Bleeding vs Thrombosis: Treatment Strategy for Women Having Large Uterine Fibroids and DVT

Kiran Sharma
In: Current Reviews in Clinical and Experimental Pharmacology · 2024 · vol. 20(2) , pp. 103–121 · doi:10.2174/0127724328317631240925051326 · PMID:40326263 · W4403466569
review OA: closed CC0
Full text JSON View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This paper examines the complex interplay of heavy uterine fibroid bleeding and deep vein thrombosis in women, exploring management strategies including anticoagulation and hormonal modification.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-18 · read from full text ⓘ

This paper examines the interplay between heavy menstrual bleeding caused by large uterine fibroids and the risk of venous thromboembolism, especially deep vein thrombosis, in women who often use procoagulant medications such as oral contraceptives, tranexamic acid, or NSAIDs. It discusses mechanisms linking increased DVT risk to hypothyroidism-related coagulation changes and to higher uterine weight that may compress the inferior vena cava, and notes that postoperative thrombosis may be riskier when hysterectomy/myomectomy is the only option. As a potential management strategy, it outlines the use of anticoagulants combined with hormonal modification via agents such as levonorgestrel intrauterine system, high-dose progestin-only therapy, danazol, aromatase inhibitors, vitamin D supplements, or selective estrogen receptor modulators, while emphasizing that adverse consequences of continued use should be monitored and that more research is needed. This paper is not centrally about endometriosis or adenomyosis; it addresses uterine fibroids, with only indirect corpus relevance through discussion of pelvic gynecologic bleeding and thrombosis mechanisms that can overlap with endometriosis-adenomyosis research topics.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

Large uterine fibroids (UFs) are clonal neoplasms of the uterus that form during the mid and late-aged women. Such women generally consume oral contraceptive pills, tranexamic acid, or NSAIDS to manage heavy menstrual bleeding (HMB) and associated complications while waiting for a conclusive procedure or avoiding hysterectomy. The procoagulant effect of these medicinal agents can result in venous stasis of the lower limbs, leading to deep vein thrombosis (DVT), a challenging complication with HMB. We examine the complicated state of heavy bleeding with thrombosis and explore better management options. It has been seen that women with hypothyroidism have an increased risk of getting DVT due to an alteration in the coagulation system. These incidences are mostly associated with higher uterine weight, which is related to the extrinsic compression of the inferior vena cava. In such cases, the occurrence of postoperative thrombosis is riskier if hysterectomy/myomectomy is the only option. Utilization of appropriate anticoagulants with modification of the steroid-hormone system using hormone agonists or antagonists (e.g., levonorgestrel intrauterine system, high-dose progestin-only therapy, danazol, aromatase inhibitors, Vitamin-D supplements or selective estrogen receptor modulators) could be an effective technique, but adverse consequences of continued use should be monitored. More research is needed into the basic biology associated with the role of growth factors and genetic alterations in these malignancies. The development of new leiomyomas following conservative therapy is also a significant issue.
Full text 30,806 characters · extracted from oa-doi-fallback · 2 sections · click to expand

Abstract

Large uterine fibroids (UFs) are clonal neoplasms of the uterus that form during the mid and late-aged women. Such women generally consume oral contraceptive pills, tranexamic acid, or NSAIDS to manage heavy menstrual bleeding (HMB) and associated complications while waiting for a conclusive procedure or avoiding hysterectomy. The procoagulant effect of these medicinal agents can result in venous stasis of the lower limbs, leading to deep vein thrombosis (DVT), a challenging complication with HMB. We examine the complicated state of heavy bleeding with thrombosis and explore better management options. It has been seen that women with hypothyroidism have an increased risk of getting DVT due to an alteration in the coagulation system. These incidences are mostly associated with higher uterine weight, which is related to the extrinsic compression of the inferior vena cava. In such cases, the occurrence of postoperative thrombosis is riskier if hysterectomy/myomectomy is the only option. Utilization of appropriate anticoagulants with modification of the steroid-hormone system using hormone agonists or antagonists (e.g., levonorgestrel intrauterine system, high-dose progestin-only therapy, danazol, aromatase inhibitors, Vitamin-D supplements or selective estrogen receptor modulators) could be an effective technique, but adverse consequences of continued use should be monitored. More research is needed into the basic biology associated with the role of growth factors and genetic alterations in these malignancies. The development of new leiomyomas following conservative therapy is also a significant issue.

Keywords

Uterine fibroids, deep venous thrombosis, hypothyroidism, progesterone, anticoagulants, heavy mensuration bleeding. [1] Orlando MS, Sinha A, Yao M, Shippey E, Kho RM. Perioperative venous thromboembolism in patients undergoing hysterectomy for fibroids: A nationwide sample. J Minim Invasive Gynecol 2022; 29(11): S2-3. [http://dx.doi.org/10.1016/j.jmig.2022.09.020] [http://dx.doi.org/10.1016/j.jmig.2022.09.020] [2] Shaffer RK, Fast AM, Vu KN, Dobberfuhl AD, Ghanouni P, Chen B. Association between uterine fibroid findings on pelvic MRI, bleeding symptoms, and quality of life (19Q). Obstet Gynecol 2018; 131(1): 189S. [http://dx.doi.org/10.1097/01.AOG.0000533231.44638.dd] [http://dx.doi.org/10.1097/01.AOG.0000533231.44638.dd] [3] Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet 2005; 365(9465): 1163-74. [http://dx.doi.org/10.1016/S0140-6736(05)71880-8] [PMID: 15794972] [http://dx.doi.org/10.1016/S0140-6736(05)71880-8] [PMID: 15794972] [4] Heit JA, O’Fallon WM, Petterson TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study. Arch Intern Med 2002; 162(11): 1245-8. [http://dx.doi.org/10.1001/archinte.162.11.1245] [PMID: 12038942] [http://dx.doi.org/10.1001/archinte.162.11.1245] [PMID: 12038942] [5] Anton A, Campreciós G, Pérez-Campuzano V, Orts L, García-Pagán JC, Hernández-Gea V. The pathophysiology of portal vein thrombosis in cirrhosis: Getting deeper into Virchow’s Triad. J Clin Med 2022; 11(3): 800. [http://dx.doi.org/10.3390/jcm11030800] [PMID: 35160251] [http://dx.doi.org/10.3390/jcm11030800] [PMID: 35160251] [6] Latif H, Baez Sosa V, Farid S, et al. Venous thromboembolism in women with uterine fibroids. Blood 2020; 136 (Suppl. 1): 28-9. [http://dx.doi.org/10.1182/blood-2020-136678] [http://dx.doi.org/10.1182/blood-2020-136678] [7] Tinawi M. Massive uterine fibroid resulting in extensive deep venous thrombosis, compartment syndrome and rhabdomyolysis. Arch Intern Med Res 2020; 3(1): 69-73. [http://dx.doi.org/10.26502/aimr.0024] [http://dx.doi.org/10.26502/aimr.0024] [8] Anagani M, Agrawal P, Agrawal R. Acute right lower limb deep venous thrombosis due to pressure from large adenomyotic uterus-laparoscopic management. Int J Reprod Contracept Obstet Gynecol 2020; 9(11): 4749-53. [http://dx.doi.org/10.18203/2320-1770.ijrcog20204850] [http://dx.doi.org/10.18203/2320-1770.ijrcog20204850] [9] Ciebiera M, Ali M, Zgliczyńska M, Skrzypczak M, Al-Hendy A. Vitamins and uterine fibroids: Current data on pathophysiology and possible clinical relevance. Int J Mol Sci 2020; 21(15): 5528. [http://dx.doi.org/10.3390/ijms21155528] [PMID: 32752274] [http://dx.doi.org/10.3390/ijms21155528] [PMID: 32752274] [10] Ciebiera M, Włodarczyk M, Zgliczyński S, Łoziński T, Walczak K, Czekierdowski A. The role of miRNA and related pathways in pathophysiology of uterine fibroids—from bench to bedside. Int J Mol Sci 2020; 21(8): 3016. [http://dx.doi.org/10.3390/ijms21083016] [PMID: 32344726] [http://dx.doi.org/10.3390/ijms21083016] [PMID: 32344726] [11] Okonofua F. Uterine fibroid and hysterectomy Contemporary obstetrics and gynecology for developing countries. Cham: Springer 2021; pp. 451-60. [12] Fang C, Yang J, Ding W, et al. Incidence of symptomatic deep vein thrombosis after gynecological surgery: A retrospective study in Chinese population. Eur J Gynaecol Oncol 2019; 40(6): 939-42. [http://dx.doi.org/10.12892/ejgo4675.2019] [http://dx.doi.org/10.12892/ejgo4675.2019] [13] Levin V, Booth R, Minassian S. Bleeding disorders and ART Textbook of assisted reproduction. Berlin, Heidelberg: Springer Link 2020. [http://dx.doi.org/10.1007/978-981-15-2377-9_35] [http://dx.doi.org/10.1007/978-981-15-2377-9_35] [14] Yu PT, Chen CY, Lin CY. Uterine Myoma— induced venal thrombosis and acute pulmonary thromboembolism: 2 case reports. Airiti Lib 2019; 34(3): 133-8. [15] Finianos ES, Yacoub SF, Chammas MF. Ovarian vein thrombosis complicated by pulmonary embolism after cesarean delivery in the presence of a large fibroid: Case report and literature review of contributing factors. Case Rep Obstet Gynecol 2021; 2021: 1-7. [http://dx.doi.org/10.1155/2021/6389713] [PMID: 34540300] [http://dx.doi.org/10.1155/2021/6389713] [PMID: 34540300] [16] Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part I. Diagnosis. Am Fam Physician 2004; 69(12): 2829-36. [PMID: 15222648] [PMID: 15222648] [17] Tinelli A, Vinciguerra M, Malvasi A, Andjić M, Babović I, Sparić R. Uterine fibroids and diet. Int J Environ Res Public Health 2021; 18(3): 1066. [http://dx.doi.org/10.3390/ijerph18031066] [PMID: 33504114] [http://dx.doi.org/10.3390/ijerph18031066] [PMID: 33504114] [18] Donnez J, Carmona F, Maitrot-Mantelet L, Dolmans MM, Chapron C. Uterine disorders and iron deficiency anemia. Fertil Steril 2022; 118(4): 615-24. [http://dx.doi.org/10.1016/j.fertnstert.2022.08.011] [PMID: 36182260] [http://dx.doi.org/10.1016/j.fertnstert.2022.08.011] [PMID: 36182260] [19] Kirschen GW, AlAshqar A, Miyashita-Ishiwata M, Reschke L, El Sabeh M, Borahay MA. Vascular biology of uterine fibroids: Connecting fibroids and vascular disorders. Reproduction 2021; 162(2): R1-R18. [http://dx.doi.org/10.1530/REP-21-0087] [PMID: 34034234] [http://dx.doi.org/10.1530/REP-21-0087] [PMID: 34034234] [20] Donnez J. Uterine fibroids and progestogen treatment: Lack of evidence of its efficacy: A review. J Clin Med 2020; 9(12): 3948. [http://dx.doi.org/10.3390/jcm9123948] [PMID: 33291422] [http://dx.doi.org/10.3390/jcm9123948] [PMID: 33291422] [21] Abo S, Smith D, Stadt M, Layton A. Modelling female physiology from head to Toe: Impact of sex hormones, menstrual cycle, and pregnancy. J Theor Biol 2022; 540: 111074. [http://dx.doi.org/10.1016/j.jtbi.2022.111074] [PMID: 35227731] [http://dx.doi.org/10.1016/j.jtbi.2022.111074] [PMID: 35227731] [22] Yin H, Lo JH, Kim JY, et al. Expression profiling of nuclear receptors identifies key roles of NR4A subfamily in uterine fibroids. Mol Endocrinol 2013; 27(5): 726-40. [http://dx.doi.org/10.1210/me.2012-1305] [PMID: 23550059] [http://dx.doi.org/10.1210/me.2012-1305] [PMID: 23550059] [23] Ranhotra HS. The NR4A orphan nuclear receptors: Mediators in metabolism and diseases. J Recept Signal Transduct Res 2015; 35(2): 184-8. [http://dx.doi.org/10.3109/10799893.2014.948555] [PMID: 25089663] [http://dx.doi.org/10.3109/10799893.2014.948555] [PMID: 25089663] [24] Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers 2016; 2(1): 16043. [http://dx.doi.org/10.1038/nrdp.2016.43] [http://dx.doi.org/10.1038/nrdp.2016.43] [25] Zannotti A, Greco S, Pellegrino P, et al. Macrophages and immune responses in uterine fibroids. Cells 2021; 10(5): 982. [http://dx.doi.org/10.3390/cells10050982] [PMID: 33922329] [http://dx.doi.org/10.3390/cells10050982] [PMID: 33922329] [26] Gao L, Ge L, Zhu M, Yao X. Association between tumor necrosis factor α and uterine fibroids. Medicine (Baltimore) 2020; 99(33): e21667. [http://dx.doi.org/10.1097/MD.0000000000021667] [PMID: 32872031] [http://dx.doi.org/10.1097/MD.0000000000021667] [PMID: 32872031] [27] Hamzaq FM, Al-Hilli NM. Correlation between serum interleukin-33 level and uterine fibroids. Prof.(Dr). RK Sharma 2020; 20(4): 4722. [28] Narzullayeva NS. Innovative methods of diagnosis and treatment in women with infertility associated with uterine fibroids. J Pharm Negat Results 2022; 4: 3313-21. [http://dx.doi.org/10.47750/pnr.2022.13.S08.407] [http://dx.doi.org/10.47750/pnr.2022.13.S08.407] [29] Hou A, Yan Z, Zhang Y, Hou J. Oral administration of mifepristone combined with ultrasound-guided radiofrequency ablation in treating patients with uterine fibroids: Efficacy, safety, and alternations of inflammatory cytokines, adhesion molecules, and growth factors. J Nanomater 2021; 2021: 1-7. [http://dx.doi.org/10.1155/2021/9946224] [http://dx.doi.org/10.1155/2021/9946224] [30] Baranov VS, Osinovskaya NS, Yarmolinskaya MI. Pathogenomics of uterine fibroids development. Int J Mol Sci 2019; 20(24): 6151. [http://dx.doi.org/10.3390/ijms20246151] [PMID: 31817606] [http://dx.doi.org/10.3390/ijms20246151] [PMID: 31817606] [31] De Gregorio A, Bekes I, De-Gregorio N, et al. Comparison of preoperative serum VEGF in leiomyosarcoma and uterus myomatosus patients: A proof of concept study. J Clin Oncol 2019; 37(15): e17117. [http://dx.doi.org/10.1200/JCO.2019.37.15_suppl.e17117] [http://dx.doi.org/10.1200/JCO.2019.37.15_suppl.e17117] [32] Yang MJ, Yu RQ, Chen W, Chen JY, Wang ZB. A prediction of NPVR≥ 80% of ultrasound-guided high-intensity focused ultrasound ablation for uterine fibroids. Front Surg 2021; 8: 663128. [http://dx.doi.org/10.3389/fsurg.2021.663128] [PMID: 34150838] [http://dx.doi.org/10.3389/fsurg.2021.663128] [PMID: 34150838] [33] Zeng L, Yang K, Liu H, Zhang G. A network pharmacology approach to investigate the pharmacological effects of Guizhi Fuling Wan on uterine fibroids. Exp Ther Med 2017; 14(5): 4697-710. [http://dx.doi.org/10.3892/etm.2017.5170] [PMID: 29201170] [http://dx.doi.org/10.3892/etm.2017.5170] [PMID: 29201170] [34] Yang Q, Al-Hendy A. Update on the role and regulatory mechanism of extracellular matrix in the pathogenesis of uterine fibroids. Int J Mol Sci 2023; 24(6): 5778. [http://dx.doi.org/10.3390/ijms24065778] [PMID: 36982852] [http://dx.doi.org/10.3390/ijms24065778] [PMID: 36982852] [35] Ali M, Esfandyari S, Al-Hendy A. Evolving role of microRNAs in uterine fibroid pathogenesis: Filling the gap! Fertil Steril 2020; 113(6): 1167-8. [http://dx.doi.org/10.1016/j.fertnstert.2020.04.011] [PMID: 32482253] [http://dx.doi.org/10.1016/j.fertnstert.2020.04.011] [PMID: 32482253] [36] Chuang TD, Quintanilla D, Boos D, Khorram O. Long noncoding RNA MIAT modulates the extracellular matrix deposition in leiomyomas by sponging MiR-29 family. Endocrinology 2021; 162(11): bqab186. [http://dx.doi.org/10.1210/endocr/bqab186] [PMID: 34491311] [http://dx.doi.org/10.1210/endocr/bqab186] [PMID: 34491311] [37] Chuang TD, Rehan A, Khorram O. Tranilast induces MiR-200c expression through blockade of RelA/p65 activity in leiomyoma smooth muscle cells. Fertil Steril 2020; 113(6): 1308-18. [http://dx.doi.org/10.1016/j.fertnstert.2019.12.002] [PMID: 32199621] [http://dx.doi.org/10.1016/j.fertnstert.2019.12.002] [PMID: 32199621] [38] Bernstein DL, Jiang X, Rom S. let-7 microRNAs: Their role in cerebral and cardiovascular diseases, inflammation, cancer, and their regulation. Biomedicines 2021; 9(6): 606. [http://dx.doi.org/10.3390/biomedicines9060606] [PMID: 34073513] [http://dx.doi.org/10.3390/biomedicines9060606] [PMID: 34073513] [39] Leppert PC, Jayes FL, Segars JH. The extracellular matrix contributes to mechanotransduction in uterine fibroids. Obstet Gynecol Int 2014; 2014: 1-12. [http://dx.doi.org/10.1155/2014/783289] [PMID: 25110476] [http://dx.doi.org/10.1155/2014/783289] [PMID: 25110476] [40] Moro E, Degli EE, Borghese G, et al. The impact of hormonal replacement treatment in postmenopausal women with uterine fibroids: A state-of-the-art review of the literature. Medicina (Kaunas) 2019; 55(9): 549. [http://dx.doi.org/10.3390/medicina55090549] [PMID: 31480288] [http://dx.doi.org/10.3390/medicina55090549] [PMID: 31480288] [41] Mlodawska OW, Saini P, Parker JB, et al. Epigenomic and enhancer dysregulation in uterine leiomyomas. Hum Reprod Update 2022; 28(4): 518-47. [http://dx.doi.org/10.1093/humupd/dmac008] [PMID: 35199155] [http://dx.doi.org/10.1093/humupd/dmac008] [PMID: 35199155] [42] El Andaloussi A, Al-Hendy A, Ismail N, Boyer TG, Halder SK. Introduction of somatic mutation in MED12 induces Wnt4/β-catenin and disrupts autophagy in human uterine myometrial cell. Reprod Sci 2020; 27(3): 823-32. [http://dx.doi.org/10.1007/s43032-019-00084-7] [PMID: 32046450] [http://dx.doi.org/10.1007/s43032-019-00084-7] [PMID: 32046450] [43] Koltsova A, Efimova O, Pendina A. A view on uterine leiomyoma genesis through the prism of genetic, epigenetic and cellular heterogeneity. Int J Mol Sci 2023; 24(6): 5752. [http://dx.doi.org/10.3390/ijms24065752] [PMID: 36982825] [http://dx.doi.org/10.3390/ijms24065752] [PMID: 36982825] [44] Das D, Banerjee A, Jena AB, Duttaroy AK, Pathak S. Essentiality, relevance, and efficacy of adjuvant/combinational therapy in the management of thyroid dysfunctions. Biomed Pharmacother 2022; 146: 112613. [http://dx.doi.org/10.1016/j.biopha.2022.112613] [PMID: 35062076] [http://dx.doi.org/10.1016/j.biopha.2022.112613] [PMID: 35062076] [45] Wei WT, Liu PPS, Lin SM, et al. Hypothyroidism and the risk of venous thromboembolism: A nationwide cohort study. Thromb Haemost 2020; 120(3): 505-14. [http://dx.doi.org/10.1055/s-0039-3402761] [PMID: 32028535] [http://dx.doi.org/10.1055/s-0039-3402761] [PMID: 32028535] [46] Garg DSS, Ramalakshmi DS. Menstrual disorders in chronic kidney disease: Causes and management. Int J Clin Obstetrics Gynaecol 2020; 4(2): 353-8. [http://dx.doi.org/10.33545/gynae.2020.v4.i2f.549] [http://dx.doi.org/10.33545/gynae.2020.v4.i2f.549] [47] 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. [http://dx.doi.org/10.1507/endocrj.EJ20-0340] [PMID: 33028746] [http://dx.doi.org/10.1507/endocrj.EJ20-0340] [PMID: 33028746] [48] Yuk JS, Kim JM. Uterine fibroids increase the risk of thyroid goiter and thyroid nodules. Sci Rep 2022; 12(1): 6620. [http://dx.doi.org/10.1038/s41598-022-10625-x] [PMID: 35459918] [http://dx.doi.org/10.1038/s41598-022-10625-x] [PMID: 35459918] [49] Dolmans MM, 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. [http://dx.doi.org/10.3390/jcm10194389] [PMID: 34640407] [http://dx.doi.org/10.3390/jcm10194389] [PMID: 34640407] [50] Cayton VKC, Facadio AM, Maher JY, Cross CI. Fibroids and endometrial receptivity/embryo implantation. Fibroids Reprod 2020; 34: 23-32. [http://dx.doi.org/10.1201/9780203728987-3] [http://dx.doi.org/10.1201/9780203728987-3] [51] Levai AM, Rotar IC, Muresan D. Torsion of a uterine leiomyoma – a rare cause of hemoperitoneum; a case report and review of the literature. Med Ultrason 2019; 21(1): 77-82. [http://dx.doi.org/10.11152/mu-1784] [PMID: 30779835] [http://dx.doi.org/10.11152/mu-1784] [PMID: 30779835] [52] Brewster LM, Perrotta ID, Jagernath Z, Taherzadeh Z, van Montfrans GA. Ultrastructural changes in resistance arterioles of normotensive and hypertensive premenopausal women with uterine fibroids. Ultrastruct Pathol 2023; 47(2): 104-15. [http://dx.doi.org/10.1080/01913123.2023.2171168] [PMID: 36780499] [http://dx.doi.org/10.1080/01913123.2023.2171168] [PMID: 36780499] [53] Shiota M, Kotani Y, Umemoto M, et al. Deep-vein thrombosis is associated with large uterine fibroids. Tohoku J Exp Med 2011; 224(2): 87-9. [http://dx.doi.org/10.1620/tjem.224.87] [PMID: 21576892] [http://dx.doi.org/10.1620/tjem.224.87] [PMID: 21576892] [54] Raguramana S, Vathanan V. Lower extremity deep venous thrombosis and pulmonary embolism associated with an uterine leiomyoma. Sri Lanka J Obstetrics Gynaecol 2020; 42(1): 32. [http://dx.doi.org/10.4038/sljog.v42i1.7931] [http://dx.doi.org/10.4038/sljog.v42i1.7931] [55] Kościelna-Buczek K, Mędoń E, Widuch M, Kończyk B, Kuczmik W, Urbanek T. Lumbar overlordosis—towards the better understanding of the May-Thurner syndrome pathogenesis. Chirurgia Polska 2021; 23(2): 1-10. [56] Khaund A, Lumsden MA. Impact of fibroids on reproductive function. Best Pract Res Clin Obstet Gynaecol 2008; 22(4): 749-60. [http://dx.doi.org/10.1016/j.bpobgyn.2008.01.009] [PMID: 18547868] [http://dx.doi.org/10.1016/j.bpobgyn.2008.01.009] [PMID: 18547868] [57] Pandurevic S, Macut D, Fanelli F, Pagotto U, Gambineri A. Biomediators in polycystic ovary syndrome and cardiovascular risk. Biomolecules 2021; 11(9): 1350. [http://dx.doi.org/10.3390/biom11091350] [PMID: 34572562] [http://dx.doi.org/10.3390/biom11091350] [PMID: 34572562] [58] Navarro A, Bariani MV, Yang Q, Al-Hendy A. Understanding the impact of uterine fibroids on human endometrium function. Front Cell Dev Biol 2021; 9: 633180. [http://dx.doi.org/10.3389/fcell.2021.633180] [PMID: 34113609] [http://dx.doi.org/10.3389/fcell.2021.633180] [PMID: 34113609] [59] Ali M, Chaudhry ZT, Al-Hendy A. Successes and failures of uterine leiomyoma drug discovery. Expert Opin Drug Discov 2018; 13(2): 169-77. [http://dx.doi.org/10.1080/17460441.2018.1417381] [PMID: 29254389] [http://dx.doi.org/10.1080/17460441.2018.1417381] [PMID: 29254389] [60] Moulder JK, Siedhoff MT, Till SR, Moll S. Management considerations for patients with uterine fibroids and concurrent venous thromboembolism. Curr Opin Obstet Gynecol 2016; 28(4): 329-35. [http://dx.doi.org/10.1097/GCO.0000000000000286] [PMID: 27253238] [http://dx.doi.org/10.1097/GCO.0000000000000286] [PMID: 27253238] [61] Serfaty D. Update on the contraceptive contraindications. J Gynecol Obstet Hum Reprod 2019; 48(5): 297-307. [http://dx.doi.org/10.1016/j.jogoh.2019.02.006] [PMID: 30796985] [http://dx.doi.org/10.1016/j.jogoh.2019.02.006] [PMID: 30796985] [62] James PD. Women and bleeding disorders: Diagnostic challenges. Hematology (Am Soc Hematol Educ Program) 2020; 2020(1): 547-52. [http://dx.doi.org/10.1182/hematology.2020000140] [http://dx.doi.org/10.1182/hematology.2020000140] [63] Parazzini F, Chiaffarino F, Polverino G, Chiantera V, Surace M, La Vecchia C. Uterine fibroids risk and history of selected medical conditions linked with female hormones. Eur J Epidemiol 2003; 19(3): 249-53. [http://dx.doi.org/10.1023/B:EJEP.0000020448.43323.2a] [PMID: 15117118] [http://dx.doi.org/10.1023/B:EJEP.0000020448.43323.2a] [PMID: 15117118] [64] Keenan L, Kerr T, Duane M, Van Gundy K. Systematic review of hormonal contraception and risk of venous thrombosis. Linacre Q 2018; 85(4): 470-7. [http://dx.doi.org/10.1177/0024363918816683] [PMID: 32431379] [http://dx.doi.org/10.1177/0024363918816683] [PMID: 32431379] [65] Goldhaber SZ. Risk factors for venous thromboembolism. J Am Coll Cardiol 2010; 56(1): 1-7. [http://dx.doi.org/10.1016/j.jacc.2010.01.057] [PMID: 20620709] [http://dx.doi.org/10.1016/j.jacc.2010.01.057] [PMID: 20620709] [66] Pickar JH, MacNeil T, Ohleth K. SERMs: Progress and future perspectives. Maturitas 2010; 67(2): 129-38. [http://dx.doi.org/10.1016/j.maturitas.2010.05.009] [PMID: 20580502] [http://dx.doi.org/10.1016/j.maturitas.2010.05.009] [PMID: 20580502] [67] Pillai LS, Regidi S, Varghese SD, et al. Nonhormonal selective estrogen receptor modulator 1‐(2‐(4‐{(3R, 4S)‐7‐Methoxy‐2, 2‐dimethyl‐3‐phenyl‐chroman‐4yl} phenoxy) ethyl) pyrrolidine hydrochloride (ormeloxifene hydrochloride) for the treatment of breast cancer. Drug Dev Res 2018; 79(6): 275-86. [http://dx.doi.org/10.1002/ddr.21440] [PMID: 30284735] [http://dx.doi.org/10.1002/ddr.21440] [PMID: 30284735] [68] McCormack PL. Tranexamic Acid. Drugs 2012; 72(5): 585-617. [http://dx.doi.org/10.2165/11209070-000000000-00000] [PMID: 22397329] [http://dx.doi.org/10.2165/11209070-000000000-00000] [PMID: 22397329] [69] Berntorp E, Follrud C, Lethagen S. No increased risk of venous thrombosis in women taking tranexamic acid. Thromb Haemost 2001; 86(2): 714-5. [PMID: 11522029] [PMID: 11522029] [70] Bofill RM, Lethaby A, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Libr 2019; 2019(9): CD000400. [http://dx.doi.org/10.1002/14651858.CD000400.pub4] [PMID: 31535715] [http://dx.doi.org/10.1002/14651858.CD000400.pub4] [PMID: 31535715] [71] Balkansky S, Peikova L, Grigorov E, Getov I. A review of the use of low-dose acetylsalicylic acid for antithrombotic therapy. S’rdechno-s’ dovi Zabolyavaniya/Medical Review-. Cardiovasc Dis 2014; 45(3): 3-9. [72] Evans J, Salamonsen LA. Inflammation, leukocytes and menstruation. Rev Endocr Metab Disord 2012; 13(4): 277-88. [http://dx.doi.org/10.1007/s11154-012-9223-7] [PMID: 22865231] [http://dx.doi.org/10.1007/s11154-012-9223-7] [PMID: 22865231] [73] Maybin JA, Critchley HOD. Medical management of heavy menstrual bleeding. Womens Health (Lond Engl) 2016; 12(1): 27-34. [http://dx.doi.org/10.2217/whe.15.100] [PMID: 26695687] [http://dx.doi.org/10.2217/whe.15.100] [PMID: 26695687] [74] De La Cruz MSD, Buchanan EM. Uterine fibroids: Diagnosis and treatment. Am Fam Physician 2017; 95(2): 100-7. [PMID: 28084714] [PMID: 28084714] [75] DiVasta AD, Laufer MR, Gordon CM. Bone density in adolescents treated with a GnRH agonist and add-back therapy for endometriosis. J Pediatr Adolesc Gynecol 2007; 20(5): 293-7. [http://dx.doi.org/10.1016/j.jpag.2007.04.008] [PMID: 17868896] [http://dx.doi.org/10.1016/j.jpag.2007.04.008] [PMID: 17868896] [76] Kavoussi SK, Esqueda AS, Jukes LM. Elagolix to medically treat a uterine adenomyoma: A case report. Eur J Obstet Gynecol Reprod Biol 2020; 247: 266-7. [http://dx.doi.org/10.1016/j.ejogrb.2020.02.027] [PMID: 32088070] [http://dx.doi.org/10.1016/j.ejogrb.2020.02.027] [PMID: 32088070] [77] Donnez O, Donnez J. Gonadotropin-releasing hormone antagonist (linzagolix): A new therapy for uterine adenomyosis. Fertil Steril 2020; 114(3): 640-5. [http://dx.doi.org/10.1016/j.fertnstert.2020.04.017] [PMID: 32507315] [http://dx.doi.org/10.1016/j.fertnstert.2020.04.017] [PMID: 32507315] [78] Syed YY. Relugolix/Estradiol/Norethisterone (Norethindrone) Acetate: A review in symptomatic uterine fibroids. Drugs 2022; 6: 1-8. [79] Donnez J. Liver injury and ulipristal acetate: An overstated tragedy? Fertil Steril 2018; 110(4): 593-5. [http://dx.doi.org/10.1016/j.fertnstert.2018.06.044] [PMID: 30196943] [http://dx.doi.org/10.1016/j.fertnstert.2018.06.044] [PMID: 30196943] [80] Angioni S, D’Alterio MN, Daniilidis A. Highlights on medical treatment of uterine fibroids. Curr Pharm Des 2021; 27(36): 3821-32. [http://dx.doi.org/10.2174/18734286MTEysOTUkw] [PMID: 33388011] [http://dx.doi.org/10.2174/18734286MTEysOTUkw] [PMID: 33388011] [81] Ciebiera M, Vitale SG, Ferrero S, et al. Vilaprisan, a new selective progesterone receptor modulator in uterine fibroid pharmacotherapy-will it really be a breakthrough? Curr Pharm Des 2020; 26(3): 300-9. [http://dx.doi.org/10.2174/1381612826666200127092208] [PMID: 31985366] [http://dx.doi.org/10.2174/1381612826666200127092208] [PMID: 31985366] [82] Bhatnagar AS, Brodie AMH, Long BJ, Evans DB, Miller WR. Intracellular aromatase and its relevance to the pharmacological efficacy of aromatase inhibitors. J Steroid Biochem Mol Biol 2001; 76(1-5): 199-202. [http://dx.doi.org/10.1016/S0960-0760(01)00050-4] [PMID: 11384878] [http://dx.doi.org/10.1016/S0960-0760(01)00050-4] [PMID: 11384878] [83] Moroni RM, Ferriani RA, Candido-dos-Reis FJ, Brito LGO, Vieira CS. Pharmacological treatment of uterine fibroids. Ann Med Health Sci Res 2014; 4(9) (Suppl. 3): 185. [http://dx.doi.org/10.4103/2141-9248.141955] [PMID: 25364587] [http://dx.doi.org/10.4103/2141-9248.141955] [PMID: 25364587] [84] Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 2017; 377(23): 2240-52. [http://dx.doi.org/10.1056/NEJMoa1615066] [PMID: 29211671] [http://dx.doi.org/10.1056/NEJMoa1615066] [PMID: 29211671] [85] Barnaby J, Martynov A, Shah S, Ramanathan A. Giant subserosal myoma causing deep venous thrombosis in a patient with pre-existing May-Thurner syndrome. Radiol Case Rep 2020; 15(6): 644-9. [http://dx.doi.org/10.1016/j.radcr.2020.02.010] [PMID: 32280393] [http://dx.doi.org/10.1016/j.radcr.2020.02.010] [PMID: 32280393] [86] Chan N, Sobieraj-Teague M, Eikelboom JW. Direct oral anticoagulants: Evidence and unresolved issues. Lancet 2020; 396(10264): 1767-76. [http://dx.doi.org/10.1016/S0140-6736(20)32439-9] [PMID: 33248499] [http://dx.doi.org/10.1016/S0140-6736(20)32439-9] [PMID: 33248499] [87] Schwarb H, Tsakiris D. New direct oral anticoagulants (DOAC) and their use today. Dent J 2016; 4(1): 5. [http://dx.doi.org/10.3390/dj4010005] [PMID: 29563447] [http://dx.doi.org/10.3390/dj4010005] [PMID: 29563447] [88] Müller M, Eastline J, Nagler M, Exadaktylos AK, Sauter TC. Application of prothrombin complex concentrate for reversal of direct oral anticoagulants in clinical practice: Indications, patient characteristics and clinical outcomes compared to reversal of vitamin K antagonists. Scand J Trauma Resusc Emerg Med 2019; 27(1): 48. [http://dx.doi.org/10.1186/s13049-019-0625-3] [PMID: 31014373] [http://dx.doi.org/10.1186/s13049-019-0625-3] [PMID: 31014373] [89] White K, Faruqi U, Cohen AAT. New agents for DOAC reversal: A practical management review. Br J Cardiol 2022; 29(1): 1. [PMID: 35747314] [PMID: 35747314] [90] Binymin KA, Nasher M, Patel D. Warfarin-induced deep vein thrombosis. Int Med Case Rep J 2014; 7: 123-5. [http://dx.doi.org/10.2147/IMCRJ.S62100] [PMID: 25246809] [http://dx.doi.org/10.2147/IMCRJ.S62100] [PMID: 25246809] [91] Vranckx P, Valgimigli M, Heidbuchel H. The Significance of drug—Drug and drug—Food interactions of oral anticoagulation. Arrhythm Electrophysiol Rev 2018; 7(1): 55-61. [http://dx.doi.org/10.15420/aer.2017.50.1] [PMID: 29636974] [http://dx.doi.org/10.15420/aer.2017.50.1] [PMID: 29636974] [92] Arepally GM. Heparin-induced thrombocytopenia. Blood 2017; 129(21): 2864-72. [http://dx.doi.org/10.1182/blood-2016-11-709873] [PMID: 28416511] [http://dx.doi.org/10.1182/blood-2016-11-709873] [PMID: 28416511] [93] Ieko M, Tarumi T, Nakabayashi T, Yoshida M, Naito S, Koike T. Factor Xa inhibitors: New anti-thrombotic agents and their characteristics. Front Biosci 2006; 11(1): 232-48. [http://dx.doi.org/10.2741/1794] [PMID: 16146728] [http://dx.doi.org/10.2741/1794] [PMID: 16146728] [94] Arbit B, Nishimura M, Hsu JC. Reversal agents for direct oral anticoagulants: A focused review. Int J Cardiol 2016; 223: 244-50. [http://dx.doi.org/10.1016/j.ijcard.2016.07.304] [PMID: 27541665] [http://dx.doi.org/10.1016/j.ijcard.2016.07.304] [PMID: 27541665] [95] Van Gorp R, Schurgers L. New insights into the pros and cons of the clinical use of vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs). Nutrients 2015; 7(11): 9538-57. [http://dx.doi.org/10.3390/nu7115479] [PMID: 26593943] [http://dx.doi.org/10.3390/nu7115479] [PMID: 26593943] [96] Goldhaber SZ, Eriksson H, Kakkar A, et al. Efficacy of dabigatran versus warfarin in patients with acute venous thromboembolism in the presence of thrombophilia: Findings from RE-COVER ®, RE-COVER™ II, and RE-MEDY™. Vasc Med 2016; 21(6): 506-14. [http://dx.doi.org/10.1177/1358863X16668588] [PMID: 27807306] [http://dx.doi.org/10.1177/1358863X16668588] [PMID: 27807306] [97] Diener HC, Connolly SJ, Ezekowitz MD, et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: A subgroup analysis of the RE-LY trial. Lancet Neurol 2010; 9(12): 1157-63. [http://dx.doi.org/10.1016/S1474-4422(10)70274-X] [PMID: 21059484] [http://dx.doi.org/10.1016/S1474-4422(10)70274-X] [PMID: 21059484] [98] Cohen AT, Bauersachs R. Rivaroxaban and the EINSTEIN clinical trial programme. Blood Coagul Fibrinolysis 2019; 30(3): 85-95. [http://dx.doi.org/10.1097/MBC.0000000000000800] [PMID: 30920394] [http://dx.doi.org/10.1097/MBC.0000000000000800] [PMID: 30920394] [99] Moik F, Posch F, Zielinski C, Pabinger I, Ay C. Direct oral anticoagulants compared to low‐molecular‐weight heparin for the treatment of cancer‐associated thrombosis: Updated systematic review and meta‐analysis of randomized controlled trials. Res Pract Thromb Haemost 2020; 4(4): 550-61. [http://dx.doi.org/10.1002/rth2.12359] [PMID: 32548553] [http://dx.doi.org/10.1002/rth2.12359] [PMID: 32548553] [100] Stefano VD, Martinelli I. Rare thromboses of cerebral, splanchnic and upper-extremity veins. Thromb Haemost 2010; 103(6): 1136-44. [http://dx.doi.org/10.1160/TH09-12-0873] [PMID: 20352171] [http://dx.doi.org/10.1160/TH09-12-0873] [PMID: 20352171] [101] Martinelli I, Lensing AWA, Middeldorp S, et al. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use. Blood 2016; 127(11): 1417-25. [http://dx.doi.org/10.1182/blood-2015-08-665927] [PMID: 26696010] [http://dx.doi.org/10.1182/blood-2015-08-665927] [PMID: 26696010] [102] Carrier M, Abou-Nassar K, Mallick R, et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med 2019; 380(8): 711-9. [http://dx.doi.org/10.1056/NEJMoa1814468] [PMID: 30511879] [http://dx.doi.org/10.1056/NEJMoa1814468] [PMID: 30511879] [103] Raskob G, Ageno W, Cohen AT, et al. Extended duration of anticoagulation with edoxaban in patients with venous thromboembolism: A post-hoc analysis of the Hokusai-VTE study. Lancet Haematol 2016; 3(5): e228-36. [http://dx.doi.org/10.1016/S2352-3026(16)00023-5] [PMID: 27132697] [http://dx.doi.org/10.1016/S2352-3026(16)00023-5] [PMID: 27132697] [104] Skjøth F, Larsen TB, Rasmussen LH, Lip GY. Efficacy and safety of edoxaban in comparison with dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation. An indirect comparison analysis. Thromb Haemost 2014; 111(5): 981-8. [PMID: 24577485] [PMID: 24577485] 69 2

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (97)

SciLite annotations

organisms 2
noordeloos 2009062 noordeloos 2009062
chemicals 6
tranexamic acid steroid levonorgestrel progestin danazol d-thyroxine

Source provenance

openalex
last seen: 2026-05-11T04:31:24.775200+00:00
scilite
last seen: 2026-05-18T04:26:01.642840+00:00
License: CC0 · commercial use OK