Sparic, R., Mirkovic, L., Malvasi, A., & Tinelli, A. (2016). Epidemiology of Uterine Myomas: A Review. International journal of fertility & sterility, 9(4), 424-35. https://doi.org/10.22074/ijfs.2015.4599
Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of Uterine Myomas: A Review. International journal of fertility & sterility. 2016;9(4):424-35. doi:10.22074/ijfs.2015.4599
Sparic, Radmila, et al. "Epidemiology of Uterine Myomas: A Review." International journal of fertility & sterility, vol. 9, no. 4, 2016, pp. 424-35.
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Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
Myoma risk rises with age in the reproductive years, differs by race
A 2016 narrative review of studies published from 1990 to 2013 reports that uterine myomas are the most common benign growths of the reproductive organs during the childbearing years. During the reproductive years, risk climbs with age, and it differs by race. Hormones, pregnancy history, body weight and lifestyle also relate to risk, though many findings disagree.
Key Findings
Estimates of how many women have myomas range from 5.4 to 77%, depending on who was studied and which diagnostic technique was used.
Diagnosis occurs in 20-25% of women during the reproductive years and in 30-40% of women over age 40.
A screening study of pregnant women found myomas in 18% of black women and 8% of white women. The figures were 10% for Hispanic women and 13% for the others group.
A higher number of term pregnancies goes with lower myoma risk, while pregnancies that ended before full term seem to have no influence on risk.
A cohort of black women found a 65% higher incidence of myomas with polycystic ovary syndrome (PCOS, also called PMOS, Polyendocrine Metabolic Ovarian Syndrome).
Interpretation
The paper is a narrative review. Its authors searched MEDLINE and PubMed for 1990 to 2013, took randomized controlled studies when they existed, and otherwise picked the studies they judged most relevant. The cited work includes cohort, case-control, twin and laboratory studies, so the findings describe associations. Results for diet, smoking, caffeine and alcohol conflict across studies. The authors say part of the conflict could stem from patient selection, since some studies enrolled surgical or symptomatic women and others found myomas incidentally.
RRM Context
Restorative reproductive medicine looks for the root cause of a problem. The review describes hormone exposure, pregnancy history, weight and insulin. Myomas are the reason for 40-60% of all hysterectomies, according to the literature the authors cite. The authors say research on risk factors that can change may point to ways to prevent myomas and treat them without surgery.
Our editorial summary of this paper, not the article's abstract.
Abstract
Myomas are the most common benign tumors of the genital organs in women of childbearing age, causing significant morbidity and impairing their quality of life. In our investigation, we have reviewed the epidemiological data related to the development of myomas in order to homogenize the current data. Therefore, a MEDLINE and PubMed search, for the years 1990-2013, was conducted using a combination of keywords, such as "myoma," "leiomyoma," "fibroids," "myomectomy," "lifestyle," "cigarette," "alcohol," "vitamins," "diet," and "hysterectomy". Randomized controlled studies were selected based upon the authors' estimation. Peer-reviewed articles examining myomas were sorted by their relevance and included in this research. Additional articles were also identified from the references of the retrieved papers and included according to authors' estimation. Many epidemiologic factors are linked to the development of myomas; however, many are not yet fully understood. These factors include age, race, heritage, reproductive factors, sex hormones, obesity, lifestyle (diet, caffeine and alcohol consumption, smoking, physical activity and stress), environmental and other influences, such as hypertension and infection. Some of the epidemiological data is conflicting. Thus, more research is needed to understand all the risk factors that contribute to myoma formation and how they exactly influence their onset and growth.
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