University of Oulu

Uimari O, Subramaniam KS, Vollenhoven B and Tapmeier TT (2022) Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding. Front. Reprod. Health 4:818243. doi: 10.3389/frph.2022.818243

Uterine fibroids (Leiomyomata) and heavy menstrual bleeding

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Author: Uimari, Outi1,2; Subramaniam, Kavita S.3,4; Vollenhoven, Beverley5,6;
Organizations: 1Department of Obstetrics and Gynecology, Oulu University, Oulu, Finland
2Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO) Research Unit and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
3St John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
4Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
5Women's and Newborn Program, Monash Health, Clayton, VIC, Australia
6Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Frontiers Media, 2022
Publish Date: 2023-06-14


Uterine Fibroids, or leiomyomata, affect millions of women world-wide, with a high incidence of 75% within women of reproductive age. In ~30% of patients, uterine fibroids cause menorrhagia, or heavy menstrual bleeding, and more than half of the patients experience symptoms such as heavy menstrual bleeding, pelvic pain, or infertility. Treatment is symptomatic with limited options including hysterectomy as the most radical solution. The genetic foundations of uterine fibroid growth have been traced to somatic driver mutations (MED12, HMGA2, FH−/−, and COL4A5-A6). These also lead to downstream expression of angiogenic factors including IGF-1 and IGF-2, as opposed to the VEGF-driven mechanism found in the angiogenesis of hypoxic tumors. The resulting vasculature supplying the fibroid with nutrients and oxygen is highly irregular. Of particular interest is the formation of a pseudocapsule around intramural fibroids, a unique structure within tumor angiogenesis. These aberrations in vascular architecture and network could explain the heavy menstrual bleeding observed. However, other theories have been proposed such as venous trunks, or venous lakes caused by the blocking of normal blood flow by uterine fibroids, or the increased local action of vasoactive growth factors. Here, we review and discuss the evidence for the various hypotheses proposed.

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Series: Frontiers in reproductive health
ISSN: 2673-3153
ISSN-E: 2673-3153
ISSN-L: 2673-3153
Volume: 4
Article number: 818243
DOI: 10.3389/frph.2022.818243
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3123 Gynaecology and paediatrics
Copyright information: © 2022 Uimari, Subramaniam, Vollenhoven and Tapmeier. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.