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子宫肌瘤的负担、流行率和治疗:对美国女性的调查。

Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women.

机构信息

1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan.

2 Department of Obstetrics and Gynecology, University of Illinois at Chicago , Chicago, Illinois.

出版信息

J Womens Health (Larchmt). 2018 Nov;27(11):1359-1367. doi: 10.1089/jwh.2018.7076. Epub 2018 Sep 19.

Abstract

BACKGROUND

Most women will experience uterine fibroids by the age of 50, yet few data exist describing the overall patient experience with fibroids. The objective of this population-based survey was to characterize symptom burden, patient awareness, and treatment decision-making for fibroids, including a comparison among women of varying backgrounds.

MATERIALS AND METHODS

Women (≥18 years) were recruited via email from GfK KnowledgePanel, a representative panel of US households, or identified with opt-in consumer panels. The Uterine Fibroid Symptom and Health-Related Quality of Life (UFS-QOL) questionnaire and Aberdeen Menorrhagia Severity Scale (AMSS) were included.

RESULTS

Eligible women were grouped into three cohorts: "at-risk" (symptoms suggestive of fibroids without clinical diagnosis, n = 300), "diagnosed" (n = 871), and fibroid-related "hysterectomy" (n = 272). Cohort and intracohort race/ethnicity and income analyses revealed differences in symptom burden, awareness/perception, and treatment history. Based on UFS-QOL scores, at-risk women reported significantly greater symptom severity and decreased health-related QOL versus diagnosed women; Hispanic women reported greater symptom severity versus white and black women. At-risk women also reported heavy menstrual bleeding and significant impact on work productivity. Among diagnosed women, 71% used pharmacologic therapy for symptom relief, and 30% underwent surgical or procedural treatment. Initial discussions with healthcare providers significantly impacted treatment outcomes; the hysterectomy cohort was most likely to first discuss hysterectomy.

CONCLUSIONS

Women with fibroids or symptoms suggestive of fibroids experience significant distress that reduces QOL, particularly racial minorities and women in lower income brackets. Survey results suggest that many women are likely undiagnosed, underscoring the need for improved awareness and education.

摘要

背景

大多数女性在 50 岁之前都会经历子宫肌瘤,但很少有数据描述子宫肌瘤患者的整体体验。本基于人群的调查旨在描述子宫肌瘤的症状负担、患者意识和治疗决策,包括不同背景女性之间的比较。

材料和方法

通过 GfK KnowledgePanel、美国家庭代表性小组或选择加入的消费者小组向女性(≥18 岁)发送电子邮件招募参与者。调查使用了子宫肌瘤症状和健康相关生活质量(UFS-QOL)问卷和阿伯丁月经过多严重程度量表(AMSS)。

结果

符合条件的女性被分为三组:“有风险”(有症状提示子宫肌瘤,但未经临床诊断,n=300)、“诊断”(n=871)和子宫肌瘤相关“子宫切除术”(n=272)。队列和队列内种族/族裔和收入分析显示,症状负担、意识/认知和治疗史存在差异。根据 UFS-QOL 评分,有风险的女性报告的症状严重程度明显高于诊断的女性,健康相关生活质量降低;与白人和黑人女性相比,西班牙裔女性报告的症状严重程度更高。有风险的女性也报告了月经过多和对工作生产力的重大影响。在诊断的女性中,71%使用药物治疗缓解症状,30%接受手术或程序治疗。与医疗保健提供者的初步讨论显著影响治疗结果;子宫切除术组最有可能首先讨论子宫切除术。

结论

患有子宫肌瘤或有子宫肌瘤症状的女性会经历严重的痛苦,从而降低生活质量,特别是少数族裔和低收入群体的女性。调查结果表明,许多女性可能未被诊断,这突显了提高认识和教育的必要性。

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本文引用的文献

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Epidemiology of uterine fibroids: a systematic review.子宫肌瘤的流行病学:系统评价。
BJOG. 2017 Sep;124(10):1501-1512. doi: 10.1111/1471-0528.14640. Epub 2017 May 13.
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Uterine fibroids.子宫肌瘤。
Nat Rev Dis Primers. 2016 Jun 23;2:16043. doi: 10.1038/nrdp.2016.43.
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Prevalence, morbidity, and current medical management of uterine leiomyomas.子宫平滑肌瘤的患病率、发病率及当前医疗管理
Int J Gynaecol Obstet. 2015 Nov;131(2):117-22. doi: 10.1016/j.ijgo.2015.04.051. Epub 2015 Aug 5.

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