Uterine Fibroids: Symptoms, Types, Fertility, and Modern Treatments

Uterine leiomyomas (fibroids) represent the most prevalent benign clonal neoplasms of the female genital tract, affecting upwards of 70% of women by age 50. Despite their benign histology, fibroids exert a profound socioeconomic and clinical burden, representing the leading indication for gynecological hospitalizations and hysterectomies globally. Misunderstanding their etiology often drives unnecessary fear of malignant transformation.

1. Histopathology and Hormonal Responsiveness

Uterine leiomyomas originate from the neoplastic transformation of a single smooth muscle cell (myocyte) within the myometrium:

• Somatic Mutations: Approximately 70% harbor mutations in the MED12 gene, along with chromosomal rearrangements ($HMGA2$).

• Hormonal Driving Forces: Estrogen ($E_2$) and progesterone are essential promoters of fibroid proliferation via upregulation of epidermal growth factor (EGF), insulin-like growth factor-1 (IGF-1), and transforming growth factor-beta (TGF-$\beta$).

• Extracellular Matrix (ECM) Deposition: Excessive synthesis of collagen, fibronectin, and proteoglycans creates the characteristic rigid, whorled, pseudo-capsulated architecture.

2. The FIGO Anatomical Staging System

The International Federation of Gynecology and Obstetrics (FIGO) classifies fibroid topography from 0 to 8:

3. Modern Uterine-Sparing Therapeutic Modalities

1. Non-Hormonal Hemostatic Agents: • Tranexamic acid ($1\text{--}1.5\,\text{g}$ TID during menses) reduces fibrinolysis.

2. Hormonal Interventions: • Levonorgestrel-releasing Intrauterine System ($52\,\text{mg}$ LNG-IUS / Mirena) suppresses endometrial vascularity. • Selective Progesterone Receptor Modulators (SPRMs) & Oral GnRH Antagonists (Linzagolix/Relugolix).

3. Minimally Invasive / Surgical Interventions: • Hysteroscopic Myomectomy (for FIGO Types 0–1; incisionless transcervical resection). • Laparoscopic / Robotic Myomectomy (precise myometrial reconstruction for fertility preservation). • Uterine Artery Embolization (UAE / UFE; polyvinyl alcohol particle devascularization).

“⚠️ Medical Disclaimer: This article provides evidence-based clinical education. Malignant leiomyosarcoma is exceedingly rare (<0.5%) and arises de novo rather than from benign fibroids. For heavy menstrual bleeding or pelvic mass evaluation, consult an obstetrician-gynecologist.