Vascular biology of uterine fibroids: connecting fibroids and vascular disorders

Abstract

Fibroids are benign tumors caused by proliferation of myometrial smooth muscle cells in the uterus that can lead to symptoms such as abdominal pain, constipation, urinary retention, and infertility. While traditionally thought of as a disease process intrinsic to the uterus, accumulating evidence suggests that fibroid growth may be linked with the systemic vasculature system, although cell-intrinsic factors are certainly of principal importance in their inception. Fibroids are associated with essential hypertension and preeclampsia, as well as atherosclerosis, for reasons that are becoming increasingly elucidated. Factors such as the renin-angiotensin-aldosterone system, estrogen, and endothelial dysfunction all likely play a role in fibroid pathogenesis. In this review, we lay out a framework for reconceptualizing fibroids as a systemic vascular disorder, and discuss how pharmaceutical agents and other interventions targeting the vasculature may aid in novel treatment of fibroids.

The relationship between muscle sympathetic nerve activity and systemic hemodynamics is altered in women with uterine fibroids

“…It is proposed that elevated blood pressure damages the smooth muscle cells of the myometrium, leading to tissue proliferation and fibrosis. (Kirschen et al, 2021 ) Such a response would be similar to that of the vascular smooth muscle in the environment of elevated blood pressure. (Humphrey, 2008 )…”

“…It is proposed that elevated blood pressure damages the smooth muscle cells of the myometrium, leading to tissue proliferation and fibrosis. (Kirschen et al, 2021) Such a response would be similar to that of the vascular smooth muscle in the environment of elevated blood pressure. (Humphrey, 2008) We suspected that the autonomic system would be the physiological link between UF and blood pressure, as elevated MSNA levels are seen in many individuals with an elevated risk of hypertension (e.g., those with obesity, heart failure, etc.).…”

Clinicopathological Patterns and Biochemical Markers in Serum of Uterine Leiomyoma Patients

“…A significant increase in diastolic blood pressure was observed in leiomyoma group. Endothelial dysfunction caused by altered secretions of certain vasoactive factors may be responsible for hypertension in leiomyoma patients (Kirschen et al, 2021).…”

Advances in the clinical application of ultrasound elastography in uterine imaging

“…Adenomyosis is usually diagnosed as myometrial glandular and interstitial heterotopia. Histopathology shows hyperplasia and hypertrophy of surrounding smooth muscle cells with hyper-fascicular trabecular pattern and increased extensive fibrosis and micro-vascularization [ 6 , 7 ]. Benign lesions such as endometrial hyperplasia, polyps, and endometrial atrophy originate from endometrial soft tissue and endometrial gland hyperplasia, containing a small amount of fibrous interstitial components, have soft stiffness, and are accompanied by an increased proportion of nucleosomes.…”