Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Preventative Gynecology Research Center, Universal Scientific Education and Research Network (USERN), Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Cell and Molecular Biology, School of Biological Sciences, Kharazmi University, Tehran, Iran

5 Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background and Objective: Uterine fibroids (UFs) the most common pelvic tumors among women at reproductive age affecting women’s quality of life even their confidence with its symptoms. We designed a study to investigate the clinical, laboratory, and imaging characteristics of Iranian women with UF.
Methods: This cross-sectional study was performed April 2016- September 2022 at Imam Hossein hospital (Tehran, Iran). We included all women with UF referring to the Obstetrics and Gynecology Clinic of Imam Hossein Hospital. Based on a checklist a research team interviewed the patients to investigate clinical characteristics. Also we explored laboratory and transvaginal sonography (TVS) findings of all patients.
Results: The mean age of 439 studied patients was 44.47±8.80 years (range: 23-81). The most prevalent underlying disease was hypertension (17.1%), followed by thyroid diseases (15.7%) and diabetes mellitus (13.7%). The patients mainly complained of AUB (abnormal menstrual bleeding) (60.0%), abdominal pain (23.7%). The mean NLR (neutrophil to lymphocyte ratio) and the mean PLR (platelet to lymphocyte ratio) were significantly higher than the normal upper limit (P<0.001). Largest diameter of UF was 49.89±47.92 mm. Most fibroids were located anteriorly (43.1%). The multivariate linear regression model revealed that age (β=-0.931, 95%CI= (-1.657, -0.204), P=0.012) and number of fibroid (β=22.418, 95%CI= (16.360, 28.476), P<0.001) could predict the size of fibroid.
Conclusion: Our results showed that NLR and PLR were increased in UF patients. It seems that patient’s age and number of fibroid may be the predict factors for UF's size.
Keywords: Abnormal Uterine Bleeding, hypertension, Neutrophil, Leiomyoma, Lymphocyte, Ultrasonography.


Main Subjects

1. Manickavasagam M. Management of Cesarean Myomectomy in a Patient with Multiple Fibroids and an Obstructing Lower Uterine Segment Fibroid. J Obstet Gynaecol Cancer Res. 2020;5(2):57-60. [DOI:10.30699/jogcr.5.2.57]
2. Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, Al-Hendy A. Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocr Rev. 2022;43(4):678-719. [DOI:10.1210/endrev/bnab039] [PMID] [PMCID]
3. Giuliani E, As‐Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynecol Obstet. 2020;149(1):3-9. [DOI:10.1002/ijgo.13102] [PMID]
4. Stewart EA, Cookson C, Gandolfo RA, Schulze‐Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501-12. [DOI:10.1111/1471-0528.14640] [PMID]
5. Kwas K, Nowakowska A, Fornalczyk A, Krzycka M, Nowak A, Wilczyński J, Szubert M. Impact of contraception on uterine fibroids. Medicina. 2021;57(7):717. [DOI:10.3390/medicina57070717] [PMID] [PMCID]
6. Vilos GA, Allaire C, Laberge P-Y, Leyland N, Vilos AG, Murji A, Chen I. The management of uterine leiomyomas. J Obstet Gynaecol. 2015;37(2):157-78. [DOI:10.1016/S1701-2163(15)30338-8] [PMID]
7. De La Cruz MSD, Buchanan EM. Uterine fibroids: diagnosis and treatment. Am Fam Physician. 2017;95(2):100-7.
8. Freytag D, Günther V, Maass N, Alkatout I. Uterine fibroids and infertility. Diagnostics. 2021;11(8):1455. [DOI:10.3390/diagnostics11081455] [PMID] [PMCID]
9. Laughlin-Tommaso SK, Fuchs EL, Wellons MF, Lewis CE, Calderon-Margalit R, Stewart EA, Schreiner PJ. Uterine fibroids and the risk of cardiovascular disease in the coronary artery risk development in young adult women's study. J Womens Health. 2019;28(1):46-52. [DOI:10.1089/jwh.2018.7122] [PMID] [PMCID]
10. Chen Y, Lin M, Guo P, Xiao J, Huang X, Xu L, et al. Uterine fibroids increase the risk of hypertensive disorders of pregnancy: a prospective cohort study. J Hypertens. 2021;39(5):1002-8. [DOI:10.1097/HJH.0000000000002729] [PMID] [PMCID]
11. Li S, Li W, Sheng B, Zhu X. Relationship between thyroid disorders and uterine fibroids among reproductive-age women. Endocr J. 2021;68(2):211-9. [DOI:10.1507/endocrj.EJ20-0340] [PMID]
12. Baird DD, Travlos G, Wilson R, Dunson DB, Hill MC, D'Aloisio AA, et al. Uterine leiomyomata in relation to insulin-like growth factor-I, insulin, and diabetes. Epidemiology. 2009;20(4):604-10. [DOI:10.1097/EDE.0b013e31819d8d3f] [PMID] [PMCID]
13. Wise LA, Palmer JR, Stewart EA, Rosenberg L. Polycystic ovary syndrome and risk of uterine leiomyomata. Fertil Steril. 2007;87(5):1108-15. [DOI:10.1016/j.fertnstert.2006.11.012] [PMID] [PMCID]
14. Tseng C-H. Metformin use is associated with a lower risk of uterine leiomyoma in female type 2 diabetes patients. Ther Adv Endocrinol Metab. 2019;10:2042018819895159. [DOI:10.1177/2042018819895159] [PMID] [PMCID]
15. Antunes D, Gante I, Carvalho MJ, Medeiros-Borges C, Águas F. The impact of anemia on treatment management and clinical outcomes of women hospitalized for uterine leiomyomas. Ginekol Pol. 2022;93(10):799-805. [DOI:10.5603/GP.a2022.0086] [PMID]
16. Ricci G, Scrimin F, Sartore A, Borelli M, Zito G, Romano F, Stabile G. Characteristics of Submucous Myomas and the Risk of Anemia. Medicina. 2022;58(11):1652. [DOI:10.3390/medicina58111652] [PMID] [PMCID]
17. Bachmann GA, Bahouth LA, Amalraj P, Mhamunkar V, Hoes K, Ananth CV. Uterine fibroids: Correlations of anemia and pain to fibroid location and uterine weight. J Reprod Med. 2011;56(11-12):463-6.
18. Dolmans M-M, Cacciottola L, Donnez J. Conservative management of uterine fibroid-related heavy menstrual bleeding and infertility: time for a deeper mechanistic understanding and an individualized approach. J Clin Med. 2021;10(19):4389. [DOI:10.3390/jcm10194389] [PMID] [PMCID]
19. Mourgues J, Villot A, Thubert T, Fauvet R, Pizzoferrato A-C. Uterine myomas and lower urinary tract dysfunctions: A literature review. J Gynecol Obstet Hum Reprod. 2019;48(9):771-4. [DOI:10.1016/j.jogoh.2019.03.021] [PMID]
20. Çınar M, Aksoy RT, Güzel Aİ, Tokmak A, Yenicesu O, Sarıkaya E, Evliyaoğlu Ö. The association between clinical parameters and uterine fibroid size in patients who underwent abdominal myomectomy. J Exp Ther Oncol. 2016;11:195-8.
21. Sevostyanova O, Lisovskaya T, Chistyakova G, Kiseleva M, Sevostyanova N, Remizova I, Buev Y. Proinflammatory mediators and reproductive failure in women with uterine fibroids. Gynecol Endocrinol. 2020;36(sup1):33-5. [DOI:10.1080/09513590.2020.1816726] [PMID]
22. Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2018;9(6):7204-18. [DOI:10.18632/oncotarget.23208] [PMID] [PMCID]
23. Suh DS, Song YJ, Roh H-J, Lee SH, Jeong DH, Lee TH, et al. Preoperative blood inflammatory markers for the differentiation of uterine leiomyosarcoma from leiomyoma. Cancer Manag Res. 2021;13:5001-11. [DOI:10.2147/CMAR.S314219] [PMID] [PMCID]
24. Bacanakgil BH, Kaban I, Unal F, Guven R, Sahin E, Yildirim SG. Predictive value of hematological inflammatory markers in endometrial neoplasia. Asian Pac J Cancer Prev. 2018;19(6):1529-32.
25. Duan Y, Peng Y, Shi X, Zhao Y, Liu K, Zhou R, Peng C. Correlation Between Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte Ratio in Patients with Uterine Leiomyoma: A Cross-Sectional Study. J Oncol. 2022;2022:3257887. [DOI:10.1155/2022/3257887] [PMID] [PMCID]
26. Acmaz G, Aksoy H, Unal D, Ozyurt S, Cingillioglu B, Aksoy U, Muderris I. Are neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pac J Cancer Prev. 2014;15(4):1689-92. [DOI:10.7314/APJCP.2014.15.4.1689] [PMID]
27. Niknejadi M, Haghighi H, Ahmadi F, Niknejad F, Chehrazi M, Vosough A, Moenian D. Diagnostic accuracy of transvaginal sonography in the detection of uterine abnormalities in infertile women. Iran J Radiol. 2012;9(3):139-44. [DOI:10.5812/iranjradiol.8063] [PMID] [PMCID]
28. Bougie O, Bedaiwy MA, Laberge P, Lebovic G, Leyland N, Atri M, Murji A. Quality of ultrasonography reporting and factors associated with selection of imaging modality for uterine fibroids in Canada: results from a prospective cohort registry. CMAJ Open. 2020;8(3):E506-E13. [DOI:10.9778/cmajo.20200004] [PMID] [PMCID]
29. Cagan M, Tanacan A, Donmez HG, Fadiloglu E, Unal C, Beksac MS. The effect of small size uterine fibroids on pregnancy outcomes in high-risk pregnancies. Rev Bras de Ginecol e Obstet. 2020;42:535-9. [DOI:10.1055/s-0040-1713913] [PMID] [PMCID]
30. Alborzi S, Ghannadan E, Alborzi S, Alborzi M. A comparison of combined laparoscopic uterine artery ligation and myomectomy versus laparoscopic myomectomy in treatment of symptomatic myoma. Fertil Steril. 2009;92(2):742-7. [DOI:10.1016/j.fertnstert.2008.06.011] [PMID]
31. Wallace K, Zhang S, Thomas L, Stewart EA, Nicholson WK, Wegienka GR, et al. Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids. Fertil Steril. 2020;113(3):618-26. [DOI:10.1016/j.fertnstert.2019.10.028] [PMID]
32. Mousa M, Al-Jefout M, Alsafar H, Kirtley S, Lindgren CM, Missmer SA, et al. Prevalence of Common Gynecological Conditions in the Middle East: Systematic Review and Meta-Analysis. Front Reprod Health. 2021;3:661360. [DOI:10.3389/frph.2021.661360] [PMID] [PMCID]