Uterine Fibroids

Question 1

Uterine fibroids

Answer 1

Uterine fibroids = benign tumours that originate from the myometrium and connective tissue.
* Affect approximately 30% globally. Occur between menarche and menopause but are most common in women aged 35–49 years.

Question 2

Uterine fibroids: Signs/symptoms

Answer 2

Signs/symptoms:
* 50–80% are asymptomatic.
* Heavy / prolonged menstrual bleeds.
* Pelvic discomfort / pain.
* Abdominal bloating.
* Depending on location: Frequent urination and constipation.

Question 3

Uterine fibroids: Complications

Answer 3

Complications:
* Iron deficiency anaemia, infertility, miscarriage, pre-term labour, obstructed labour, foetal anomalies, postpartum haemorrhage.

Question 4

Uterine fibroids and oestrogen

Answer 4

• Uterine fibroids are oestrogen dependent.
• Oestrogen receptors are over-expressed in fibroid tissue.
• Oestradiol concentration increases, which increases progesterone receptor availability. Progesterone completes fibroid development.
• Excess aromatisation is also seen.
• IGF and cytokines (e.g., TNF, IL-8) can also promote fibroid growth

Question 5

Uterine fibroids: Causes and risk factors

Answer 5

Causes and risk factors:
* Genetics ― polymorphisms: CYP1A1, MED12.
* Hypertension ― may cause smooth muscle
cell injury and / or cytokine release.
* Poor oestrogen metabolism / clearance, EDCs, the OCP, obesity.
* Chronic stress significantly increases risk.
* Heavy metals ― cadmium and lead activate oestrogen receptors.
* Diet / lifestyle ― increased risk with low fibre intake and low physical activity. High saturated fat, refined carbohydrates, caffeine and alcohol linked to an increased risk.
* Vitamin D deficiency ― shown to inhibit fibroid cell proliferation