To assess and compare the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve. Prospective, observational, open-label study performed at the 3rd Chair and Department of Gynecology of the Medical University of Lublin, Poland. Premenopausal Caucasian women with symptomatic uterine fibroids were recruited into 3 groupspatients qualified for supracervical hysterectomies; patients qualified for preoperative ulipristal acetate (UPA) treatment scheduled for supracervical hysterectomies or myomectomies; patients qualified for uterine artery embolization (UAE). The following markers of ovarian reserve were investigated: antral follicle count (AFC), anti-Mullerian hormone (AMH), inhibin B (INHB), follicle stimulating hormone (FSH) and estradiol (E2). These markers were assessed before and 3 months after supracervical hysterectomies, before and 3 months after UAEs, and before and after 3 months of UPA treatment, before the scheduled surgeries. Baseline characteristics (age, parity, dominant fibroid volume, hemoglobin level, BMI, as well as AFC, AMH, INHB, FSH and E2) were compared between the study groups by Kruskall-Wallis ANOVA. Pre- and post-interventional values of AFC, AMH, INHB, FSH and E2 in the studied groups were compared with the Wilcoxon matched pairs test. Twenty-six, 27 and 30 patients were included in the final analysis in the supracervical hysterectomy, UPA and UAE groups, respectively. Three months after supracervical hysterectomy INHB and E2 significantly decreased, while AFC, AMH and FSH remained unchanged. After 3 months of UPA treatment the values of all the assessed markers of ovarian reserve were not significantly different in comparison to baseline. Conversely, three months after UAE the values of AFC, AMH, INHB, and E2 were significantly decreased, while FSH was significantly increased. Of the compared fibroid treatment methods UAE seems to have the greatest impact on ovarian function and should not be offered to patients concerned about their ovarian function. Supracervical hysterectomy did not affect the most accurate markers of ovarian reserve, and therefore appears to be safe in terms of ovarian function. UPA did not change any of the studied markers of ovarian reserve and seems a reasonable option when ovarian function is concerned.

Perimenopausal changes caused by oestrogen deficiency are accompanied by a decrease in the content of collagen and elastin in the tissues, leading to thinning of the epithelium and the resultant disappearance of the superficial layer, which leads to smooth muscle dysfunction as well as...

Uterine fibroids, benign tumors originating from uterine smooth muscle cells, vary in prevalence depending on patient ethnicity, hormonal exposure, and genetics. Due to their high incidence, these neoplasms pose a significant burden on healthcare systems. Current treatment strategies range from routine monitoring in asymptomatic cases to surgical procedures such as myomectomy or hysterectomy in symptomatic patients, with an increasing trend toward uterus -preserving or non -surgical alternatives. This review examines the existing medical treatments for uterine fibroids and delves into the potential of emerging therapies. A scoping review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta -Analyses extension for Scoping Reviews. Medical therapies are divided into hormonal and non -hormonal treatments; however, long-term, safe, and effective treatments in the treatment of uterine fibroids are limited. In addition to established therapies, there is an increasing number of studies investigating the effect of substances such as vitamin D or green tea extract on uterine fibroids. Some studies investigate acupuncture as a possible alternative therapy. While existing treatments offer symptomatic relief and preparation for surgery, our findings point to a significant need for further research into long-term solutions, especially owing to recent limitations in the use of ulipristal acetate due to risk of liver damage. Initial studies involving vitamin D and epigallocatechin gallate are encouraging; however, additional research is required to establish definitive therapeutic roles.

Purpose: To assess the role of elastography in preoperative ultrasound assessment of abdominal wall endometriosis (AWE) location. Materials and Methods: 33 patients qualified for surgical excision of AWE were included in the study. Preoperative assessment of AWE was performed transabdominally on a Samsung Medison V20 Prestige with a transvaginal probe and Elastoscan^® option. The following B-mode settings were used: focus set to the lower end of the lesion, gain adjusted to obtain best image quality, tissue harmonic imaging activated. For elastographic examinations the color map from red (soft) to purple (hard) and the alpha blend option (a blend of B-mode and elastographic image) were used. AWE location was first assessed by B-mode ultrasound as: superficial (located in SCT only; SCT visible between the fascia and the lesion; intact fascia), intermediate (located in SCT or in RAM; no subcutaneous or muscle tissue between the lesion and the fascia; fascia infiltrated); or deep (located in RAM; muscle tissue visible between the lesion and the fascia; fascia intact). Then the AWE location was assessed by alphablend elastography as: superficial (hard lesion in soft SCT; soft SCT between the fascia and the lesion; no hard areas on the fascia); intermediate (hard lesion in soft SCT or soft RAM; no soft subcutaneous or muscle tissue between the lesion and the fascia; hard areas on the fascia); or deep (hard lesion located in RAM; soft muscle tissue between the fascia and the lesion; no hard areas on the fascia). These findings were verified during surgery. The surgeons were blinded to the results of elastography. The influence of obesity on the accuracy of ultrasound and elastography in assessing the location of AWE was evaluated. Results: During surgery superficial AWE was found in 6, intermediate in 19 and deep in 8 patients. Preoperative ultrasound assessment was correct in 33.3 % of cases, while adding the elastography option improved the accuracy of AWE location assessment to 87.9 % (p < 0.05). The diagnostic accuracy of ultrasound alone, but not with the elastography option, was significantly decreased in the preoperative assessment of AWE location in overweight and obese patients. 4 patients required implantation of a mesh. In all cases the pathological examination confirmed the diagnosis of AWE. Conclusion: Elastography significantly improved the accuracy of ultrasound in evaluating the depth of infiltration of AWE, is not affected by increased BMI, and should be considered in patients qualified for surgical treatment of AWE. Ziel: Bewertung der Rolle der Elastografie bei der präoperativen sonografischen Beurteilung der Lokalisation der AWE. Material und Methoden: 33 Patienten eigneten sich für eine chirurgische Entfernung der AWE und wurden in die Studie eingeschlossen. Die präoperative Beurteilung der AWE erfolgte transabdominal auf einem Samsung Medison V20 Prestige, mit transvaginaler Sonde und Elastoscan^®-Option. Folgende B-Mode-Einstellungen wurden verwendet: Der Fokus wurde auf das untere Ende der Läsion gesetzt, der Gain wurde angepasst, um die beste Bildqualität zu erzeugen und das Tissue-Harmonic-Imaging wurde aktiviert. Für die elastografischen Untersuchungen wurde die Farbkarte von rot (weich) zu violett (hart) und die Alpha-Blending-Option (Mischung von B-Mode und elastografischem Bild) verwendet. Die Lokalisation der AWE wurde zuerst mittels B-Mode-Sonografie bewertet als: Oberflächlich (Lokalisation nur im SCT, SCT zwischen Faszie und Herd sichtbar, intakte Faszie), intermediär (Lokalisation im SCT oder RAM, Fehlen von SCT oder Muskelgewebe zwischen Herd und Faszie, infiltrierte Faszie) oder tief (Lokalisation im RAM, sichtbares Muskelgewebe zwischen Herd und Faszie sichtbar, intakte Faszie). Anschließende Beurteilung des AWE-Herd durch Alpha-Blend-Elastografie als: Oberflächlich (harter Herd im weichen SCT, weiches SCT zwischen Faszie und Herd; keine harten Bereiche auf der Faszie), intermediär (harter Herd im weichen SCT oder weichen RAM; Fehlen von weichem SCT oder Muskelgewebe zwischen Herd und Faszie; harte Bereiche auf der Faszie) oder tief (harter Herd mit Lokalisation im RAM; weiches Muskelgewebe zwischen Faszie und Herd; keine harten Bereiche auf der Faszie). Diese Befunde wurden bei der Operation verifiziert, die Chirurgen wurden verblindet in Bezug auf die Elastografie-Ergebnisse. Auch der Einfluss von Adipositas auf die Genauigkeit des Ultraschalls und der Elastografie bei der Beurteilung der Lokalisation der AWE wurde untersucht. Ergebnisse: Bei der Operation wurde die AWE bei 6 als oberflächlich, bei 19 als intermediär und bei 8 Patienten als tief diagnostiziert. Die präoperative Ultraschallbeurteilung war in 33,3 % der Fälle richtig, wobei die Elastografie-Option die Genauigkeit der Lokalisation der AWE auf 87,9 % (p < 0.05). Die diagnostische Genauigkeit des Ultraschalls alleine, ohne Elastografie-Option führte zu einem statistisch signifikanten Rückgang der Genauigkeit der Lokalisation der AWE bei übergewichtigen und adipösen Patienten. Bei 4 Patienten war die Implantation eines Netzes erforderlich. In allen Fällen wurde die AWE-Diagnose durch die pathologische Untersuchung bestätigt. Schlussfolgerung: Die Elastografie verbesserte die Genauigkeit der Sonografie signifikant in Bezug auf die Beurteilung der Infiltrationstiefe der AWE. Sie wird nicht von einem erhöhten BMI beeinflusst und kann bei Patienten, die für eine chirurgische Behandlung der AWE vorgesehen sind, zum Einsatz kommen.

Background: The aim of the present study is to report a rare occurrence of a successful twin pregnancy in a woman with pure 46,XY gonadal dysgenesis. Result(s): A patient with Swyer syndrome (pure 46,XY gonadal dysgenesis) presented with a twin pregnancy after in vitro fertilization. Due to unidentified conditions, the patient developed selective intrauterine growth restriction in one of the fetuses. Twins were born at 33 weeks of pregnancy due to the risk of asphyxia. Nonetheless, the patient did not develop gonadal malignancies before the pregnancy and, despite receiving estrogen, remained amenorrheic. Conclusion(s): The aim of this case report is to show the course of twin pregnancy in patients with Swyer syndrome through assisted reproduction. Due to certain disorders in the development of their reproductive organs, such as the less mature uterus, such pregnancies may be associated with an increased risk. The above case report demonstrates the need to systematize methods of pregnancy management in patients with Swyer syndrome, such as: preparation for the pregnancy, assessment of the uterus, medications used, and necessary checkups. Capsule: This case report and review shows clinicians that patients with Swyer syndrome may become pregnant. Twin pregnancies may occur without any major problems through assisted reproduction.