UTERINE FIBROIDS (LEIOMYOMA): ETIOLOGY, CLINICAL MANIFESTATIONS, AND MODERN TREATMENT APPROACHES

Uterine fibroids, also known as leiomyomas, are the most common benign tumors of the female reproductive system, originating from the smooth muscle cells of the myometrium. They affect up to 60–70% of women of reproductive age, with higher prevalence observed among women aged 30–50 years. Although many fibroids remain asymptomatic, a significant proportion cause clinical symptoms that negatively impact quality of life and reproductive health. The exact etiology of uterine fibroids is multifactorial and not fully understood; however, hormonal influences, genetic predisposition, growth factors, and environmental factors play crucial roles in their development and progression. Clinically, uterine fibroids present with a wide spectrum of symptoms, including abnormal uterine bleeding, pelvic pain, pressure symptoms on adjacent organs, infertility, and pregnancy complications. Diagnosis is primarily based on pelvic examination and imaging modalities, particularly transvaginal ultrasonography and magnetic resonance imaging. Management of uterine fibroids has evolved significantly over recent decades. Traditional surgical treatments such as myomectomy and hysterectomy remain definitive options, especially in severe cases. However, modern medical therapies, minimally invasive procedures, and uterus-sparing techniques have expanded treatment choices, allowing individualized management based on patient age, symptom severity, fertility desires, and fibroid characteristics. These include hormonal therapies, gonadotropin-releasing hormone (GnRH) analogs and antagonists, selective progesterone receptor modulators, uterine artery embolization, and focused ultrasound surgery. This article provides a comprehensive overview of the etiology, pathophysiology, clinical manifestations, diagnostic approaches, and contemporary treatment strategies for uterine fibroids. Emphasis is placed on evidence-based management and personalized treatment planning to optimize clinical outcomes and preserve reproductive potential when desired.

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