Factors Predisposing Women to Fibroids

Uterine leiomyomata, or fibroids, are very common, affecting approximately 70% of women at some point in their lives.¹ However, many cases go undiagnosed, increasing the probable incidence.¹

In general, genetics and ovarian hormone exposure are the known antecedents for the development of fibroids.² The heavy bleeding associated with fibroids can cause anemia, fatigue, and pain.¹ Women with uterine fibroids report a decreased quality of life, difficulty getting diagnosed, and concerns about available treatment options.³

Often, women with fibroids want to avoid hysterectomy.³ However, in the US, uterine fibroids are the top cause of hysterectomies.³ Yet it is well known that even when the ovaries are conserved, hysterectomies can greatly increase other health risks like cardiovascular and metabolic conditions, including congestive heart failure.⁴ What risk factors may play a role, and what options other than hysterectomy are available to clinicians?

Risk factors for fibroid development

Factors that predispose women to fibroids are not yet well understood,⁵ but research has identified that modifiable lifestyle factors and antecedents play a role. Increased blood pressure correlates with the increased risk of fibroids, due to changes in atherogenesis.⁵ High serum lipids and metabolic syndrome also increase the risk of fibroids, suggesting a cardiometabolic connection.⁶ Low vitamin D levels may also increase risk for fibroids.⁷ In addition, cytokines show different seasonal variance in women with and without fibroids, suggesting that a highly inflamed immune system may play a role in fibroid formation.⁷

African-American women are much more likely to develop fibroids, and to report more severe symptoms.^8,9 Adding to this connection, central centrifugal cicatricial alopecia (which primarily affects black women) is highly correlated with uterine fibroids, suggesting a similar underlying pathophysiological mechanism.¹⁰