***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: STUDY OBJECTIVE To compare uterine size reduction obtained with three monthly subcutaneous injections of 3.6 mg of goserelin versus a single subcutaneous injection of 10.8 mg . DESIGN Prospect i ve , r and omized clinical trial ( Canadian Task Force classification I ) . SETTING Department of Gynecology and Obstetrics at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo . PATIENTS Forty-five premenopausal women with uterine leiomyomas and uterine size greater than 600 cm(3 ) r and omized to one of two groups . INTERVENTION Group A : 23 women received three monthly subcutaneous 3.6-mg doses of goserelin . Group B : 22 women received a single subcutaneous injection of 10.8 mg of goserelin .  Follicle-stimulating hormone ( FSH ) , estradiol , and hemoglobin levels were measured monthly . After 3 months , uterine size was determined by transvaginal and /or abdominal ultrasound . MEASUREMENTS AND MAIN RESULTS In group A , mean reduction of uterine size was 43 % ( 426 cm(3 ) ) at the end of treatment . In Group B , mean reduction of uterine size was 54 % ( 494 cm(3 ) ) . Serum levels of FSH and estradiol were in postmenopausal range during treatment . Hemoglobin level improvement was equivalent in both groups . CONCLUSION Use of single injection of 10.8 mg of goserelin promoted significantly greater reduction in uterine size than three monthly 3.6-mg injections in patients with voluminous uterine leiomyomas OBJECTIVE To characterize the relationship between self reported bleeding symptoms and uterine leiomyoma size and location . METHODS The leiomyoma status of a r and omly selected sample of women aged 35–49 in the Washington , DC , area was determined using abdominal and transvaginal ultrasound  to measure size and location of leiomyomata found at screening . Women were asked about symptoms of heavy bleeding ( gushing-type bleeding , long menses , pad/ tampon use ) in a telephone interview . Using multivariable regression , we examined the relationships between leiomyoma characteristics and heavy bleeding symptoms among 910 premenopausal women . RESULTS Women with leiomyomata ( n = 596 ) were more likely to report gushing-type bleeding than women without leiomyomata ; risk increased with leiomyoma size . Adjusted relative risks with 95 % confidence intervals ( CI ) for women in each leiomyoma size category compared with the reference category ( women without leiomyomata ) were as follows : adjusted relative risk of 1.4 ( 95 % CI 1.1 , 1.9 ) for diffuse only , adjusted relative risk of 1.4 ( 95 % CI 1.1 , 1.8 ) for small leiomyomata ( less than 2 cm ) , adjusted relative risk of 1.6 ( 95 % CI 1.3 , 2.0 ) for medium leiomyomata ( 2–5 cm ) , and adjusted relative risk of 1.9 ( 95 % CI 1.5 , 2.5 ) for large leiomyomata ( greater than 5 cm ) . Reported use of eight or more pads/tampons on the heaviest days of menstrual bleeding increased with leiomyoma size , with a nearly 2.5-fold risk for women with large leiomyomata compared with women without leiomyomata ( adjusted relative risk of 2.4 ; 95 % CI 1.8 , 3.1 ) . Nonsubmucosal leiomyomata were associated with essentially the same increase in heavy bleeding as submuscosal leiomyomata of similar size . CONCLUSION Small leiomyomata were associated with increased risk of heavy bleeding , and risk increased with size . Contrary to published articles , nonsubmucosal leiomyomata were associated with heavy bleeding to the same extent as submucosal leiomyomata The purpose of this study was to evaluate efficacy and safety parameters in women with leiomyomata uteri treated with the GnRH agonist leuprolide acetate depot , 3.75 mg intramuscularly every 4 weeks for 24 weeks . One hundred twenty-eight patients were enrolled in a r and omized , double-blind ,  placebo-controlled  multicenter study involving 13 investigative centers . Mean uterine volume decreased by 36 % at 12 weeks and 45 % at 24 weeks of leuprolide therapy . Patients treated with placebo had increases in mean uterine volume of 16 % at 12 weeks and 5 % at 24 weeks . Seventyseven percent of leuprolide-treated patients had a more than 25 % reduction in uterine volume , compared with 9 % of placebo-treated controls . Mean uterine volume returned to pre-treatment size 24 weeks after cessation of leuprolide treatment . The majority of patients had resolution or improvement of their fibroid-related symptoms after 24 weeks of leuprolide treatment . Of 38  leuprolide-treated patients presenting with menorrhagia , 37 ( 97 % ) had resolution of this symptom at the time of the final visit . Although 95 % of women treated with leuprolide acetate experienced some side effects related to hypoestrogenism , only five patients ( 8 % ) terminated treatment prematurely . We conclude that leuprolide acetate depot treatment of leiomyomata uteri is safe and causes significant but temporary reductions in uterine size and fibroid-related symptoms Fourteen premenopausal women with uterine leiomyomata were r and omized to receive a gonadotropin-releasing hormone agonist ( GnRH-a ) , leuprolide , either by daily subcutaneous ( SC ) injection ( 500 micrograms/day ) or by intranasal ( IN ) spray ( 1600 micrograms/day ) for 24 weeks . In the SC group , a significant reduction in uterine volume occurred from a pretreatment volume of 368 + /- 60 ( mean + /- st and ard error of the mean [ SEM ] ) cm3 to 202 + /- 61 cm3 at 12 weeks of therapy ( P less than 0.01 ) and to 172 + /- 49 cm3 at 24 weeks of therapy ( P less than 0.005 ) . In the IN group , no significant reduction in uterine volume occurred . In addition , there was a significant negative correlation between the serum estradiol concentration during treatment and the percent decrease in uterine volume ( r = -0.55 , P less than 0.05 ) . Four months after completing therapy , uterine volume increased to 296 + /- 104 cm3 in the SC group , which was not significantly different from pretreatment volume . These findings suggest that reduction in uterine volume depends on the degree of hypoestrogenism induced and that uterine volume increases soon after cessation of GnRH-a therapy BACKGROUND Our aim was to evaluate the long-term effectiveness and safety of GnRH agonist plus raloxifene administration in women with symptomatic uterine leiomyomas . METHODS Fifty pre-menopausal women with uterine leiomyomas were treated with leuprolide acetate depot at dose of 3.75 mg/28 days and raloxifene hydrochloride at 60 mg/day for 18 cycles . At admission and after each six cycles of treatment , bone mineral density ( BMD ) , uterine , leiomyoma and non-leiomyoma dimensions , serum bone metabolism markers , lipid , glucose and insulin levels were evaluated . Leiomyoma-related and climacteric-like symptoms were assessed using a daily diary . RESULTS Throughout the study , no significant change in BMD or in any bone metabolism markers was observed . A significant decrease in uterine , leiomyoma and non-leiomyoma sizes was detected in comparison with baseline already after 6 months . No other significant change was observed at the successive follow-up visits . No significant change in lipid and glucose profile was detected throughout the study . The treatments were well tolerated . All treatment withdrawals ( 16 % , eight out of 50 ) were due to lack of compliance , and none to drug-related adverse experiences . CONCLUSION GnRH agonist plus raloxifene administration is an effective and safe treatment for pre-menopausal women with uterine leiomyomas BACKGROUND Raloxifene hydrochloride is a synthetic non-steroidal drug used for the prevention and treatment of post-menopausal osteoporosis . Pre- clinical and clinical data have shown that raloxifene may have a beneficial effect on leiomyomas . The aim of this prospect i ve single-blind , r and omized , placebo-controlled clinical trial was to evaluate the effectiveness of the addition of raloxifene to GnRH analogues on uterine , leiomyoma , and non-leiomyoma sizes , and on the occurrence of leiomyoma-related symptoms . METHODS After r and omization using a computer-generated list , 100 pre-menopausal women with symptomatic uterine leiomyomas received either leuprolide acetate depot plus raloxifene 60 mg daily ( group A ) or leuprolide plus placebo tablet ( group B ) for six cycles of 28 days . At baseline and after treatment , uterine , leiomyoma and non-leiomyoma sizes , and leiomyoma-related symptoms were evaluated for each woman . Analysis was by intention-to-treat method . RESULTS After six cycles of treatment , a significant decrease in uterine , leiomyoma , and non-leiomyoma sizes was detected in both groups in comparison with baseline . At the same time , no significant difference in uterine and non-leiomyoma sizes was observed between the groups . Leiomyoma sizes were significantly ( P < 0.05 ) lower in group A than in group B. No difference was observed in leiomyoma-related symptoms between groups throughout the study period . CONCLUSIONS In women treated with GnRH analogue , the raloxifene administration induces a higher reduction of leiomyoma sizes Background . In articles and textbooks the prevalence of uterine leiomyomas is said to be 20–25 % in women over the age of 30 . The aim of this study was to investigate the rate of uterine leiomyoma , the thickness and the texture of the endometrium , and the size of the uterus in a r and om sample of asymptomatic women 25–40 years old 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 assess the efficacy of tibolone add-back therapy with Goserelin treatment of uterine fibroids . DESIGN R and omized placebo-controlled study . SETTING Gynecology department of an inner-city teaching hospital . PATIENT(S ) Seventy-five women of reproductive age with uterine fibroids . INTERVENTION(S ) All women were given monthly SC implants of 3.6 mg goserelin and were r and omized to take 3 months of placebo followed by 3 months of tibolone 2.5 mg daily ( delayed administration ) , tibolone 2.5 mg daily for 6 months , or placebo for 6 months . MAIN OUTCOME MEASURE(S ) Changes in bone mineral density ( BMD ) at the hip and spine , fibroid and uterine size , and patient symptomatology . RESULT ( S ) In the tibolone group , 2 % loss of BMD at the spine was observed compared with 5.5 % loss in the placebo group . For total hip , tibolone led to a 0.7 % gain in BMD compared with a loss of 1.7 % in the placebo group . Tibolone did not affect GnRH analogue-induced fibroid shrinkage . Vasomotor symptom scores in women taking tibolone were 2.2 and were significantly lower than those taking placebo or in the delayed administration groups ( mean scores 2.9 and 2.7 , respectively ) . CONCLUSION ( S ) Tibolone appears to be a safe and effective add-back therapy which can be 
    Output:
    
This short-term follow-up is usually insufficient to observe any significant effect of the treatment on bone health ( such as the occurrence of fractures ) , limiting the findings .
There was low or moderate quality evidence that tibolone , raloxifene , estriol and ipriflavone help to preserve bone density and that MPA and tibolone may reduce vasomotor symptoms .
Larger uterine volume was an adverse effect associated with some add-back therapies ( MPA , tibolone and conjugated estrogens ) .