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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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.
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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