A COMPREHENSIVE REVIEW OF UTERINE FIBROIDS: PATHOGENESIS, DIAGNOSIS, TREATMENT, AND FUTURE PERSPECTIVES

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Afshan Bano
Calvin R Wei
Ayesha Abdul Qadir Memon
Muhammad Osama
Shumaila Shaikh
Qararo Shah
Dua Rabel
Fahad Jibran Siyal

Keywords

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Abstract

Fibroid, myoma, and leiomyoma are interchangeable terms used to describe the most common gynecological tumors, which are benign neoplasms originating in the smooth muscles of the uterus. These tumors are a leading cause of hysterectomies. The prevalence of fibroids varies between studies and countries, ranging from 4.5% to 68.6%, with their occurrence increasing with age, peaking in one's early 40s. Age and race are the primary risk factors for uterine fibroids, with African American women experiencing higher incidence rates compared to Caucasian women. A family history of uterine fibroids also increases the risk of developing them. Lifestyle factors such as obesity, dietary choices, sedentary living, and smoking have been linked to fibroid occurrence, possibly due to their influence on estrogen production. Stress may also be a contributing risk factor for fibroids, as it is associated with a higher body mass index. A diet rich in red meat has been connected to a 70% increased risk of fibroids. These tumors are often asymptomatic, but when symptoms do occur, they typically manifest as menorrhagia, pelvic pain, pressure symptoms, or infertility. Diagnosis relies on a combination of medical history, physical examination, and imaging studies, such as ultrasound and MRI. Medical treatment, including hormonal and non-hormonal options, can be employed to manage symptoms, especially heavy menstrual bleeding. Surgical interventions, such as hysterectomy, myomectomy, and uterine artery embolization, are available based on the patient's specific needs and desire for fertility preservation. It's worth noting that large fibroids can impact the uterine cavity's configuration, potentially affecting embryo implantation and increasing the risk of miscarriage.

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References

Vilos GA, Allaire C, Laberge P-Y, Leyland N, Vilos AG, Murji A, et al. The management of uterine leiomyomas. 2015;37(2):157-78.
2. Wise LA, Laughlin-Tommaso SKJCo, gynecology. Epidemiology of uterine fibroids–from menarche to menopause. 2016;59(1):2.
3. Omole-Ohonsi A, Belga FJO, international g. Surgical management of uterine fibroids at Aminu Kano Teaching Hospital. 2012;2012.
4. Bulun SEJNEJoM. Uterine fibroids. 2013;369(14):1344-55.
5. Stewart EA, Cookson C, Gandolfo RA, Schulze‐Rath RJBAIJoO, Gynaecology. Epidemiology of uterine fibroids: a systematic review. 2017;124(10):1501-12.
6. Giuliani E, As‐Sanie S, Marsh EEJIJoG, Obstetrics. Epidemiology and management of uterine fibroids. 2020;149(1):3-9.
7. Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven BJNRDP. Uterine fibroids (Primer). 2016;2(1).
8. Stewart EAJTL. Uterine fibroids. 2001;357(9252):293-8.
9. Nowak RAJBP, Obstetrics RC, Gynaecology. Fibroids: pathophysiology and current medical treatment. 1999;13(2):223-38.
10. Lethaby A, Vollenhoven BJBce. Fibroids (uterine myomatosis, leiomyomas). 2015;2015.
11. Reis FM, Bloise E, Ortiga-Carvalho TMJBP, Obstetrics RC, Gynaecology. Hormones and pathogenesis of uterine fibroids. 2016;34:13-24.
12. Okolo SJBp, obstetrics rC, gynaecology. Incidence, aetiology and epidemiology of uterine fibroids. 2008;22(4):571-88.
13. Tinelli A, Vinciguerra M, Malvasi A, Andjić M, Babović I, Sparić RJIjoer, et al. Uterine fibroids and diet. 2021;18(3):1066.
14. Fernandez HJLRdp. Uterine fibroids. 2014;64(4):540-4.
15. Su W-H, Lee W-L, Cheng M-H, Yen M-S, Chao K-C, Wang P-HJJotCMA. Typical and atypical clinical presentation of uterine myomas. 2012;75(10):487-93.
16. Grube M, Neis F, Brucker SY, Kommoss S, Andress J, Weiss M, et al. Uterine Fibroids-Current Trends and Strategies. 2019;34:257-63.
17. De La Cruz MSD, Buchanan EMJAfp. Uterine fibroids: diagnosis and treatment. 2017;95(2):100-7.
18. Khan AT, Shehmar M, Gupta JKJIjowsh. Uterine fibroids: current perspectives. 2014:95-114.
19. McWilliams MM, Chennathukuzhi VM, editors. Recent advances in uterine fibroid etiology. Seminars in reproductive medicine; 2017: Thieme Medical Publishers.
20. Laughlin SK, Schroeder JC, Baird DD, editors. New directions in the epidemiology of uterine fibroids. Seminars in reproductive medicine; 2010: Published in 2010 by Thieme Medical Publishers.
21. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia FJBp, obstetrics rC, et al. Epidemiology and risk factors of uterine fibroids. 2018;46:3-11.
22. Styer AK, Rueda BRJBp, obstetrics rC, gynaecology. The epidemiology and genetics of uterine leiomyoma. 2016;34:3-12.
23. Chabbert-Buffet N, Esber N, Bouchard PJF, sterility. Fibroid growth and medical options for treatment. 2014;102(3):630-9.
24. Islam MS, Protic O, Stortoni P, Grechi G, Lamanna P, Petraglia F, et al. Complex networks of multiple factors in the pathogenesis of uterine leiomyoma. 2013;100(1):178-93.
25. West CP. Uterine fibroids. Obstetrics & Gynaecology: CRC Press; 2016. p. 574-82.
26. Soave I, Marci RJCMR, Opinion. From obesity to uterine fibroids: an intricate network. 2018;34(11):1877-9.
27. Flake GP, Andersen J, Dixon DJEhp. Etiology and pathogenesis of uterine leiomyomas: a review. 2003;111(8):1037-54.
28. Parazzini F, Di Martino M, Candiani M, Viganò PJN, cancer. Dietary components and uterine leiomyomas: a review of published data. 2015;67(4):569-79.
29. McLucas BJBp, obstetrics rC, gynaecology. Diagnosis, imaging and anatomical classification of uterine fibroids. 2008;22(4):627-42.
30. Kirchner L, Aas-Eng K, Hudelist GJH. Classification of uterine fibroids and correlation with surgical outcome. 2018:375-86.
31. Sparić R, Terzić M, Malvasi A, Tinelli AJAci. Uterine fibroids-clinical presentation and complications. 2014;61(3):41-8.
32. Yuan Y, Chen L, Zhao T, Yu MJB, Pharmacotherapy. Pathogenesis, diagnosis and treatment of uterine lipoleiomyoma: A review. 2021;142:112013.
33. Lumsden MA, Hamoodi I, Gupta J, Hickey MJB. Fibroids: diagnosis and management. 2015;351.
34. Zupi E, Centini G, Sabbioni L, Lazzeri L, Argay IM, Petraglia FJBp, et al. Nonsurgical alternatives for uterine fibroids. 2016;34:122-31.
35. Woźniak A, Woźniak SJMRPM. Ultrasonography of uterine leiomyomas. 2017;16(4):113-7.
36. Sabry M, Al-Hendy AJRs. Medical treatment of uterine leiomyoma. 2012;19(4):339-53.
37. Abdusattarova K, Mettler L, Alkatout I, Dempfle AJMIT, Technologies A. Endoscopic treatment of symptomatic fibroids at reproductive age and beyond. 2017;26(6):355-61.
38. Emanuel MHJBP, Obstetrics RC, Gynaecology. Hysteroscopy and the treatment of uterine fibroids. 2015;29(7):920-9.
39. Pritts EA, Vanness DJ, Berek JS, Parker W, Feinberg R, Feinberg J, et al. The prevalence of occult leiomyosarcoma at surgery for presumed uterine fibroids: a meta-analysis. 2015;12(3):165-77.
40. Donnez J, Dolmans M-MJHru. Uterine fibroid management: from the present to the future. 2016;22(6):665-86.
41. Angioni S, D'Alterio MN, Daniilidis AJCPD. Highlights on medical treatment of uterine fibroids. 2021;27(36):3821-32.
42. Sohn GS, Cho S, Kim YM, Cho C-H, Kim M-R, Lee SRJO, et al. Current medical treatment of uterine fibroids. 2018;61(2):192-201.
43. Taylor DK, Leppert PCJDDTTS. Treatment for uterine fibroids: searching for effective drug therapies. 2012;9(1):e41-e9.
44. Moroni R, Vieira C, Ferriani RA, Candido‑dos‑Reis FJ, Brito LJAom, research hs. Pharmacological treatment of uterine fibroids. 2014;4(3):185-92.
45. Fritton K, Borahay MA, editors. New and emerging therapies for uterine fibroids. Seminars in reproductive medicine; 2017: Thieme Medical Publishers.
46. Vilos GA, Vilos AG, Abu-Rafea B, Leyland N, Allaire C, Laberge P-Y, et al. Interventional uterine-sparing therapies for leiomyomas: a commentary on myolysis. 2020;42(2):169-72.
47. Song H, Lu D, Navaratnam K, Shi GJCDoSR. Aromatase inhibitors for uterine fibroids. 2013(10).
48. Faustino F, Martinho M, Reis J, Águas FJEJoO, Gynecology, Biology R. Update on medical treatment of uterine fibroids. 2017;216:61-8.
49. Murji A, Whitaker L, Chow TL, Sobel MLJCDoSR. Selective progesterone receptor modulators (SPRMs) for uterine fibroids. 2017(4).
50. Puchar A, Feyeux C, Luton D, Koskas MJMG. Therapeutic management of uterine fibroid tumors. 2015;68(4):466-76.
51. Peitsidis P, Koukoulomati AJWJoCCW. Tranexamic acid for the management of uterine fibroid tumors: a systematic review of the current evidence. 2014;2(12):893.
52. Salama SS, Kılıç GSJJotTGGA. Uterine fibroids and current clinical challenges. 2013;14(1):40.
53. Horng H-C, Wen K-C, Su W-H, Chen C-S, Wang P-HJTJoO, Gynecology. Review of myomectomy. 2012;51(1):7-11.
54. Hurst BSJUIiRMAiIW-u, Treatment, ART. Uterine fibroids. 2019:137-53.
55. Spies JBJCo, gynecology. Current role of uterine artery embolization in the management of uterine fibroids. 2016;59(1):93-102.
56. Gupta JK, Sinha A, Lumsden MA, Hickey MJCDoSR. Uterine artery embolization for symptomatic uterine fibroids. 2014(12).
57. Zepiridis LI, Grimbizis GF, Tarlatzis BCJBP, Obstetrics RC, Gynaecology. Infertility and uterine fibroids. 2016;34:66-73.
58. Parazzini F, Tozzi L, Bianchi SJBp, obstetrics rC, gynaecology. Pregnancy outcome and uterine fibroids. 2016;34:74-84.
59. Lisiecki M, Paszkowski M, Woźniak SJMRPM. Fertility impairment associated with uterine fibroids–a review of literature. 2017;16(4):137-40.
60. Ahmad A, Kumar M, Bhoi NR, Badruddeen, Akhtar J, Khan MI, et al. Diagnosis and management of uterine fibroids: current trends and future strategies. 2023;34(3):291-310.

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