Uterine Fibroids Prevalence and Risk Factors
Uterine fibroids are the most common benign tumours in women of reproductive age
The true prevalence of uterine fibroids is often underestimated, as women who do not come into contact with healthcare professionals are not captured in the incidence statistics. However it is known that incidence increases with age 8.
Uterine fibroids are the most common benign tumours in women of reproductive age with a clinically relevant prevalence in 20-40% of women during their reproductive years2, although they are rare in teenagers. They are more common in Black women than Caucasian women, and in fact are estimated to be 2-3 times higher in women of African descent compared to European descent18.
Around 25% of these women will have symptoms that impact activities of daily life or require treatment19.
Figure illustrating Prevalence of uterine fibroids9
Figure illustrating Prevalence of uterine fibroids9
- 126 Reference 2 - Wallach EE, et al. Uterine Myomas: An overview of development, clinical features and management. Obstet Gynecol 2004;104(2):393-406.
- 481 Reference 8 - Evans P., et al. “Uterine fibroid tumors: diagnosis and treatment.” American Family Physician 2007; 75(10):1503-1508.
- 482 Reference 9 - Baird DD, et al. High cumulative incidence of uterine leioyomyoma in black and white women : Ultrasound evidence. Am J Obstet Gynecol 2003;188(1):100-107.
- 494 Reference 18 - Wise L, Ruiz-Narvaez E, Palmer J, Cozier Y, Tandon A, Patterson N, Radin R, Rosenberg L, Reich D. African Ancestry and Genetic Risk for Uterine Leiomyomata. 2012. Am J Epidemiol. 176(12): 1159-1168.
- 495 Reference 19 - Borah.B, et al. “The impact of uterine leiomyomas: a national survey of affected women.” AM J Obstet Gynaecol. 2013; 209 (4): 319.e1-319.e20
While there is no clear consensus and limited literature regarding predisposing risk factors for development of uterine fibroids, risk of uterine fibroids has been associated with such factors as age, ethnicity, family history, reproductive factors, lifestyle and medical conditions, and use of exogenous sex steroids10.
Women are most likely to be diagnosed with fibroids during their forties; however, it is not clear whether this is due to an increased formation or increased fibroid growth secondary to hormonal changes during this time10.
Fibroids are more common in Black women than Caucasian women, and in fact are estimated to be 2-3 times higher in women of African descent compared to European descent, however the incidence reported may be due to health access, method of diagnosis or verification of self-reported diagnosis20,21.
Although no specific gene has been identified as the cause of non-syndromic fibroids, there is convincing evidence of the role of heredity as a risk factor for uterine fibroids 22. Furthermore, it appears that fibroids with familial prevalence behave differently from those that occur sporadically in families, lending weight to the argument that fibroids are not a uniform pathological condition13.
Several studies have shown that reproductive factors including age at menarche, parity, pregnancy, interval since last term pregnancy and levels of endogenous hormones are associated with uterine fibroids13, 23-30.
Lifestyle and medical conditions, including non-smoker status, a diet rich in red meat and obesity have all been linked with an elevated risk of uterine fibroids 10, 13, 23, 31-36.
- 484 Reference 10 - Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. 725-36. Fertil Steril. 2007 Apr;87(4).
- 487 Reference 13 - Okolo, S.,2008. Incidence, aetiology and epidemiology of uterine fibroids. Best Practice and Research Clinical Obstetrics and Gynaecology. Vol 22:4. Pp 571-588.
- 496 Reference 20 - Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, Willett WC, Hunter DJ. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997 Dec;90(6):967-73
- 497 Reference 21 - Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM. Uterine leiomyomas. Racial differences in severity,symptoms and age at diagnosis. J Reprod Med. 1996 Jul;41(7):483-90.
- 498 Reference 22 - Okolo SO, Gentry CC, Perrett CW, Maclean AB. Familial prevalence of uterine fibroids is associated with distinct clinical and molecular features. Hum Reprod. 2005 Aug;20(8):2321-4.
- 499 Reference 23 - Ross RK, Pike MC, Vessey MP, Bull D, Yeates D, Casagrande JT. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives. Br Med J (Clin Res Ed). 1986 Aug 9;293(6543):359-62.
- 500 Reference 24 - Wise LA, Palmer JR, Harlow BL, Spiegelman D, Stewart EA, Adams-Campbell LL, Rosenberg L. Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. Am J Epidemiol. 2004 Jan 15;159(2):113-23.
- 501 Reference 25 - Kawaguchi K, Fujii S, Konishi I, Iwai T, Nanbu Y, Nonogaki H, Ishikawa Y, Mori T. Immunohistochemical analysis of oestrogen receptors, progesterone receptors and Ki-67 in leiomyoma and myometrium during the menstrual cycle and pregnancy. Virchows Arch A Pathol Anat Histopathol. 1991;419(4):309-15.
- 2926 Reference 26 - Musey VC, Collins DC, Musey PI, Martino-Saltzman D, Preedy JR. Long-term effect of a first pregnancy on the secretion of prolactin. N Engl J Med. 1987 Jan 29;316(5):229-34
- 2925 Reference 27 - Walker CL, Cesen-Cummings K, Houle C, Baird D, Barrett JC, Davis B. Protective effect of pregnancy for development of uterine leiomyoma. Carcinogenesis. 2001 Dec;22(12):2049-52.
- 2924 Reference 28 - Cesen-Cummings K, Copland JA, Barrett JC, Walker CL, Davis BJ. Pregnancy, parturition, and prostaglandins: defining uterine leiomyomas. Environ Health Perspect. 2000 Oct;108 Suppl 5:817-20.
- 2923 Reference 29 - Baird DD, Kesner JS, Dunson DB. Luteinizing hormone in premenopausal women may stimulate uterine leiomyomata development. J Soc Gynecol Investig. 2006 Feb;13(2):130-5.
- 2922 Reference 30 - Wise LA, Palmer JR, Stewart EA, Rosenberg L. Polycystic ovary syndrome and risk of uterine leiomyomata Fertil Steril. 2007 May; 87(5): 1108–1115.
- 2921 Reference 31 - Faerstein E, Szklo M, Rosenshein N. Risk factors for uterine leiomyoma: a practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking. Am J Epidemiol. 2001 Jan 1;153(1):1-10.
- 2920 Reference 32 - Parazzini F, Negri E, La Vecchia C, Rabaiotti M, Luchini L, Villa A, Fedele L. Uterine myomas and smoking. Results from an Italian study. J Reprod Med. 1996 May;41(5):316-20.
- 2919 Reference 33 - Chiaffarino F, Parazzini F, La Vecchia C, Chatenoud L, Di Cintio E, Marsico S. Diet and uterine myomas. Obstet Gynecol. 1999 Sep;94(3):395-8.
- 2918 Reference 34 - Terry KL, Missmer SA, Hankinson SE, Willett WC, De Vivo I. Lycopene and other carotenoid intake in relation to risk of uterine leiomyomata. Am J Obstet Gynecol. 2008 Jan;198(1):37.e1-8
- 2917 Reference 35 - Shikora SA, Niloff JM, Bistrian BR, Forse RA, Blackburn GL. Relationship between obesity and uterine leiomyomata. Nutrition. 1991 Jul-Aug;7(4):251-5.
- 2916 Reference 36 - Wise LA, Palmer JR, Spiegelman D, Harlow BL, Stewart EA, Adams-Campbell LL, Rosenberg L. Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women. Epidemiology. 2005 May;16(3):346-54.