HORMONAL AND METABOLIC FACTORS IN THE DEVELOPMENT OF UTERINE FIBROIDS

Abstract

Uterine fibroids, also known as uterine leiomyomas, are benign monoclonal tumors arising from the smooth muscle cells of the myometrium. They are among the most common gynecological tumors in women of reproductive age and represent a major cause of abnormal uterine bleeding, pelvic pain, infertility, pregnancy complications, anemia, and reduced quality of life. Although fibroids are histologically benign, their biological behavior is strongly influenced by hormonal and metabolic factors. Estrogen and progesterone are central regulators of fibroid growth, while obesity, insulin resistance, chronic low-grade inflammation, dyslipidemia, vitamin D deficiency, and altered extracellular matrix metabolism may contribute to fibroid initiation, progression, and symptom severity.
Modern studies increasingly describe uterine fibroids as hormonally responsive and metabolically active tumors rather than simple “overgrowths” of uterine muscle Fibroid cells respond to ovarian steroids through estrogen and progesterone receptors, and their growth is supported by local growth factors, angiogenesis, extracellular matrix accumulation, and altered cellular signaling. Recent evidence also suggests that metabolic disorders, especially obesity and insulin resistance, may increase fibroid risk or prevalence. A 2025 meta-analysis reported that obesity may increase the risk/prevalence of uterine fibroids, while insulin resistance and body mass index may be independently associated with fibroid presence in non-diabetic women