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Chapter 11 - Fibroids and Fertility

Published online by Cambridge University Press:  03 June 2019

Jane A. Stewart
Affiliation:
Newcastle Hospitals NHS Foundation Trust
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Summary

Uterine fibroids are the most common pelvic tumours, occurring in 30% of women over the age of 30 years. Their incidence increases with age, and they are more common in certain ethnic populations. The frequency of fibroids reported in literature varies widely due to differences in diagnostic tests used, populations studied and study design. The largest study to date, prospectively followed up 95,061 female nurses in America aged between 25 and 44 years with questionnaires every two years, to determine the incidence of fibroids among premenopausal women by age and race [1]. The diagnosis of fibroids was self reported and confirmed for a sample of cases. The crude incidence rate in this study was 12.8 per 1,000 woman years. The standardised rates were much higher in black women than in white women, 30.6 and 8.9 per 1,000 woman years respectively. Even after adjusting for variables such as body mass index, infertility and contraception, the rates among black women were significantly higher than those amongst white women (RR 3.25; 95% CI 2.71–3.88). Another large American survey included 1,364 women aged between 35 and 49 years who were randomly selected from an urban health plan. All recruited women underwent transvaginal ultrasonography. The cumulative incidence of fibroids at 50 years of age was 70 and >80% for whites and African Americans respectively. The prevalence of fibroids is lower in Europe, although still remarkable from the healthcare point of view. An Italian cohort study documented an incidence of ultrasonographically detectable fibroids of 21% in a series of 341 unselected women residing in an urban zone aged between 30 and 60 years [2]. A Swedish study recruiting 335 unselected subjects from an urban district and who accepted to undergo transvaginal ultrasonography showed a prevalence of 3% in women aged between 25 and 32 years and 8% in those aged between 33 and 40 years [3].

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Publisher: Cambridge University Press
Print publication year: 2019

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References

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