{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:47:38Z","timestamp":1787726858190,"version":"build-2784847793"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T00:00:00Z","timestamp":1668470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Uterine fibroids still represent the most common indication for hysterectomy for benign pathologies. In the United States, more than 479,000 hysterectomies are performed annually, 46.6% for myomas and 47.7% in women aged from 18 to 44 years. By applying appropriateness criteria to this procedure, it has been estimated that overuse ranges from 16 to 70%. One of the main reasons that induce patients and gynecologists to consider hysterectomy is represented by severe anemia. Materials and Methods: This is a retrospective cohort study of 202 patients with uterine fibroids diagnosed by transvaginal ultrasound who underwent a hysteroscopic procedure. Myoma grade, size, location, and number were assessed by transvaginal scan and office hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Univariate analysis showed that anemia does not have a statistically significant association with myoma number and with age considered as a numerical predictor. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia. On the contrary, in patients with myoma type 1 or type 2, the possibility of having anemia varies according to the presence or absence of menorrhagia. If there is menorrhagia, the risk of moderate anemia is only present for myomas &gt;60 mm. Conclusions: The results of this study may contribute to defining objective criteria for the management of submucous myomas and anemia. Our data suggest that submucosal myomas type 0 &gt;10 mm should always be treated, putting patients at risk for anemia. Myomas type 2 and 3 should be treated for the risk of anemia in the presence of menorrhagia episodes or if &gt; of 60 mm. Adequate management of anemia and myomas could reduce the rate of unnecessary hysterectomies.<\/jats:p>","DOI":"10.3390\/medicina58111652","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T02:27:34Z","timestamp":1668565654000},"page":"1652","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Characteristics of Submucous Myomas and the Risk of Anemia"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8031-1102","authenticated-orcid":false,"given":"Giuseppe","family":"Ricci","sequence":"first","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Scrimin","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Sartore","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6461-6563","authenticated-orcid":false,"given":"Massimo","family":"Borelli","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7836-4934","authenticated-orcid":false,"given":"Gabriella","family":"Zito","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2157-8330","authenticated-orcid":false,"given":"Federico","family":"Romano","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9266-3896","authenticated-orcid":false,"given":"Guglielmo","family":"Stabile","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2014.00096","DOI":"10.4293\/JSLS.2014.00096","article-title":"Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy","volume":"18","author":"Cohen","year":"2014","journal-title":"JSLS"},{"key":"ref_2","unstructured":"(2022, April 12). Centers for Disease Control and Prevention, 2019 Assisted Reproductive Technology (ART) Fertility Clinic and National Summary Report, Available online: https:\/\/www.cdc.gov\/art\/reports\/2019\/pdf\/2019-Report-ART-Fertility-Clinic-National-Summary-h.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/GRF.0000000000000164","article-title":"Epidemiology of Uterine Fibroids: From Menarche to Menopause","volume":"59","author":"Wise","year":"2016","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1001\/archsurg.2011.581","article-title":"Appropriateness Criteria to Assess Variations in Surgical Procedure Use in the United States","volume":"146","author":"Lawson","year":"2011","journal-title":"Arch. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/SPV.0b013e3182523a03","article-title":"The effect of preoperative checklists on final histology and rates of hysterectomy for benign conditions","volume":"18","author":"Hullfish","year":"2012","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"304.e1","DOI":"10.1016\/j.ajog.2014.11.031","article-title":"Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative","volume":"212","author":"Corona","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ejogrb.2012.07.030","article-title":"Therapeutic management of uterine fibroid tumors: Updated French guidelines","volume":"165","author":"Marret","year":"2012","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/j.jogc.2019.01.010","article-title":"Guideline No. 389-Medical Management of Symptomatic Uterine Leiomyomas\u2014An Addendum","volume":"41","author":"Laberge","year":"2019","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins\u2013Gynecology (2021). Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228. Obstet. Gynecol., 137, e100\u2013e115.","DOI":"10.1097\/AOG.0000000000004401"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/1471-0528.16928","article-title":"Appraisal of national and international uterine fibroid management guidelines: A systematic review","volume":"129","author":"Amoah","year":"2022","journal-title":"BJOG"},{"key":"ref_11","unstructured":"Hartmann, K.E., Fonnesbeck, C., Surawicz, T., Krishnaswami, S., Andrews, J.C., Wilson, J.E., Velez-Edwards, D., Kugley, S., Sathe, N.A., and Management of Uterine Fibroids (2022, April 12). Rockville (MD): Agency for Healthcare Research and Quality (US), Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537742\/."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3285","DOI":"10.1007\/s43032-021-00618-y","article-title":"The Future of Uterine Fibroid Management: A More Preventive and Personalized Paradigm","volume":"28","author":"Borahay","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_13","first-page":"53","article-title":"Surgical Treatment of Fibroids in Heavy Menstrual Bleeding","volume":"12","author":"Saridogan","year":"2016","journal-title":"Womens Health"},{"key":"ref_14","first-page":"63","article-title":"Hysterectomy for heavy menstrual bleeding","volume":"12","author":"Emanuel","year":"2016","journal-title":"Womens Health"},{"key":"ref_15","first-page":"431","article-title":"Self-reported heavy bleeding associated with uterine leiomyomata","volume":"101","author":"Wegienka","year":"2003","journal-title":"Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1093\/humrep\/deh407","article-title":"Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study","volume":"19","author":"Marino","year":"2004","journal-title":"Hum. Reprod."},{"key":"ref_17","unstructured":"De La Cruz, M.S., and Buchanan, E.M. (2017). Uterine Fibroids: Diagnosis and Treatment. Am. Fam. Physician, 15."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.jmig.2013.04.015","article-title":"Sensitivity of myoma imaging using laparoscopic ultrasound compared with magnetic resonance imaging and transvaginal ultrasound","volume":"20","author":"Levine","year":"2013","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_19","first-page":"463","article-title":"Uterine fibroids: Correlations of anemia and pain to fibroid location and uterine weight","volume":"56","author":"Bachmann","year":"2011","journal-title":"J. Reprod. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1016\/j.fertnstert.2011.01.142","article-title":"Impact of submucous myoma on the severity of anemia","volume":"95","author":"Yang","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"38.e1","DOI":"10.1016\/j.ajog.2013.09.038","article-title":"Submucosal fibroids and the relation to heavy menstrual bleeding and anemia","volume":"210","author":"Puri","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00404-016-4239-y","article-title":"Symptoms of uterine myomas: Data of an epidemiological study in Germany","volume":"295","author":"Foth","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/nyas.14092","article-title":"Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries","volume":"1450","author":"Chaparro","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1017\/S1368980008002401","article-title":"Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993\u20132005","volume":"12","author":"Cogswell","year":"2009","journal-title":"Public Health Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1002\/jum.15510","article-title":"Cotyledonoid Leiomyoma Clinical Characteristics, Imaging Features, and Review of the Literature","volume":"40","author":"Buonomo","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Stabile, G., Mangino, F.P., Romano, F., Zinicola, G., and Ricci, G. (2020). Ectopic Cervical Pregnancy: Treatment Route. Medicina, 12.","DOI":"10.1155\/2020\/8703496"},{"key":"ref_27","first-page":"736","article-title":"Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: Results regarding the degree of intramural extension","volume":"82","author":"Wamsteker","year":"1993","journal-title":"Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1198\/106186006X133933","article-title":"Unbiased recursive partitioning: A conditional inference framework","volume":"15","author":"Hothorn","year":"2006","journal-title":"J. Comput. Graph Stat."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1109\/TAC.1974.1100705","article-title":"A new look at the statistical model identification","volume":"AC-19","author":"Akaike","year":"1974","journal-title":"IEEE Trans. Autom. Control"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1460","DOI":"10.1002\/wics.1460","article-title":"The Akaike information criterion: Background, derivation, properties, application, interpretation, and refinements","volume":"11","author":"Cavanaugh","year":"2019","journal-title":"WIREs Comput. Stat."},{"key":"ref_31","unstructured":"Computing, R. (2013). R: A Language and Environment for Statistical Computing, R Core Team."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.bpobgyn.2016.09.008","article-title":"The role of leiomyomas in the genesis of abnormal uterine bleeding (AUB)","volume":"40","author":"Lasmar","year":"2017","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ura, B., Monasta, L., Arrigoni, G., Battisti, I., Licastro, D., Di Lorenzo, G., Romano, F., Aloisio, M., Peterlunger, I., and Stabile, G. (2019). Phosphoproteins Involved in the Inhibition of Apoptosis and in Cell Survival in the Leiomyoma. J. Clin. Med., 16.","DOI":"10.3390\/jcm8050691"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1093\/ajcp\/94.4.435","article-title":"The frequency of uterine leiomyomas","volume":"94","author":"Cramer","year":"1990","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.13102","article-title":"Epidemiology and management of uterine fibroids","volume":"149","author":"Giuliani","year":"2020","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_36","first-page":"82","article-title":"A 41-year-old woman with menorrhagia, anemia, and fibroids: Review of treatment of uterine fibroids","volume":"7","year":"2009","journal-title":"JAMA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1097\/AOG.0000000000002785","article-title":"Moving Toward Individualized Medicine for Uterine Leiomyomas","volume":"132","author":"Stewart","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"607","DOI":"10.2147\/IJWH.S138982","article-title":"Updated approaches for management of uterine fibroids","volume":"5","author":"Mas","year":"2017","journal-title":"Int. J. Womens Health"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1652\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:18:53Z","timestamp":1760145533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1652"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,15]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["medicina58111652"],"URL":"https:\/\/doi.org\/10.3390\/medicina58111652","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,15]]}}}