title: Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?
abstract: OBJECTIVE
  To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom.
  
  
  METHODS
  We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding.
  
  
  RESULTS
  In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding.
  
  
  CONCLUSIONS
  A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors.
authors.affiliation: Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. E-mail. tkinay@hotmail.com.
authors.forename: Tugba
authors.initials: T
authors.lastname: Kinay
authors.forename: Zehra O
authors.initials: ZO
authors.lastname: Basarir
authors.forename: Serap F
authors.initials: SF
authors.lastname: Tuncer
authors.forename: Funda
authors.initials: F
authors.lastname: Akpinar
authors.forename: Fulya
authors.initials: F
authors.lastname: Kayikcioglu
authors.forename: Sevgi
authors.initials: S
authors.lastname: Koc
authors.forename: Jale
authors.initials: J
authors.lastname: Karakaya
mesh_terms: D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000150:complications*; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000209:etiology*; D014594:Uterine Neoplasms / Q000150:complications*