Uterine fibroids - Causes, impact, treatment, and lens to the African perspective

Abstract

Leiomyomas, or uterine fibroids as they are commonly known, are mostly seen in women of reproductive age. However, they can go undetected in most women, and approximately 25% of women show clinical symptoms. Although fibroids are a global burden impacting 80% of premenopausal women, they are more prevalent among Black women than among women of other races. Based on clinical diagnosis, the estimated cumulative incidence of fibroids in women ≤50 years old is significantly higher for black (>80%) versus white women (∼70%). The cause of leiomyomas is not clearly known, but studies have shown evidence of factors that drive the development or exacerbation of the disease. Evidence has linked risk factors such as lifestyle, age, environment, family history of uterine fibroids, and vitamin D deficiencies to an increased risk of uterine fibroids, which impact women of African descent at higher rates. Treatments may be invasive, such as hysterectomy and myomectomy, or non-invasive, such as hormonal or non-hormonal therapies. These treatments are costly and tend to burden women who have the disease. Sub-Saharan Africa is known to have the largest population of black women, yet the majority of uterine fibroid studies do not include populations from the continent. Furthermore, the prevalence of the disease on the continent is not well determined. To effectively treat the disease, its drivers need to be understood, especially with regard to racial preferences. This paper aims to review the existing literature and build a case for conducting future research on African women.

Keywords: Africa; causes and treatment; fibroid; lifestyle; perspective; race; types and classification.

FIGURE 1

Typical healthy uterus. In a healthy uterus, there are no lesions. The endometrium is a thin layer that surrounds the uterine cavity and myometrium. Both fallopian tubes and ovaries are present. The uterine cavity is empty. No part of the uterus is distended or disformed.

FIGURE 2

Uterus with multiple fibroid types 0: Pedunculated submucosal, 100% of the fibroid is in the uterine cavity. 1: Submucosal, greater than 50% of the fibroid is within the myometrium and the other portion is distorting the endometrium and uterine cavity. 2: Submucosal, less than 50% of the fibroid is within the myometrium and the majority is distorting the endometrium and uterine cavity. 3: Intramural, the fibroid is within the myometrium but touches the endometrium, and it does not distort the uterine cavity. 4: Intramural, the fibroid is completely within the myometrium. 5: Intramural, the fibroid is predominantly within the myometrium with less than 50% extending outside of the myometrium. 6: Subserosal, greater than 50% of the fibroid is located outside of the myometrium. 7: Pedunculated subserosal, 100% of the fibroid is outside of the myometrium. See Table 1 for classification details.

FIGURE 3

Side view of the uterus with multiple fibroid types -Key: See Table 1. 0: Pedunculated submucosal, 100% of the fibroid is in the uterine cavity. 1: Submucosal, greater than 50% of the fibroid is within the myometrium and the other portion is distorting the endometrium and uterine cavity. 2: Submucosal, less than 50% of the fibroid is within the myometrium and the majority is distorting the endometrium and uterine cavity. 3: Intramural, the fibroid is within the myometrium but touches the endometrium and does not distort the uterine cavity. 4: Intramural, the fibroid is completely with the myometrium. 5: Intramural, the fibroid is predominantly within the myometrium with less than 50% extending outside of the myometrium. 6: Subserosal, greater than 50% of the fibroid is located outside of the myometrium. 7: Pedunculated subserosal, 100% of the fibroid is outside of the myometrium. See Table 1 for classification details.

FIGURE 4

Representative photographs of tissue slices showing differences in the gross appearance of fibroids. (A) Classical irregular whorled pattern. (B–D) Patterns of nodules. (E,F) Trabecular structures. (G) Characteristics of multiple patterns. This example shows a trabecular/nodular pattern. (H) Not categorized. This example shows a tightly gyrated pattern. (I) Myometrial tissue shown for comparison. Note the seedling fibroid embedded in the tissue (white). Ruler (cm) shown for size. This figure and description were adapted from Jayes et al., 2019.

FIGURE 5

Map of Fibroid prevalence across africa.