The burden of uterine fibroids in five European countries.

OBJECTIVE: To quantify the burden of uterine fibroids (UF) on health-related quality of life (HRQOL) and work productivity in a general population of women. STUDY DESIGN: Women diagnosed with or experiencing UF-related symptoms living in five Western European countries (France, Germany, Italy, Spain, and the United Kingdom) were identified through a cross-sectional Internet-based survey. The following parameters and outcomes of interest were captured and analysed: patient history and demographics, treatment and diagnosis patterns, symptom severity and HRQOL, work productivity and activity impairment, and disease or symptom-related health care resource use for the past year (e.g., provider visits, hospitalisation). RESULTS: This analysis included 1756 women (France, 358; Germany, 345; Italy, 351; Spain, 352; United Kingdom, 350). Prevalence of a diagnosis of UF ranged from 11.7% to 23.6%, and that of undiagnosed bleeding symptoms from 14.7% to 24.6% across the five countries. Between 9.0% and 32.5% of women waited > or =5 years before seeking treatment for UF. Mean UFS-QOL symptom severity scores ranged from 24.7 (95% confidence interval [CI], 21.1-28.3) to 37.6 (95% CI, 32.2-43.0; P<0.001), suggesting mild to moderate severity. Mean UFS-QOL scores ranged from 59.2 (95% CI, 54.2-64.2) to 69.7 (95% CI, 66.5-73.0; P=0.002), suggesting moderate impairment. In pooled analyses, absenteeism was reported by 32.7% of employed women with a diagnosis of UF. Overall worker productivity was reduced by 36.1% and general activity was impaired by 37.9%. CONCLUSIONS: UF are common in women residing in Western Europe. They are associated with impairment of HRQOL and productivity. A substantial number of women delay seeking medical help. Encouraging symptomatic women to seek help and treatment earlier may benefit women by improving their HRQOL and may also benefit society through enhanced worker productivity.

Microwave endometrial ablation: development and clinical application.

Heavy menstrual bleeding is a common problem. Hysterectomy has been the standard treatment for women with heavy menstrual bleeding who have not responded to medical treatment. Minimally invasive procedures to destroy the lining of the uterus (the endometrium) are alternatives to hysterectomy. They involve destroying the endometrium using lasers, radiofrequency waves, electrocautery, microwaves, heated saline, or a heated balloon. Microwave endometrial ablation (MEA) is one of these minimally invasive procedures. In this Chapter, use of microwave MEA in the management of heavy menstrual bleeding is described. MEA was developed in Bath, UK in the mid 1990s. MEA is a second-generation method of EA, which involves the use of microwaves at a fixed frequency of 9.2 GHz to destroy the endometrial lining. Initial results for MEA were encouraging, with active treatment times of less than three minutes and high satisfaction rates. Recent studies also showed an equivalent outcome with regards to patients' satisfaction and health-related quality-of-life issues. The procedure, indications, contraindications, principles of operation, potential risks, results, and patient-satisfaction is described herein.

Ambulatory gynaecology: what can we do?

The aim of ambulatory gynaecology is to admit, treat and discharge the patient on the same day in an outpatient setting. Traditional inpatient operations are being rapidly replaced by office, outpatient or day surgery procedures. In this review, a brief assessment of current ambulatory gynaecological practice is attempted, followed by a discussion of audit and quality assessment methods. Epidemiological studies, clinical trials, socio-economic studies and meta-analyses offer research opportunities in the ambulatory setting. There is a need to review the training of junior gynaecologists and nurses in this field. At present, only a few gynaecology residency programmes offer experience in outpatient procedures and ambulatory care. Specific issues that need to be addressed include training, patient selection, consenting issues, decisions to cancel/transfer as inpatients, and the management of common gynaecological problems.