data transmitter, and WHOTS-3 had two Iridium data transmitters. In cooperation with R. Lukas of the University of Hawaii, the upper 155 m of the morrings were outfitted with oceanographic sensors for the measurement of temperature, conductivity, and velocity. The WHOTS mooring turnaround was done on the Scripps Institution of Oceanography ship Revelle, Cruise AMAT-07, by the Upper Ocean Processes Group of the Woods Hole Oceanographic Institution and Roger Lukas’group at the University of Hawaii. The cruise took place between 22 and 29 June 2006. Operations on site were initiated with an intercomparison of shipboard meteorological observations with the WHOTS-2 buoy. Dr. Frank Bradley, CSIRO, Australia, assisted with these comparisons. This was followed by recovery of the WHOTS-2 mooring on 24 June. A number of recovered instruments were calibrated by attaching them to the rosette frame of the CTD. Shallow CTD profiles were taken every two hours for 12 hours on the 25th of June. A fish trap was deployed on June 25th by John Yeh, a University of Hawaii graduate student. The WHOTS-3 mooring was deployed on 26 June at approximately 22°46'N, 157°54'W in 4703 m of water. A ship-buoy intercomparison period and series of shallow CTDs followed along with a second deployment of the fishtrap. A NOAA Teacher-At-Sea, Diana Griffiths, and a NOAA Hollings Scholar, Terry Smith, participated in the cruise. This report describes the mooring operations, some of the pre-cruise buoy preparations and CTD casts taken during the cruise, the fish trap deployments, and the experiences of the Teacher-at-Sea and Hollings Scholar.Funding was provided by the National Oceanic and Atmospheric Administration under grant No. NA17RJ1223 for the Cooperative Institute for Climate and Ocean Research (CICOR)

WHOI Hawaii Ocean Timeseries Station (WHOTS) : WHOTS-5 2008 mooring turnaround cruise report

The Woods Hole Oceanographic Institution (WHOI) Hawaii Ocean Timeseries (HOT) Site (WHOTS), 100 km north of Oahu, Hawaii, is intended to provide long-term, high-quality air-sea fluxes as a part of the NOAA Climate Observation Program. The WHOTS mooring also serves as a coordinated part of the HOT program, contributing to the goals of observing heat, fresh water and chemical fluxes at a site representative of the oligotrophic North Pacific Ocean. The approach is to maintain a surface mooring outfitted for meteorological and oceanographic measurements at a site near 22.75°N, 158°W by successive mooring turnarounds. These observations will be used to investigate air–sea interaction processes related to climate variability. The first four WHOTS moorings (WHOTS-1 through 4) were deployed in August 2004, July 2005, June 2006, and June 2007, respectively. This report documents recovery of the WHOTS-4 mooring and deployment of the fifth mooring (WHOTS-5). Both moorings used Surlyn foam buoys as the surface element and were outfitted with two Air–Sea Interaction Meteorology (ASIMET) systems. Each ASIMET system measures, records, and transmits via Argos satellite the surface meteorological variables necessary to compute air–sea fluxes of heat, moisture and momentum. The upper 155 m of the moorings were outfitted with oceanographic sensors for the measurement of temperature, conductivity and velocity in a cooperative effort with R. Lukas of the University of Hawaii. A pCO2 system was installed on the WHOTS-5 buoy in a cooperative effort with Chris Sabine at the Pacific Marine Environmental Laboratory. The WHOTS mooring turnaround was done on the University of Hawaii research vessel Kilo Moana, Cruise KM-08-08, by the Upper Ocean Processes Group of the Woods Hole Oceanographic Institution. The cruise took place between 3 and 11 June 2008. Operations began with deployment of the WHOTS-5 mooring on 5 June at approximately 22°46.1'N, 157°54.1'W in 4702 m of water. This was followed by meteorological intercomparisons and CTDs at the WHOTS-4 site. A period of calmer weather was taken advantage of to recover WHOTS-4 on 6 June 2008. The Kilo Moana then returned to the WHOTS-5 mooring for CTD operations and meteorological intercomparisons. This report describes these cruise operations, as well as some of the in-port operations and pre-cruise buoy preparations.Funding was provided by the National Oceanic and Atmospheric Administration under Grant No. NA17RJ1223 for the Cooperative Institute for Climate and Ocean Research (CICOR)

What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Community survey and qualitative study

Background: Heavy menstrual bleeding is a common symptom amongst women of reproductive age, yet questions remain about why some women experience this as a problem while others do not. We investigated the concerns of women who reported heavy menstrual bleeding on questionnaire. Methods: A cross-sectional postal survey and qualitative interviews were carried out amongst a community-based sample of women in Lothian, Scotland. 906 women aged 25 to 44 reported heavy or very heavy periods in response to a postal survey of 2833 women registered with 19 general practices. Amongst those who had reported heavy menstrual bleeding, analysis was carried out of responses to the free text questionnaire item, "What bothers you most about your periods?" In addition, 32 of these women participated in qualitative interviews and their accounts were analysed to explore how menstrual symptoms and 'problems' with periods were experienced. Results: Even amongst this subgroup of women, selected on the basis of having reported their periods as heavy in the survey, pain was the aspect of their periods that 'most bothered' them, followed by heaviness, mood changes or tiredness, and irregularity or other issues of timing. Interviewees' accounts similarly suggested that a range of menstrual symptoms were problematic and some women did not disentangle which was worst. Judgements of periods as a problem were based on the impact of menstrual symptoms on daily life and this was contingent on social circumstances such as type of paid work and other responsibilities. Although women spoke readily of whether their periods were a problem, there was less clarity in accounts of whether or not menstrual loss was 'heavy'; women said they made judgements based on what was normal for them, degree of difficulty in containing blood loss and pattern of loss. Conclusion: Women with heavy periods are bothered by a range of menstrual symptoms and their impact on everyday life. Clinical emphasis should be on clarifying the presenting problem and providing help and advice for this, as well as on excluding serious disease. Sometimes simple approaches, such as help with analgesia, may be all that is required

Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants

Background: The demand for uterus-sparing treatments is increasing as more women postpone childbirth to their 30–40s, when fibroids are more symptomatic. With an increasing choice of treatment options and changing care-provider profiles, now is an opportune time to survey current practices and opinions. Using a 25-stem questionnaire, a web-based survey was used to capture the practices and opinions of UK consultant gynecologists on the treatment of symptomatic fibroids, including the types of procedure most frequently used, methods used to reduce blood loss, and awareness and acceptability of treatment options, and to assess the impact of gender and experience of the treating gynecologist. Results: The response rate was 22%. Laparascopic myomectomy is used least frequently, with 80% of the respondents using GnRHa preoperatively to minimize blood loss and correct anemia, while vasopressin is most frequently used to reduce intraoperative blood loss. Female consultants operate significantly less frequently than males. Those with more than 10 years consultant experience are more likely to perform an open myomectomy compared to those with less than 10 years experience. Conclusions: Compared to a similar survey performed 10 years ago, surgical methods remain to be the most common treatments, but use of less invasive treatments such as UAE has increased. Consultants’ attitudes appear to be responding to the patient demand for less radical treatments. However, it is yet to be seen if the changing consultant demographics will keep up with this demand. The low response rate warrants cautious interpretation of the results, but they provide an interesting snapshot of current views and practices