***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Uterine leiomyoma , or fibroid tumors , are the leading indication for hysterectomy in the United States , but the proportion of women in whom fibroid tumors develop is not known . This study screened for fibroid tumors , independently of clinical symptoms , to estimate the age-specific proportion of black and white women in whom fibroid tumors develop . STUDY DESIGN R and omly selected members of an urban health plan who were 35 to 49 years old participated ( n = 1364 women ) .  Medical records and self-report were used to assess fibroid status for those women who were no longer menstruating ( most of whom had had hysterectomies ) . Premenopausal women were screened by ultrasonography . We estimated the age-specific cumulative incidence of fibroid tumors for black and white women . RESULTS Thirty-five percent of premenopausal women had a previous diagnosis of fibroid tumors . Fifty-one percent of the premenopausal women who had no previous diagnosis had ultrasound evidence of fibroid tumors . The estimated cumulative incidence of tumors by age 50 was > 80 % for black women and nearly 70 % for white women . The difference between the age-specific cumulative incidence curves for black and white women was highly significant ( odds ratio , 2.9 ; 95 % CI , 2.5 - 3.4 ; P < .001 ) . CONCLUSION The results of this study suggest that most black and white women in the United States develop uterine fibroid tumors before menopause and that uterine fibroid tumors develop in black women at earlier ages than in white women OBJECTIVE To analyze the lifetime incidence of benign gynecological tumors  . STUDY DESIGN The German Cohort Study on Women 's Health was launched in 1998 as historic cohort study with prospect i ve follow up . The study ascertained self-reported information on tumors by calendar time . The incidence of benign gynecological tumors was calculated from the data of the first cohort period . RESULTS The cohort comprised 396000 women-years of observation and 1676 benign tumors were observed . This lead to incidence estimates of 27.0 , 18.6 , and 23.3 per 100000 women-years of observation for all benign tumors of the uterus , ovary , and breast respectively . CONCLUSION In absence of other data , it is reasonable to use incidence rates generated by a large cohort of German women as a best estimate for the population up to 65 years of age OBJECTIVE To determine the acceptability and effectiveness of a gonadotropin-releasing hormone ( GnRH ) agonist for the treatment of perimenopausal women with symptomatic uterine myomas . MATERIAL S AND METHODS The participants included 43 women with symptomatic myomas who wished to retain their uteri . All the women were older than 45 years old , agreed to use the GnRH agonist for menopause induction , and were without any underlying malignancy . They were treated with six courses of GnRH agonist between 2004 and 2005 . The definition of re-intervention included : ( 1 ) surgical intervention , such as hysterectomy , myomectomy or laparoscopic uterine vessel occlusion , or ( 2 ) modification of GnRH agonist use . Modification of GnRH agonist use included either failure to complete a 6-month GnRH agonist treatment course , or re-use of GnRH agonist with/without interruption of continuity . Failure was defined as women who underwent surgical intervention or failed to complete the 6-month GnRH agonist treatment . Evaluations were performed every 6 months , for up to 2 years . RESULTS Re-intervention rates were 14.0 % ( n = 6 ) , 23.3 % ( n = 10 ) and 32.6 % ( n = 14 ) , and failure rates were 7.0 % ( n = 3 ) , 11.6 % ( n = 5 ) and 16.3 % ( n = 7 ) , at the end of the 6- , 12- and 24-month follow-up periods , respectively . Three patients failed to complete the 6-month GnRH agonist treatment , and four received surgical interventions . CONCLUSION More than 80 % of women in this study benefited from the use of GnRH agonist to produce menopause , suggesting that this can be an alternative choice for managing perimenopausal women with symptomatic uterine myomas STUDY OBJECTIVE To compare the postoperative recovery of patients undergoing laparoscopic and minilaparotomic myomectomy .  DESIGN R and omized study ( Canadian Task Force classification I ) . SETTING University hospital . PATIENTS One hundred forty-eight women requiring surgical myomectomy . INTERVENTIONS Myomectomy by minilaparotomy or laparoscopy . MEASUREMENTS AND MAIN RESULTS Operation time was significantly lower in the minilaparotomy group ( p < .001 ) . When compared with minilaparotomy , laparoscopy was associated with a lower decline of hemoglobin concentration ( p < .001 ) , a reduced length of postoperative ileus ( p < .001 ) , and a shorter time to discharge ( p < .001 ) . Pain intensity at 6 hours after surgery was significantly lower in the laparoscopy group ( p < .001 ) ; also , patients who underwent laparoscopy requested analgesics less frequently in the first 48 hours after the operation ( p < .001 ) . Patients included in the laparoscopy group were fully recuperated on postoperative day 15 more frequently than those included in the minilaparotomy group ( p = .012 ) . No complications were observed in the minilaparotomy group . There were two complications in the laparoscopy group ( one laparoconversion caused by difficulties of hemostasis and one acute diffuse peritonitis caused by ileal perforation ) . Laparoscopic and minilaparotomic myomectomy  cost , respectively , 2250 euros and 1975 euros . CONCLUSION When compared with minilaparotomic myomectomy , laparoscopic myomectomy may offer the benefits of lower postoperative analgesic use and faster postoperative recovery OBJECTIVE To evaluate the effectiveness of hysteroscopic submucous myomectomy for women with heavy menstrual bleeding ( HMB ) over a minimum 1-year period and assess prognostic factors associated with treatment success . STUDY DESIGN Prospect i ve observational study set in a university teaching hospital in UK involving 92 women symptomatic of HMB with submucous myomas consecutively recruited between June 2003 and November 2006 .  Hysteroscopic myomectomy was performed under outpatient local anaesthetic ( n=35 , 38 % ) or daycase general anaesthesia ( n=57 , 62 % ) using Gynecare Versascope bipolar system . The main outcome measures were : the need for secondary surgical or medical re-intervention , menstrual improvement and patient satisfaction . Other outcome measures include : successful completion of primary resection , type of secondary treatment . RESULT Mean follow up was 2.6 years ( 95 % CI 2.3 - 2.9 ) . Complete fibroid excision was achieved in 66 % . Secondary surgical re-intervention was required in 27 ( 29 % ) of which 11 ( 12 % ) were repeat hysteroscopic myomectomy and 10 ( 11 % ) were hysterectomy procedures . Multiple uterine fibroids and adenomyosis were identified in 80 % of hysterectomies . At follow up , improved menstrual symptoms and patient satisfaction were reported by 91 % and 86 % , respectively . Irregular cycle HMB and incomplete fibroid excision were associated with secondary retreatment . Size of the submucous fibroid resected , presence of intramural and subserosal fibroids , or LA vs. GA setting were unrelated to treatment success . CONCLUSION HMB with submucous myomas may be successfully treated by completely removing the intracavity myoma component , irrespective of co-existent intramural or subserosal fibroids or size of fibroid resected . This effect remains sustained over at least a 1 - 2 year period OBJECTIVE The purpose of this study was to compare advantages , disadvantages , and outcomes in patients who undergo vaginal or abdominal hysterectomy for enlarged symptomatic uteri . STUDY DESIGN In a prospect i ve , r and omized study , 60 vaginal hysterectomies ( study group ) were compared with 59 abdominal hysterectomies ( control group ) ;  all of the hysterectomies were performed for symptomatic uterine fibroids from January 1997 through December 2000 . We excluded from the study the other common causes of hysterectomy such as prolapse , bleeding , adenomyosis , and endometrial or cervical carcinoma . In both groups , uterine weights ranged from 200 g to 1300 g. For enlarged uteri , vaginal hysterectomies were performed with the use of volume reduction techniques : Intramyometrial coring , corporal bisection , and morcellation . The evaluated parameters included patient age , weight , parity , uterine weight , operative time , blood loss , dem and for analgesics , eventual surgical complications , length of admission , and hospital charges . The Mann-Whitney U test and chi(2 ) tests were applied for statistical analysis . Probability values of < .05 were considered statistically significant . RESULTS There were no major differences in patient age , weight , parity , and uterine weight between the two groups . Operative time was significantly lower for the vaginal route as compared with the abdominal route ( 86 minutes vs 102 minutes , P < .001 ) . No intraoperative complications were noted both in the study and control groups or the control group . Surgical bleeding ( expressed by hemoglobin loss ) was not significantly different between the two groups . In the postoperative period , we found a higher incidence of fever ( 30.5 % vs 16.6 % , P < .05 ) and dem and for analgesics ( 86 % vs 66 % , P < .05 ) in the abdominal group as compared with the vaginal group . Significant advantages of vaginal hysterectomy were a reduction in the hospital stay ( 3 days vs 4 days , P < .001 ) and cost . CONCLUSION These results should lead to the choice of vaginal hysterectomy as a valid alternative to the abdominal hysterectomy , even for enlarged uteri PURPOSE To investigate whether uterine artery embolization ( UAE ) is a cost-effective alternative to hysterectomy for patients with symptomatic uterine fibroids , the authors performed an economic evaluation alongside the multicenter r and omized EMMY ( EMbolization versus hysterectoMY ) trial . MATERIAL S AND METHODS Between February 2002 and February 2004 , 177 patients were r and omized to undergo UAE ( n = 88 ) or hysterectomy ( n = 89 ) and followed up until 24 months after initial treatment allocation . Conditional on the equivalence of clinical outcome , a cost minimization analysis was performed according to the intention to treat principle . Costs included health care costs inside and outside the hospital as well as costs related to absence from work ( societal perspective ) . Cumulative st and ardized costs were estimated as volumes multiplied with prices . The nonparametric bootstrap method was used to quantify differences in mean ( 95 % confidence interval [ CI ] ) costs between the strategies . RESULTS In total , 81 patients underwent UAE  and 75 underwent  hysterectomy . In the UAE group , 19 patients ( 23 % ) underwent secondary hysterectomies . The mean total costs per patient in the UAE group were significantly lower than those in the hysterectomy group ( $ 11,626 vs $ 18,563 ; mean difference , -$6,936 [ -37 % ] , 95 % CI : -$9,548 , $ 4,281 ) . The direct medical in-hospital costs were significantly lower in the UAE group : $ 6,688 vs $ 8,313 ( mean difference , -$1,624 [ -20 % ] , 95 % CI : -$2,605 , -$586 ) . Direct medical out-of-hospital and direct nonmedical costs were low in both groups ( mean cost difference , $ 156 in favor of hysterectomy ) . The costs related to absence from work differed significantly between the treatment strategies in favor of UAE ( mean difference , -$5,453 ; 95 % CI : -$7,718 , -$3,107 ) . The costs of absence from work accounted for 79 % of the difference in total costs . CONCLUSIONS The 24-month cumulative cost of UAE is lower than that of hysterectomy . From a societal economic perspective , UAE is the superior treatment strategy in women with symptomatic uterine fibroids OBJECTIVE To evaluate the therapeutic efficacy of laparoscopic uterine artery occlusion combined with myomectomy through a minilaparotomy in the treatment of recurrent uterine myomas , compared with myomectomy alone . DESIGN Controlled , nonr and omized clinical study . SETTING University-affiliated tertiary care referral center . PATIENT(S ) Eighty-two women with symptomatic , recurrent myomas warranting surgical treatment , who expressed a strong desire to retain their uterus . Fifty-two patients ( 63.4 % ) underwent lapar 
    Output:
    
The results of this systematic literature review highlight the substantial direct and indirect costs that are associated with uterine fibroid tumors to health care payers and society .