Twelve important risk factors for Uterine Fibroid identified: A systematic review

First and only systematic review conducted so far to know the prevalence and risk factors for developing Uterine Fibroid (UF), identified race and ovarian hormone exposure as the most important determinants of fibroid development. The review was published recently in BJOG.

Uterine fibroids are most common benign neoplasm in women and nearly affect 2/3 of women before menopause, but largely remain undetected as only 25% cause symptoms that warrant treatment.

They are also the number one cause of gynecological hospital admissions and also an important indication for hysterectomy.

A literature search identified 60 studies that were eligible to be included in the review. There was considerable variations in type of studies, some reported single center experience while mostly were registry based studies. Studies included cohort and case control studies with international or local population with women from different race and ethnicity.

Fibroids were diagnosed by pelvic examination, Ultrasound or at the time of surgery.

There was a wide range in incidence of UF, and varied between 217–3745 cases per 100 000 women-years while the prevalence was between 4.5% to 68.6%.

After analysis of data, broadly 30 factors were identified that increased a woman’s risk of developing UF, of which  12 were of considerable magnitude.

Risk Factors:

Demographically, black race is important risk  factor and increases the risk by 2-3-fold as compared to  whites, followed  by age. 

Age increases the risk by nearly 10 folds,  for women between age the  40 -60 years as compared to women in their 20s. 

A positive family history also predisposes the women to higher risk for UF.

More than 5 years since child birth puts you at higher risk as compared to woman who has recently given birth.

Premenopausal women have 3-5 times increased risk as compared to postmenopausal women.

Women who are diagnosed with hypertension are 5 times the risk as compared to their normotensive counterparts.

Consuming food with additives and Soyabean increases the risk by 2.5times.

Protective Factors:

Increased parity (more than 3 children) is protective against UF and lowers the risk by 80% as compared to Nulliparous woman.

Smoking was found to be protective, but only in women with low BMI

Oral and injectable contraceptives protect against UF and reduces the risk by nearly 20-50%.

This study supports the view that genetic and ovarian hormones are two important risk factors for development of UF. The genetic aspect cannot be modified, but life style and hormonal modification can reduce the risk of fibroid development.

In an accompanying commentary, Vercellini P and Frattaruolo MP stress the importance of therapies using selective progesterone receptor modulators (SPRMs) as an alternative to invasive treatments for fibroid associated menorrhagia and volume symptoms.

This study has identified important risk factors that can be used by physicians in clinical settings and researchers for further drug and treatment development.

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