CC BY-NC-ND 4.0 · Semin Reprod Med 2017; 35(06): 473-480
DOI: 10.1055/s-0037-1607264
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Uterine Fibroids: Burden and Unmet Medical Need

Ayman Al-Hendy
1   Division of Translational Research, Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
Evan Robert Myers
2   Division of Clinical and Epidemiological Research, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
Elizabeth Stewart
3   Department of Obstetrics and Gynecology and Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
03 November 2017 (online)


Uterine fibroids affect a wide cross-section of the population, with prevalence, symptom severity, and overall disease burden generally higher among black women, likely due to both genetic and environmental factors. Potential symptoms of uterine fibroids include painful and excessive uterine bleeding, interference with everyday life and self-image, and impaired fertility. Because of the high estimated prevalence and costs associated with treatments, the direct and indirect costs of uterine fibroids are substantial for both the health care system and the individual patient. Special patient populations—such as black women, women seeking to retain fertility, and women with asymptomatic fibroids—have particular treatment needs that require a variety of diagnostic methods and treatment options. Despite the widespread occurrence of uterine fibroids and newer treatment options, little high-quality data are available to formulate evidence-based guidelines that address these unmet patient needs. Specific areas in need of attention include improving diagnostic techniques, increasing patient access to early treatment, and identifying best practices for this diverse patient population.

  • References

  • 1 Drayer SM, Catherino WH. Prevalence, morbidity, and current medical management of uterine leiomyomas. Int J Gynaecol Obstet 2015; 131 (02) 117-122
  • 2 Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017; 124 (10) 1501-1512
  • 3 Roger VL, Go AS, Lloyd-Jones DM. , et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012; 125 (01) e2-e220
  • 4 Breast Cancer Statistics. Available at: . Accessed September 26, 2017
  • 5 NCI. SEER Cancer Stat Facts: Ovarian Cancer. National Cancer Institute Web Site. . Accessed September 26, 2017
  • 6 Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188 (01) 100-107
  • 7 Ciebiera M, Włodarczyk M, Słabuszewska-Jóźwiak A, Nowicka G, Jakiel G. Influence of vitamin D and transforming growth factor β3 serum concentrations, obesity, and family history on the risk for uterine fibroids. Fertil Steril 2016; 106 (07) 1787-1792
  • 8 Van Voorhis BJ, Romitti PA, Jones MP. Family history as a risk factor for development of uterine leiomyomas. Results of a pilot study. J Reprod Med 2002; 47 (08) 663-669
  • 9 Navarro A, Yin P, Monsivais D. , et al. Genome-wide DNA methylation indicates silencing of tumor suppressor genes in uterine leiomyoma. PLoS One 2012; 7 (03) e33284
  • 10 Maekawa R, Sato S, Yamagata Y. , et al. Genome-wide DNA methylation analysis reveals a potential mechanism for the pathogenesis and development of uterine leiomyomas. PLoS One 2013; 8 (06) e66632
  • 11 Mehine M, Kaasinen E, Mäkinen N. , et al. Characterization of uterine leiomyomas by whole-genome sequencing. N Engl J Med 2013; 369 (01) 43-53
  • 12 Eggert SL, Huyck KL, Somasundaram P. , et al. Genome-wide linkage and association analyses implicate FASN in predisposition to uterine leiomyomata. Am J Hum Genet 2012; 91 (04) 621-628
  • 13 Cha PC, Takahashi A, Hosono N. , et al. A genome-wide association study identifies three loci associated with susceptibility to uterine fibroids. Nat Genet 2011; 43 (05) 447-450
  • 14 Gallagher CS, Morton CC. Genetic association studies in uterine fibroids: risk alleles presage the path to personalized therapies. Semin Reprod Med 2016; 34 (04) 235-241
  • 15 Yatsenko SA, Mittal P, Wood-Trageser MA. , et al. Highly heterogeneous genomic landscape of uterine leiomyomas by whole exome sequencing and genome-wide arrays. Fertil Steril 2017; 107 (02) 457-466.e9
  • 16 Yang Q, Mas A, Diamond MP, Al-Hendy A. The mechanism and function of epigenetics in uterine leiomyoma development. Reprod Sci 2016; 23 (02) 163-175
  • 17 Mäkinen N, Heinonen HR, Moore S, Tomlinson IP, van der Spuy ZM, Aaltonen LA. MED12 exon 2 mutations are common in uterine leiomyomas from South African patients. Oncotarget 2011; 2 (12) 966-969
  • 18 Mehine M, Mäkinen N, Heinonen HR, Aaltonen LA, Vahteristo P. Genomics of uterine leiomyomas: insights from high-throughput sequencing. Fertil Steril 2014; 102 (03) 621-629
  • 19 Brakta S, Diamond JS, Al-Hendy A, Diamond MP, Halder SK. Role of vitamin D in uterine fibroid biology. Fertil Steril 2015; 104 (03) 698-706
  • 20 Mitro SD, Zota AR. Vitamin D and uterine leiomyoma among a sample of US women: findings from NHANES, 2001-2006. Reprod Toxicol 2015; 57: 81-86
  • 21 Paffoni A, Somigliana E, Vigano' P. , et al. Vitamin D status in women with uterine leiomyomas. J Clin Endocrinol Metab 2013; 98 (08) E1374-E1378
  • 22 Sabry M, Halder SK, Allah AS, Roshdy E, Rajaratnam V, Al-Hendy A. Serum vitamin D3 level inversely correlates with uterine fibroid volume in different ethnic groups: a cross-sectional observational study. Int J Womens Health 2013; 5: 93-100
  • 23 Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of uterine myomas: a review. Int J Fertil Steril 2016; 9 (04) 424-435
  • 24 Wong JY, Chang PY, Gold EB, Johnson WO, Lee JS. Environmental tobacco smoke and risk of late-diagnosis incident fibroids in the Study of Women's Health across the Nation (SWAN). Fertil Steril 2016; 106 (05) 1157-1164
  • 25 Tak YJ, Lee SY, Park SK. , et al. Association between uterine leiomyoma and metabolic syndrome in parous premenopausal women: a case-control study. Medicine (Baltimore) 2016; 95 (46) e5325
  • 26 Korkmaz V, Ozkaya E, Özer Kadife S, Kara F, Kucukozkan T. Investigation of cardiovascular disease risk in women with uterine leiomyomas. Ir J Med Sci 2016; 185 (03) 689-693
  • 27 Uimari O, Auvinen J, Jokelainen J. , et al. Uterine fibroids and cardiovascular risk. Hum Reprod 2016; 31 (12) 2689-2703
  • 28 Ciavattini A, Delli Carpini G, Serri M. , et al. Hypovitaminosis D and “small burden” uterine fibroids: opportunity for a vitamin D supplementation. Medicine (Baltimore) 2016; 95 (52) e5698
  • 29 Borahay MA, Fang X, Baillargeon JG, Kilic GS, Boehning DF, Kuo YF. Statin use and uterine fibroid risk in hyperlipidemia patients: a nested case-control study. Am J Obstet Gynecol 2016; 215 (06) 750.e1-750.e8
  • 30 Bartels CB, Cayton KC, Chuong FS. , et al. An evidence-based approach to the medical management of fibroids: a systematic review. Clin Obstet Gynecol 2016; 59 (01) 30-52
  • 31 Nelson AL, Ritchie JJ. Severe anemia from heavy menstrual bleeding requires heightened attention. Am J Obstet Gynecol 2015; 213 (01) 97.e1-97.e6
  • 32 David M, Pitz CM, Mihaylova A, Siedentopf F. Myoma-associated pain frequency and intensity: a retrospective evaluation of 1548 myoma patients. Eur J Obstet Gynecol Reprod Biol 2016; 199: 137-140
  • 33 Gupta S, Jose J, Manyonda I. Clinical presentation of fibroids. Best Pract Res Clin Obstet Gynaecol 2008; 22 (04) 615-626
  • 34 Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update 2016; 22 (06) 665-686
  • 35 Levy G, Hill MJ, Beall S, Zarek SM, Segars JH, Catherino WH. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet 2012; 29 (08) 703-712
  • 36 Ghant MS, Sengoba KS, Recht H, Cameron KA, Lawson AK, Marsh EE. Beyond the physical: a qualitative assessment of the burden of symptomatic uterine fibroids on women's emotional and psychosocial health. J Psychosom Res 2015; 78 (05) 499-503
  • 37 Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health 2012; 12: 6
  • 38 Downes E, Sikirica V, Gilabert-Estelles J. , et al. The burden of uterine fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol 2010; 152 (01) 96-102
  • 39 Borah BJ, Nicholson WK, Bradley L, Stewart EA. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol 2013; 209 (04) 319.e1-319.e20
  • 40 Stewart EA, Nicholson WK, Bradley L, Borah BJ. The burden of uterine fibroids for African-American women: results of a national survey. J Womens Health (Larchmt) 2013; 22 (10) 807-816
  • 41 Armed Forces Health Surveillance Center (AFHSC). Uterine fibroids, active component females, U.S. Armed Forces, 2001-2010. MSMR 2011; 18 (12) 10-13
  • 42 Cardozo ER, Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol 2012; 206 (03) 211.e1-211.e9
  • 43 Go AS, Mozaffarian D, Roger VL. , et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013; 127 (01) 143-152
  • 44 Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit 2008; 14 (01) CR24-CR31
  • 45 Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers 2016; 2: 16043
  • 46 Borah BJ, Laughlin-Tommaso SK, Myers ER, Yao X, Stewart EA. Association between patient characteristics and treatment procedure among patients with uterine leiomyomas. Obstet Gynecol 2016; 127 (01) 67-77
  • 47 Soliman AM, Yang H, Du EX, Kelkar SS, Winkel C. The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol 2015; 213 (02) 141-160
  • 48 Borah BJ, Carls GS, Moore BJ, Gibson TB, Moriarty JP, Stewart EA. Cost comparison between uterine-sparing fibroid treatments one year following treatment. J Ther Ultrasound 2014; 2 (10) 7
  • 49 Cain-Nielsen AH, Moriarty JP, Stewart EA, Borah BJ. Cost-effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA. J Comp Eff Res 2014; 3 (05) 503-514
  • 50 Fuldeore M, Yang H, Soliman AM, Winkel C. Healthcare utilization and costs among women diagnosed with uterine fibroids: a longitudinal evaluation for 5 years pre- and post-diagnosis. Curr Med Res Opin 2015; 31 (09) 1719-1731
  • 51 Marshall LM, Spiegelman D, Barbieri RL. , et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997; 90 (06) 967-973
  • 52 Huyck KL, Panhuysen CI, Cuenco KT. , et al. The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyomata among affected sisters. Am J Obstet Gynecol 2008; 198 (02) 168.e1-168.e9
  • 53 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; 41 (07) 483-490
  • 54 Roth TM, Gustilo-Ashby T, Barber MD, Myers ER. Effects of race and clinical factors on short-term outcomes of abdominal myomectomy. Obstet Gynecol 2003; 101 (5, Pt 1): 881-884
  • 55 Peddada SD, Laughlin SK, Miner K. , et al. Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci U S A 2008; 105 (50) 19887-19892
  • 56 Wise LA, Ruiz-Narvaez EA, Palmer JR. , et al. African ancestry and genetic risk for uterine leiomyomata. Am J Epidemiol 2012; 176 (12) 1159-1168
  • 57 Wise LA, Radin RG, Palmer JR, Kumanyika SK, Rosenberg L. A prospective study of dairy intake and risk of uterine leiomyomata. Am J Epidemiol 2010; 171 (02) 221-232
  • 58 Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin D and the risk of uterine fibroids. Epidemiology 2013; 24 (03) 447-453
  • 59 Wise LA, Palmer JR, Reich D, Cozier YC, Rosenberg L. Hair relaxer use and risk of uterine leiomyomata in African-American women. Am J Epidemiol 2012; 175 (05) 432-440
  • 60 Moorman PG, Myers ER, Schildkraut JM, Iversen ES, Wang F, Warren N. Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol 2011; 118 (06) 1271-1279
  • 61 Trabuco EC, Moorman PG, Algeciras-Schimnich A, Weaver AL, Cliby WA. Association of ovary-sparing hysterectomy with ovarian reserve. Obstet Gynecol 2016; 127 (05) 819-827
  • 62 Murji A, Crosier R, Chow T, Ye XY, Shirreff L. Role of ethnicity in treating uterine fibroids with ulipristal acetate. Fertil Steril 2016; 106 (05) 1165-1169
  • 63 Ekpo GE, Ghant MS, Woodley LM, Recht HS, McKnight T, Marsh EE. Knowledge of uterine fibroid symptoms and presentation among African-American women: a pilot study. J Reprod Med 2014; 59 (9-10): 448-454
  • 64 Sengoba KS, Ghant MS, Okeigwe I, Mendoza G, Marsh EE. Racial/Ethnic differences in women's experiences with symptomatic uterine fibroids: a qualitative assessment. J Racial Ethn Health Disparities 2017; 4 (02) 178-183
  • 65 Ezzati M, Norian JM, Segars JH. Management of uterine fibroids in the patient pursuing assisted reproductive technologies. Womens Health (Lond) 2009; 5 (04) 413-421
  • 66 Olive DL. The surgical treatment of fibroids for infertility. Semin Reprod Med 2011; 29 (02) 113-123
  • 67 Purohit P, Vigneswaran K. Fibroids and infertility. Curr Obstet Gynecol Rep 2016; 5: 81-88
  • 68 Metwally M, Cheong YC, Horne AW. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 2012; 11: CD003857
  • 69 Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009; 91 (04) 1215-1223
  • 70 Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31 (01) 73-85
  • 71 Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 2014; (12) CD005073
  • 72 Rabinovici J, David M, Fukunishi H, Morita Y, Gostout BS, Stewart EA. ; MRgFUS Study Group. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 2010; 93 (01) 199-209
  • 73 Gorny KR, Borah BJ, Brown DL, Woodrum DA, Stewart EA, Hesley GK. Incidence of additional treatments in women treated with MR-guided focused US for symptomatic uterine fibroids: review of 138 patients with an average follow-up of 2.8 years. J Vasc Interv Radiol 2014; 25 (10) 1506-1512
  • 74 Gliklich RE, Leavy MB, Velentgas P. , et al. Identification of future research needs in the comparative management of uterine fibroid disease: a report on the priority-setting process, preliminary data analysis, and research plan. Effective Healthcare Research Report No. 31. Agency for Healthcare Research and Quality. . Published March. Accessed January 9, 2017
  • 75 Jacoby VL, Jacoby A, Learman LA. , et al. Use of medical, surgical and complementary treatments among women with fibroids. Eur J Obstet Gynecol Reprod Biol 2014; 182: 220-225
  • 76 Zapata LB, Whiteman MK, Tepper NK, Jamieson DJ, Marchbanks PA, Curtis KM. Intrauterine device use among women with uterine fibroids: a systematic review. Contraception 2010; 82 (01) 41-55
  • 77 Wagenfeld A, Saunders PT, Whitaker L, Critchley HO. Selective progesterone receptor modulators (SPRMs): progesterone receptor action, mode of action on the endometrium and treatment options in gynecological therapies. Expert Opin Ther Targets 2016; 20 (09) 1045-1054
  • 78 Taylor DK, Holthouser K, Segars JH, Leppert PC. Recent scientific advances in leiomyoma (uterine fibroids) research facilitates better understanding and management. F1000 Res 2015; 4 (F1000 Faculty Rev): 183
  • 79 Munro MG, Critchley HO, Broder MS, Fraser IS. ; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011; 113 (01) 3-13
  • 80 Available at: . Accessed September 26, 2017
  • 81 Pritts EA, Vanness DJ, Berek JS. , et al. The prevalence of occult leiomyosarcoma at surgery for presumed uterine fibroids: a meta-analysis. Gynecol Surg 2015; 12 (03) 165-177
  • 82 Mao J, Pfeifer S, Zheng XE, Schlegel P, Sedrakyan A. Population-based estimates of the prevalence of uterine sarcoma among patients with leiomyomata undergoing surgical treatment. JAMA Surg 2015; 150 (04) 368-370
  • 83 Li HM, Liu J, Qiang JW, Zhang H, Zhang GF, Ma F. Diffusion-weighted imaging for differentiating uterine leiomyosarcoma from degenerated leiomyoma. J Comput Assist Tomogr 2017; 41 (04) 599-606
  • 84 Sumi A, Terasaki H, Sanada S. , et al. Assessment of MR imaging as a tool to differentiate between the major histological types of uterine sarcomas. Magn Reson Med Sci 2015; 14 (04) 295-304
  • 85 Donnez J, Donnez O, Dolmans MM. With the advent of selective progesterone receptor modulators, what is the place of myoma surgery in current practice?. Fertil Steril 2014; 102 (03) 640-648
  • 86 Gurusamy KS, Vaughan J, Fraser IS, Best LM, Richards T. Medical therapies for uterine fibroids - a systematic review and network meta-analysis of randomised controlled trials. PLoS One 2016; 11 (02) e0149631
  • 87 Ghant MS, Sengoba KS, Vogelzang R, Lawson AK, Marsh EE. An altered perception of normal: understanding causes for treatment delay in women with symptomatic uterine fibroids. J Womens Health (Larchmt) 2016; 25 (08) 846-852
  • 88 Patel PR, Lee J, Rodriguez AM. , et al. Disparities in use of laparoscopic hysterectomies: a nationwide analysis. J Minim Invasive Gynecol 2014; 21 (02) 223-227
  • 89 Radley DC, Schoen C. Geographic variation in access to care--the relationship with quality. N Engl J Med 2012; 367 (01) 3-6
  • 90 Experimental technology poses pricey dilemma for hospitals. Available at: . Accessed September 26, 2017
  • 91 American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol 2008; 112 (2, Pt 1): 387-400
  • 92 Vilos GA, Allaire C, Laberge PY, Leyland N. ; SPECIAL CONTRIBUTORS. The management of uterine leiomyomas. J Obstet Gynaecol Can 2015; 37 (02) 157-178
  • 93 American Association of Gynecologic Laparoscopists (AAGL): Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 2012; 19 (02) 152-171