Clinical gynaecological perspectives to improve validity in clinical research: comment on the article by Chiuve et al

We read the article by Chiuve et al with great interest. We appreciate the authors’ novel and interesting study using large US nationwide healthcare insurance data to determine the rate of mental health diagnosis in women with uterine fibroids (UF), a topic that has never been studied.1 However, for future clinical research, we have two suggestions regarding its external validity and internal validity from clinical gynaecological perspectives.

Our first concern is regarding its external validity. What clinical settings should gynaecologists extrapolate the results of this study to, for patients diagnosed with UF? UF is a widespread condition with high heterogeneity in women of reproductive age, and most patients are asymptomatic. The nature, clinical course and treatment of UF vary greatly depending on the clinical setting, whether they were diagnosed because of severe symptoms or found incidentally, and the life stage at diagnosis. How patients suffer from the…

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