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.
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.
