Sandra Fyfe

Worldwide, 1 in 10 women suffer from endometriosis and often find it difficult to control their symptoms, which include painful intercourse, constipation, dysmenorrhea, and persistent pelvic pain.

Symptom management has been more challenging during the COVID-19 pandemic, due to limited access to healthcare. Mike Armour, PhD, of the NICM Health Research Institute at Western Sydney University in Penrith, New South Wales, Australia and colleagues set out to examine how frequently women used cannabis over a period of 12 weeks to manage their endometriosis symptoms during the pandemic in a survey-based study.

Researchers recruited women between the ages of 18-55 with the condition using social media to access some of the largest endometriosis support and advocacy groups worldwide. These included Nancy’s Nook, Endometriosis Australia, Endometriosis NZ, the World Endometriosis Organization, the Centre for Endometriosis Research, Endometriosis Ireland, and The Endometriosis Network Canada, for a total pool of about 95,000 women.

 The authors ensured that surveys could only be taken once per IP address to prevent multiple submissions from an individual.

The anonymous, cross-sectional, online survey was designed by a team that included cannabis, endometriosis, and menstrual health academics and gynecologists. Researchers collected demographic information, endometriosis symptoms, diagnosis method, and current management approaches, in addition to current and previous cannabis use and method of consumption.

Armour and colleagues received 1635 responses worldwide, and reported the average age of respondents was 30 (mean 25 years).

 Twenty percent of respondents said they had previously used cannabis. Pre-pandemic, 61% of women said they used cannabis at least once a day, with 51% using inhaled forms. Sixty-five percent of users reported they stopped using cannabis because of the pandemic. The authors said cannabis use increased among current users during the pandemic.

Fifty-one percent of respondents (846) said they consumed cannabis in the past 3 months; of these, 55% (465) reported using it for symptomatic management. “Legal access was associated both with a greater likelihood of using cannabis and greater disclosure to health care professionals,” the authors said.

Stress/anxiety was the most common reason (59%) participants reported using cannabis, followed by symptomatic management due to difficulty accessing medical care (48%) the authors reported. They also noted that the way women consumed cannabis changed during the pandemic, with increases in edibles and oil consumption (40% and 25.2% respectively) and a 39.5% decrease in inhalation methods. Survey respondents said the decline in inhaled use was due to respiratory health concerns during the COVID-19 pandemic.

One of the barriers to consumption was cost; this included both the cost of the product and the expense of obtaining a medical prescription in places where cannabis is not legal for recreational consumption. “Lack of public (Medicare-like) insurance reimbursement and limited private health insurance coverage push the out-of-pocket costs associated with cannabis medicines onto patient households, a burden not every patient/family can bear, regardless of its reported effectiveness in the management of endometriosis,” the authors wrote. They said this creates barriers for women who would use it to alleviate their symptoms.

Armour and colleagues noted several weaknesses of the study: there was no proof of diagnosis, selection bias may have occurred due to nonresponse in social media groups, and study participants may have experienced recall bias. Study strengths noted by researchers included international reach of the survey, the size of the sample, and the ability to report anonymously encouraged study participants to disclose information.

“Use of cannabis for symptom relief was common, with over half of respondents having used cannabis for symptom management in the 12 weeks preceding survey completion,” the authors said.

Armour M, Sinclair J, Cheng J, et al. Endometriosis and Cannabis Consumption During the COVID-19 Pandemic: An International Cross-Sectional Survey [published online ahead of print, 2022 Jan 21]. 

. 2022;10.1089/can.2021.0162. doi:10.1089/can.2021.0162

Articles

A study published in Cannabis and Cannabinoid Research found that women often used cannabis to manage endometriosis symptoms during the COVID-19 pandemic.

Cannabis consumption and endometriosis management during the COVID-19 pandemic

Elke Hunsche, PhD, of Global Market Access and Health Economics and Outcomes Research at Myovant Sciences GmbHIn in Basal, Switzerland and colleagues conducted the substudy. Thirty women with heavy menstrual bleeding (HMB) who participated in the phase 3, randomized, double-blind, placebo-controlled 

 trials were selected for the substudy. Liberty 1 and 2 were performed to evaluate the safety and efficacy of relugolix. Women chosen for the substudy were from the US trials sites, fluent in English, and reported improvement on a 5-point global assessment scale at week 12 for their symptoms.

Researchers conducted interviews via telephone (26 women/86.7%) or web-based video conferencing (4 women, 13.3%) that were scheduled between 3 and 14 days after the final week of the study visit (week 24).

 Women participating were between 35-51 years of age (mean 43 years). Over 86% of women reported attending college or higher education. Twenty-one women were Black or African American.

Hunsche and colleagues used a semi-structured format of open-ended questions followed up with targeted probes to gather data about women’s experiences with UF before and after participating in the Liberty 1 and 2 trials. Researchers asked women to describe the onset, frequency, severity, and duration of their UF symptoms and impact, and to consider and their lifetime experience with the disease.

More than 90% of women reported HMB as the most frequent symptom (n=30, 100.0%).

 The impact of open-ended questions is clear. Researchers said, “one woman characterized HMB as 'no matter how many sanitary towels you put in, when the blood comes out, it drains down to your feet because it pours.' 

 Pain was the second most commonly reported symptom (n=28, 93.3%), according to study authors. One woman described her pain as "a stabbing pain. I could be walking—just walking around a store and literally be broke down, like something literally is trying to rip out of me—or it’s a sharp, stabbing pain." the authors wrote.

 The passing of blood clots was also frequently reported (n=28, 93.3%).

 that the data found that UF symptoms had a negative impact on almost every aspect of women’s lives. They affected activities of daily life, work-school attendance and productivity, emotional wellbeing, sleep quality and social activities, and placed a burden on women both physically, emotionally, and financially, she said.

Hunsche explained that the most important takeaway from the research is that it “emphasizes the importance of care providers discussing with women which symptoms of uterine fibroids have a significant impact on their daily lives, so that treatments can be tailored to individual needs.” 

In addition, she said that the interview approach differs from traditional patient questionnaires by giving women the chance to freely share their experiences of UF symptomatic burden and impact has on women’s daily lives. “This allows greater opportunity to identify symptoms and impacts that are perhaps discussed less frequently in the clinical setting,” she said.

For next steps to be taken, Hunsche told 

 that “further research should be conducted in a population of women with UF not experiencing heavy menstrual bleeding, as well as in countries other than the US, to assess the burden of UF in a broader population.” She said additional research could explore the development of a short questionnaire for assessing the most bothersome symptoms and impacts of UF for regular use in clinical practice.

Hunsche said she and her colleagues have conducted a similar interview study to assess the symptomatic burden and impact of endometriosis-associated pain, the results of which will be published soon. “This study provides insights on the experience and perspectives of endometriosis – a disease reported in up to 15% of premenopausal women – as described by women in their own words,” Hunsche said.

Hunsche and Rakov are employed by Myovant Sciences and are shareholders of the company. McCain was an employee and a shareholder of Myovant Sciences at the time of writing. Witherspoon is employed by Endpoint Outcomes, who was compensated by Myovant Sciences to conduct this research. Scippa was an employee of Endpoint Outcomes at the time this research was conducted.

Hunsche E, Rakov V, Scippa K, Witherspoon B, McKain L. The Burden of Uterine Fibroids from the Perspective of US Women Participating in Open-Ended Interviews

 2022 Mar 4;3(1):286-296. doi: 10.1089/whr.2021.0086. PMID: 35415708; PMCID: PMC8994433.

A study published in Women’s Health Reports offers deeper knowledge of women’s lived experience with fibroids in their own words, and confirms the burden of the disease.

Open-ended interviews shed light on US women’s perspective of fibroid burden

 infections are among the most common reasons patients visit their providers. What increases the likelihood of these infections? In a 10-year, lab-based cohort study, researchers examined how seasonal variations and changes in diet, clothing, exposure to the sun, and temperature play a role in 

Gilbert G G Donders, MD, PhD, of Femicare, Clinical Research for Women in Tienen, Belgium, and also the departments of obstetrics and gynecology at both Regional Hospital Heilig Hart (also in Tienen), and University Hospital in Antwerpen, Belgium, and colleagues conducted the study. Researchers examined 12,941 vaginal cultures from vulvovaginitis clinic patients from the Department of the Regional Hospital Heilig Hart in Tienen, Belgium from September 2007 to August 2017. Seventy percent of the women were from the area local to the hospital and 30% were from more rural areas, Donders and colleagues reported. Five percent were from non-European countries. “At this consultation, mainly patients presenting with recurrent vulvovaginal symptoms, with vague and undetermined symptoms, or for follow up during treatment regimens were seen,” researchers reported.1

Swab samples were collected from the upper lateral vaginal vault using a speculum and immediately placed into a liquid Amies preservation medium, then transported to a lab and examined for 

Researchers comparedthe presence of albicans and non-albicans species monthly to look for seasonal variation in the winter and summer using Chi-square and chi-square for trend analysis.

Donders and colleagues reported that in 2019, 16% of samples were positive with albicans versus non-albicans species only varying between 1-2% per month and no large differences on a monthly basis.1 For the 10-year period, researchers said June was the month with the highest number of infections (19.0%, p = 0.008) and December had the lowest number (14.5%, p = 0.04).1 Summer had the most number at 15.5% from June, July, and August, while the winter months of December, January, and February had 14%.1

“Change in temperature, dietary habits, and bodily adaptations due to increased amount of sunlight were discussed as potential pathophysiological mechanisms to explain the excess of Candida in summertime. Further confirmatory research would be beneficial. Women at risk for Candida vulvovaginitis should pay more attention to living habits in summertime to avoid recurrences,” Donders and colleagues reported.1

® Donders said caring for women with recurrent 

 vaginitis is very difficult. “Very often, physicians and other health care providers don’t know how to handle the disease and start to provide personal advice,” he said. This can include changing underwear, avoiding soap use on the genitals, refraining from bathing, and changing their diet, Donders explained. “Unfortunately, most of these ‘don’t do’s’ only accumulate and make a woman’s life miserable. They seldomly solve or improve the problem of recurrent vulvovaginitis,” Donders said.

 that there is vast experience in taking care of patients lasting over several decades, with a large quantity of lab test results and clinical data. “This allowed us to study in more detail several host factors such as the influence of genetic predisposition, concomitant skin disease, glucose metabolism, and multiple site colonization with candida in women with recurrent vulvovaginal candidiasis,” he said. He added that the nature of the infecting organism and symptom severity may differ from person to person. The organism can also give closer insight into the development of both antimycotic resistance of

 albicans towards more non-albicans Candida infections in women taking antimycotic regularly.

“We had the clinical impression that Candida vaginitis presented more often during summertime, and less in wintertime, but this has never been studied before to our knowledge,” Donders explained to 

“We studied the seasonal influence on an undeniable standard: the number and proportion of positive vaginal cultures per month, over a period of 10 years.” He said this showed a peak of 

 vaginitis is present in June-July and a dip in winter. “Being able to use a large database from a single lab, using an unchanged technique over that period of time, we were able to find a difference in rates in winter versus summertime and speculated about the hypothetical reasons for this. We could also determine that non-albicans strains were not the cause of the differences found,” Donder said.

Donders GGG, Ruban K, Donders F, Reybrouck R. Lab-Based Retrospective 10-Year Analysis Shows Seasonal Variation of Vaginal Candida Infection Rates in Belgium. 

. 2022;11(3):574. Published 2022 Jan 24. doi:10.3390/jcm11030574

The research published in the Journal of Clinical Medicine found women were more likely to have infections in the summer.

Belgian study finds seasonal variance in Candida infections

Vered H Eisenberg, MD, MHA, senior obstetrician-gynecologist at Sheba Medical Center in the Sackler Faculty of Medicine at Tel Aviv University in Israel and colleagues conducted the retrospective, case-controlled study.

 Researchers reviewed case records from a computerized database of a nationwide Israeli healthcare plan containing 2.1 million members. This is approximately 25% of the country’s population and reflects its demographics. Researchers cited another study where data sources are fully described.

From this database, researchers examined 6,146 women between the ages of 15-55 years (mean age ± SD: 40.4 ± 8.0) as of December 31st, 2015 that had been enrolled in the health care plan for a full year and had been diagnosed by a PCP or other specialist with endometriosis between 1998-2015. “While the results of imaging and surgical evaluation were not used for validating the diagnosis, more than 90% had a previous record of a pelvic/gynecological US examination,” the authors said. Endometriosis patients were compared with 24,572 controls who had not been diagnosed with the condition. They were matched 1:4 based on age in 5-year groupings, and on where participants resided.

Eisenberg and colleagues reported that women with endometriosis (WWE) were more likely to be of higher socioeconomic status (SES) and have lower body mass index (BMI) than controls. They also said those with endometriosis were more likely to live in the Central region of Israel and less likely to live in areas with mainly Arab or orthodox Haredi populations.

Researchers reported that after adjusting for BMI and SES, study participants with endometriosis were significantly more likely to experience infertility, with 36.9% of women being affected. The highest lifetime infertility rates in women with endometriosis were in those aged 40-44, according to the authors.

In addition to infertility, WWE were more likely to have chronic comorbidities, including chronic kidney disease, diabetes, cancer, hypertension, and cardiovascular disease.

 Researchers also noted a higher incidence of irritable bowel disease and appendicitis, “conditions with potentially overlapping abdominal pain symptoms, where the distinction between comorbidity and misdiagnosis is often challenging.”

WWE were much more likely to have seen a PCP or gynecologist within the past year than controls Eisenberg and colleagues said; nearly 20% had at least 5 gynecological visits, which researchers said was 1.5 times as many as the control group. The endometriosis group also had higher rates of hospitalizations and ED visits, with double the chance of controls being hospitalized once, and triple the chance of being hospitalized at least twice.

They were also more likely to have imaging procedures such as MRI and ultrasound, and to also have more lab tests for complete blood count, luteinizing hormone, and follicle-stimulating hormone tests. “Overall, 42.2% of women with endometriosis had a pelvic/genital US, of which only 3.1% underwent a dedicated endometriosis US.,” researchers said. 

The endometriosis group was also more likely to undergo CA-125 and CA-15.3 testing for ovarian and breast cancer respectively. The additional healthcare needed by endometriosis patients adds up: “Overall, endometriosis was associated with an excess in total per-person direct medical costs across all age groups and with an age-adjusted OR of 1.75 (95% CI 1.69–1.85),” researchers reported.

WWE were more likely to use oral contraceptives (23.6% versus 15.6% in the control group) for the past twelve months and had an even higher rate of lifetime use at 71% versus 53.2% in controls.1 “Women aged 25–29 had the highest rates of oral contraceptive use in 2015: 86.4% and 73.4% among endometriosis patients and controls, respectively,” Eisenberg and colleagues said. They reported a similar, low rate of IUD insertion for both groups. Gonadotropin use was triple in the endometriosis group compared to controls. Pain medication use, such as narcotics like tramadol, was also higher in the endometriosis group, as was antidepressant use (11.8 versus 8.6% in controls).

Researchers noted that young women between 15–19 years old with endometriosis had a much higher rate of oral contraceptive use (76.9% vs. 9.6%), PCP visits (57.7% vs. 14.4%), and gynecological visits (57.7% vs. 14.4%). Women aged 20-24 also had an increase in PCP visits (92.8% vs. 83.1%), gynecological visits (76.6% vs. 54.8%), and oral contraceptives (83.8% vs. 56.7%). Researchers said pain medication and contraceptive use in this younger age group also had higher use than in the age-matched control group.

“Women with a diagnosis of endometriosis have a significantly higher burden of infertility and chronic comorbidities, increased healthcare resource utilization, and excess costs, particularly younger patients whose healthcare needs may differ widely from those of otherwise healthy women,” Eisenberg and colleagues concluded.

Eisenberg VH, Decter DH, Chodick G, Shalev V, Weil C. Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization

 2022;11(4):1133. Published 2022 Feb 21. doi:10.3390/jcm11041133

Eisenberg VH, Weil C, Chodick G, Shalev V. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. 

. 2018;125(1):55-62. doi:10.1111/1471-0528.14711

A study published in the Journal of Clinical Medicine highlights the high burden of endometriosis, including infertility, comorbidities, health care usage, and medical costs.

The burden of endometriosis on patients and the health care system

Iwona Szydłowska, MD, of the department of gynecology, endocrinology and gynecological oncology at Pomeranian Medical University in Szczecin, Poland, and colleagues used PubMed and Medline to conduct the literature review. Researchers examined 272 English language, full-text articles from 120 publications and assessed the correlation between diet and uterine fibroid (UF) risk and treatment.

“The aim of the review was to evaluate data on natural, non-hormonal, effective, and safe therapeutic options for treatment of this disease,” the authors said. They used a collection of keywords in combination: leiomyoma, uterine fibroids, uterine myoma, curcumin, dairy products, diet, fruits, plants, vegetables, turmeric, green tea, selenium, carotenoids, Vitamin A, Vitamin C, Vitamin D, Vitamin E, dysbiosis, and gut microbiota. The results of the literature analysis revealed found statistically relevant effects from some vitamins, plant compounds, and 1 trace element.

After study analysis, they reported a strong link between Vitamin D deficiency and UF. They recommended analogs of 25-hydroxyvitamin D3 as therapy because tissue 24-hydroxylase is unable to degrade it. “Vitamin D3 may be a promising option in prevention and treatment of UFs. The majority of presented studies consider treatment with Vitamin D3 as safe and effective,” the authors said.

 Concentrations of physiological vitamin D prevent fibroid cells from growing, especially in women with vitamin D deficiency, researchers said.

While past Vitamin A research contradicts itself, synthetic retinoid analogs in addition to a Vitamin A-rich diet may prevent tumors from growing, Szydłowska and colleagues explained. Vitamin A “reduces cell proliferation and extracellular matrix formation and increases apoptosis in fibroids,” they noted.

Szydłowska and colleagues reported little data on Vitamin E, and the existing study results they did find were contradictory. In fact, high concentrations may contribute to fibroid growth, especially in Caucasian women.

 “Vitamin E, despite its antioxidant properties, appears not to demonstrate proven beneficial effects in terms of leiomyoma prevention and management,” the authors reported.

Vitamin C also did not have much data for its role in UF, with researchers reporting a non-statistically significant association with increased risk of UF.

“A diet enriched in fruits and vegetables, as sources of carotenoids, polyphenols, quercetin, and indole-3-carbinol, constitutes an easily modifiable lifestyle element with beneficial results in patients with UFs,” researchers said. However, researchers added that there were caveats. For example, high consumption of β-carotene combined with smoking cigarettes actually increased the risk of uterine fibroids.

 The role of polyphenols in UF prevention was dependent on the type selected by the patient, the dose, and the duration of use. Curcumin/turmeric possesses anti-inflammatory properties and researchers said it appeared to be a good choice for women at risk of developing UF in addition to women who had already been diagnosed.

Szydłowska and colleagues reported that the analysis showed selenium may have a role in prevention and treatment in UF, but did not affect the number of tumors. No other trace elements were found to be beneficial. The role of probiotics has not been fully investigated, but dairy products such as yogurt may also play a protective role, the authors said.

In addition to genetic predisposition, substances associated with UF formation included heavy metals, endocrine-disrupting chemicals (EDC), and cigarettes. A diet low in antioxidants and fiber is also correlated with UF growth. Researchers said EDCs can bind to hormone receptors and stimulate them to change the production and/or function of the hormones. “Induction of both genomic and non-genomic signaling and pro-inflammatory effects of EDCs increase the risk of UFs,” they said.

Szydłowska and colleagues concluded that vitamins, plant compounds, and selenium are useful in treating and preventing UF. “Natural compounds present as an alternative route in UF treatment, especially in patients with contraindications for hormonal therapy,” they said. They emphasized the usefulness of this therapy and said that even for conventional treatment of UFs therapeutic effects can be strengthened by these compounds.

Szydłowska I, Nawrocka-Rutkowska J, Brodowska A, Marciniak A, Starczewski A, Szczuko M. Dietary Natural Compounds and Vitamins as Potential Cofactors in Uterine Fibroids Growth and Development. 

. 2022;14(4):734. Published 2022 Feb 9. doi:10.3390/nu14040734

Ciebiera M, Szymańska-Majchrzak J, Sentkowska A, et al. Alpha-Tocopherol Serum Levels Are Increased in Caucasian Women with Uterine Fibroids: A Pilot Study. Biomed Res Int. 2018;2018:6793726. Published 2018 Jul 24. doi:10.1155/2018/6793726

Terry KL, Missmer SA, Hankinson SE, Willett WC, De Vivo I. Lycopene and other carotenoid intake in relation to risk of uterine leiomyomata. Am J Obstet Gynecol. 2008;198(1):37.e1-37.e378. doi:10.1016/j.ajog.2007.05.033

Vitamins and diet can play a role in the prevention and treatment of uterine fibroids, according to a literature review spanning 20 years published in the journal Nutrients. 

Vitamins and dietary compounds play a role in uterine fibroids

An ERAS protocol can help patients who receive focused ultrasound ablation surgery (FUAS) for uterine fibroids recover faster, lessen the need for opioids, and cut costs, according to a study published in the 

Guowei Sang, from the State Key Laboratory of Ultrasound in Medicine and Engineering at the College of Biomedical Engineering at Chongqing Medical University in Chongqing, China, and colleagues emphasized the need for a specific ERAS protocol for FUAS. 

ERAS has special procedural and recovery requirements, the authors explained. Researchers stated that current ERAS protocols for laparoscopy are insufficient for FUAS because these patients require proper pain management while keeping them awake to avoid nerve injury. 

They said that after FUAS treatment, patients need to be moved from the traditional prone position to a more comfortable position, and also need different postoperative health education. In addition, Sang and colleagues noted that because patients need an MRI to locate tumors prior to the procedure, FUAS treatment costs more than uterine artery embolization.

Researchers conducted a retrospective data analysis of measured clinical outcomes at Chongqing HAIFU gynecological teaching hospital, which in addition to treatment and rehabilitation, conducts scientific research. 

Sang and colleagues recorded data prior to the implementation of an ERAS protocol at Chongqing HAIFU for FUAS from September- December 2019 (pre-ERAS, 224 patients), during implementation from April-July 2020 (interim-ERAS, 179 patients), and after a program had been introduced from August-November 2020 (post-ERAS, 224 patients). 

Researchers reported that patients were of similar diagnosis, maximum diameter of myoma, location of myoma, preoperative anemia, age, and BMI in all 3 groups.

In April for the interim-ERAS group, researchers implemented postoperative comfortable position, preoperative education, prevention of venous thromboembolism preoperative blood, and preoperative glucose control. 

In May, they added individualized diet preparation and mannitol lubrication instead of an enema. In June, preoperative energy intake was calculated by body weight. Patients unable to eat were given IV nutrition, and all patients were given chronic disease management assistance via the internet. In July, patients received multimodal postoperative pain medication and had improved pain assessment. The ERAS program was considered complete after these additions.

Researchers said that following the ERAS implementation, the median total length of stay (LOS) was reduced by a full day, from 3.0 days to 2.0 (IQR = 1.00); the median postoperative stay was 1.0 days, lower than the length of hospital stay before ERAS had been implemented [total LOS of pre-ERAS 3.00 (1.00) days, 

=.000] and postoperative LOS for pre-ERAS [1.00 (0–4) day, 

Researchers also reported reduced costs, from a pre-ERAS median of 23694.35¥ (IQR=3358.32) to a post-ERAS 22612.51¥ (IQR= 3189.23). The interim ERAS median cost was reported as 23229.78¥ (IQR= 2836.42).

Researchers said that regular medications such as NSAIDs and tramadol were used during the pre-ERAS and interim-ERAS periods. They reported a single dose of 40mg phloroglucinol was given to 6 patients in the interim-ERAS group. While more patients in the post-ERAS group (21.08%, 47/223) received NSAIDS than those in the pre-ERAS group (4.91%/11/224), fewer patients in the interim-ERAS group received tramadol (4.47%, 8/179) than the pre-ERAS group (10.27%, 23/224).

Sang and colleagues also noted less use of hydromorphone in the post-ERAS group before leaving the operating room. This suggests that ERAS reduced opioid use, researchers wrote.

ERAS also resulted in a reduction of postoperative nausea and vomiting, with 6.8% (48/179) patients in the interim-ERAS group compared to 16.6% (37/223) patients in the post-ERAS group (p=.013).

Sang and colleagues noted several limitations to their study. “Real-world data, clinical practice, and some variables were not collected regularly during the practice,” they wrote, including data such as post-operative limb pain and pain score records. 

They added that more studies are needed to examine ERAS programs for uterine fibroid patients. They also noted that only one hospital was used in the study, and confirmation is needed by repeating the study in more hospitals.

After evaluating the protocol at Chongqing HAIFU, researchers concluded that “implementation of the ERAS program improves patient comfort during treatment and reduces the postoperative pain level, the number of postoperative complications, the hospital stay duration, and treatment costs, all of which contribute to increased overall hospital productivity.”

Sang G, Zhang X, Fan H, Ao X, Chen Y, Shi Q. Implementation of an enhanced recovery after surgery program in the treatment of uterine fibroids with focused ultrasound ablation surgery. 

 2022;39(1):414-420. doi:10.1080/02656736.2022.2037740

Enhanced recovery after surgery (ERAS) programs could help reduce hospitalization time, costs, and opioid use.