The Hormonal Origin of Uterine Fibroids: An Hypothesis

Abstract

Uterine fibroids are the commonest of pelvic neoplasms and therefore should command the interest of all gynecologists. What is the source of these tumors is a question that is asked daily and one which can be answered only in generalities. I n three former contributions (1, 2, 3) excessive stimulation of the myometrium by the ovarian follicular hormone has been suggested as a cause. That the action of this hormone is not specific for the endometrium, as demonstrated by the endometrial changes during the normal menstrual cycle, but that it affects the genital tract as a whole, is easily proved (4). When the action on the endometrium is abnormal, with resulting endometri a1 hyperplasia, there is an equally abnormal action upon the myometrium, which, if it is prolonged sufficiently, results in cellular metaplasia of the uterine muscle cell or cells, with the subsequent development of uterine fibroids.According to Meyer (5), the histogenetic study of fibroids does not reveal any distinctive myoma mother cells in the uterine muscle from which a proliferating myoma might develop. He reports that the earliest appearance of a myoma is represented by a thickening of the uterine muscle buiidles which a r e directly connected with the normal musculature of the uterus. De Snoo (6), on the other hand, claims that the uterus is a very primitive special organ which contains many nndifferentiated cells, genitoblasts. During embryonic life these cells form the uterus proper, while in later life they provide the means of gestational hyperplasia and of regeneration of the endometrium during the puerperium. Under pathological conditions, due. to ovarian hormonal dysfunction, these genitoblasts can give rise to the formation of uterine fibroids, endometriomns, or adenomyomas.It is not the object of this paper to enter into a discussion of the primary source of the uterine fibroid, whether it be from myoma mother cells, as genitoblasts, or from cellular metaplasia of normal uterine muscle cells. The actual origin of the fibroid is unimportant ; the paramount question is the determination of the exciting factor which controls the cellular change or which stimulates the geiiitoblasts to tumor proliferation. The hypothesis is here set forth that this exciting cause has its origin in excessive stimulation on the uterine muscle tissue by the ovarian folliculsr hormone. Grttves (7) has aptly observed that uterine fibroids possess certain attributes that seem to place them in a borderland between physiologic hypertrophy and true neoplastic growths. " Their great frequency 402

Clinical Presentation & Operative Treatment of Leiomyoma of Uterus and its Outcome

“…Despite the lack of clear evidence of their role in preventing conception, submucosal fibroid, intramural fibroids that distort the uterine cavity , fibroids larger than 5cm, and multiple fibroids are often treated in patients with otherwise unexplained infertility. However one fact is clear, infertility either voluntary or involuntary is likely to be followed in time with the development of uterine fibroid, and on the other hand, once fibroid have developed, fertility is likely to be decrease or in abeyance 11,12 .…”

Large umbilical hernia complicating huge uterine fibroid: Case report in a tertiary hospital in Port Harcourt, Nigeria

“…With increasing size of the fibroid, distension, stretching, weakness of the anterior abdominal wall muscles and fascia results. The developmental origin, pathogenesis, and treatment of uterine fibroid have been well studied and reported [2][3][4][5][6][7]. Medical, surgical, and radiologically guided interventions are known options for the treatment of symptomatic uterine fibroids, and the Gonadotrophin releasing hormone agonists (GRH) and selective progesterone receptor modulators (SPRMs) are reported to show good promise out of the available medical alternatives [8] .…”

Uterine leiomyomas: a demographical and clinico-pathological exploration in a rustic setup of Tamil Nadu: a comprehensive study

“…The normal myometrium of leiomyoma containing uterus expresses high level of oestrogen receptors, a fact that may be related to their pathogenesis [6]. The ovarian follicular hormone acts upon myometrium and results in cellular metaplasia with subsequent development of uterine fibroids [7].…”