Uterine fibroid - Knowledge (XXG)

1425:(MRI), which guides and monitors the treatment. During the procedure, delivery of focused ultrasound energy is guided and controlled using MR thermal imaging. Patients who have symptomatic fibroids, who desire a non-invasive treatment option and who do not have contraindications for MRI are candidates for MRgFUS. About 60% of patients qualify. It is an outpatient procedure and takes one to three hours depending on the size of the fibroids. It is safe and about 75% effective. Symptomatic improvement is sustained for two plus years. Need for additional treatment varies from 16 to 20% and is largely dependent on the amount of fibroid that can be safely ablated; the higher the ablated volume, the lower the re-treatment rate. There are currently no randomized trial between MRgFUS and UAE. A multi-center trial is underway to investigate the efficacy of MRgFUS vs. UAE. 996: 1012: 867:

invasion of adjacent organs and metastases to distant organs (e.g. lung). MRI findings suggestive of a malignancy include nodular/ill-circumscribed tumor margins, intermediate/high T2-weighted signal intensity of the solid tumor components, regions with high signal T1-weighted sequences in keeping with subacute hemorrhage, fine/wispy enhancement of the solid parts of the tumor, and restricted diffusion on diffusion-weighted imaging (DWI). A biopsy is rarely performed and if performed, is rarely diagnostic. Should there be an uncertain diagnosis after ultrasounds and MRI imaging, surgery is generally indicated.

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uterine fibroids with atypical imaging features and fibroids with variant growth patterns. MRI can also identify other uterine (e.g. adenomyosis, endometrial polyps, endometrial cancer) and extrauterine (e.g. benign and malignant ovarian tumors, endometriosis) disorders that may mimic the appearance of uterine fibroids and/or contribute to the patient's symptoms. However, a small proportion of uterine fibroids can mimic other malignant uterine tumors (e.g. leiomyosarcoma) on all available imaging modalities (e.g. ultrasound, CT, MRI and PET-CT).

905: 945: 1494:. African American women are two to three times more likely to get fibroids than Caucasian women. In African American women fibroids seem to occur at a younger age, grow more quickly, and are more likely to cause symptoms. This leads to higher rates of surgery for African Americans, both myomectomy, and hysterectomy. Increased risk of fibroids in African Americans causes them to fare worse in in-vitro fertility treatments and raises their risk of premature births and delivery by Caesarean section. 890: 917: 957: 674: 933: 969: 1174:(SPRM) that has tentative evidence to support its use for presurgical treatment of fibroids with low side-effects. Long-term UPA-treated fibroids have shown volume reduction of about 70%. In some cases UPA alone is used to relieve symptoms without surgery, and to allow successful pregnancies without fibroid regrowth. Indeed, in the tumor cells, the molecule blocks the cell proliferation, induces their 1301: 520: 60: 1290: 488: 484:. Fibroids grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance on histological section. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall. 473: 1254:(UAE) is a noninvasive procedure that blocks blood flow to fibroids, causing them to shrink. Long-term outcomes with respect to how happy people are with the procedure are similar to that of surgery. There is tentative evidence that traditional surgery may result in better fertility. One review found that UAE doubles the future risk of 1279: 682: 1473:

they usually decrease in size. Surgery to remove uterine fibroids occurs more frequently in women in "higher social classes". Adolescents develop uterine fibroids much less frequently than older women. Up to 50% of women with uterine fibroids have no symptoms. The prevalence of uterine fibroids among

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Uterine artery ligation, sometimes also laparoscopic occlusion of uterine arteries are minimally invasive methods to limit blood supply of the uterus by a small surgery that can be performed transvaginally or laparoscopically. The principal mechanism of action may be similar like in UAE but is easier

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cause temporary regression of fibroids by decreasing estrogen levels. Because of the limitations and side effects of this medication, it is rarely recommended other than for preoperative use to shrink the size of the fibroids and uterus before surgery. It is typically used for a maximum of six months

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are located within the muscular wall of the uterus and are the most common type. Unless they are large, they may be asymptomatic. Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the

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While fibroids are common, they are not a typical cause for infertility, accounting for about 3% of reasons why a woman may not be able to have a child. The majority of women with uterine fibroids will have normal pregnancy outcomes. In cases of intercurrent uterine fibroids in infertility, a fibroid

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Fibroids may be single or multiple. Most fibroids start in the muscular wall of the uterus. With further growth, some lesions may develop towards the outside of the uterus or towards the internal cavity. Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and

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and other typically postmenopausal complications. The main side effects are transient postmenopausal symptoms. In many cases the fibroids will regrow after cessation of treatment, however, significant benefits may persist for much longer in some cases. Several variations are possible, such as GnRH

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They are in most cases still hormone dependent but may cause life-threatening complications when they appear in distant organs. Some sources suggest that a substantial share of the cases may be late complications of surgeries such as myomectomy or hysterectomy. Particularly laparoscopic myomectomy

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Fifty percent of uterine fibroids demonstrate a genetic abnormality. Often a translocation is found on some chromosomes. Fibroids are partly genetic. If a mother had fibroids, risk in the daughter is about three times higher than average. Black women have a 3–9 times increased chance of developing

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have been used experimentally to reduce fibroids. The effect is believed to be due partially by lowering systemic estrogen levels and partially by inhibiting locally overexpressed aromatase in fibroids. However, fibroid growth has recurred after treatment was stopped. Experience from experimental

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Physical examination and ultrasound are sufficient for diagnosing uterine fibroids in the majority of patients. When ultrasound findings are inconclusive, magnetic resonance imaging (MRI) may be able to confirm the diagnosis of uterine fibroids in most cases. In addition, MRI can identify benign

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and other endometrial diseases. Aromatase inhibitors are currently considered for treatment, at certain doses they would completely inhibit estrogen production in the fibroid while not largely affecting ovarian production of estrogen (and thus systemic levels of it). Aromatase overexpression is

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have been tested, there is evidence that it relieves some symptoms and improves quality of life but because of adverse histological changes that have been observed in several trials it can not be currently recommended outside of research setting. Fibroid growth has recurred after antiprogestin

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Malignant tumors of the uterine wall (e.g. leiomyosarcoma) are very rare. Findings suggestive of a malignant uterine tumor rather than a benign fibroid include, fast or unexpected growth (particularly after menopause), interruption/effacement of the endometrial stripe, lymph node enlargement,

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Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whorled). These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and

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For decades, a common approach to treating symptomatic fibroids was "either get a hysterectomy or wait until menopause diminishes the symptoms," but minimally invasive and noninvasive options were often not offered. Especially since the 2010s, minimally invasive and noninvasive options are

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Growth and location are the main factors that determine if a fibroid leads to symptoms and problems. A small lesion can be symptomatic if located within the uterine cavity while a large lesion on the outside of the uterus may go unnoticed. Different locations are classified as follows:

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is an effective treatment to shrink fibroids and control symptoms. Its use is limited by unpleasant side effects. Mechanism of action is thought to be antiestrogenic effects. Recent experience indicates that safety and side effect profile can be improved by more cautious dosing.

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Laparoscopic myomectomy has less pain and shorter time in hospital than open surgery. An analysis of 15,000 women found that those who had myomectomy required fewer additional procedures to manage fibroids (including hysterectomies) over the next 5 years than those who had UAE.

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in the United Kingdom) guidelines state UAE/UFE can be offered to women with symptomatic fibroids (fibroids being usually >30mm in size). Women should be informed that UAE and myomectomy (the surgical removal of fibroids) may potentially allow them to retain their fertility.

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surgeries each year, which affect 22% of African Americans and 7% of Caucasian women. The bill also called for more funding for research and educational purposes. It also states that of the $ 28 billion issued to NIH, $ 5 million was allocated for uterine fibroids in 2004.

850:-dependent growth of fibroids. These stem-progenitor cells are deficient in estrogen receptor α and progesterone receptor and instead rely on substantially higher levels of these receptors in surrounding differentiated cells to mediate estrogen and progesterone actions via 416:

Diets high in fruits and vegetables tend to lower the risk of developing fibroids. Fibers, vitamin A, C and E, phytoestrogens, carotenoids, meat, fish, and dairy products are of unclear effect. Normal dietary levels of vitamin D may reduce the risk of developing fibroids.

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Genetic and hereditary causes are being considered and several epidemiologic findings indicate considerable genetic influence especially for early onset cases. First degree relatives have a 2.5-fold risk, and nearly 6-fold risk when considering early onset cases.

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Since 2011 the FIGO published their consensus paper on the classification of fibroids, namely from 0 to 8. This is part of the PALM COEIN classification and is the most frequently used in clinical practise and research Please continue reading here:

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Some risk factors associated with the development of uterine fibroids are modifiable. Fibroids are more common in obese women. Fibroids are dependent on estrogen and progesterone to grow and therefore relevant only during the reproductive years.

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Some women with uterine fibroids do not have symptoms. Abdominal pain, anemia and increased bleeding can indicate the presence of fibroids. There may also be pain during intercourse (penetration), depending on the location of the fibroid. During

1158:) is released in low concentration locally. While most levongestrel-IUD studies concentrated on treatment of women without fibroids a few reported good results specifically for women with fibroids including a substantial regression of fibroids. 995: 4693: 4678: 630:

Fibroids of uterine origin located in other parts of the body, sometimes also called parasitic myomas have been historically extremely rare, but are now diagnosed with increasing frequency. They may be related or identical to metastasizing

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Awiwi MO, Badawy M, Shaaban AM, Menias CO, Horowitz JM, Soliman M, et al. (July 2022). "Review of uterine fibroids: imaging of typical and atypical features, variants, and mimics with emphasis on workup and FIGO classification".

1787:"Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013" 1406:

is a minimally invasive treatments for fibroids. In this technique the fibroid is shrunk by inserting a needle-like device into the fibroid through the abdomen and heating it with radio-frequency (RF) electrical energy to cause

391:, or interference with the position of the fetus. A uterine fibroid can cause rectal pressure. The abdomen can grow larger mimicking the appearance of pregnancy. Some large fibroids can extend out through the cervix and vagina. 810:

Aromatase and 17beta-hydroxysteroid dehydrogenase are aberrantly expressed in fibroids, indicating that fibroids can convert circulating androstenedione into estradiol. Similar mechanism of action has been elucidated in

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About 20% to 80% of women develop fibroids by the age of 50. In 2013, it was estimated that 171 million women were affected worldwide. They are typically found during the middle and later reproductive years. After

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About 20% to 80% of women develop fibroids by the age of 50. Globally in 2013 it was estimated that 171 million women were affected. They are typically found during the middle and later reproductive years. After

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myomectomy is done through a small incision near the navel. The physician uses a laparoscope and surgical instruments to remove the fibroids. Studies have suggested that laparoscopic myomectomy leads to lower

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Myomectomy is a surgery to remove one or more fibroids. It is usually recommended when more conservative treatment options fail for women who want fertility preserving surgery or who want to retain the uterus.

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The appearance of prominent nucleoli with peri-nucleolar halos should alert the pathologist to investigate the possibility of the extremely rare hereditary leiomyomatosis and renal cell cancer (Reed) syndrome.

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is being tested with promising results as a possible use as a treatment for fibroids, intended to provide the advantages of progesterone antagonists without their adverse effects. Low dietary intake of

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In disseminated intraperitoneal leiomyomatosis, leiomyomata grow diffusely on the peritoneal and omental surfaces, with uterine fibroids as their source. This can simulate a malignant tumor but behaves

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Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=cervical fibroid, f=fibroid of the broad

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The exact cause of fibroids is not clearly understood, but the current working hypothesis is that genetic predispositions, prenatal hormone exposure and the effects of hormones, growth factors and

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can be used if the fibroids are only within the uterus and not intramural and relatively small. High failure and recurrence rates are expected in the presence of larger or intramural fibroids.

2024:"Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations" 904: 1186:, hence explaining the long-term benefit. Yet, due to some rare but severe hepatic injuries after UPA treatment, the licence was suspended in 2020 in the EU and voluntary removed in Canada. 426:

uterine fibroids than white women. Only a few specific genes or cytogenetic deviations are associated with fibroids. 80–85% of fibroids have a mutation in the mediator complex subunit 12 (

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in a moderate and well-tolerated dose has been shown in two studies to shrink fibroids effectively. The mechanism of action responsible for how cabergoline shrinks fibroids is unclear.

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Courtoy GE, Donnez J, Ambroise J, Arriagada P, Luyckx M, Marbaix E, et al. (August 2018). "Gene expression changes in uterine myomas in response to ulipristal acetate treatment".

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can be used to reduce painful menstrual periods. Oral contraceptive pills may be prescribed to reduce uterine bleeding and cramps. Anemia may be treated with iron supplementation.

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class may decrease the size of the fibroids but are expensive and associated with side effects. If greater symptoms are present, surgery to remove the fibroid or uterus may help.

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are located on the surface of the uterus. They can also grow outward from the surface and remain attached by a small piece of tissue and then are called pedunculated fibroids.

3292:"Fibroids are serious. Surgery isn't the only way to stop them. Many women are not told about noninvasive treatments that don't affect fertility. Experts want to change that" 1491: 4822: 2428:

Garg K, Tickoo SK, Soslow RA, Reuter VE (2011). "Morphologic Features of Uterine Leiomyomas Associated with Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome".

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and apoptotic factors as well as other hormones. Furthermore, the actions of estrogen and progesterone are modulated by the cross-talk between estrogen, progesterone and

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myomectomy) is the most invasive surgical procedure to remove fibroids. The physician makes an incision in the abdominal wall and removes the fibroids from the uterus.

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was the classical method of treating fibroids. Although it is now recommended only as last option, fibroids are still the leading cause of hysterectomies in the US.

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Zapata LB, Whiteman MK, Tepper NK, Jamieson DJ, Marchbanks PA, Curtis KM (2010). "Intrauterine device use among women with uterine fibroids: a systematic review☆".

1077: 439: 4213:"Uterine-preserving treatments or hysterectomy reintervention after myomectomy or uterine artery embolisation: A retrospective cohort study of long-term outcomes" 1501:

are more likely to have fibroids. Other suggested causes include the tendency of African American women to consume food with less than the daily requirements for

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is typically located in a submucosal position and it is thought that this location may interfere with the function of the lining and the ability of the embryo to

3873: 1414: 1258:. UAE also appears to require more repeat procedures than if surgery was done initially. A person will usually recover from the procedure within a few days. 549:

are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity; even small lesions in this location may lead to bleeding and

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There are a number of rare conditions in which fibroids metastasize. They still grow in a benign fashion, but can be dangerous depending on their location.

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The 2016 NICE (National Institute of Clinical Excellence – the non governmental public body that publishes guidelines in the use of health technologies and

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There are a number of rare conditions in which fibroids metastasize. They still grow in a benign fashion, but can be dangerous depending on their location.

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Most fibroids do not require treatment unless they are causing symptoms. After menopause, fibroids shrink, and it is unusual for them to cause problems.

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in cell nuclei is a consistent finding in uterine leiomyomas, and helps in distinguishing such tumors from β-catenin positive spindle cell tumors.

5262: 5171: 660:, leiomyomata grow in more distant sites such as the lungs and lymph nodes. The source is not entirely clear. Pulmonary involvement can be fatal. 2666: 4815: 2006: 1523: 800: 339: 216: 1132:

increasingly being offered as they have advanced on their technological journey from being new and unusual to being common clinical practice.

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Talaulikar VS, Manyonda IT (August 2012). "Ulipristal acetate: a novel option for the medical management of symptomatic uterine fibroids".

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signaling which controls the expression of the respective nuclear receptors. It is believed that estrogen promotes growth by up-regulating

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of cells. The treatment is a potential option for women who have fibroids, have completed child-bearing and want to avoid a hysterectomy.

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agonists with add-back regimens intended to decrease the adverse effects of estrogen deficiency. Several add-back regimes are possible,

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It is unclear why fibroids are more common in African American women. Some studies suggest that black women who are obese and who have

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instrument inserted through the vagina and cervix that can use high-frequency electrical energy to cut tissue, or a similar device.

5310: 4866: 4620:"Histology of uterine leiomyoma and occurrence in relation to reproductive activity in the Baltic gray seal (Halichoerus grypus)" 2090:

Parazzini F, Di Martino M, Candiani M, Viganò P (2015). "Dietary components and uterine leiomyomas: a review of published data".

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Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders

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Pérez-López FR (April 2015). "Ulipristal acetate in the management of symptomatic uterine fibroids: facts and pending issues".

932: 4960: 2356:"Mutations in the fumarate hydratase gene cause hereditary leiomyomatosis and renal cell cancer in families in North America" 831:

Expansion of uterine fibroids occurs by a slow rate of cell proliferation combined with the production of copious amounts of

657: 2582:"Parasitic myomas after laparoscopic surgery: An emerging complication in the use of morcellator? Description of four cases" 968: 646:

In leiomyoma with vascular invasion, an ordinary-appearing fibroid invades into a vessel but there is no risk of recurrence.

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Kashani BN, Centini G, Morelli SS, Weiss G, Petraglia F (July 2016). "Role of Medical Management for Uterine Leiomyomas".

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indicates that aromatase inhibitors might be particularly useful in combination with a progestogenic ovulation inhibitor.

292:. Someone can have one uterine fibroid or many. It is uncommon but possible that fibroids may make it difficult to become 5148: 4923: 2674: 2498:"FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age" 1518:

The 2005 S.1289 bill was read twice and referred to the committee on Health, Labor, and Pensions but never passed for a

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Eighty percent of African American women will develop benign uterine fibroid tumors by their late 40s, according to the

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The exact cause of uterine fibroids is unclear. However, fibroids run in families and appear to be partly determined by

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Wallach EE, Vlahos NF (August 2004). "Uterine myomas: an overview of development, clinical features, and management".

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vote; the proposed Uterine Fibroid Research and Education Act of 2005 mentioned that $ 5 billion is spent annually on

1251: 1125: 1118: 1076:, of the myometrium can develop. In extremely rare cases uterine fibroids may present as part or early symptom of the 689: 396: 343: 192: 3701:"Matrix Metalloproteinase Activity Correlates With Uterine Myoma Volume Reduction After Ulipristal Acetate Treatment" 559:

are located in the wall of the cervix (neck of the uterus). Rarely, fibroids are found in the supporting structures (

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Akinola OI, Fabamwo AO, Ottun AT, Akinniyi OA (2005). "Uterine artery ligation for management of uterine fibroids".

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are effective in limiting menstrual blood flow and improving other symptoms. Side effects are typically few as the

1050: 880: 650: 265: 3797:"Allergan Inc. voluntarily withdraws its drug Fibristal, used to treat uterine fibroids, from the Canadian market" 553:. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix. 5341: 5315: 725: 3291: 5138: 4719: 3869: 2944:, Yang S, Fang Z, Gurates B, Tamura M, Zhou J, et al. (2001). "Role of aromatase in endometrial disease". 1183: 709:. When multiple fibroids are present they frequently have unrelated genetic defects. Specific mutations of the 706: 560: 5230: 3398:"Review of the safety, efficacy and patient acceptability of the levonorgestrel-releasing intrauterine system" 4551: 5346: 5290: 5176: 1403: 1108: 788: 103: 2407: 577: 5013: 1266: 164: 3177:"Wnt/β-catenin signaling pathway in uterine leiomyoma: role in tumor biology and targeting opportunities" 653:, leiomyomata grow in veins with uterine fibroids as their source. Involvement of the heart can be fatal. 5300: 5066: 4970: 3218: 1539:

Uterine fibroids are rare in other mammals, although they have been observed in certain dogs and Baltic

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Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders (April 2011).

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in uterine leiomyoma, which is negative as there is only staining of cytoplasm but not of cell nuclei.

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A very large (9 cm) fibroid of the uterus which is causing pelvic congestion syndrome as seen on

4888: 3980:"Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids" 2726: 2267: 2256:"Multiple clinical characteristics separate MED12-mutation-positive and -negative uterine leiomyomas" 1519: 1392: 1305: 1294: 1147: 1030: 1017: 847: 832: 568: 461: 68: 3533:

Donnez J, Tomaszewski J, Vázquez F, Bouchard P, Lemieszczuk B, Baró F, et al. (February 2012).

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effect on leiomyoma cells and also act by influencing (directly and indirectly) a large number of

5257: 5133: 5125: 4950: 4918: 4893: 4487: 4284: 4250: 4044: 3681: 3515: 3472: 3113: 2969: 2923: 2752: 2715:"MED12, the Mediator Complex Subunit 12 Gene, is Mutated at High Frequency in Uterine Leiomyomas" 2535: 2453: 2236: 2115: 1862: 1482:

The incidence of uterine fibroids in Europe is thought to be lower than the incidence in the US.

1167: 453: 312: 153: 87: 5052: 4062: 2667:"FDA Updated Assessment of The Use of Laparoscopic Power Morcellators to Treat Uterine Fibroids" 2315:"Strong family history of uterine leiomyomatosis warrants fumarate hydratase mutation screening" 445: 4395:

Stewart EA, Rabinovici J, Tempany CM, Inbar Y, Regan L, Gostout B, et al. (January 2006).

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A relatively large submucosal leiomyoma; it fills out the major part of the endometrial cavity.

5074: 4835: 4759: 4730: 4641: 4469: 4418: 4377: 4242: 4234: 4193: 4142: 4107: 4036: 4001: 3960: 3939:"Uterine artery embolization for fibroids is associated with an increased risk of miscarriage" 3919: 3851: 3763: 3722: 3673: 3638: 3597: 3556: 3507: 3464: 3429: 3378: 3332: 3269: 3206: 3156: 3105: 3064: 3027: 2961: 2915: 2880: 2828: 2787: 2744: 2648: 2613: 2560: 2527: 2519: 2445: 2385: 2336: 2295: 2228: 2107: 2053: 1947: 1941: 1922: 1854: 1816: 1764: 1697: 821: 449: 281: 148: 75: 2554: 2254:

Heinonen HR, Pasanen A, Heikinheimo O, Tanskanen T, Palin K, Tolvanen J, et al. (2017).

4905: 4843: 4631: 4459: 4449: 4408: 4367: 4359: 4321: 4276: 4224: 4183: 4173: 4134: 4097: 4089: 4028: 3991: 3950: 3909: 3901: 3841: 3833: 3753: 3712: 3665: 3628: 3587: 3546: 3499: 3456: 3419: 3409: 3370: 3324: 3259: 3251: 3196: 3188: 3097: 3054: 3017: 3009: 2953: 2907: 2870: 2862: 2818: 2779: 2734: 2640: 2603: 2593: 2509: 2437: 2375: 2367: 2326: 2285: 2275: 2218: 2185: 2099: 2043: 2035: 1912: 1902: 1846: 1806: 1798: 1754: 1746: 803:(TGIF) is increased in leiomyoma compared with myometrium. TGIF is a potential repressor of 787:

signaling. Progesterone is thought to promote the growth of leiomyoma through up-regulating

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There are also hybrid leimyomas, like the type 2-5 which are both subserosal as submucosal.

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Courtoy GE, Henriet P, Marbaix E, de Codt M, Luyckx M, Donnez J, et al. (April 2018).

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has been reported. This is associated with a mutation in the gene that produces the enzyme

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Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J, et al. (January 2016).

2010: 1417:, is a non-invasive intervention (requiring no incision) that uses high intensity focused 843: 825: 388: 316: 289: 157: 4800: 4517: 2851:"Transforming growth interacting factor expression in leiomyoma compared with myometrium" 4269:"Surgical removal of fibroids has better long-term outcomes than blocking blood vessels" 4188: 4161: 3914: 3893: 3617:"In vivo mechanisms of uterine myoma volume reduction with ulipristal acetate treatment" 3576:"First series of 18 pregnancies after ulipristal acetate treatment for uterine fibroids" 3328: 3264: 3239: 2730: 2271: 5244: 5110: 5088: 5018: 4928: 4852: 4464: 4437: 4397:"Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids" 4372: 4347: 4102: 4077: 3846: 3821: 3424: 3397: 3201: 3022: 2997: 2875: 2850: 2380: 2355: 2290: 2255: 2048: 2023: 1917: 1890: 1850: 1811: 1786: 1434: 1151: 1073: 1058: 986: 799:. Progesterone is believed to counteract growth by downregulating IGF-1. Expression of 564: 351: 181: 169: 33: 3996: 3979: 3592: 3575: 3047:"Genetic heterogeneity among uterine leiomyomata: insights into malignant progression" 2957: 1802: 5330: 5282: 5272: 5027: 4413: 4396: 4288: 4254: 3955: 3938: 3758: 3741: 3633: 3616: 3117: 2927: 2866: 2598: 2581: 2539: 1891:"Presentation and treatment of uterine leiomyoma in adolescence: a systematic review" 1240: 1062: 812: 748: 717: 639:

using a morcellator has been associated with an increased risk of this complication.

363: 4770: 4702: 4162:"Minimally invasive surgical techniques versus open myomectomy for uterine fibroids" 3685: 3519: 3476: 2756: 2713:

Mäkinen N, Mehine M, Tolvanen J, Kaasinen E, Li Y, Lehtonen HJ, et al. (2011).

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Kämpjärvi K, Park MJ, Mehine M, Kim NH, Clark AD, Bützow R, et al. (Sep 2014).

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Toro JR, Nickerson ML, Wei MH, Warren MB, Glenn GM, Turner ML, et al. (2003).

1558:, have been under investigation. Another selective progesterone receptor modulator 1527: 1381: 1321: 1283: 1228: 1224: 1214: 1201: 1113: 1054: 989:

of uterine fibroids typically show smooth muscle in a whorled (fascicular) pattern.

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Luyckx M, Squifflet JL, Jadoul P, Votino R, Dolmans MM, Donnez J (November 2014).

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Moroni RM, Vieira CS, Ferriani RA, Reis RM, Nogueira AA, Brito LG (January 2015).

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Segars JH, Parrott EC, Nagel JD, Guo XC, Gao X, Birnbaum LS, et al. (2014).

1457: 17: 4754: 1342: 1255: 1161: 1066: 737: 550: 476:

An enucleated uterine leiomyoma – external surface on left, cut surface on right

384: 331: 285: 208: 131: 108: 4363: 4280: 4032: 3669: 3192: 3101: 2644: 2514: 2497: 2280: 1717: 1300: 519: 59: 5115: 5097: 4776: 4735: 4454: 4125:

Agdi M, Tulandi T (August 2008). "Endoscopic management of uterine fibroids".

3460: 2998:"Ovarian steroids, stem cells and uterine leiomyoma: therapeutic implications" 2898:

Shozu M, Murakami K, Inoue M (2004). "Aromatase and Leiomyoma of the Uterus".

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Okolo S (2008). "Incidence, aetiology and epidemiology of uterine fibroids".

2523: 4765: 4687: 4229: 4212: 3013: 2996:

Moravek MB, Yin P, Ono M, Coon JS, Dyson MT, Navarro A, et al. (2015).

2823: 2806: 2739: 2714: 2331: 2314: 2039: 1564: 1540: 1502: 1470: 1442: 1438: 1348: 1334: 1175: 1155: 839: 796: 756: 744: 702: 632: 487: 481: 380: 359: 327: 257: 229: 223: 204: 173: 4781: 4645: 4473: 4422: 4381: 4246: 4197: 4146: 4111: 4040: 4005: 3964: 3923: 3855: 3767: 3726: 3677: 3642: 3601: 3560: 3511: 3468: 3433: 3382: 3336: 3273: 3210: 3109: 3068: 3031: 2965: 2919: 2884: 2849:

Yen-Ping Ho J, Man WC, Wen Y, Polan ML, Shih-Chu Ho E, Chen B (June 2009).

2832: 2791: 2748: 2652: 2617: 2531: 2449: 2389: 2340: 2299: 2232: 2111: 2057: 1926: 1858: 1820: 1768: 1441:. There is no consensus among pathologists regarding the transformation of 3742:"Long-term medical management of uterine fibroids with ulipristal acetate" 3717: 3700: 3551: 3534: 2911: 583:

Type 0: pedunculated submucosal, intracavitary (i.e. inside of the uterus)

338:

supplements may be needed in those with heavy periods. Medications of the

5295: 5196: 5023: 3361:

Sankaran S, Manyonda IT (August 2008). "Medical management of fibroids".

3059: 3046: 1759: 1555: 1408: 1218: 1206: 1179: 1128:

and surgical options have similar outcomes with respect to satisfaction.

804: 768: 752: 729: 308: 293: 141: 4636: 4619: 3820:

Tristan M, Orozco LJ, Steed A, Ramírez-Morera A, Stone P (August 2012).

838:

A small population of the cells in a uterine fibroid have properties of

4975: 4965: 4438:"Abstracts of the 2nd European symposium on focused ultrasound therapy" 2608: 2223: 2207:"Mutations in Exon 1 highlight the role of MED12 in uterine leiomyomas" 2206: 1189: 791:, TGF-beta1 and TGF-beta3, and promotes survival through up-regulating 775:, and promotes aberrant survival of leiomyoma cells by down-regulating 721: 504: 448:) that causes uterine leiomyomata along with cutaneous leiomyomata and 304: 300: 277: 137: 4670: 3414: 2190: 2173: 1333:), the fibroid can be removed by either the use of a resectoscope, an 472: 4682: 1696:(2nd ed.). Philadelphia, PA: Elsevier/Mosby. p. Chapter U. 1433:

About 1 out of 1,000 lesions are or become malignant, typically as a

1328: 1046: 323: 261: 4346:

Shen SH, Fennessy F, McDannold N, Jolesz F, Tempany C (April 2009).

2807:"Sex steroidal regulation of uterine leiomyoma growth and apoptosis" 2313:

Tolvanen J, Uimari O, Ryynänen M, Aaltonen LA, Vahteristo P (2012).

1437:

on histology. A sign that a lesion may be malignant is growth after

1057:

and bloatedness are possible. Compression of the ureter may lead to

268:. Some people with fibroids have no symptoms while others may have 4160:

Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C (Oct 21, 2014).

3535:"Ulipristal acetate versus leuprolide acetate for uterine fibroids" 2772:

Best Practice & Research. Clinical Obstetrics & Gynaecology

2631:

Nezhat C, Kho K (2010). "Iatrogenic Myomas: New Class of Myomas?".

2371: 53:

Uterine leiomyoma, uterine myoma, myoma, fibromyoma, fibroleiomyoma

4831: 2580:

Cucinella G, Granese R, Calagna G, Somigliana E, Perino A (2011).

1968:"Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment" 1299: 1288: 1277: 792: 760: 710: 688: 680: 672: 595:

Type 4: intramural (i.e. completely inside the wall of the uterus)

518: 486: 471: 427: 4713: 1278: 879:

A very large (9 cm) fibroid of the uterus which is causing

780: 772: 335: 4804: 681: 618:

If the uterus contains too many to count, it is referred to as

4436:

Kurashvili J, Stepanov A, Kulabuchova E, Batarshina O (2014).

4217:

BJOG: An International Journal of Obstetrics & Gynaecology

3894:"Uterine artery embolization for symptomatic uterine fibroids" 3872:. FEmISA: Fibroid Embolisation: Information, Support, Advice. 3285: 3283: 3240:"Uterine artery embolization for symptomatic uterine fibroids" 776: 720:

cause fibroid growth. Known risk factors are African descent,

1095:

medication to control symptoms (i.e., symptomatic management)

950:

A subserosal uterine fibroid with a diameter of 5 centimeters

4076:

Metwally M, Raybould G, Cheong YC, Horne AW (January 2020).

3238:

Gupta JK, Sinha A, Lumsden MA, Hickey M (26 December 2014).

2469: 2467: 1053:. Due to pressure effects gastrointestinal problems such as 626:

Extrauterine fibroids of uterine origin, metastatic fibroids

322:

Treatment is typically not needed if there are no symptoms.

3615:

Courtoy GE, Donnez J, Marbaix E, Dolmans MM (August 2015).

3175:

El Sabeh M, Saha SK, Afrin S, Islam MS, Borahay MA (2021).

2174:"A review of evidence-based management of uterine fibroids" 2172:

Younas K, Hadoura E, Majoko F, Bunkheila A (January 2016).

2000:

American Society of Reproductive Medicine Patient Booklet:

1351:

rates and faster recovery than does laparotomic myomectomy.

1005:

distinguishes muscle (yellow) from connective tissue (red).

3132:"Uterine fibroids - Diagnosis and treatment - Mayo Clinic" 824:

have double concordance rate for hysterectomy compared to

4796:

NIH Fibroid Treatment Study: Information and NIH research

3892:

Gupta JK, Sinha A, Lumsden MA, Hickey M (December 2014).

3165:

Topic Completed: 1 August 2011. Revised: 15 December 2019

2946:

The Journal of Steroid Biochemistry and Molecular Biology

1140:

A number of medications may be used to control symptoms.

1567:

is associated with the development of uterine fibroids.

571:) of the uterus that also contain smooth muscle tissue. 615:

cystic changes. They tend to calcify after menopause.

354:. They do not appear to develop from benign fibroids. 1045:

Fibroids that lead to heavy vaginal bleeding lead to

779:, increasing expression of the anti-apoptotic factor 743:

It is believed that estrogen and progesterone have a

4660: 922:

A small uterine fibroid seen within the wall of the

350:

versions of fibroids are very rare and are known as

5281: 5243: 5218: 5195: 5157: 5124: 5096: 5087: 5065: 5043: 4989: 4941: 4876: 4860: 4851: 4842: 4745: 4664: 4322:"FDA Approves New Device to Treat Uterine Fibroids" 4021:

International Journal of Gynaecology and Obstetrics

2502:

International Journal of Gynaecology and Obstetrics

1785:Global Burden of Disease Study 2013 (5 June 2015). 1492:

National Institute of Environmental Health Sciences

1072:In very rare cases, malignant (cancerous) growths, 816:particularly pronounced in African-American women. 713:protein have been noted in 70 percent of fibroids. 235: 222: 198: 187: 163: 147: 130: 122: 114: 102: 86: 74: 49: 44: 4348:"Image-guided thermal therapy of uterine fibroids" 4304:"A New Treatment to Help Women Avoid Hysterectomy" 3795:Government of Canada, Health Canada (2020-09-16). 1200:or less because after longer use they could cause 4618:Bäcklin BM, Eriksson L, Olovsson M (March 2003). 4078:"Surgical treatment of fibroids for subfertility" 2991: 2989: 2987: 2985: 2983: 592:Type 3: contacts the endometrium, 100% intramural 3356: 3354: 3352: 3350: 3348: 3346: 1262:to perform and fewer side effects are expected. 1221:alone, and combined estrogens and progestogens. 1091:Symptomatic uterine fibroids can be treated by: 4488:"Helping Black Women Recognize, Treat Fibroids" 1178:and stimulates the remodeling of the extensive 1078:hereditary leiomyomatosis and renal cell cancer 440:Hereditary leiomyomatosis and renal cell cancer 3978:Liu WM, Ng HT, Wu YC, Yen YK, Yuan CC (2001). 2700:Fletcher's Diagnostic Histopathology of Tumors 1069:may be mistaken for or coexist with fibroids. 4816: 4571:"Black Women and High Prevalence of Fibroids" 2694: 2692: 693:Multiple uterine leiomyoma with calcification 8: 3887: 3885: 3883: 3223:: CS1 maint: multiple names: authors list ( 2481:. U.K. National Health Service. 2017-10-19. 1657: 1655: 1653: 1651: 1649: 1647: 1645: 1643: 1641: 1639: 1637: 1635: 1633: 1631: 1629: 1627: 1625: 1623: 1621: 1619: 1617: 1615: 1613: 1611: 1609: 1607: 1605: 1421:waves to destroy tissue in combination with 1415:Magnetic resonance guided focused ultrasound 1304:After treatment of an intramural fibroid by 4166:The Cochrane Database of Systematic Reviews 3244:The Cochrane Database of Systematic Reviews 2844: 2842: 2805:Maruo T, Ohara N, Wang J, Matsuo H (2004). 1943:Reproductive Surgery in Assisted Conception 1718:"Uterine Fibroids | Fibroids | MedlinePlus" 1603: 1601: 1599: 1597: 1595: 1593: 1591: 1589: 1587: 1585: 974:Giant leiomyomas almost filling the abdomen 366:, uterine fibroids are a common reason for 5093: 4873: 4857: 4848: 4823: 4809: 4801: 4661: 2430:The American Journal of Surgical Pathology 2085: 2083: 2081: 2079: 2077: 2075: 2073: 2071: 2069: 2067: 1832: 1830: 1552:Selective progesterone receptor modulators 962:MRI image with multiple uterine leiomyomas 58: 41: 4635: 4565: 4563: 4561: 4522:Philadelphia Black Women's Health Project 4463: 4453: 4412: 4371: 4228: 4187: 4177: 4101: 3995: 3954: 3913: 3845: 3757: 3716: 3632: 3591: 3550: 3423: 3413: 3263: 3200: 3058: 3021: 2874: 2822: 2738: 2607: 2597: 2513: 2379: 2330: 2289: 2279: 2222: 2189: 2141:The Merck Manual of Diagnosis and Therapy 2047: 1916: 1906: 1884: 1882: 1880: 1878: 1876: 1810: 1780: 1778: 1758: 1172:selective progesterone receptor modulator 494:of a lipoleiomyoma, a type of leiomyoma. 27:Benign smooth-muscle tumors of the uterus 2633:Journal of Minimally Invasive Gynecology 607:Type 8: other (e.g. cervcial, parasitic) 362:, they usually decrease in size. In the 330:, may help with pain and bleeding while 276:. If large enough, they may push on the 5263:Clear-cell adenocarcinoma of the vagina 2131: 2129: 1995: 1993: 1991: 1989: 1987: 1581: 869: 3216: 3082: 3080: 3078: 1293:Treatment of an intramural fibroid by 1197:Gonadotropin-releasing hormone analogs 1065:, which itself may cause infertility. 1061:. Fibroids may also present alongside 938:Two calcified fibroids (in the uterus) 801:transforming growth interacting factor 601:Type 6: subserosal, <50% intramural 586:Type 1: submucosal, <50% intramural 340:gonadotropin-releasing hormone agonist 217:gonadotropin releasing hormone agonist 5253:Squamous-cell carcinoma of the vagina 5144:Endometrial intraepithelial neoplasia 4581:from the original on 25 December 2010 4518:"African American Women and Fibroids" 4063:"Uterine Fibroid Embolisation Africa" 3157:"Uterus - Stromal tumors - Leiomyoma" 1315:There are three types of myomectomy: 701:tumors and approximately 40–50% show 7: 4981:Sex cord tumour with annular tubules 4550:. Women's Health.gov. Archived from 4498:from the original on 22 January 2012 2178:The Obstetrician & Gynaecologist 1098:medication aimed at shrinking tumors 926:on a cross-sectional ultrasound view 334:(acetaminophen) may help with pain. 4899:Papillary serous cystadenocarcinoma 4127:Best Pract Res Clin Obstet Gynaecol 3822:"Mifepristone for uterine fibroids" 3363:Best Pract Res Clin Obstet Gynaecol 3329:10.1016/j.contraception.2010.02.011 1739:Best Pract Res Clin Obstet Gynaecol 1148:Levonorgestrel intrauterine devices 598:Type 5: subserosal, ≥50% intramural 589:Type 2: submucosal, ≥50% intramural 118:Middle and later reproductive years 5167:Cervical intraepithelial neoplasia 5139:Uterine papillary serous carcinoma 4324:(Press release). FDA. 2004-10-22. 3937:Homer H, Saridogan E (June 2010). 1851:10.1097/01.AOG.0000136079.62513.39 846:, and contribute significantly to 25: 5268:Vaginal intraepithelial neoplasia 5210:Gestational trophoblastic disease 4528:from the original on 1 April 2011 4211:Amoah A, Quinn SD (1 June 2023). 3593:10.1016/j.fertnstert.2014.07.1253 2900:Seminars in Reproductive Medicine 1239:aromatase inhibitor treatment of 5311:Vulvar intraepithelial neoplasia 4414:10.1016/j.fertnstert.2005.04.072 3956:10.1016/j.fertnstert.2009.02.069 3876:from the original on 2014-05-31. 3759:10.1016/j.fertnstert.2015.09.032 3634:10.1016/j.fertnstert.2015.04.025 3402:Patient Preference and Adherence 2867:10.1016/j.fertnstert.2009.05.001 2599:10.1016/j.fertnstert.2011.05.095 2485:from the original on 2008-05-05. 2161:from the original on 2016-02-09. 2157:. womenshealth.gov. 2016-12-15. 1673:from the original on 7 July 2015 1010: 994: 979: 967: 955: 943: 931: 915: 903: 888: 872: 383:, they may also be the cause of 311:. Diagnosis can be performed by 67:Uterine fibroids as seen during 4328:from the original on 2008-05-09 2702:(3rd ed.). pp. 692–4. 795:expression and down-regulating 604:Type 7: pedunculated subserosal 480:Fibroids are a type of uterine 4179:10.1002/14651858.CD004638.pub3 4094:10.1002/14651858.CD003857.pub4 3906:10.1002/14651858.CD005073.pub4 3838:10.1002/14651858.CD007687.pub2 3256:10.1002/14651858.CD005073.pub4 1101:ultrasound fibroid destruction 807:pathways in myometrial cells. 658:benign metastasizing leiomyoma 620:diffuse uterine leiomyomatosis 368:surgical removal of the uterus 1: 5187:Villoglandular adenocarcinoma 4139:10.1016/j.bpobgyn.2008.01.011 3997:10.1016/S0015-0282(00)01724-6 3396:Kailasam C, Cahill D (2008). 3375:10.1016/j.bpobgyn.2008.03.001 2958:10.1016/S0960-0760(01)00134-0 2784:10.1016/j.bpobgyn.2008.04.002 2155:"Uterine fibroids fact sheet" 2104:10.1080/01635581.2015.1015746 1803:10.1016/S0140-6736(15)60692-4 1751:10.1016/j.bpobgyn.2015.11.016 1663:"Uterine fibroids fact sheet" 1360:myomectomy (also known as an 456:, located on the long arm of 303:levels. Risk factors include 5306:Extramammary Paget's disease 5149:Uterine clear-cell carcinoma 4924:Ovarian clear-cell carcinoma 4575:Fibroid Treatment Collective 3782:"European Medicament Agency" 3504:10.3109/13697137.2014.981133 3045:Hodge JC, Morton CC (2007). 2675:Food and Drug Administration 2442:10.1097/PAS.0b013e318223ca01 1124:In those who have symptoms, 460:(1q42.3-43). Inheritance is 1252:Uterine artery embolization 1126:uterine artery embolization 1119:uterine artery embolization 515:Location and classification 344:Uterine artery embolization 286:pain during penetrative sex 258:benign smooth muscle tumors 193:uterine artery embolization 5363: 5106:Uterine fibroids/leiomyoma 4961:Sertoli–Leydig cell tumour 4884:Ovarian serous cystadenoma 4364:10.1053/j.sult.2008.12.002 4281:10.3310/nihrevidence_59961 4082:Cochrane Database Syst Rev 4033:10.1016/j.ijgo.2005.07.012 3898:Cochrane Database Syst Rev 3870:"The Embolisation Process" 3826:Cochrane Database Syst Rev 3670:10.1016/j.rbmo.2018.04.050 3193:10.1007/s11010-021-04174-6 3102:10.1007/s00261-022-03545-x 2645:10.1016/j.jmig.2010.04.004 2556:Obstetrics and Gynaecology 2515:10.1016/j.ijgo.2010.11.011 2281:10.1038/s41598-017-01199-0 1940:Metwally M, Li TC (2015). 1423:magnetic resonance imaging 881:pelvic congestion syndrome 677:Multiple uterine leiomyoma 651:intravenous leiomyomatosis 437: 266:female reproductive system 31: 5316:Bartholin gland carcinoma 5258:Botryoid rhabdomyosarcoma 4914: 4548:"Minority Women's Health" 4455:10.1186/2050-5736-2-s1-a1 3461:10.1007/s12325-012-0042-8 3155:Mohamed Mokhtar Desouki. 2811:Human Reproduction Update 2559:. John Wiley & Sons. 2553:Impey L, Child T (2016). 1946:. Springer. p. 107. 1908:10.1186/s12905-015-0162-9 1184:matrix metalloproteinases 726:polycystic ovary syndrome 707:chromosomal abnormalities 66: 57: 5337:Gynaecological neoplasia 4943:Sex cord–gonadal stromal 4862:Glandular and epithelial 3051:Human Molecular Genetics 1667:Office on Women's Health 1325:myomectomy (also called 738:never having given birth 685:Large subserosal fibroid 282:frequent need to urinate 32:Not to be confused with 4308:The Wall Street Journal 4230:10.1111/1471-0528.17412 3984:Fertility and Sterility 3705:J Clin Endocrinol Metab 3290:Cimons M (2022-12-11). 3053:. 16 Spec No 1: R7–13. 2740:10.1126/science.1208930 2586:Fertility and Sterility 1404:Radiofrequency ablation 1232:treatment was stopped. 1109:radiofrequency ablation 239:~50% of women by age 50 5014:Endodermal sinus tumor 4600:Office of Budget (PDF) 4352:Semin Ultrasound CT MR 3801:healthycanadians.gc.ca 1308: 1297: 1286: 1282:Submucosal fibroid in 1267:good clinical practice 694: 686: 678: 525: 499: 477: 284:. They may also cause 191:Medications, surgery, 165:Differential diagnosis 5301:Papillary hidradenoma 5231:Mixed Müllerian tumor 5182:Glassy-cell carcinoma 4971:Granulosa cell tumour 4577:. November 29, 2010. 4302:Beck M (2010-01-20). 4275:. 22 September 2023. 3718:10.1210/jc.2017-02295 3552:10.1056/NEJMoa1103180 3014:10.1093/humupd/dmu048 2912:10.1055/s-2004-823027 2824:10.1093/humupd/dmh019 2332:10.1093/humrep/des105 2040:10.1093/humupd/dmt058 1458:extrauterine fibroids 1303: 1292: 1281: 692: 684: 676: 522: 490: 475: 438:Further information: 5172:Clear-cell carcinoma 4889:Mucinous cystadenoma 3658:Reprod Biomed Online 2144:Professional Edition 1669:. January 15, 2015. 1393:Endometrial ablation 1388:Endometrial ablation 1306:laparoscopic surgery 1295:laparoscopic surgery 1236:Aromatase inhibitors 1227:antagonists such as 1041:Coexisting disorders 1031:immunohistochemistry 1018:Immunohistochemistry 833:extracellular matrix 578:FIGO classification. 569:uterosacral ligament 434:Familial leiomyomata 69:laparoscopic surgery 5009:Embryonal carcinoma 4956:Sertoli cell tumour 4867:surface epithelial- 4637:10.1354/vp.40-2-175 4448:(Suppl 1): A1–A25. 2731:2011Sci...334..252M 2272:2017NatSR...7.1015H 2028:Hum. Reprod. Update 1509:Related legislation 1499:high blood pressure 1474:teenagers is 0.4%. 852:paracrine signaling 547:Submucosal fibroids 541:Subserosal fibroids 534:Intramural fibroids 5134:Endometrioid tumor 4951:Leydig cell tumour 4919:Endometrioid tumor 4894:Cystadenocarcinoma 4746:External resources 4605:2011-09-30 at the 3161:pathology Outlines 3136:www.mayoclinic.org 3060:10.1093/hmg/ddm043 2319:Human Reproduction 2224:10.1002/humu.22612 2009:2008-07-03 at the 1895:BMC Women's Health 1309: 1298: 1287: 1168:Ulipristal acetate 1003:Van Gieson's stain 695: 687: 679: 526: 500: 478: 462:autosomal dominant 454:fumarate hydratase 374:Signs and symptoms 313:pelvic examination 250:uterine leiomyomas 154:Pelvic examination 5324: 5323: 5239: 5238: 5083: 5082: 5075:Adenomatoid tumor 5061: 5060: 4937: 4936: 4836:urogenital system 4791: 4790: 4442:J Ther Ultrasound 3752:(1): 165–173.e4. 3415:10.2147/ppa.s3464 3090:Abdom Radiol (NY) 3002:Hum Reprod Update 2725:(6053): 252–255. 2566:978-1-119-01080-7 2191:10.1111/tog.12223 1953:978-1-4471-4953-8 1797:(9995): 743–800. 1703:978-0-323-07699-9 1692:Ferri FF (2010). 822:Monozygotic twins 783:and antagonizing 557:Cervical fibroids 450:renal cell cancer 243: 242: 211:(acetaminophen), 149:Diagnostic method 39:Medical condition 18:Uterine leiomyoma 16:(Redirected from 5354: 5342:Benign neoplasms 5094: 5004:Nongerminomatous 4906:Krukenberg tumor 4874: 4858: 4849: 4825: 4818: 4811: 4802: 4662: 4650: 4649: 4639: 4615: 4609: 4597: 4591: 4590: 4588: 4586: 4567: 4556: 4555: 4544: 4538: 4537: 4535: 4533: 4514: 4508: 4507: 4505: 4503: 4484: 4478: 4477: 4467: 4457: 4433: 4427: 4426: 4416: 4392: 4386: 4385: 4375: 4343: 4337: 4336: 4334: 4333: 4318: 4312: 4311: 4299: 4293: 4292: 4265: 4259: 4258: 4232: 4208: 4202: 4201: 4191: 4181: 4172:(10): CD004638. 4157: 4151: 4150: 4122: 4116: 4115: 4105: 4073: 4067: 4066: 4059: 4053: 4052: 4016: 4010: 4009: 3999: 3975: 3969: 3968: 3958: 3934: 3928: 3927: 3917: 3900:(12): CD005073. 3889: 3878: 3877: 3866: 3860: 3859: 3849: 3817: 3811: 3810: 3808: 3807: 3792: 3786: 3785: 3778: 3772: 3771: 3761: 3737: 3731: 3730: 3720: 3711:(4): 1566–1573. 3696: 3690: 3689: 3653: 3647: 3646: 3636: 3627:(2): 426–34.e1. 3612: 3606: 3605: 3595: 3571: 3565: 3564: 3554: 3530: 3524: 3523: 3487: 3481: 3480: 3444: 3438: 3437: 3427: 3417: 3393: 3387: 3386: 3358: 3341: 3340: 3312: 3306: 3305: 3303: 3302: 3287: 3278: 3277: 3267: 3250:(12): CD005073. 3235: 3229: 3228: 3222: 3214: 3204: 3187:(9): 3513–3536. 3181:Mol Cell Biochem 3172: 3166: 3164: 3152: 3146: 3145: 3143: 3142: 3128: 3122: 3121: 3096:(7): 2468–2485. 3084: 3073: 3072: 3062: 3042: 3036: 3035: 3025: 2993: 2978: 2977: 2938: 2932: 2931: 2895: 2889: 2888: 2878: 2846: 2837: 2836: 2826: 2802: 2796: 2795: 2767: 2761: 2760: 2742: 2710: 2704: 2703: 2696: 2687: 2686: 2684: 2682: 2671: 2663: 2657: 2656: 2628: 2622: 2621: 2611: 2601: 2577: 2571: 2570: 2550: 2544: 2543: 2517: 2493: 2487: 2486: 2471: 2462: 2461: 2436:(8): 1235–1237. 2425: 2419: 2418: 2416: 2415: 2406:. Archived from 2400: 2394: 2393: 2383: 2351: 2345: 2344: 2334: 2310: 2304: 2303: 2293: 2283: 2251: 2245: 2244: 2226: 2202: 2196: 2195: 2193: 2169: 2163: 2162: 2151: 2145: 2136:Uterine Fibroids 2133: 2124: 2123: 2087: 2062: 2061: 2051: 2019: 2013: 2002:Uterine Fibroids 1997: 1982: 1981: 1979: 1978: 1972:Cleveland Clinic 1964: 1958: 1957: 1937: 1931: 1930: 1920: 1910: 1886: 1871: 1870: 1834: 1825: 1824: 1814: 1782: 1773: 1772: 1762: 1734: 1728: 1727: 1725: 1724: 1714: 1708: 1707: 1689: 1683: 1682: 1680: 1678: 1659: 1445:into a sarcoma. 1399:Other procedures 1014: 1001:This variant of 998: 983: 971: 959: 947: 935: 919: 907: 892: 876: 844:progenitor cells 771:, TGF-beta3 and 248:, also known as 246:Uterine fibroids 213:iron supplements 136:Family history, 62: 45:Uterine fibroids 42: 21: 5362: 5361: 5357: 5356: 5355: 5353: 5352: 5351: 5327: 5326: 5325: 5320: 5277: 5235: 5226:Uterine sarcoma 5214: 5205:Choriocarcinoma 5191: 5153: 5120: 5079: 5057: 5053:Meigs' syndrome 5039: 5033:Choriocarcinoma 4985: 4933: 4910: 4868: 4865: 4838: 4829: 4792: 4787: 4786: 4782:Uterine fibroid 4741: 4740: 4673: 4659: 4654: 4653: 4617: 4616: 4612: 4607:Wayback Machine 4598: 4594: 4584: 4582: 4569: 4568: 4559: 4546: 4545: 4541: 4531: 4529: 4516: 4515: 4511: 4501: 4499: 4486: 4485: 4481: 4435: 4434: 4430: 4394: 4393: 4389: 4345: 4344: 4340: 4331: 4329: 4320: 4319: 4315: 4301: 4300: 4296: 4267: 4266: 4262: 4210: 4209: 4205: 4159: 4158: 4154: 4124: 4123: 4119: 4088:(1): CD003857. 4075: 4074: 4070: 4061: 4060: 4056: 4018: 4017: 4013: 3977: 3976: 3972: 3936: 3935: 3931: 3891: 3890: 3881: 3868: 3867: 3863: 3832:(8): CD007687. 3819: 3818: 3814: 3805: 3803: 3794: 3793: 3789: 3780: 3779: 3775: 3739: 3738: 3734: 3698: 3697: 3693: 3655: 3654: 3650: 3614: 3613: 3609: 3573: 3572: 3568: 3532: 3531: 3527: 3489: 3488: 3484: 3446: 3445: 3441: 3395: 3394: 3390: 3360: 3359: 3344: 3314: 3313: 3309: 3300: 3298: 3296:Washington Post 3289: 3288: 3281: 3237: 3236: 3232: 3215: 3174: 3173: 3169: 3154: 3153: 3149: 3140: 3138: 3130: 3129: 3125: 3086: 3085: 3076: 3044: 3043: 3039: 2995: 2994: 2981: 2940: 2939: 2935: 2897: 2896: 2892: 2848: 2847: 2840: 2804: 2803: 2799: 2769: 2768: 2764: 2712: 2711: 2707: 2698: 2697: 2690: 2680: 2678: 2669: 2665: 2664: 2660: 2630: 2629: 2625: 2579: 2578: 2574: 2567: 2552: 2551: 2547: 2495: 2494: 2490: 2473: 2472: 2465: 2427: 2426: 2422: 2413: 2411: 2404:"Reed syndrome" 2402: 2401: 2397: 2353: 2352: 2348: 2312: 2311: 2307: 2253: 2252: 2248: 2204: 2203: 2199: 2171: 2170: 2166: 2153: 2152: 2148: 2134: 2127: 2089: 2088: 2065: 2021: 2020: 2016: 2011:Wayback Machine 1998: 1985: 1976: 1974: 1966: 1965: 1961: 1954: 1939: 1938: 1934: 1888: 1887: 1874: 1836: 1835: 1828: 1784: 1783: 1776: 1736: 1735: 1731: 1722: 1720: 1716: 1715: 1711: 1704: 1691: 1690: 1686: 1676: 1674: 1661: 1660: 1583: 1578: 1573: 1549: 1537: 1516: 1511: 1488: 1480: 1466: 1451: 1431: 1401: 1390: 1379: 1276: 1249: 1170:is a synthetic 1138: 1086: 1051:iron deficiency 1043: 1025: 1015: 1006: 999: 990: 984: 975: 972: 963: 960: 951: 948: 939: 936: 927: 920: 911: 908: 899: 893: 884: 877: 860: 848:ovarian steroid 826:dizygotic twins 671: 628: 537:uterine cavity. 517: 470: 468:Pathophysiology 446:Reed's syndrome 442: 436: 423: 414: 405: 389:premature labor 376: 352:leiomyosarcomas 346:may also help. 317:medical imaging 290:lower back pain 158:medical imaging 40: 37: 28: 23: 22: 15: 12: 11: 5: 5360: 5358: 5350: 5349: 5347:Uterine tumour 5344: 5339: 5329: 5328: 5322: 5321: 5319: 5318: 5313: 5308: 5303: 5298: 5293: 5287: 5285: 5279: 5278: 5276: 5275: 5270: 5265: 5260: 5255: 5249: 5247: 5241: 5240: 5237: 5236: 5234: 5233: 5228: 5222: 5220: 5216: 5215: 5213: 5212: 5207: 5201: 5199: 5193: 5192: 5190: 5189: 5184: 5179: 5174: 5169: 5163: 5161: 5155: 5154: 5152: 5151: 5146: 5141: 5136: 5130: 5128: 5122: 5121: 5119: 5118: 5113: 5111:Leiomyosarcoma 5108: 5102: 5100: 5091: 5085: 5084: 5081: 5080: 5078: 5077: 5071: 5069: 5067:Fallopian tube 5063: 5062: 5059: 5058: 5056: 5055: 5049: 5047: 5041: 5040: 5038: 5037: 5036: 5035: 5030: 5021: 5019:Gonadoblastoma 5016: 5011: 5001: 4995: 4993: 4987: 4986: 4984: 4983: 4978: 4973: 4968: 4963: 4958: 4953: 4947: 4945: 4939: 4938: 4935: 4934: 4932: 4931: 4929:Brenner tumour 4926: 4921: 4915: 4912: 4911: 4909: 4908: 4903: 4902: 4901: 4891: 4886: 4880: 4878: 4871: 4855: 4846: 4840: 4839: 4834:of the female 4830: 4828: 4827: 4820: 4813: 4805: 4799: 4798: 4789: 4788: 4785: 4784: 4773: 4762: 4750: 4749: 4747: 4743: 4742: 4739: 4738: 4727: 4716: 4705: 4690: 4674: 4669: 4668: 4666: 4665:Classification 4658: 4657:External links 4655: 4652: 4651: 4610: 4592: 4557: 4554:on 2010-08-30. 4539: 4509: 4479: 4428: 4401:Fertil. Steril 4387: 4338: 4313: 4294: 4260: 4223:(7): 823–831. 4203: 4152: 4117: 4068: 4054: 4011: 3970: 3929: 3879: 3861: 3812: 3787: 3773: 3732: 3691: 3664:(2): 224–233. 3648: 3607: 3566: 3525: 3482: 3439: 3388: 3342: 3307: 3279: 3230: 3167: 3147: 3123: 3074: 3037: 2979: 2952:(1–5): 19–25. 2933: 2890: 2861:(3): 1078–83. 2855:Fertil. Steril 2838: 2817:(3): 207–220. 2797: 2778:(4): 571–588. 2762: 2705: 2688: 2658: 2639:(5): 544–550. 2623: 2592:(2): e90–e96. 2572: 2565: 2545: 2488: 2463: 2420: 2395: 2372:10.1086/376435 2360:Am J Hum Genet 2346: 2305: 2246: 2217:(9): 1136–41. 2211:Human Mutation 2197: 2164: 2146: 2125: 2063: 2014: 1983: 1959: 1952: 1932: 1872: 1845:(2): 393–406. 1839:Obstet Gynecol 1826: 1774: 1729: 1709: 1702: 1684: 1580: 1579: 1577: 1574: 1572: 1569: 1548: 1545: 1536: 1533: 1515: 1512: 1510: 1507: 1487: 1484: 1479: 1476: 1465: 1462: 1450: 1447: 1435:leiomyosarcoma 1430: 1427: 1400: 1397: 1389: 1386: 1378: 1375: 1370: 1369: 1352: 1338: 1275: 1272: 1248: 1247:Uterine artery 1245: 1152:levonorgestrel 1137: 1134: 1122: 1121: 1116: 1111: 1102: 1099: 1096: 1085: 1082: 1074:leiomyosarcoma 1059:hydronephrosis 1042: 1039: 1027: 1026: 1016: 1009: 1007: 1000: 993: 991: 987:Histopathology 985: 978: 976: 973: 966: 964: 961: 954: 952: 949: 942: 940: 937: 930: 928: 921: 914: 912: 909: 902: 900: 894: 887: 885: 878: 871: 859: 856: 749:growth factors 703:karyotypically 670: 667: 666: 665: 661: 654: 647: 627: 624: 609: 608: 605: 602: 599: 596: 593: 590: 587: 584: 573: 572: 565:broad ligament 561:round ligament 554: 544: 538: 516: 513: 469: 466: 435: 432: 422: 419: 413: 410: 404: 401: 375: 372: 264:, part of the 241: 240: 237: 233: 232: 228:Improve after 226: 220: 219: 202: 196: 195: 189: 185: 184: 182:ovarian cancer 170:Leiomyosarcoma 167: 161: 160: 151: 145: 144: 134: 128: 127: 124: 120: 119: 116: 112: 111: 106: 100: 99: 90: 84: 83: 78: 72: 71: 64: 63: 55: 54: 51: 47: 46: 38: 34:Leiomyosarcoma 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 5359: 5348: 5345: 5343: 5340: 5338: 5335: 5334: 5332: 5317: 5314: 5312: 5309: 5307: 5304: 5302: 5299: 5297: 5294: 5292: 5289: 5288: 5286: 5284: 5280: 5274: 5273:Vaginal cysts 5271: 5269: 5266: 5264: 5261: 5259: 5256: 5254: 5251: 5250: 5248: 5246: 5242: 5232: 5229: 5227: 5224: 5223: 5221: 5217: 5211: 5208: 5206: 5203: 5202: 5200: 5198: 5194: 5188: 5185: 5183: 5180: 5178: 5175: 5173: 5170: 5168: 5165: 5164: 5162: 5160: 5156: 5150: 5147: 5145: 5142: 5140: 5137: 5135: 5132: 5131: 5129: 5127: 5123: 5117: 5114: 5112: 5109: 5107: 5104: 5103: 5101: 5099: 5095: 5092: 5090: 5086: 5076: 5073: 5072: 5070: 5068: 5064: 5054: 5051: 5050: 5048: 5046: 5042: 5034: 5031: 5029: 5028:Struma ovarii 5025: 5022: 5020: 5017: 5015: 5012: 5010: 5007: 5006: 5005: 5002: 5000: 4997: 4996: 4994: 4992: 4988: 4982: 4979: 4977: 4974: 4972: 4969: 4967: 4964: 4962: 4959: 4957: 4954: 4952: 4949: 4948: 4946: 4944: 4940: 4930: 4927: 4925: 4922: 4920: 4917: 4916: 4913: 4907: 4904: 4900: 4897: 4896: 4895: 4892: 4890: 4887: 4885: 4882: 4881: 4879: 4875: 4872: 4870: 4869:stromal tumor 4863: 4859: 4856: 4854: 4850: 4847: 4845: 4841: 4837: 4833: 4826: 4821: 4819: 4814: 4812: 4807: 4806: 4803: 4797: 4794: 4793: 4783: 4779: 4778: 4774: 4772: 4768: 4767: 4763: 4761: 4757: 4756: 4752: 4751: 4748: 4744: 4737: 4733: 4732: 4728: 4726: 4722: 4721: 4717: 4715: 4711: 4710: 4706: 4704: 4700: 4699: 4695: 4691: 4689: 4685: 4684: 4680: 4676: 4675: 4672: 4667: 4663: 4656: 4647: 4643: 4638: 4633: 4630:(2): 175–80. 4629: 4625: 4621: 4614: 4611: 4608: 4604: 4601: 4596: 4593: 4580: 4576: 4572: 4566: 4564: 4562: 4558: 4553: 4549: 4543: 4540: 4527: 4523: 4519: 4513: 4510: 4497: 4493: 4489: 4483: 4480: 4475: 4471: 4466: 4461: 4456: 4451: 4447: 4443: 4439: 4432: 4429: 4424: 4420: 4415: 4410: 4406: 4402: 4398: 4391: 4388: 4383: 4379: 4374: 4369: 4365: 4361: 4358:(2): 91–104. 4357: 4353: 4349: 4342: 4339: 4327: 4323: 4317: 4314: 4309: 4305: 4298: 4295: 4290: 4286: 4282: 4278: 4274: 4273:NIHR Evidence 4270: 4264: 4261: 4256: 4252: 4248: 4244: 4240: 4236: 4231: 4226: 4222: 4218: 4214: 4207: 4204: 4199: 4195: 4190: 4185: 4180: 4175: 4171: 4167: 4163: 4156: 4153: 4148: 4144: 4140: 4136: 4133:(4): 707–16. 4132: 4128: 4121: 4118: 4113: 4109: 4104: 4099: 4095: 4091: 4087: 4083: 4079: 4072: 4069: 4065:. 2017-02-23. 4064: 4058: 4055: 4050: 4046: 4042: 4038: 4034: 4030: 4027:(2): 137–40. 4026: 4022: 4015: 4012: 4007: 4003: 3998: 3993: 3990:(2): 417–22. 3989: 3985: 3981: 3974: 3971: 3966: 3962: 3957: 3952: 3949:(1): 324–30. 3948: 3944: 3943:Fertil Steril 3940: 3933: 3930: 3925: 3921: 3916: 3911: 3907: 3903: 3899: 3895: 3888: 3886: 3884: 3880: 3875: 3871: 3865: 3862: 3857: 3853: 3848: 3843: 3839: 3835: 3831: 3827: 3823: 3816: 3813: 3802: 3798: 3791: 3788: 3783: 3777: 3774: 3769: 3765: 3760: 3755: 3751: 3747: 3746:Fertil Steril 3743: 3736: 3733: 3728: 3724: 3719: 3714: 3710: 3706: 3702: 3695: 3692: 3687: 3683: 3679: 3675: 3671: 3667: 3663: 3659: 3652: 3649: 3644: 3640: 3635: 3630: 3626: 3622: 3621:Fertil Steril 3618: 3611: 3608: 3603: 3599: 3594: 3589: 3586:(5): 1404–9. 3585: 3581: 3580:Fertil Steril 3577: 3570: 3567: 3562: 3558: 3553: 3548: 3545:(5): 421–32. 3544: 3540: 3536: 3529: 3526: 3521: 3517: 3513: 3509: 3505: 3501: 3498:(2): 177–81. 3497: 3493: 3486: 3483: 3478: 3474: 3470: 3466: 3462: 3458: 3455:(8): 655–63. 3454: 3450: 3443: 3440: 3435: 3431: 3426: 3421: 3416: 3411: 3407: 3403: 3399: 3392: 3389: 3384: 3380: 3376: 3372: 3369:(4): 655–76. 3368: 3364: 3357: 3355: 3353: 3351: 3349: 3347: 3343: 3338: 3334: 3330: 3326: 3322: 3318: 3317:Contraception 3311: 3308: 3297: 3293: 3286: 3284: 3280: 3275: 3271: 3266: 3261: 3257: 3253: 3249: 3245: 3241: 3234: 3231: 3226: 3220: 3212: 3208: 3203: 3198: 3194: 3190: 3186: 3182: 3178: 3171: 3168: 3162: 3158: 3151: 3148: 3137: 3133: 3127: 3124: 3119: 3115: 3111: 3107: 3103: 3099: 3095: 3091: 3083: 3081: 3079: 3075: 3070: 3066: 3061: 3056: 3052: 3048: 3041: 3038: 3033: 3029: 3024: 3019: 3015: 3011: 3007: 3003: 2999: 2992: 2990: 2988: 2986: 2984: 2980: 2975: 2971: 2967: 2963: 2959: 2955: 2951: 2947: 2943: 2937: 2934: 2929: 2925: 2921: 2917: 2913: 2909: 2905: 2901: 2894: 2891: 2886: 2882: 2877: 2872: 2868: 2864: 2860: 2856: 2852: 2845: 2843: 2839: 2834: 2830: 2825: 2820: 2816: 2812: 2808: 2801: 2798: 2793: 2789: 2785: 2781: 2777: 2773: 2766: 2763: 2758: 2754: 2750: 2746: 2741: 2736: 2732: 2728: 2724: 2720: 2716: 2709: 2706: 2701: 2695: 2693: 2689: 2677: 2676: 2668: 2662: 2659: 2654: 2650: 2646: 2642: 2638: 2634: 2627: 2624: 2619: 2615: 2610: 2605: 2600: 2595: 2591: 2587: 2583: 2576: 2573: 2568: 2562: 2558: 2557: 2549: 2546: 2541: 2537: 2533: 2529: 2525: 2521: 2516: 2511: 2507: 2503: 2499: 2492: 2489: 2484: 2480: 2476: 2470: 2468: 2464: 2459: 2455: 2451: 2447: 2443: 2439: 2435: 2431: 2424: 2421: 2410:on 2012-02-24 2409: 2405: 2399: 2396: 2391: 2387: 2382: 2377: 2373: 2369: 2366:(1): 95–106. 2365: 2361: 2357: 2350: 2347: 2342: 2338: 2333: 2328: 2325:(6): 1865–9. 2324: 2320: 2316: 2309: 2306: 2301: 2297: 2292: 2287: 2282: 2277: 2273: 2269: 2265: 2261: 2257: 2250: 2247: 2242: 2238: 2234: 2230: 2225: 2220: 2216: 2212: 2208: 2201: 2198: 2192: 2187: 2183: 2179: 2175: 2168: 2165: 2160: 2156: 2150: 2147: 2143: 2142: 2137: 2132: 2130: 2126: 2121: 2117: 2113: 2109: 2105: 2101: 2098:(4): 569–79. 2097: 2093: 2086: 2084: 2082: 2080: 2078: 2076: 2074: 2072: 2070: 2068: 2064: 2059: 2055: 2050: 2045: 2041: 2037: 2034:(3): 309–33. 2033: 2029: 2025: 2018: 2015: 2012: 2008: 2005: 2003: 1996: 1994: 1992: 1990: 1988: 1984: 1973: 1969: 1963: 1960: 1955: 1949: 1945: 1944: 1936: 1933: 1928: 1924: 1919: 1914: 1909: 1904: 1900: 1896: 1892: 1885: 1883: 1881: 1879: 1877: 1873: 1868: 1864: 1860: 1856: 1852: 1848: 1844: 1840: 1833: 1831: 1827: 1822: 1818: 1813: 1808: 1804: 1800: 1796: 1792: 1788: 1781: 1779: 1775: 1770: 1766: 1761: 1760:11365/1031597 1756: 1752: 1748: 1744: 1740: 1733: 1730: 1719: 1713: 1710: 1705: 1699: 1695: 1688: 1685: 1672: 1668: 1664: 1658: 1656: 1654: 1652: 1650: 1648: 1646: 1644: 1642: 1640: 1638: 1636: 1634: 1632: 1630: 1628: 1626: 1624: 1622: 1620: 1618: 1616: 1614: 1612: 1610: 1608: 1606: 1604: 1602: 1600: 1598: 1596: 1594: 1592: 1590: 1588: 1586: 1582: 1575: 1570: 1568: 1566: 1561: 1557: 1553: 1546: 1544: 1542: 1535:Other animals 1534: 1532: 1529: 1525: 1521: 1514:United States 1513: 1508: 1506: 1504: 1500: 1495: 1493: 1486:United States 1485: 1483: 1477: 1475: 1472: 1463: 1461: 1459: 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