Abstract

UTERINE VOLUME AND ITS RELEVANCE IN CLINICAL PRACTICE

A.A. Rabarijaona*, M. Rhemimet, O. Sardaoui, Najia Zeraidi, Amina Lakhdar, Aziz Baydada

ABSTRACT

Introduction: The relevant uterine size is its total size. Aim of the study: The aim of the study is a literature review on how to assess the uterine volume and its relevance in clinical practice. Materials and Methods: We searched articles by using the following keywords: Uterine volume, endometrial volume, Uterine size, Uterine weight, Enlarge uterus. Science direct and Pubmed are the data bases we used. Totally, we included 52 studies. Our inclusion critearia was the study who evaluated their uterine volume by the ellipsoid formula and or the 3D ultrasonography and or the Magnetic Resonance Images (MRI). We included too the study who elaborate the relationship between uterine volume and his clinical relevance. We excluded articles who evaluate the uterine size by his height and the studies who evaluated just the cavity volume. The estimation of uterine volume is more accurate with VOCALTM and Cavalieri Method compared with 2D Ultrasonography. Moreover, the ellipsoid method used in ultrasound images may be inadequate for determining the volume of uterine layers especially the volume of the endometrium. The uterine volume increases during childhood, with a faster increase in adolescence reflecting the influence of puberty, followed by a slow but gradual increase in adulthood. There is a relative lack of data on uterine volume in girls over seven years of age. At the age of three, the predicted uterine volume is 1.5 cm3 (68% prediction limit 1.5 - 3.2 cm3), while the predicted uterine volume (post -pubertal) at the age of 15 is 25.8 cm3 (68% preferred limit 25.8 - 77.8 cm3). Women aged 16 to 20 with normal sized uteri, with normal pelvic ultrasound findings, showed uterine volume to vary from 24 to 50 cm3, averaging 34 cm3. For women aged 45 to 55 with normal pelvis and ultrasound normal-sized uteri, ultrasound results showed uterine volume ranged from 15 to 56 cm3, with an average of 35 cm3. After puberty, the steady increase in uterine volume is probably related to parity. It was found that despite standard oestrogen therapy, uterine growth is often compromised in those with hypogonadism (48% had total uterine volume measurements less than the 5th percentile). Uterine development was clearly jeopardized when estrogen insufficiency started at a very young age. Besides, total body bone mineral density (BMD) proved to be more affected by precocious estrogen deficiency too in younger age groups. The Uterine volume < 5 cm3 (p< 0.0001) - Total body BMD (p = 0.0005) was in Primary amenorrhea = 53,3% - 0.99 ± 0.10 g/ cm3, in Secondary amenorrhea ≤ 5years ga (Gynecologic age) = 93,6% - 1.04 ± 0.08 g/ cm3, in Secondary amenorrhea 6 - 15years ga = 61,8% - 1.09 ± 0.10 g/ cm3, Secondary amenorrhea > 15years ga = 83,3% - 1.12 ± 0.11 g/cm3. Maternal smoking, but not variations in fetal growth, may lead to a reduction in uterine volume in adolescent. Linear regression showed that daughters of mothers who smoked had a significantly smaller uterus compared with nonsmokers: 31.6 cm3 (28.2–35.5) vs 38.6 cm3 (36.2– 41.1), (P = 0.019). Girls with AUB have significantly larger uterine volume than healthy girls (63.2 ± 24.8 vs 47.8 ± 17.5 cm3) and even higher than in healthy nulliparous women of childbearing age. Cytotoxic treatment in childhood does not affect adult uterine size: chemotherapy only (median 47 mL, range 22-88 ml), radiotherapy above the diaphragm (median 40 mL, range 24-61ml), or radiotherapy below the diaphragm not directly involving the uterus (median 34 mL, range 8-77ml), (p < 0.02 in all comparisons). In contrast, uterine irradiation at a young age reduces adult uterine volume (median: 13 mL, range 1-52 mL) and the radiotherapy-induced damage is probably irreversible. As well as, bone marrow transplantation as main treatment and Total Body Irradiation (TBI) and busulfan as conditioning regimens which have a worst effect on uterine and ovarian sizes compared with healthy controls. Median uterus and ovarian volumes were reduced by 64% (95% CI, 56.6-70.6) and 83.6% (95% CI, 79.6-86.7), respectively. Uterine volume was reduced after TBI (percent reduction 81.9%; 95% CI, 71.8-87.8) or busulfan (percentage reduction 67.4%; 95% CI, 58.5-75.6) compared with those who had not received a conditioning regimen (percentage reduction 24.4%; 95% CI, 7.6-38.2). The endometrial and uterine body volume ratio (EV / UCV) with a cutoff value greater than 0.017 may be predictive of atypia or endometrial malignancy in postmenopausal bleeding women. Patients with Polycystic ovary syndrom (PCOS) and body mass index (BMI) ≥ 25 kg / m2 had a larger uterine volume than PCOS patients with a BMI < 25 kg / m2 (P

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