The epidemiology and pathogenesis of uterine fibroids

Uterine fibroids, or leiomyomas, are the most common benign tumors of the female reproductive tract, ultimately affecting a majority of women worldwide, primarily during their reproductive years. While their origin appears genetic, manifesting in monoclonal tumors, diverse features and mechanisms contribute to their growth and further development. Understanding the interplay between epidemiological and biological factors is vital for clinicians and essential for investigators, whether basic, translational, clinical, or epidemiological, who aim to shed light on this ubiquitous clinical problem. Leiomyomas are experienced globally, and while there are relatively minor differences in the lifetime prevalence for women, the tumors appear to develop in those of African ancestry earlier than white women. While most leiomyomas are not symptomatic, those that cause symptoms can adversely affect lifestyle, physical function, and fertility and exert substantial socioeconomic pressure on healthcare systems. Because most leiomyomas are asymptomatic, it is also apparent that, in many cases, presenting symptoms may not be caused by the tumors themselves. As a result, it is essential that the clinician understand the pathogenesis of these tumors and how they manifest with symptoms. Despite their prevalence and evolving understanding of genetic, racial, and environmental factors contributing to their growth and development, much remains to be learned about these ubiquitous tumors in a way that can inform strategies for prevention, early detection, and effective therapy. This paper reviews the current understanding of the epidemiology and pathogenesis of uterine fibroids, highlighting key risk factors, genetic and molecular mechanisms, and implications for public health.