European Journal of Cardiovascular Medicine

Uterine fibroids, also known as leiomyomas, are the most common benign tumors of the female reproductive system¹. These smooth muscle tumors originate from the myometrium and are often diagnosed during the reproductive years, particularly between the ages of 30 and 50. It is estimated that fibroids are present in up to 70% of women by the age of 50, although many remain asymptomatic^2,3. The clinical presentation of uterine fibroids can vary widely depending on their size, number, and location. Common symptoms include abnormal uterine bleeding, pelvic pain, pressure symptoms, and infertility⁴. In some cases, fibroids may also lead to complications during pregnancy, such as miscarriage or preterm labor⁵.

The exact etiology of uterine fibroids remains unclear, though several factors, including hormonal imbalances (particularly estrogen and progesterone), genetic predisposition, and environmental influences, are thought to play a role in their development⁶. While many fibroids do not cause symptoms, those that do can significantly impact a woman’s quality of life. Medical treatments, such as hormonal therapy, and surgical interventions, including myomectomy and hysterectomy, are commonly employed to manage symptomatic fibroids⁷.

This study aims to evaluate the clinical spectrum, surgical management, and pathological characteristics of uterine fibroids in women undergoing hysterectomy at KIMS Hospital, Amalapuram. By examining the relationship between clinical symptoms and histopathological findings, the study seeks to provide insights into the diagnosis, treatment, and management of fibroid uterus in the local population.

Study Design and Setting:

This was a prospective observational study conducted at the Department of Obstetrics and Gynecology, Konaseema Institute of Medical Sciences (KIMS), Amalapuram, from December 2019 to October 2021. The study aimed to analyze the clinical, pathological, and surgical profiles of patients diagnosed with fibroid uterus.

Study Population:

The study included 100 women diagnosed with uterine fibroids who underwent hysterectomy during the study period. Patients were selected consecutively based on the inclusion and exclusion criteria.

Inclusion Criteria:

Women diagnosed with symptomatic fibroid uterus (manifesting symptoms such as menstrual irregularities, abdominal pain, pelvic mass, or urinary disturbances).

Women who had completed their family or had no desire for future pregnancies.

Women who provided informed consent for participation in the study.

Exclusion Criteria:

Women with asymptomatic fibroids.

Women with infertility who wished to preserve the uterus for future pregnancy.

Women with systemic illnesses such as HIV, Hepatitis B, renal diseases, or coagulation disorders.

Women who were not willing to participate in the study.

Data Collection:

Data were collected through patient interviews, clinical examinations, and detailed review of medical records. A structured proforma was used to gather information on demographic characteristics, clinical symptoms, medical history, and relevant investigations. The surgical procedure and histopathological findings were also recorded.

Histopathological Examination:

The uterine specimens obtained during hysterectomy were sent for histopathological examination. The endometrial and myometrial tissues were analyzed for pathological changes, including proliferative, secretory, hyperplasia, cystic glandular hyperplasia, and atrophic patterns. Additionally, the presence of degenerative changes such as hyaline, myxoid, cystic, and calcareous degeneration was noted.

Statistical Analysis:

Descriptive statistical methods were employed to summarize the data. The analysis included the calculation of means, standard deviations, and percentages. The distribution of variables was presented in tables and charts. Statistical software IBM SPSS 16.0 was used for data analysis, and a p-value of <0.05 was considered statistically significant.

Ethical Considerations:

The study was approved by the Institutional Ethics Committee of KIMS, Amalapuram. Informed written consent was obtained from all participants, ensuring confidentiality and voluntary participation. The risks and benefits of the study were explained to the participants prior to their enrollment.

A prospective observational study was conducted on 100 patients diagnosed with fibroid uterus who underwent hysterectomy at the Department of Obstetrics and Gynecology, KIMS, Amalapuram, from December 2019 to October 2021. The demographic and clinical data, along with surgical and histopathological findings, are presented below.

Age Distribution

The majority of patients (42%) were in the age group of 31-40 years, followed closely by 40% in the 41-50 year range. The mean age of the patients was 42.06 ± 7.21 years, with the age range spanning from 25 to 60 years (Table 1).

Table 1: Distribution of Age Among the Study Population

Parity

In terms of parity, 46% of the patients had three children, followed by 33% with two children, 16% with one child, and 5% who were nulliparous (Table 2).

Table 2: Distribution of Parity Among the Study Population

Time Interval Between Last Childbirth and First Symptom

The study observed that the majority of women (51.6%) experienced symptoms more than 20 years after their last childbirth, with the mean interval being 18.15 ± 4.78 years (Table 3).

Table 3: Distribution of Time Interval Between Last Childbirth and First Symptom

Clinical Symptoms

Menstrual disturbances were the most common symptoms, affecting 77% of the patients. Other prevalent symptoms included abdominal pain (35%), dysmenorrhea (22%), and infertility (16%). A small number of patients also presented with urinary symptoms (17%), white discharge (13%), and mass per abdomen (14%) (Table 4).

Table 4: Distribution of Symptoms Among the Study Population (n=100)

Anemia

Anemia was observed in 42% of the patients, with 42.8% suffering from severe anemia, 31% from moderate anemia, and 26.2% from mild anemia (Table 5).

Table 5: Distribution of Anemia Among the Study Population (n=42)

Menstrual Disturbances

Among the patients with menstrual disturbances (77%), menorrhagia was the most common type (54.5%), followed by polymenorrhoea (20.8%) and polymenorrhagia (11.7%) (Table 6).

Table 6: Distribution of Menstrual Disturbances Among the Study Population (n=77)

Surgical Procedures

The most common surgical procedure was total abdominal hysterectomy, which was performed on 43% of the patients, followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy (29%) and myomectomy (8%). A few patients underwent other procedures, including total laparoscopic hysterectomy (7%) and laparoscopic assisted vaginal hysterectomy (2%) (Table 7).

Table 7: Distribution of Various Surgeries Done Among the Study Population (n=100)

Size of Uterus

The majority of patients (69%) had a uterus size of less than 16 weeks. The mean uterine size was 12.23 ± 5.29 weeks, with a range of 6 to 24 weeks (Table 8).

Table 8: Distribution of Size of Uterus Among the Study Population (n=100)

Types of Uterine Fibroids

Intramural fibroids were the most common, affecting 61% of the patients, followed by multiple fibroids (16%) and submucous fibroids (9%). Other types included cervical (6%), subserous (5%), and broad ligament fibroids (3%) (Table 9).

Table 9: Distribution of Various Types of Uterine Fibroids Among the Study Population (n=100)

Figure No:1. Distribution of Various Types of Uterine Fibroids Among the Study Population

Degenerations

Degenerations of uterine fibroids were observed in 5 cases, with myxoid degeneration being the most common (40%), followed by hyaline, cystic, and calcareous degeneration (20% each) (Table 10).

Table 10: Distribution of Degenerations Among the Study Populations (n=5)

Figure No:2. Distribution of Degenerations Among the Study Populations

Endometrial Histopathological Findings

The most common endometrial histopathological finding was proliferative endometrium, observed in 67% of the cases, followed by secretory endometrium (11%), atrophic endometrium (9%), and simple hyperplasia (5%) (Table 11).

Table 11:  Distribution of Endometrial Histopathological Patterns Among the Study Population (n=100)

Figure No:3. Distribution of Endometrial Histopathological Patterns Among the Study Population

Pelvic Pathology

Chronic cervicitis was the most common associated pelvic pathology, affecting 86% of the patients, followed by adenomyosis (15%) and cystic ovaries (7%). Other conditions such as endometritis and pelvic inflammatory disease were present in a smaller percentage of patients (Table 12).

Table 12: Distribution of Histopathological Abnormalities Associated with Pelvic Pathology Among Study Population (n=100)

Figure No:4. Distribution of Histopathological Abnormalities Associated with Pelvic Pathology Among Study Population

Co-morbidities
The most common co-morbidity observed was hypothyroidism (29.6%), followed by hypertension (25.9%), diabetes mellitus (18.5%), and a combination of diabetes and hypertension (18.5%) (Table 13).

Table 13: Distribution of Co-morbidities Among the Study Population (n=100)

Figure No:5. Distribution of Co-morbidities Among the Study Population

Uterine fibroids, or leiomyomas, are the most common benign tumors in women, especially during their reproductive years. The findings from this study, conducted at KIMS Hospital, Amalapuram, align with those reported in other literature regarding the age distribution of women affected by fibroids. The majority of the patients in this study (42%) were between the ages of 31 and 40 years, with 40% in the 41–50 year range, reflecting the peak prevalence of fibroids in the perimenopausal age group. This is consistent with the findings of Seema Dayal et al. (2014) [8], where fibroids were predominantly diagnosed in women aged 30-50 years, a range known to correlate with estrogen and progesterone's effect on fibroid development. The mean age of 42.06 ± 7.21 years observed in this study is also in line with previous reports from similar studies globally (Medikare et al., 2011 [9]; Ciavattini et al., 2013 [10]).

Regarding parity, 46% of the patients had three children, followed by 33% with two children. Lower parity was observed in women with fibroids, consistent with the findings of Chhabra and Ohri (1993) [11], which suggested that lower parity is associated with an increased risk of fibroid development. This finding is further supported by Kulkarni et al. (2016) [12], who observed that higher parity might offer a protective effect against fibroids, possibly due to hormonal changes occurring during pregnancy.

Menstrual disturbances, particularly menorrhagia, were the most common symptom reported, with 54.5% of the patients affected. This is in line with Vilos et al. (2015) [14], who highlighted that fibroids are a leading cause of abnormal uterine bleeding. Menorrhagia can often lead to significant anemia, and 42% of the patients in this study were found to be anemic, with 42.8% suffering from severe anemia. The high prevalence of menorrhagia and anemia in this study further emphasizes the need for early detection and intervention to manage these complications, as noted in earlier studies (Seema Dayal et al., 2014 [8]).

Surgical treatment remains the most common management approach for symptomatic fibroids, particularly for women who have completed their family. The majority of the patients (43%) in this study underwent total abdominal hysterectomy, which aligns with the findings of Chhabra and Ohri (1993) [11], who reported that hysterectomy is a widely performed procedure for managing fibroids. Myomectomy (8%) and laparoscopic hysterectomy (7%) were other surgical options, reflecting the trend toward minimally invasive procedures in modern gynecological practice. This is consistent with the study by Vilos et al. (2015) [14], who discussed the advantages of minimally invasive techniques for fibroid removal.

Histopathologically, intramural fibroids (61%) were the most common type, consistent with findings from multiple studies (Seema Dayal et al., 2014 [8]). Intramural fibroids, due to their location within the myometrium, can lead to significant uterine enlargement, pelvic pain, and menorrhagia. Myxoid degeneration, noted in 40% of the fibroids in this study, is a frequently observed degenerative change that may arise due to ischemia caused by inadequate blood supply to the fibroid, a finding corroborated by previous research (Ciavattini et al., 2013 [10]).

Chronic cervicitis (86%) was the most common associated pathology in this study, which is frequently seen in women with fibroids. Kulkarni et al. (2016) [12] also found a similar prevalence of cervicitis, suggesting a possible association between long-term inflammation from fibroid growth and the development of chronic cervicitis. Additionally, adenomyosis (15%) was another common pathological finding, which concurs with findings from other studies that reported a higher prevalence of adenomyosis in women with fibroids (Chhabra and Ohri, 1993 [11]; Usha et al., 1992 [7]).

Limitations

The study was conducted at a single center, limiting the generalizability of findings to a broader population.The sample size of 100 patients may not fully represent variations in fibroid presentation and management across different demographics.The study focused only on patients undergoing hysterectomy, excluding those managed with conservative or non-surgical treatments.Long-term outcomes and recurrence rates post-hysterectomy were not assessed, restricting insights into the effectiveness of different treatment approaches.

This study provides valuable insights into the clinical, pathological, and surgical profiles of uterine fibroids in women undergoing hysterectomy. The findings indicate that fibroids predominantly affect women in the 31-50 year age group, with menorrhagia being the most common symptom. Surgical interventions, particularly hysterectomy, remain the most effective treatment for symptomatic fibroids. Intramural fibroids were the most commonly observed type, with myxoid degeneration being the most prevalent form of degeneration. Histopathological examination revealed proliferative endometrium in the majority of cases. The study highlights the importance of early detection and appropriate treatment strategies to manage fibroid-related symptoms, improve patient outcomes, and enhance the quality of life for women affected by fibroids.

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