Uterine leiomyomata, or fibroids, are very common, affecting approximately 70% of women at some point in their lives.1 However, many cases go undiagnosed, increasing the probable incidence.1
In general, genetics and ovarian hormone exposure are the known antecedents for the development of fibroids.2 The heavy bleeding associated with fibroids can cause anemia, fatigue, and pain.1 Women with uterine fibroids report a decreased quality of life, difficulty getting diagnosed, and concerns about available treatment options.3
Often, women with fibroids want to avoid hysterectomy.3 However, in the US, uterine fibroids are the top cause of hysterectomies.3 Yet it is well known that even when the ovaries are conserved, hysterectomies can greatly increase other health risks like cardiovascular and metabolic conditions, including congestive heart failure.4 What risk factors may play a role, and what options other than hysterectomy are available to clinicians?
Risk factors for fibroid development
Factors that predispose women to fibroids are not yet well understood,5 but research has identified that modifiable lifestyle factors and antecedents play a role. Increased blood pressure correlates with the increased risk of fibroids, due to changes in atherogenesis.5 High serum lipids and metabolic syndrome also increase the risk of fibroids, suggesting a cardiometabolic connection.6 Low vitamin D levels may also increase risk for fibroids.7 In addition, cytokines show different seasonal variance in women with and without fibroids, suggesting that a highly inflamed immune system may play a role in fibroid formation.7
African-American women are much more likely to develop fibroids, and to report more severe symptoms.8,9 Adding to this connection, central centrifugal cicatricial alopecia (which primarily affects black women) is highly correlated with uterine fibroids, suggesting a similar underlying pathophysiological mechanism.10
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