{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T10:16:25Z","timestamp":1777716985835,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T00:00:00Z","timestamp":1571097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"The Genesee Hospital Foundation and Rochester General Hospital Foundation.","award":["none"],"award-info":[{"award-number":["none"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Surg Pathol"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:p>Objectives. We recently suggested that increased intramural pressure may often explain pain and\/or bleeding. Hysterectomies for bleeding tend to have outward bulges and endometrial vascular ectasia, while hysterectomies for pain tend to have deflection of pressure inward by subserosal ridges, which promote inner myometrial elastosis (IME). Study design. We analyzed causes of increased intramural pressure in 58 hysterectomies for pain and\/or bleeding, excluding clinically fibroid uteri and prolapsed uteri. Postfixation photographs were used to avoid missing grossly obvious myometrial hyperplasia (MMH). Results. The most common cause of increased intramural pressure was grossly obvious MMH in 40\/58 cases (69%). Other causes included clinically occult myomas (3 cases), adenomyosis (6 cases), and multifactorial causes (7 cases). Hysterectomies for bleeding weighed more than hysterectomies for pain ( P = .035). Hysterectomies for pain had more IME than hysterectomies for bleeding ( P = .029). Conclusions. When subserosal ridges deflect pressure inward, bulky MMH may cause pelvic pain and IME, but when they do not, bulkier MMH in heavier uteri may lead to both outward bulges and abnormal bleeding from endometrial vascular ectasia.<\/jats:p>","DOI":"10.1177\/1066896919879980","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T07:33:30Z","timestamp":1571124810000},"page":"153-162","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["A Comparison of Hysterectomies for Bleeding With Hysterectomies for Pain"],"prefix":"10.1177","volume":"28","author":[{"given":"Bradley M.","family":"Turner","sequence":"first","affiliation":[{"name":"Highland Hospital, Rochester, NY, USA"},{"name":"University of Rochester, Rochester, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stewart F.","family":"Cramer","sequence":"additional","affiliation":[{"name":"University of Rochester, Rochester, NY, USA"},{"name":"Rochester General Hospital, Rochester, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8378-4642","authenticated-orcid":false,"given":"Debra S.","family":"Heller","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School, Newark, NJ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,10,15]]},"reference":[{"key":"bibr1-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1177\/1066896917748194"},{"key":"bibr2-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(66)90661-2"},{"key":"bibr3-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.11076"},{"key":"bibr4-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(62)90550-1"},{"key":"bibr5-1066896919879980","doi-asserted-by":"publisher","DOI":"10.3109\/00016347909154050"},{"key":"bibr6-1066896919879980","first-page":"220","volume":"4","author":"Langlois PL.","year":"1970","journal-title":"J Reprod Med"},{"key":"bibr7-1066896919879980","volume-title":"Blaustein\u2019s Pathology of the Female Genital Tract","volume":"575","author":"Kurman RJ","year":"2002","edition":"5"},{"key":"bibr8-1066896919879980","first-page":"743","volume":"38","author":"Farrer-Brown G","year":"1971","journal-title":"Obstet Gynecol"},{"key":"bibr9-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0b013e31827630d4"},{"key":"bibr10-1066896919879980","first-page":"213","volume-title":"The Extracellular Matrix of the Uterus, Cervix, and Fetal Membranes","volume":"1991","author":"Cramer SF"},{"key":"bibr11-1066896919879980","first-page":"71","volume":"8","author":"Cramer SF","year":"1995","journal-title":"Mod Pathol"},{"key":"bibr12-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1016\/S1083-3188(03)00158-X"},{"key":"bibr13-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2007.01.010"},{"key":"bibr14-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2008.07.004"},{"key":"bibr15-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2014.12.002"},{"key":"bibr16-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2017.08.013"},{"key":"bibr17-1066896919879980","first-page":"369","volume":"9","author":"Baker AB.","year":"1933","journal-title":"Am J Pathol"},{"key":"bibr18-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.31.7.633"},{"key":"bibr19-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1177\/1933719111426603"},{"key":"bibr20-1066896919879980","volume-title":"Surgical Pathology of the Uterus","author":"Silverberg SG.","year":"1977"},{"key":"bibr21-1066896919879980","first-page":"548","volume":"40","author":"Soldo V","year":"2013","journal-title":"Clin Exp Obstet Gynecol"},{"key":"bibr22-1066896919879980","doi-asserted-by":"publisher","DOI":"10.1089\/gyn.1989.5.149"},{"key":"bibr23-1066896919879980","unstructured":"Berek JS. 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