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UTERINE FIBROIDS

This web site is a project I did during graduate school. Most of the information was copied from an article in Fertility and Sterility.

Twenty-five years ago, Fertility and Sterility published Buttram and Reiter’s (1) classic review on uterine fibroids (also commonly called fibroid tumors or fibroid cysts). At that time, little was known about the biology of fibroids. Although fibroids are still not well understood, much has been learned in the interim about the genetic factors the lead to the formation of fibroids and the proteins that stimulate their growth. Epidemiologic studies have illuminated the risk factors for the development of fibroids, and approaches to their diagnosis have been clarified. Better evidence regarding the effect of fibroids on fertility and pregnancy is now available.

Despite the prevalence of this condition, fibroid research is underfunded compared with other nonmalignant diseases. It is likely that innovation has been slow to come to fibroid treatment because fibroids are benign, many women with fibroids are asymptomatic, and fibroids almost always cause morbidity rather than mortality (2). This article summarizes the available literature regarding the biology, symptomatology, and diagnosis of fibroids.

UTERINE FIBROIDS

Description

Fibroids are benign, monoclonal tumors of the smooth muscle cells of the myometrium. They are composed of large amounts of extracellular matrix containing collagen, fibronectin, and proteoglycan. Collagen type I and type III are abundant, but the collagen fibrils are formed abnormally and are in disarray, much like the collagen found in keloid formation (3–5).

Incidence

Fibroids are remarkably common. Fine serial sectioning of uteri from 100 consecutive women who underwent hysterectomy found fibroids in 77%, including some as small as 2 mm (6). Fibroids were found no less frequently in women who had a hysterectomy for other indications than for uterine fibroids, although they were smaller and less numerous. Because most imaging techniques lack resolution <1 cm., they underestimate the true incidence of this condition, although small fibroids may be of no clinical significance. The hysterectomy specimens from premenopausal women with fibroids have had an average of 7.6 fibroids; postmenopausal women have had on average 4.2 fibroids (6). A random sampling of women aged 35 to 49 who were screened by self-report, medical record review, and sonography found that by age 35 the incidence of fibroids was 60% among African-American women; the incidence increased to over 80% by age 50 (Fig. 1). Caucasian women have an incidence of 40% by age 35, and almost 70% by age 50 (7).

Fibroids are an enormous healthcare concern; they were the primary indication for surgery in 199,000 hysterectomies and 30,000 myomectomies performed in the United States in 1997 (8). Inpatient surgery for fibroids cost $2.1 billion in the United States in 1997, and the cost of outpatient surgeries, medical and nonmedical costs, and time away from work or family adds significantly to these expenditures (9).

 
 

 

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