Fibroids: diagnosis and management
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4887 (Published 13 October 2015) Cite this as: BMJ 2015;351:h4887
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Not mentioned in this otherwise thorough review of treatment options for uterine fibroids was magnetic resonance-guided focused ultrasound surgery (MRfGUS), also known as focused ultrasound surgery (FUS). This noninvasive outpatient procedure, was approved by the FDA in 2004 and more than 10,000 women have benefited from it since then. The painless and safe treatment takes 2 or 3 hours and patients return home and resume normal activities the following day, making it very cost effective. FUS is also being used to treat bone tumors; Parkinson's disease and studies are under way to determine its efficacy in treating brain tumors and rapidly liquefying clots in acute stroke. Additional information on all the above can be obtained at www.fusfoundation.org, as well as the following.
White JP, Jolesz FA. MRI-Guided Focused Ultrasound; A method for noninvasive surgery and other clinical applications. In Rosch PJ Ed. Bioelectromagnetic and Subtle Energy Medicine, Boca Raton: CRC Press;
2015, p. 363-374.
Ellens N, Hynynen K. Simulation study of the effects of near- and far-field heating during focused ultrasound uterine fibroid ablation using an electronically focused phased array: A theoretical analysis of patient safety. Med Phys. 2014 Jul;41(7):072902. doi: 10.1118/1.4883777.
Cain-Nielsen AH, Moriarty JP, Stewart EA, Borah BJ. Cost-effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA. J Comp Eff Res. 2014 May 30:1-12.
Competing interests: No competing interests
Routine blood pressure measurement in women with uterine fibroids
In a recent article, Lumsden et al [1] reviewed uterine fibroids, and detailed on the clinical management of women with this condition. However, an important association was omitted, with high blood pressure [2].
Increasing evidence shows that uterine fibroids are associated with hypertension, with an odds ratio around 2.5 [2-4]. This association is probably due to a shared pathophysiology of increased proliferation of vascular and uterine smooth muscle, and is independent of ancestry, age, and body mass index [2]. Hypertension is the main risk factor for cardiovascular death, and up to 25% of the women with hypertension are unaware of their condition [5]. The hypertension prevalence in women is about 28% [2, 5]. However, the prevalence exceeds 40% in women with uterine fibroids [2].
Therefore, we suggest that blood pressure measurement should be part of the care of all patients, but particularly of women with fibroids.
References
1. Lumsden MA, Hamoodi I, Gupta J, Hickey M. Fibroids: diagnosis and management. BMJ. 2015;351:h4887.
2. Haan YC, Oudman I, de Lange ME, Timmermans A, Ankum WM, van Montfrans GA, et al. Hypertension risk in Dutch women with symptomatic uterine fibroids. Am J Hypertens. 2015;28(4):487-92.
3. Faerstein E, Szklo M, Rosenshein NB. Risk factors for uterine leiomyoma: a practice-based case-control study. II. Atherogenic risk factors and potential sources of uterine irritation. Am J Epidemiol. 2001;153(1):11-9.
4. Haan Y, De Lange ME, Suhooli HJM, Ankum WM, Timmermans TA, Limpens J, et al. The association between hypertension and uterine fibroids: A systematic review and meta-analysis. Journal of Hypertension. 2015;33:e274.
5. Falaschetti E, Mindell J, Knott C, Poulter N. Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet. 2014;383(9932):1912-9.
Competing interests: No competing interests