COMPARATIVE ANALYSIS OF THE STRUCTURE AND FREQUENCY OF RISK FACTORS FOR UTERINE FIBROIDS IN WOMEN FROM SRI LANKA AND RUSSIA

Relevance. Uterine fibroids is a benign neoplasm composed of uterine smooth muscle and fibrous connective tissue that supports it. This is also introduced as Fibroids, Leiomyoma or Fibromyoma [1].  Uterine fibroids grow in place and don’t spread or metastasis to other parts of the body.It is the commonest solid gynecological benign tumor in reproductive age. Frequently seen in nulliparous patients and women with low parity.They are estrogen dependent tumors. It grows whenever there is excessive estrogen and associated with women who are hyper estrogenic [2, 4, 6]. Fibroids can be vary in sizes. Some fibroids can be microscopic, some can be big as oranges. These fibroids are often found during routine pelvic examinations. When fibroids are suspected, patient is advised to undergo testing, transvaginal ultrasound, MRI or hysteroscopy. The size and location of uterine fibroids can vary greatly and microscopic size fibroids, submucosal fibroids and small fibroids that are hidden behind large tumors can be undetectable through a routine pelvic ultrasound [4, 5]. These fibroids are benign tumors, they are very common and arise from the uterus. They really don’t cause an issue unless they cause symptoms, and there are variety of symptoms that can go along with fibroids depending on where they are located within the uterus [1, 2]. These fibroids can hang within the uterine cavity, sometimes they can be exophytic which means they hang on outside of the uterus and other times they can line the mucosa or the lining of the uterus and depending on where they are and the number they can have different impacts on a woman in terms of symptoms [3, 4].

About 20% to 80% of women develop fibroids by the age of 50. In 2019, it was estimated that 171 million women were affected worldwide [1]. They are typically found during the middle and later reproductive years. After menopause, they usually decrease in size.

Objective: comparative analysis of the structure and frequency of risk factors for Uterine fibroids in women from Sri Lanka and Russia.

Research objectives:

1. Evaluate the structure and the causes for Uterine fibroids in Sri Lanka.

2. Evaluate the structure and the causes for Uterine fibroids in Russia.

3. Conduct a comparative analysis of the frequency of causes for Uterine fibroids in Sri Lanka and Russia.

Materials and methods. Anamnesis data, clinical symptoms, physical examination, laboratory and instrumental methods of examination of patients diagnosed with Uterine fibroids were analyzed.

Results of the study.

Main etiological factors of Uterine fibroids in Sri Lanka.

1. Changes in the hormonal sensitivity of the myometrium 68%

2. Family history 37%

3. Age: 20-30 years 27%; 31-40 years 46%; 41- 50 years 27%

4. Nulliparity 19.9%

5. Early menarche 13%

6. Late menarche 12.5%

7. Late menopause 4.8%

8. Unhealthy diet 32%

9. Prolonged use of oral contraceptives 18%

10. Endocrine diseases; Obesity and Diabetes Mellitus 21.7%

11. Chronic extra genital diseases; Hypertension 12%

12. Heavy menstrual bleeding 23%

13. Ethnicity of the patients: Sinhalese 87.9%

Non- Sinhalese 12.1%

Causes of Uterine fibroids in Russia.

1. Changes in the hormonal sensitivity of the myometrium (75%).

In the development of uterine fibroids sex hormones Estrogen and Progesterone plays an important role. The number of estrogen and progesterone receptors are higher in the fibroids than in the unchanged myometrium, but lower than in the endometrium. In degree of hormonal sensitivity, fibroid tissue is closer to the endometrial tissue than the myometrium. Main role in the occurrence and growth of fibroids belongs to the synergistic effect on the myometrium of estrogens, growth factors and immunoreactive insulin. Also due to the influence of progestin, increasing the activity of mitotic can be seen.

2. The effect of growth factors on myometrial cells (65%).

Due to the action of growth factors, hormonal stimulation of the growth of myomatous nodes occurs. Growth factors have a short, distant, local effect and provide intracellular interaction. The body has strict immunological control over the two main processes of cell life:  proliferation and apoptosis. As a result of imbalance in the process of proliferation and apoptosis in the myometrium, hyperplasia occurs in the myometrium. This is further established by the increased expression in the fibroids of the proto-oncogene bcl-2 and Ki-67. The main regulatory systems of proliferation and apoptosis are the endocrine and immune systems.

3. Late menarche (15%).
4. Heavy menstruation (20%).
5. Late menopause (12%).

Fibroids are estrogen dependent tumors, so longer a person exposed to estrogen increases the risk of having fibroids.

6. History of terminated pregnancy (5%).

The risk of developing uterine fibroids increases in women with a history of terminated pregnancies, and decreases in proportion to the increase in the number of term pregnancies.

7. Infertility (10%).

Most of the time, submucosal fibroids, a type of fibroid that grows and bulges into the uterine cavity, increases the risk of infertility and pregnancy loss. The main reason for this is that sudden because of fibroids distort the uterine cavity and make it more difficult for pregnancy.

8. Hereditary predisposition (25%).

If there is a family history of having fibroids patient has a higher chance of having a fibroid.

9. Chronic extra genital diseases: Hypertension (15%); Endocrine diseases (35%); Obesity and Diabetes (17%).

Women who weighed under 55kg has a particularly low risk, and overall the risk can increase roughly 21% for each 10kg increase. Women who is obesity are having increased level of estrogen which as a result cause uterine fibroids.

Table 1. Comparative analysis of the frequency of causes for Uterine fibroids in Sri Lanka and Russia.

Conclusion;

1.The most significant risk factor for Uterine fibroids in Sri Lanka are the changes in the hormonal sensitivity of the myometrium (68%).Women who has a family history of uterine fibroids (37%), women who takes an unhealthy diet (higher consumption of meat and dairy products) and lacks vitamin D (32%).

2. The most significant risk factor for uterine fibroids in Russia are the changes in the hormonal sensitivity of the myometrium (75%), the effect of growth factors on myometrium cells (65%),  Endocrine diseases like Obesity and Diabetes mellitus (35%).

3. A comparative analysis of the frequency of risk factors for Uterine fibroids in Sri Lanka and Russia showed that a significantly larger percentage of risk factor is changes in the hormonal sensitivity of the myometrium.

1. Uterine fibroids fact sheet / Office on Women’s Health. January 15, 2019. Archived from the original on 7 July 2019.Retrieved 26 June 2019.
2. Uterine Fibroids / Fibroids.  MedlinePlus.Retrieved.2018-11-07.
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