Co-Existence of Uterine Myomas and Endometriosis in Women Undergoing Myomectomy/Hysterectomy

Arwa Fatima; Tehreem  Yazdani; Bushra  Zafar; Hira  Shafqat

doi:10.51253/pafmj.v74i6.11230

Authors

Arwa Fatima Department of Obs & Gynae, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Tehreem Yazdani Department of Obs & Gynae, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Bushra Zafar Department of Obs & Gynae, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Hira Shafqat Department of Obs & Gynae, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i6.11230

Keywords:

Comorbidity, Endometriosis, Hysterectomy, Myomas.

Abstract

Objective: To determine the frequency of coexistence of myomas and endometriosis in patients undergoing myomectomy or hysterectomy.

Study Design: Cross-sectional study.

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, Pakistan from Sep 2022 to Sep 2023.

Methodology: Seventy (70) patients undergoing above mentioned myomectomy/hysterectomy were visually examined for the presence of endometriosis. The Chi-square test and Fisher's exact test were used in SPSS-20 to determine the significance of the relationship between the two conditions. Categorical data were expressed as descriptive statistics through frequency percentile. Analysis of continuous variables was carried out through the one-way ANOVA. Results were considered significant at p≤0.05.

Results: In this study, 13 out of 70(18.57%) of the patients operated for myomectomy/ hysterectomy were found to have coexisting uterine myomas and endometriosis. Statistically non-significant (p=0.08) association between these two ailments was noted. Age, parity and body weight were not found to influence the existence or coexistence of these ailments. Pain was a significant finding 13(18.57%) in cases of endometriosis and coexisting uterine myomas (p=0.00). Abnormal uterine bleeding was found significantly (p=0.02) associated with uterine myomas 54(77.14%). Subfertility though a predominant feature was not found to have a significant association with both the conditions and their coexistence (p=0.35, p=0.34 & p=0.44).

Conclusion: A non-significant association between uterine myomas and endometriosis. Pain was a significant finding where the two diseases coexisted.

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References

Verit FF, Yucel O. Endometriosis, leiomyoma and adenomyosis: the risk of gynecologic malignancy. Asian Pac J Cancer Prev 2013; 14(10): 5589-5597.

http://doi.org/10.7314/APJCP.2013.14.10.5589

Mazhin A, Dadkhah A, Kor E, Sadri G, Noroozi SG, Mostafavi SRS, et al. Association between Endometrioma and Die and Other Gynecological Diseases such as Endometrial Polyp, Myomas and Adenomyosis in Ultrasonography. Arch Pharm Pract 2020; 1: 168.

https://pjmhsonline.com/2020/apr-june/1168.pdf

Zheng Q-M, Mao H-l, Zhao Y-J, Zhao J, Wei X, Liu P-S, et al. Risk of endometrial polyps in women with endometriosis: a meta-analysis. Reprod Biol Endocrinol 2015; 13: 1-9.

https://doi.org/10.1186/s12958-015-0092-2

Okolo S. Incidence, aetiology and epidemiology of uterine fibroids. Best pract Res Clin Obstet Gynaecol 2008; 22(4): 571-588. https://doi.org/10.1016/j.bpobgyn.2008.04.002

Munusamy MM, Sheelaa WG, Lakshmi VP. Clinical presentation and prevalence of uterine fibroids: a 3-year study in 3-decade rural South Indian women. Int J Reprod Contracept Obstet Gynecol 2017; 6(12): 5596-5602.

http://doi.org/10.18203/2320-1770.ijrcog20175288

Navarro A, Bariani MV, Yang Q, Al-Hendy A. Understanding the impact of uterine fibroids on human endometrium function. Front Cell Dev Biol 2021; 9: 633180.

https://doi.org/10.3389/fcell.2021.633180

Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J of Psychol Med 2013; 35(2): 121-126. https://doi.org/10.4103/0253-7176.116232

Ahrendt HJ, Tylkoski H, Rabe T, Szczes A, Friedrich C, Friedrich R, et al. Prevalence of uterine myomas in women in Germany: data of an epidemiological study. Arch Gynecol Obstet 293, 1243–1253 (2016). https://doi.org/10.1007/s00404-015-3930-8

Maclaran K, Agarwal N, Odejinmi F. Co-existence of uterine myomas and endometriosis in women undergoing laparoscopic myomectomy: risk factors and surgical implications. J Minim Invasive Gynecol 2014; 21(6): 1086-1090.

https://doi.org/10.1016/j.jmig.2014.05.013

Huang JQ, Lathi RB, Lemyre M, Rodriguez HE, Nezhat CH, Nezhat C. Coexistence of endometriosis in women with symptomatic leiomyomas. Fertil Steril 2010; 94(2): 720-723.

https://doi.org/10.1016/j.fertnstert.2009.03.052

Nezhat C, Balassiano E, Abed S, Nezhat CH, Soliemannjad R, Nezhat FR, et al. Coexistence of Endometriosis in Women With Symptomatic Leiomyomas—A Reappraisal of the Current Literature [8J]. Obstet Gynecol 2016; 127: 83S.

http://doi.org/10.1097/01.AOG.0000483742.58479.4f

Naphatthalung W, Cheewadhanaraks S. Prevalence of endometriosis among patients with adenomyosis and/or myoma uteri scheduled for a hysterectomy. J Med Assoc Thai 2012; 95(9): 1136. https://pubmed.ncbi.nlm.nih.gov/23140029/

Uimari O, Järvelä I, Ryynänen M. Do symptomatic endometriosis and uterine fibroids appear together? J Hum Reprod Sci 2011; 4(1): 34.

https://doi.org/10.4103/0974-1208.82358

Uimari O, Nazri H, Tapmeier T. Endometriosis and uterine fibroids (leiomyomata): comorbidity, risks and implications. Front Reprod Health 2021; 3: 750018.

https://doi.org/10.3389/frph.2021.750018.

Choi EJ, Cho SB, Lee SR, Lim YM, Jeong K, Moon H-S, et al. Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet Gynecol Sci 2017; 60(6): 579-586. https://doi.org/10.5468/ogs.2017.60.6.579

Lin KY-H, Yang C-Y, Lam A, Chang CY-Y, Lin W-C. Uterine leiomyoma is associated with the risk of developing endometriosis: A nationwide cohort study involving 156,195 women. PLoS One 2021; 16(8): e0256772.

https://doi.org/10.1371/journal.pone.0256772

Nezhat C, Li A, Abed S, Balassiano E, Soliemannjad R, Nezhat A, et al. Strong association between endometriosis and symptomatic leiomyomas. J Society Laparoendoscopic Surgeons. 2016; 20(3). https://doi.org/10.4293%2FJSLS.2016.00053

Giuliani E, As-Sanie S, Marsh E. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet 2020; 149(1): 3-9.

https://doi.org/10.1002/ijgo.13102

Smolarz B, Szyłło K, Romanowicz H. Endometriosis: epidemiology, classification, pathogenesis, treatment and genetics (review of literature). Int J Mol Sci 2021; 22(19): 10554.

https://doi.org/10.3390/ijms221910554

Gallagher C, Mäkinen N, Harris H, Rahmioglu N, Uimari O, Cook J, et al. Genome-wide association and epidemiological analyses reveal common genetic origins between uterine leiomyomata and endometriosis. Nat Commun 2019; 10(1): 4857. https://doi.org/10.1038/s41467-019-12536-4

Fung JN, Holdsworth-Carson SJ, Sapkota Y, Zhao ZZ, Jones L, Girling JE, et al. Functional evaluation of genetic variants associated with endometriosis near GREB1. Hum Reprod 2015; 30(5): 1263-1275. https://doi.org/10.1038/s41467-019-12536-4

Valle RF, Ekpo GE. Pathophysiology of uterine myomas and its clinical implications. Uterine myoma, myomectomy and minimally invasive treatments. First Edition. Springer; 2015.

https://doi.org/10.1007/978-3-319-10305-1_1

Dmowski W, Steele RW, Baker GF. Deficient cellular immunity in endometriosis. Am J Obstet Gynecol 1981; 141(4): 377-383.

https://doi.org/10.1016/0002-9378(81)90598-6

Imperiale L, Nisolle M, Noël J-C, Fastrez M. Three Types of Endometriosis: Pathogenesis, Diagnosis and Treatment. State of the Art. J Clin Med 2023; 12(3): 994.

https://doi.org/10.3390/jcm12030994