Uterine Fibroids: Pathogenesis, Epidemiology and its Clinical Manifestations on Human Endometrium Functioning

Abstract

Uterine fibroids (leiomyomas) are non-cancerous tumours made up of smooth muscle cells and connective tissue. They are one of the most common gynaecological conditions in women of childbearing age. Their development and growth are strongly influenced by hormonal factors, particularly oestrogen, which stimulates proliferation during the reproductive years. Fibroids usually grow during pregnancy due to increased hormone levels, but tend to shrink after the menopause, when oestrogen production decreases. However, accelerated growth may also occur in premenopausal women with ovulatory cycles, which are associated with relative oestrogen dominance. The prevalence of uterine fibroids varies widely depending on diagnostic methods and population characteristics, ranging from 5.4% to 77%. Clinically, fibroids can vary significantly in size, ranging from microscopic lesions that are difficult to detect — especially in obese patients — to large masses comparable in size to a watermelon. Despite their high prevalence, many fibroids remain asymptomatic and are often discovered incidentally during routine examinations. Gynecological intervention is generally considered when fibroids reach the size of a 12-week pregnancy, or when they cause significant symptoms such as abnormal uterine bleeding, pelvic pain and dysmenorrhoea. Historically, hysterectomy has been regarded as the definitive treatment for large or symptomatic fibroids. However, it is a major surgical procedure associated with notable risks. Epidemiological data indicate that approximately 300,000 hysterectomies are performed annually for fibroid-related conditions. Historical records show that these procedures were associated with significant mortality rates, which highlights the importance of carefully selecting patients and considering alternative therapeutic approaches.