Uterine Fibroids: Pathophysiology, Clinical Symptoms, Diagnosis, and Modern Therapeutic Approaches
Uterine fibroids, also known as leiomyomas, are benign smooth muscle tumors of the uterus affecting millions of women, particularly between ages 25 and 50. They vary in size, number, and location—submucosal, intramural, or subserosal—and are influenced by genetic, hormonal, and environmental factors. Symptoms include heavy menstrual bleeding, pelvic pain, urinary frequency, constipation, infertility, and pregnancy complications, though many women remain asymptomatic.
Diagnosis is typically performed through pelvic ultrasound, MRI, and hysteroscopy. Treatment depends on symptoms, fibroid size, fertility desires, and patient age. Options include medication (hormonal therapy, GnRH antagonists), minimally invasive approaches like uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), radiofrequency ablation, and laparoscopic or hysteroscopic myomectomy. In severe cases or when fertility is not desired, hysterectomy is considered.
Advancements in robotic-assisted fibroid surgery, selective progesterone receptor modulators, cryotherapy, targeted drug therapy, and fibroid genomic research are transforming management. Non-invasive MR-guided focused ultrasound and embolization techniques preserve fertility and shorten recovery compared to open surgery. Dietary modifications, stress reduction, and lifestyle changes also support symptom management. Uterine fibroid treatment continues evolving toward organ-preserving, minimally invasive, and personalized therapeutic strategies.