INTRODUCTION

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing
years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated
with an increased risk of uterine cancer and almost never develop into cancer.5-20% women in
their reporductive age are reported to have fiboroids.Most common Monoclonal Benign tumors
of uterus arising in the smooth muscle cells of myometrium. Contain large aggregation of
extracellular matrix consisting of collagen, elastin, fibronectin and proteoglycan. Each fibroid is
derived from smooth muscle cells rests ,either from vessel wall or uterine musculature
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can
distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the
uterus so much that it reaches the rib cage.
As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are
unaware of them because they often cause no symptoms. Your doctor may discover fibroids
incidentally during a pelvic exam or prenatal ultrasound.

DEFINITION
Uterine fibroids, also known as uterine leiomyoma, myoma, fibromyoma, fibroleiomyoma, are
benign smooth muscle tumors of the uterus. Most women have no symptoms while others may
have painful or heavy periods. If they push on the bladder a frequent need to urinate may occur
Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single
cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The
growth patterns of uterine fibroids vary they may grow slowly or rapidly, or they may remain
the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many
fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the
uterus goes back to a normal size.
PREVALANCE
Uterine leiomyomas are the most common pelvic tumor in women. Leiomyomas have not
been described in prepubertal girls, but they are occasionally noted in adolescents. Myomas
are clinically apparent in approximately 12 to 25 percent of reproductive age women and noted
on pathological examination in approximately 80 percent of surgically excised. Most, but not
all, women have shrinkage of leiomyomas at menopause

CLINICAL MANIFESTATION
In women who have symptoms, the most common symptoms of uterine fibroids include:

Very heavy and prolonged menstrual periods

Pain in the back of the legs
Pelvic pain or pressure
Pain during sexual intercourse
Pressure on the bladder which leads to a constant need to urinate, incontinence, or the
inability to empty the bladder
Pressure on the bowel which can lead to constipation and/or bloating
An enlarged abdomen which may be mistaken for weight gain or pregnancy
Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of
nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into
surrounding tissue, causing pain and, rarely, fever. A fibroid that hangs by a stalk inside
or outside the uterus (pedunculated fibroid) can trigger pain by twisting on its stalk and
cutting off its blood supply.

Fibroid location, size and number influence signs and symptoms:

Submucosal fibroids. Fibroids that grow into the inner cavity of the uterus (submucosal fibroids)
are more likely to cause prolonged, heavy menstrual bleeding and are sometimes a problem for
women attempting pregnancy.
Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) can
sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge
from the back of your uterus, they occasionally can press either on your rectum, causing a
pressure sensation, or on your spinal nerves, causing backache.
Intramural fibroids. Some fibroids grow within the muscular uterine wall (intramural fibroids). If
large enough, they can distort the shape of the uterus and cause prolonged, heavy periods, as well
as pain and pressure.
Growth and location are the main factors that determine if a fibroid leads to symptoms and
problems.[3] A small lesion can be symptomatic if located within the uterine cavity while a large
lesion on the outside of the uterus may go unnoticed. Different locations are classified as
follows:

Intramural fibroids are located within the wall of the uterus and are the most common type;
unless large, they may be asymptomatic. Intramural fibroids begin as small nodules in the
muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing
distortion and elongation of the uterine cavity.
Subserosal fibroids are located underneath the mucosal (peritoneal) surface of the uterus and can
become very large. They can also grow out in a papillary manner to become pedunculated
fibroids. These pedunculated growths can actually detach from the uterus to become a parasitic
leiomyoma.
Submucosal fibroids are located in the muscle beneath the endometrium of the uterus and distort
the uterine cavity; even small lesions in this location may lead to bleeding and infertility. A
pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed
through the cervix.
Cervical fibroids are located in the wall of the cervix (neck of the uterus). Rarely, fibroids are
found in the supporting structures (round ligament, broad ligament, or uterosacral ligament) of
the uterus that also contain smooth muscle tissue.
Fibroids may be single or multiple. Most fibroids start in the muscular wall of the uterus. With
further growth, some lesions may develop towards the outside of the uterus or towards the
internal cavity. Secondary changes that may develop within fibroids are hemorrhage, necrosis,
calcification, and cystic changes.

If the uterus contains too many to count, it is referred to as diffuse uterine leiomyomatosis.
PREVALANCE
Uterine leiomyomas are the most common pelvic tumor in women. Leiomyomas have not
been described in prepubertal girls, but they are occasionally noted in adolescents. Myomas
are clinically apparent in approximately 12 to 25 percent of reproductive age women and noted
on pathological examination in approximately 80 percent of surgically excised. Most, but not
all, women have shrinkage of leiomyomas at menopause
TYPES OF FIBROIDS
Uterine Fibroids are classified according to their location. uterus-with-fibroidsThere are four
primary types of fibroids:

SUBSEROSAL
INTRAMURAL
SUBMUCOSAL
PEDUNCULATED
Subserosal Fibroids
Subserosal fibroids typically develop on the outer uterine wall. This type of fibroid tumor can
continue to grow outward increasing in size. The growth of a subserosal fibroid tumor will put
additional pressure on the surrounding organs. Therefore, symptoms of subserosal fibroid tumors
usually do not include abnormal or excessive menstrual bleeding or interfere with a womens
typical menstrual flow. These fibroid tumors instead cause pelvic pain and pressure. Depending
on the severity and the location of the fibroids other complications can accompany this pain and
pressure.

Intramural Fibroids
Intramural fibroid tumors typically develop within the uterine wall and expand from there. These
uterine fibroids are the most common. When an intramural fibroid tumor expands, it tends to
make the uterus feel larger than normal, which can sometimes be mistaken for pregnancy or
weight gain. This type of fibroid tumor can also cause bulk symptoms: excessive menstrual

bleeding, which can cause prolonged menstrual cycles and clot passing and pelvic pain which is
caused by the additional pressure placed on surrounding organs by the growth of the fibroid
which consequently can cause frequent urination and pressure.

Submucosal Fibroids
The least common of the various types of fibroid tumors are submucosal fibroids. These fibroids
develop just under the lining of the uterine cavity. Large submucosal fibroid tumors may increase
the size of the uterus cavity, and can block the fallopian tubes which can cause complications
with fertility. Some fibroid tumors dont produce any symptoms at all, while others can be
severely symptomatic.

Associated symptoms with submucosal fibroids include very heavy, excessive menstrual
bleeding and prolonged menstruation. These symptoms can also cause the passing of clots, and
frequent soiling which can take its toll on your everyday lifestyle. Untreated, prolonged or
excessive bleeding can cause more complicated problems such as anemia and/or fatigue, which
could potentially lead to a future need for blood transfusions.

Pedunculated Fibroids
Pedunculated uterine fibroids occur when a fibroid tumor grows on a stalk, resulting in
pedunculated submucosal or subserosal fibroids. These fibroids can grow into the uterus and also
can grow on the outside of the uterine wall. Symptoms associated with pedunculated fibroid
tumors include pain and pressure as the fibroids can sometimes twist on the stalk.

A woman may have one or all of these types of fibroids. It is common for a woman to have
multiple fibroid tumors and it may be difficult to understand which fibroid is causing your
symptoms. Because fibroid tumors can be multiple and can be spread out in the uterus, there are
usually more fibroids present than can be detected because of their small size. Even a woman
who has only one visible fibroid needs to consider that there may be multiple uterine fibroids
present when discussing therapy. Uterine fibroids may also be referred to as myoma, leiomyoma,
leiomyomata, and fibromyoma.

Subserosal Uterine Fibroids

These fibroids develop in the outer portion of the uterus and continue to grow outward.
Intramural Uterine Fibroids
The most common type of fibroid. These develop within the uterine wall and expand making the
uterus feel larger than normal (which may cause "bulk symptoms").
Submucosal Uterine Fibroids
These fibroids develop just under the lining of the uterine cavity. These are the fibroids that have
the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility
and miscarriage.
Pedunculated Uterine Fibroids
Fibroids that grow on a small stalk that connects them to the inner or outer wall of the uterus.
When to see a doctor See your doctor if you have:
Pelvic pain that doesn't go away
Overly heavy or painful periods
Spotting or bleeding between periods
Pain consistently with intercourse
Enlarged uterus and abdomen
Difficulty emptying your bladder
Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on
suddenly.

etiology Precise cause of Fibroids is not known. Advances have been made in
understanding the molecular biology of these benign tumors and there dependence on
genetic, hormonal and growth factors . (A) Genetic Fibroids are monoclonal and about
40% have chromosomal abnormalities that include-(a) translocations between
chromosomes 12 and14.(b) deletions of chromosome 7(c) Trisomy of chromosome 12 in
large tumors. 60% may have yet undetected mutations
5. Etiology Genetic more than 100 genes were found to be up- down regulated in
fibroid cells. Many of them appear to regulate cell growth, proliferation, differentiation and

mitogenesis. Genetic differences between fibroid and Leiomyosarcomas indicate that

Leiomyosarcomas do not result due to malignant changes in fibroids .
6. Etiology (B) Hormones - Both increase in number and responsiveness of receptors
for estrogen and progesterone appear to promote fibroid growth, as these are rarely found
before puberty, develop and increase during reproductive period of life and so also during
pregnancy, regress after menopause/ bilateral oophorectomy. Found more with hyper
estrogenic states like obesity, increases after ERT therapy in menopausal women,
endometriosis, Cancer endometrium, an ovulatory infertility and early menarche.
Decreased incidence are found in athletes with low body mass, increased parity. estrogen
induces increased expression of progesterone receptors thus promoting oncogenic effect of
progesterone.
7. Etiology Hormones Progesterone is most important in pathogenesis of fibroids, which
have more concentration of receptors A & B as compared to normal myometrium.
Highest mitotic counts are found in fibroid cells when progesterone concentration is also
high. GnRH agonist decrease the size of fibroid. Concurrent Progesterone and GnRH
therapy prevent regression in size of fibroid. Anti progesterone RU486 reduces the
growth of fibroids. Estrogen dependent- never develop before puberty, regress after
menopause, newer tumor seldom develop after menopause,
8. Etiology(C) Growth Factor Growth factors, proteins polypeptides produced locally by
smooth muscle cells and fibroblasts appear to promote growth of fibroids primarily by
increasing extracellular matrix. Many growth factors are participating in proliferation
and growth of cells of fibroid Tumor Growth Factor-Beta, Basic- Fibroblast Growth
Factor,increased DNA synthesis, Epidermal Growth factor, Platelet Derived Growth Factor,
Insulin like growth factor, PRL,Vascular endothelial factor etc

Risk Factors
Exercise women doing regular exercise (7hrs per week) are at low risk than those who do
not do exercise. OCS --- no definite relationship. ERTvariable reportsno increase,
minimal increase, more increase when progesterones were added. Pregnancypreexisting fibroids may enlarge, undergo red degeneration. Increased parity is associated
with lower incidence of fibroid. Smoking---decreases by decreased conversion of
androgen to estrone caused by inhibition of aromatase enzyme by nicotine, increased 2hydroxylation of estradiol, increased level of serum sex hormone binding Globulins.
Tissue injurymay increase the incidence probably by increasing local production of tissue
growth factors--?

15. Symptoms Asymptomatic Fibroid size<4cm / uterine size <12 cm(50%)

Abnormal uterine bleeding menorrhagia > 64% woman present with heavy blood loss in
gushes needing more pads or tampons on the day of heaviest blood loss. Metro
menorrhagia present in cases of infected / ulcerated fibroid polyp. Infertility Pain
Dysmenorrhoea., slight discomfort to colicky pain in suprapubic region, low backache.
Degenerated / torsion of fibroid may cause Acute abdomen /pelvic pain. Urinary
symptoms Increased uterine volume due to fibroids may cause pressure and obstructive
effect on urinary tract (frequency, nocturia, urgency, uti ) Secondary symptoms
progressive anaemia due to chronic blood loss -- CHF, ill-health, loss of appetite and work
capacity. Some patients rarely develop polycythemia due to erythropoiten production.
Abdominal Lump.

CAUSES
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to
these factors:

Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine
muscle cells. There's also some evidence that fibroids run in families and that identical twins are
more likely to both have fibroids than nonidentical twins.
Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine
lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of
fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle
cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.
Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth
factor, may affect fibroid growth.
RISK FACTORS
There are few known risk factors for uterine fibroids, other than being a woman of reproductive
age. Other factors that can have an impact on fibroid development include:
Heredity. If your mother or sister had fibroids, you're at increased risk of developing them.
Race. Black women are more likely to have fibroids than women of other racial groups. In
addition, black women have fibroids at younger ages, and they're also likely to have more or
larger fibroids.

Other factors. Onset of menstruation at an early age, having a diet higher in red meat and lower
in green vegetables and fruit, and drinking alcohol, including beer, appear to increase your risk
of developing fibroids.
Research abstract
Abstract

Prevalence, symptoms and management of uterine fibroids: an international internet-based

survey of 21,746 women
Anne ZimmermannEmail author, David Bernuit, Christoph Gerlinger, Matthias Schaefers and
Katharina Geppert BMC Women's Health2012 March 12:6
Background
In 2009 the Uterine Bleeding and Pain Women's Research Study (UBP-WRS) was conducted
interviewing 21,479 women across 8 countries in order to gain patient-based prevalence data on
uterine pain and bleeding indications and investigate uterine symptoms and women's treatment
experiences. This article shows relevant results of the study for the indication uterine fibroids
providing data on self-reported prevalence, symptomatology and management of uterine fibroids.

Methods
2,500 women (USA: 4,500 women) in each country (Brazil, Canada, France, Germany, Italy,
South Korea, the UK, the USA) completed an online survey. Women included were in their
reproductive age (age group 15-49 years; USA: 18-49 years) and had ever experienced menstrual
bleedings. Quotas were applied for age, region, level of education and household income of
respondents. Variables have been analyzed descriptively and exploratory statistical tests have
been performed.

Results
The self-reported prevalence of uterine fibroids ranged from 4.5% (UK) to 9.8% (Italy), reaching
9.4% (UK) to 17.8% (Italy) in the age group of 40-49 years. Women with a diagnosis of uterine
fibroids reported significantly more often about bleeding symptoms than women without a
diagnosis: heavy bleedings (59.8% vs. 37.4%), prolonged bleedings (37.3% vs. 15.6%), bleeding
between periods (33.3% vs. 13.5%), frequent periods (28.4% vs. 15.2%), irregular and
predictable periods (36.3% vs. 23.9%). Furthermore women with diagnosed uterine fibroids

reported significantly more often about the following pain symptoms: pressure on the bladder
(32.6% vs. 15.0%), chronic pelvic pain (14.5% vs. 2.9%), painful sexual intercourse (23.5% vs.
9.1%) and pain occurring mid-cycle, after and during menstrual bleeding (31.3%, 16.7%, 59.7%,
vs. 17.1%, 6.4%, 52.0%). 53.7% of women reported that their symptoms had a negative impact
on their life in the last 12 month, influencing their sexual life (42.9%), performance at work
(27.7%) and relationship & family (27.2%).

Conclusions
Uterine fibroid is a common concern in women at fertile age causing multiple bleeding and pain
symptoms which can have a negative impact on different aspects in women's life.
2.
Knowledge of, Perception of, and Attitude towards Uterine Fibroids among Women with
Fibroids in Lagos, Nigeria
M. A. Adegbesan-Omilabu,1 K. S. Okunade,1 and A. Gbadegesin2
Scientifica
Volume 2014 (2014), Article ID 809536, 5 pages

The study was to assess the level of knowledge of, perception of, and attitude towards uterine
fibroids among women diagnosed with the condition. Methods. It is a cross-sectional descriptive
study carried out among women diagnosed as having uterine fibroids in two gynaecological
clinics in Lagos, Nigeria. Eligible women were recruited and a structured intervieweradministered questionnaire was used to collect the required information. Statistical analysis of
data was done using EPI Info 2008. Results. Knowledge of fibroids was reported in 98.6% of the
respondents and the information on uterine fibroids was obtained from radio, parents/relatives,
health workers, and television in 29%, 27.3%, 18.7%, and 18.3%, respectively, by the
respondents. Most of the women believed that being black, being nulliparous, or having positive
family history predisposes women to having uterine fibroids. Up to 69.0% of the respondents
believed that fibroid is a spiritual problem and many thought it requires spiritual healing. Fear of
complications of surgery keeps most sufferers away from the hospital until fibroids become
advanced or associated with complications. Conclusion. Awareness of uterine fibroids is high,
but correct knowledge on aetiology and proper treatment is low. Intensive enlightenment of the
populace using the mass media by trained personnel is recommended.

Segars JH, Parrott EC, Nagel JD, Guo XC, Gao X, Birnbaum LS, Pinn VW, Dixon D
SOHum Reprod Update. 2014 May;20(3):309-33. Epub 2014 Jan 8.
BACKGROUND Uterine fibroids are the most common gynecologic tumors in women of
reproductive age yet the etiology and pathogenesis of these lesions remain poorly understood.
Age, African ancestry, nulliparity and obesity have been identified as predisposing factors for
uterine fibroids. Symptomatic tumors can cause excessive uterine bleeding, bladder dysfunction
and pelvic pain, as well as associated reproductive disorders such as infertility, miscarriage and
other adverse pregnancy outcomes. Currently, there are limited noninvasive therapies for fibroids
and no early intervention or prevention strategies are readily available. This review summarizes
the advances in basic, applied and translational uterine fibroid research, in addition to current and
proposed approaches to clinical management as presented at the 'Advances in Uterine
Leiomyoma Research: 3rd NIH International Congress'. Congress recommendations and a
review of the fibroid literature are also reported. METHODS This review is a report of meeting
proceedings, the resulting recommendations and a literature review of the subject. RESULTS
The research data presented highlights the complexity of uterine fibroids and the convergence of
ethnicity, race, genetics, epigenetics and environmental factors, including lifestyle and possible
socioeconomic parameters on disease manifestation. The data presented suggest it is likely that
the majority of women with uterine fibroids will have normal pregnancy outcomes; however,
additional research is warranted. As an alternative to surgery, an effective long-term medical
treatment for uterine fibroids should reduce heavy uterine bleeding and fibroid/uterine volume
without excessive side effects. This goal has not been achieved and current treatments reduce
symptoms only temporarily; however, a multi-disciplined approach to understanding the
molecular origins and pathogenesis of uterine fibroids, as presented in this report, makes our
quest for identifying novel targets for noninvasive, possibly nonsystemic and effective long-term
treatment very promising. CONCLUSIONS The Congress facilitated the exchange of scientific
information among members of the uterine leiomyoma research and health-care communities.
While advances in research have deepened our knowledge of the pathobiology of fibroids, their
etiology still remains incompletely understood. Further needs exist for determination of risk
factors and initiation of preventive measures for fibroids, in addition to continued development
of new medical and minimally invasive options for treatment.