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Uterine fibroids

Nature Reviews Disease Primers volume 2, Article number: 16043 (2016) Cite this article

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Abstract

Uterine fibroids (also known as leiomyomas or myomas) are common clonal neoplasms of the uterus. Fibroids have both smooth muscle and fibroblast components, in addition to a substantial amount of fibrous extracellular matrix, which all contribute to the pathogenetic process. Fibroids are extremely heterogeneous in their pathophysiology, size, location and clinical symptomatology. They are also a part of a range of disease in which some variants have facets of malignant behaviour but overall are benign. Risk for fibroids is associated with race; black women have a higher risk of developing fibroids earlier in life than their white counterparts and also develop more-severe forms of the disease. Clinically, fibroids account for one-third to half of all hysterectomies and are associated with substantial morbidity and health care costs for women of reproductive age. Indeed, current treatments are primarily surgical and interventional; approximately three-quarters of all fibroid treatments are hysterectomies. However, clinical innovations are emerging in the use of progesterone receptor modulators as a medical therapy. New information is rapidly accumulating about the genetic subgroups that lead to fibroid formation, which might aid further understanding of the clinical heterogeneity of this disease and lead to individualized treatments. This information is a crucial development given the current lack of high-quality evidence on which to base therapeutic decisions.

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Figure 1: The heterogeneity of fibroid disease.
Figure 2: Incidence rates of fibroids in different populations.
Figure 3: Current concepts in the pathogenesis of uterine fibroids.
Figure 4: The role of sex steroids in uterine fibroids.
Figure 5: Imaging modalities for uterine fibroids.
Figure 6: Treatment options for fibroid-associated heavy menstrual bleeding.
Figure 7: Surgical options for fibroid-associated bulk symptoms with or without heavy menstrual bleeding.
Figure 8: Future concepts of fibroid management.

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Acknowledgements

E.A.S. has received research support from the US NIH (R01HD060503, P50HS023418 and R01HD074711) and from Insightec Inc. The authors acknowledge the technical assistance of D. Littlefield.

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Authors and Affiliations

  1. Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic, 200 First Street SW, Rochester, 55905, Minnesota, USA

    Elizabeth A. Stewart & Shannon K. Laughlin-Tommaso

  2. Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

    William H. Catherino

  3. Department of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden

    Sujata Lalitkumar

  4. Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia

    Devashana Gupta & Beverley Vollenhoven

  5. Women's Program, Monash Health, Melbourne, Victoria, Australia

    Devashana Gupta & Beverley Vollenhoven

  6. Monash IVF, Clayton, Victoria, Australia

    Devashana Gupta & Beverley Vollenhoven

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Contributions

Introduction (E.A.S.); Epidemiology (S.K.L.-T.); Mechanisms/pathophysiology (E.A.S., B.V. and D.V.); Diagnosis, screening and prevention (W.H.C.); Management (E.A.S. and S.L.); Quality of life (E.A.S. and S.L.); Outlook (E.A.S.); Overview of Primer (E.A.S.).

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Correspondence to Elizabeth A. Stewart.

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Competing interests

E.A.S. is a consultant for AbbVie, Allergan, Astellas Pharma, Bayer Health Care, Gynesonics and Viteava and has received royalties from UpToDate and the Massachusetts Medical Society. S.K.L.-T. has received research support from InSightec and support for consulting from Truven Health Analytics and for serving on the data monitoring board for ULTRA trail from HALT medical. She is an author for UpToDate. W.H.C. has received research support from Bayer Schering Pharma and Patient-Centered Outcomes Research Institute (PCORI), and is a consultant for AbbVie Pharmaceuticals and Actavis. He is an oral boards examiner for the American Board of Obstetrics and Gynecology and a content Review Committee for the American Society of Reproductive Medicine. S.L., B.V. and D.G. declare no competing interests.

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Stewart, E., Laughlin-Tommaso, S., Catherino, W. et al. Uterine fibroids. Nat Rev Dis Primers 2, 16043 (2016). https://doi.org/10.1038/nrdp.2016.43

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