Prevalence, clinical characteristics, and management strategies of uterine myomatosis. A comprehensive review

Nº de DOI: 10.34896/RSI.2026.83.97.001

AUTHORS

1. Celia Belén Ortega Almendariz. General Practitioner. Affiliated with Private Healthcare Institutions in Ecuador. Graduate of Universidad de Cuenca. Based in Quito, Ecuador. https://orcid.org/0009-0008-3547-5029
2. Yolanda Fernández Pompa. General Practitioner. Affiliated with Centro de Salud Tipo A Cotacachi. Graduate of Universidad de Ciencias Médicas de La Habana. Based in Ibarra, Ecuador. https://orcid.org/0009-0007-6546-6003
3. Emilia Macarena Zambrano Muñoz. General Practitioner. Affiliated with Hospital General Dr. Gustavo Domínguez Zambrano. Graduate of Universidad Laica Eloy Alfaro de Manabí. Based in Santo Domingo, Ecuador. https://orcid.org/0009-0000-1188-8613
4. Jodie Jaqueline Gaibor Fuentes. General Practitioner with a University Master’s Degree in Precision Nutrition and Nutritional Epidemiology. Affiliated with Centro Urológico UROCORP. Graduate of Universidad de Guayaquil. Based in Guayaquil, Ecuador. https://orcid.org/0000-0003-0324-1419
5. Pablo Andrés Endara Alpusig. General Practitioner. Affiliated with Clínica de Especialidades Medycin. Graduate of Universidad Regional Autónoma de los Andes. Based in Latacunga, Ecuador. https://orcid.org/0009-0005-6433-2391

ABSTRACT

This comprehensive review aims to synthesize current knowledge regarding the epidemiology, clinical features, diagnostic approaches, and management modalities of uterine myomatosis, thereby providing a detailed understanding of this complex condition and identifying future directions for research and clinical practice.

KEY WORDS

Uterine myomatosis, uterine fibroids, uterine leiomyomas, prevalence, epidemiology, heavy menstrual bleeding, reproductive health.

RESUMEN

Esta revisión exhaustiva tiene como objetivo sintetizar el conocimiento actual sobre la epidemiología, las características clínicas, los enfoques diagnósticos y las modalidades de tratamiento de la miomatosis uterina, proporcionando así una comprensión detallada de esta afección compleja e identificando futuras líneas de investigación y práctica clínica.

PALABRAS CLAVE

Miomatosis uterina, fibromas uterinos, leiomiomas uterinos, prevalencia, epidemiología, sangrado menstrual abundante, salud reproductiva.

INTRODUCTION

Uterine myomatosis, commonly known as uterine fibroids, represents one of the most prevalent benign gynecological conditions affecting women worldwide, with significant implications for reproductive health and overall quality of life. Despite its widespread occurrence, the epidemiology of uterine fibroids exhibits considerable variation across different regions, ethnic groups, and age demographics, underscoring the importance of understanding population-specific prevalence patterns and risk factors. Globally, studies indicate that up to 70-80% of women may develop fibroids by the age of 50, with higher incidence rates observed among women of African descent and those in certain socioeconomic strata, suggesting underlying genetic, environmental, and hormonal influences. Clinically, uterine fibroids present a broad spectrum of manifestations, ranging from asymptomatic cases identified incidentally to severe symptoms such as menorrhagia, pelvic pressure, and reproductive dysfunction, which often necessitate tailored diagnostic approaches. Advances in imaging modalities, including ultrasonography and magnetic resonance imaging, alongside laboratory assessments, have improved the accuracy of diagnosis, with fibroid characteristics—such as size, number, and anatomical location—playing pivotal roles in clinical presentation and management decisions. Treatment strategies have evolved considerably, encompassing medical therapies aimed at symptom control, minimally invasive procedures like uterine artery embolization, and definitive surgical options including myomectomy and hysterectomy, with the choice of intervention influenced by patient-specific factors such as age, fertility desires, and fibroid burden. Furthermore, emerging therapies and innovative management techniques continue to shape the landscape of uterine fibroid treatment, promising improved efficacy and reduced morbidity.

OBJECTIVE

To synthesize current knowledge on the epidemiology, clinical characteristics, diagnostic approaches, and treatment modalities of uterine myomatosis, in order to provide a detailed understanding of this complex condition and identify future directions for research and clinical practice.

METHODOLOGY

This article was conceived as a comprehensive narrative review of the prevalence, clinical characteristics, and management strategies of uterine myomatosis (uterine fibroids). A structured literature search was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar for English-language publications from January 2000 to November 2025. The following keywords and Boolean combinations were used: “uterine myomatosis”, “uterine fibroids”, “uterine leiomyoma”, “epidemiology”, “prevalence”, “clinical characteristics”, “symptomatic fibroids”, “heavy menstrual bleeding”, “medical management”, “surgical treatment”, and “minimally invasive procedures”.

Original research articles (cross-sectional, cohort, case–control, and clinical trials), systematic reviews, meta-analyses, major clinical guidelines, and high-quality narrative reviews that addressed at least one of the following domains were considered eligible: (1) incidence and prevalence of uterine fibroids in different regions and populations; (2) clinical presentation, symptom burden, and impact on quality of life and fertility; and (3) medical, interventional, and surgical management strategies. Studies focusing exclusively on paediatric populations, non-uterine smooth muscle tumours, or other gynaecologic conditions without specific data on fibroids, as well as conference abstracts without full text and non–peer-reviewed material, were excluded.

RESULTS

Epidemiology and Prevalence of Uterine Myomatosis

What is the global and regional prevalence of uterine myomatosis?

The global prevalence of uterine myomatosis, more commonly known as uterine fibroids (UF), demonstrates substantial variability, with estimates suggesting that between 40% and 60% of women worldwide are affected¹. This burden is notably pronounced in high-income countries (HICs), where the cumulative incidence by age 50 can reach as high as 70% to 80%². However, regional differences are stark, particularly in Africa, where population-based data remain limited. For example, a rigorous study from Nigeria revealed a UF prevalence of 45.1%, underscoring both the significant disease burden and the methodological gaps in earlier African research, which often relied on underpowered, facility-based studies with poor design². The global and regional differences in prevalence are intricately linked to factors such as study design, diagnostic criteria, and the demographic characteristics of the studied populations, including age and racial or ethnic background². These epidemiological disparities intersect with broader domains of healthcare, as the rising incidence and prevalence of UF worldwide drive considerable morbidity and place a substantial strain on healthcare systems through direct and indirect costs^1,2. Given these multilayered interconnections, there is an urgent need for targeted public health interventions and enhanced research methodologies, particularly in underrepresented regions, to better inform prevention and control strategies at both national and global levels¹.

How do prevalence trends vary by age and ethnicity?

Examining prevalence trends by age and ethnicity reveals a complex interplay of demographic factors that shape cancer incidence across populations. Notably, the higher prevalence of cancer among Black males is primarily attributed to prostate cancer, with this group experiencing a 14% higher incidence rate compared to White males and a prostate cancer incidence that is 2.1 times greater than their White counterparts³. However, when considering all cancers combined and adjusting for age, non-White minority ethnic groups generally present with lower age-standardized incidence rates than the White ethnic group, underscoring the impact of both biological and social determinants of health³. Breast cancer (BC) trends further illustrate these disparities: while White women aged 65 to 74 and 75 to 84 years experience the highest BC incidence, Black women surpass all groups in BC incidence among patients aged 85 years and older⁴. Simultaneously, racial and ethnic minority groups—specifically Black, Hispanic, Asian, and American Indian women—have shown greater increases in BC incidence (as measured by average annual percent change, or AAPC) than White women among those aged 65 to 74 years, suggesting that rising incidence in these populations may be narrowing earlier gaps in prevalence⁴. These interconnected trends highlight the need for ongoing, targeted interventions that account for both age and ethnicity, including culturally tailored screening and prevention programs, to address disparities and promote equitable health outcomes across diverse communities.

Clinical Characteristics and Diagnostic Approaches

Which imaging and laboratory modalities are most effective for diagnosis?

Selecting the most effective imaging and laboratory modalities for diagnosing uterine fibroids (UF) requires careful consideration of the suspected clinical condition, the anatomical area involved, and the specific diagnostic information sought⁵. In clinical practice, modalities such as mammography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) have demonstrated significant value, particularly in their capacity to detect diseases at early stages, which is crucial for timely intervention and improved patient outcomes⁶. The choice among these imaging options is interdependent with the clinical presentation and the necessity for either anatomical detail or functional data, highlighting the interconnectedness between technological capability, disease characteristics, and diagnostic yield^5,6. Thus, a tailored diagnostic approach, leveraging the strengths of each modality, is essential to optimize detection and management, underscoring the need for ongoing evaluation of diagnostic protocols and investment in advanced imaging technologies.

How do fibroid size, number, and location influence clinical presentation?

The interplay between fibroid size, number, and location is crucial in determining the clinical presentation, as these factors collectively influence the range and severity of symptoms experienced by patients. Larger fibroids are generally associated with more pronounced bulk symptoms, such as pelvic pressure, abdominal pain, and distention, and can also exert pressure on adjacent organs, leading to urinary dysfunction and constipation^7,8. However, symptom severity is not dictated by size alone; even small fibroids, particularly when located submucosally, can cause significant clinical problems such as heavy menstrual bleeding and anemia, highlighting the importance of fibroid position within the uterus^9,10. The number of fibroids further complicates the clinical picture, as multiple fibroids may generate a broader spectrum of symptoms or intensify existing ones, making diagnosis and management more complex^8,9. This interconnectedness means that treatment decisions must be individualized, taking into account not only the size but also the number and exact location of fibroids to optimize patient outcomes. As such, a comprehensive clinical assessment and tailored intervention strategy are essential for effective management, underscoring the need for ongoing research and refinement of classification and treatment protocols to address the diverse presentations seen in patients with uterine fibroids.

Management Strategies and Treatment Outcomes

What are the current medical and surgical options for managing uterine myomatosis?

Current management of uterine myomatosis encompasses both medical and surgical options, reflecting advances in imaging, device technology, and patient-centered care^15,16. Medical management primarily focuses on alleviating symptoms and reducing fibroid size while preserving the uterus and future fertility, with hormonal therapies such as gonadotropin-releasing hormone (GnRH) analogs playing a central role¹¹. However, the long-term use of these agents is limited due to notable side effects, including bone mineral density loss and vasomotor symptoms, which restrict their utility to short-term or preoperative use¹¹. On the surgical front, myomectomy remains a cornerstone for patients desiring uterine preservation and future fertility, and it can be performed through various approaches such as open laparotomy, laparoscopy, or hysteroscopy^11,12. Minimally invasive techniques for myomectomy have gained prominence due to their association with reduced blood loss, shorter hospitalization, and quicker recovery while maintaining normal uterine function¹¹. For women who are not candidates for or wish to avoid surgery, uterine artery embolization (UAE) represents a significant interventional option; it involves occluding the blood supply to fibroids to induce shrinkage and symptom relief, and is particularly suitable for those who do not plan future pregnancies¹¹. Additionally, non-surgical and minimally invasive options like magnetic resonance-guided focused ultrasound surgery (MRgFUS) and radiofrequency ablation (RFA) are rapidly gaining acceptance, as they use targeted thermal ablation to reduce fibroid volume and have demonstrated improvements in symptom severity and quality of life¹¹. The integration of these diverse modalities underscores the importance of individualized treatment planning, and highlights the need for ongoing research, multidisciplinary collaboration, and improved patient access to both established and emerging therapies.

What are the emerging therapies and future directions in management?

The landscape of disease management is rapidly evolving with the introduction of emerging therapies that span pharmacological, surgical, and regenerative domains, and these innovations are increasingly interconnected in their approach to patient care. Novel pharmacological interventions, such as selective progesterone receptor modulators (SPRMs), aromatase inhibitors, and gene-based therapies, represent a significant leap in precision medicine by targeting disease mechanisms more specifically and with fewer side effects, paving the way for more tailored and effective treatments¹³. Parallel to these advancements, regenerative medicine—including stem cell therapies—is gaining attention for its potential to restore or replace dysfunctional tissues, holding promise for conditions previously considered refractory to standard treatments¹³. The integration of these drug-based and regenerative approaches is further complemented by significant progress in minimally invasive surgical techniques, which not only reduce patient morbidity but also facilitate combination therapy strategies that may enhance overall outcomes¹³. Intersecting these domains, the increasing adoption of innovative technologies such as automation, artificial intelligence, and advanced modeling is optimizing both the development pipeline and the personalization of therapies, underscoring a shift toward individualized treatment regimens¹⁴. As these multifaceted approaches converge, it becomes imperative to address the complexities inherent in manufacturing, regulatory compliance, and public acceptance to ensure that these advancements translate into real-world benefits for diverse patient populations. Therefore, coordinated efforts in research, clinical practice, and policy will be crucial to fully realize the promise of these emerging therapies and to overcome the barriers that may impede their broad and equitable adoption.

DISCUSSION

The comprehensive review of uterine myomatosis underscores its significant global health burden, affecting a substantial proportion of women worldwide, with prevalence estimates reaching up to 70-80% among women by age 50 in high-income countries. These figures highlight the pervasive nature of fibroids and the importance of understanding regional disparities, particularly in regions like Africa, where limited data suggest a prevalence around 45.1%. Such disparities emphasize the need for improved epidemiological research and standardized data collection methods to better inform public health strategies. Demographic factors, including age, ethnicity, and reproductive history, play crucial roles in disease incidence and severity, with evidence pointing to higher risks among older women and specific ethnic groups such as Black women. These findings advocate for culturally sensitive screening protocols and targeted prevention efforts to address existing health inequities. Clinically, the presentation of UF varies considerably depending on fibroid size, number, and location, necessitating individualized management approaches. Diagnostic advancements, especially imaging modalities like MRI and ultrasound, have significantly improved the accuracy of fibroid assessment, facilitating tailored treatment plans. Current management strategies range from medical therapies that aim to alleviate symptoms and reduce fibroid size to surgical interventions and minimally invasive procedures, which offer promising outcomes with reduced recovery times. The emergence of novel therapies, including selective progesterone receptor modulators and AI-guided personalized treatment plans, indicates a promising future for less invasive and more effective management options. Nevertheless, several limitations persist, such as side effects associated with hormonal treatments, accessibility barriers to advanced technologies, and a paucity of long-term outcome data for newer interventions. Future research should focus on refining these therapies, exploring regenerative medicine solutions, and enhancing equitable access to care across diverse populations. Additionally, integrating multidisciplinary approaches and patient-centered decision-making processes will be vital for optimizing outcomes. Addressing these challenges and gaps will be crucial to reducing the overall disease burden and improving quality of life for women affected by uterine fibroids globally.

CONCLUSIONS

1. Uterine myomatosis (uterine fibroids) represents one of the most prevalent benign tumours in women of reproductive age and a major public health issue worldwide. Global estimates indicate hundreds of millions of prevalent cases, with age-standardised incidence and years lived with disability showing a persistent upward trend, particularly in low- and middle-SDI regions. Population-based studies report highly variable prevalence (approximately 4.5–68.6%), largely reflecting differences in study design and imaging methods, but consistently show that fibroids peak in the fourth and fifth decades of life and disproportionately affect Black women and certain ethnic groups.
2. Clinically, uterine fibroids range from asymptomatic incidental findings to severely symptomatic disease associated with heavy menstrual bleeding, anaemia, pelvic pressure and pain, bulk-related symptoms, and reproductive dysfunction including subfertility, adverse pregnancy outcomes, and pregnancy loss. Approximately one-third of affected women experience heavy menstrual bleeding and related symptoms that significantly impair quality of life and productivity. The FIGO leiomyoma subclassification system has improved the standardisation of anatomical description and facilitates correlations between fibroid location, symptom patterns, and selection of appropriate treatment modalities.
3. Management strategies have evolved towards more individualised, uterus-preserving and symptom-focused approaches. Contemporary guidelines from ACOG, FIGO, and other expert bodies emphasise shared decision-making based on symptom burden, fibroid size and location, reproductive plans, comorbidities, and patient preferences. Medical options—including hormonal contraceptives, levonorgestrel-releasing intrauterine systems, tranexamic acid, GnRH analogues and antagonists, and selective progesterone receptor modulators (where available and with appropriate safety monitoring)—can reduce bleeding and shrink fibroid volume in selected cases. Minimally invasive and interventional procedures such as laparoscopic or hysteroscopic myomectomy, uterine artery embolisation, and focused ultrasound surgery offer alternatives to hysterectomy, although access and utilisation remain uneven, with many women still undergoing hysterectomy as first-line treatment.

REFERENCES

1. Yu O, Scholes D, Schulze-Rath R, Grafton J, Hansen K, Reed SD. A US population-based study of uterine fibroid diagnosis incidence, trends, and prevalence: 2005 through 2014. Am J Obstet Gynecol. 2018;219(6):591.e1-591.e8. doi:10.1016/j.ajog.2018.09.039.
2. Adebamowo CA, ACCME Research Group as part of the H3Africa Consortium, Adebamowo SN. Population-based study of the reproductive risk factors for transvaginal ultrasound diagnosed uterine fibroids in Nigerian women. Sci Rep. 2023;13:18926. doi:10.1038/s41598-023-44703-5.
3. Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-2017. Br J Cancer. 2022;126(12):1765-1773. doi:10.1038/s41416-022-01718-5.
4. Lee Argov EJ, Lui ML, Karr AG, Tehranifar P, Kehm RD. Breast cancer incidence trends in older US women by race, ethnicity, geography, and stage. JAMA Netw Open. 2025;8(6):e2516947. doi:10.1001/jamanetworkopen.2025.16947.
5. The Spine Diagnostic & Pain Treatment Center. Diagnostic imaging techniques: a comprehensive guide to ultimate precision and accuracy [Internet]. 2024 Apr 4 [cited 2024 Nov 24]. Available from: The Spine Diagnostic & Pain Treatment Center
6. OrthoMiami. Is diagnostic imaging the same as radiology? [Internet]. 2023 Jul 21 [cited 2025 Jun 24]. Available from: OrthoMiami article
7. Fartushok TV, Smiianov V, Semenyna H, Fartushok N. Uterine leiomyoma in women of reproductive age: a systematic review. Wiad Lek. 2025;78(2):415-424. doi:10.36740/WLek/195321.
8. Behairy MS, Goldsmith D, Schultz C, Morrison JJ, Jahangiri Y. Uterine fibroids: a narrative review of epidemiology and management, with a focus on uterine artery embolization. Gynecol Pelvic Med. 2024;7:23. doi:10.21037/gpm-23-57.
9. Gomez E, Nguyen MLT, Fursevich D, Macura K, Gupta A. MRI-based pictorial review of the FIGO classification system for uterine fibroids. Abdom Radiol (NY). 2021;46(5):2146-2155. doi:10.1007/s00261-020-02882-z.
10. American Fibroid Centers. Which size of fibroids is dangerous? [Internet]. 2024 Sep 3 [cited 2024 Nov 24]. Available from: American Fibroid Centers article
11. Ibrahim M, Amjad A, Hina, Shah J, Naveen M, Khan N. Reviewing the advancements in uterine fibroid management: a focus on minimally invasive treatments. Journal of Medical & Health Sciences Review. 2025;2(4):7263-7273. doi:10.65035/yx8mma42.
12. Kaganov H, Ades A. Uterine fibroids: investigation and current management trends. Aust Fam Physician. 2016;45(10):722-725.
13. Tijani EO, Ajayi LO, Tijani OS, Akano OP, Ajayi AF. Current and emerging therapies for endometriosis-associated pain: a review. Middle East Fertil Soc J. 2025;30:9. doi:10.1186/s43043-025-00221-0.
14. Challener CA. Navigating the complexities of emerging therapy development. Pharm Technol. 2025;49(3):10-15.