A new study published in the Journal of the American Heart Association has found that women with uterine fibroids have an over 80 per cent higher risk of developing long-term heart disease compared to those without the condition.
Considering that uterine fibroids affect 20–30 per cent of women, with up to 77 per cent developing them at some point during their childbearing years, they remain a significant public health concern. Often undiagnosed, only about one-third of fibroids are large enough to be detected during a physical examination. If not properly addressed, we have know that fibroids can lead to infertility and serve as an independent risk factor for adverse perinatal outcomes, including preterm birth, obstructed labour, intrauterine growth restriction, low birth weight, placenta previa, placental abruption, cesarean section, postpartum haemorrhage, and postpartum maternal anaemia.
The new study reveals that the impact of uterine fibroids might extend beyond reproductive health and could also affect heart health - an association experts say deserves attention in India, where awareness and screening for fibroids remain limited.
What are uterine fibroids and how do they affect women’s health?
Uterine fibroids, also known as leiomyomas, are growths composed of muscle and connective tissue that develop in or on the uterine wall. While they are benign and noncancerous, fibroids are the most common tumours of the female reproductive system.
Fibroids can vary widely in size, from as small as a seed to more than 20 centimetres in diameter, comparable to a watermelon in extreme cases. They can form as single nodules or clusters and may grow within the uterine wall, inside the cavity of the uterus, or on its outer surface.
Symptoms of fibroids are diverse and largely depend on their size and location within the uterus.
While small fibroids often go unnoticed and may not cause any discomfort, larger growths can lead to a range of issues. Women may experience excessive or painful menstrual bleeding, as well as bleeding between periods. The presence of fibroids can create a feeling of fullness or bloating in the lower abdomen and may put pressure on the bladder, causing frequent urination. Pain during sexual intercourse and lower back pain are also common, along with constipation or a sense of pressure on the rectum. Some women may have chronic vaginal discharge or difficulty fully emptying their bladder. In cases where fibroids grow significantly, abdominal distention can occur, causing the belly to appear enlarged.
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Hormones, particularly estrogen and progesterone, are thought to influence fibroid growth. They typically develop during reproductive years and may enlarge during pregnancy, while shrinking after menopause when hormone levels decline.
Risk factors for fibroids include obesity, higher body mass index (BMI), family history, not having children, early onset of menstruation, and later age at menopause. Though most fibroids do not cause serious complications, potential issues include pain, abdominal or pelvic swelling, excessive bleeding, anaemia, and, in rare cases, infertility. Anaemia can result from heavy or frequent bleeding, affecting oxygen delivery to organs, and requires timely medical intervention.
What the new study found
The recent study, led by researchers at the Perelman School of Medicine, University of Pennsylvania, explored the relationship between uterine fibroids and long-term cardiovascular disease risk. Using earlier research as a foundation, the team compared 4.5 lakh women diagnosed with fibroids to over 22.5 lakh women without the condition. Participants were aged between 18 and 50 and had no prior history of hysterectomy, menopause, or cardiovascular disease.
The researchers followed the participants for nearly a decade or until they experienced a cardiovascular event, focusing on incidents such as heart attacks, strokes, and peripheral artery disease. Each woman with fibroids was matched to five women of the same age without fibroids.
The findings were striking. Women with fibroids experienced approximately 6.5 cardiovascular events per 1,000 person-years, compared to 3 events per 1,000 person-years in the comparison group. Over both one-year and ten-year follow-ups, the fibroid group consistently showed higher rates of cardiovascular complications. By the 10-year mark, 5.4 per cent of women with fibroids had developed cardiovascular disease, compared to 3 per cent of women without fibroids.
Even after adjusting for potential confounders such as race, BMI, smoking, diabetes, and hypertension, the study found that women with fibroids had an 81 per cent higher risk of major cardiovascular disease over ten years. The greatest risk was observed in women under 40, whose 10-year cardiovascular risk was more than three times higher than that of the comparison group.
Julia D. DiTosto, M.S., a PhD. Candidate in Epidemiology and co-author of the study, said, “Our findings suggest that fibroids may serve as an important marker for identifying women at elevated cardiovascular risk, with sustained increased risk persisting up to 10 years after diagnosis.” She added, “However, it's important to note that more research is needed to confirm these findings in other populations before formal changes are made to cardiovascular risk assessment guidelines. In the meantime, these results support having thoughtful conversations between women and their providers about heart health in the context of a fibroid diagnosis.”
Implications for India: Expert advice
Uterine fibroids are a common health concern in India, yet awareness remains limited. A hospital-based retrospective study conducted at Government Lady Goshen Hospital, Mangalore, from February 2015 to February 2015, analysed records of 177 patients diagnosed with fibroids in 2013 and 2014. Most patients were aged 31–40 years. “Menstrual disturbances were common, with menorrhagia being predominant. Complications such as infertility and vaginal discharge were observed in 21.5% of cases. Surgical treatment, particularly hysterectomy, was commonly employed, resulting in a cure rate of 76.8%,” the study highlighted.
The study concluded that “prompt diagnosis and appropriate management, considering socio-demographic factors and associated complications, are essential for improved outcomes in patients with uterine fibroids.”
Another 2024 study aimed to assess knowledge, attitudes, and perceptions about uterine fibroids among women of reproductive age. Conducted over three months in an outpatient department of Obstetrics and Gynaecology, the study collected data through a pre-tested questionnaire covering clinical symptoms, awareness, and perceptions regarding fibroids.
The results revealed that “most women show poor knowledge concerning fibroids. Most women fear that surgery (hysterectomy) may cause loss of femininity due to the amenorrhea. The subjects opined that fibroids increase with age and positive family history is seen in 48%. Participants opined that there is an association of obesity with the clinical presentation of heavy menstrual bleeding and pain. Eighty seven percent felt herbal drugs and lifestyle modifications is the treatment for fibroids. It affects childbearing is not known in 76% of subjects.”
The study concluded that “patient counselling plays an important role to improve patient knowledge and encourage early reporting. Educational programmes can be conducted to increase their awareness of uterine fibroids. Camps can be conducted in rural areas regarding uterine fibroids to improve the awareness of women which helps in early management and thereby preventing the complications of the disease.”
Explaining the possible biological link between uterine fibroids and cardiovascular disease, Dr (Prof) Tarun Kumar, Associate Director and Head of the Medanta Moolchand Heart Centre, said researchers believe the two conditions may share common underlying pathological processes.
“One of the proposed mechanisms is smooth muscle cell proliferation,” Dr Kumar explained. “Both uterine fibroids and atherosclerotic plaques involve excessive growth of smooth muscle cells. In that sense, they may have a common regenerative pathway.”
He further pointed to the role of inflammation as a shared risk factor. According to Dr Kumar, fibroids can trigger systemic inflammation in the body. “Inflammatory markers such as cytokines and high-sensitivity C-reactive protein (hs-CRP) are indicators of vascular inflammation. This inflammation can contribute to the formation of atherosclerotic plaques and, in some cases, their rupture, leading to cardiovascular events,” he said.
Hormonal influence is another important factor linking the two conditions. “Hormones like estrogen and progesterone play a key role in fibroid growth, but they also affect vascular health,” Dr Kumar noted. “These hormones can promote smooth muscle growth and vascular calcification. Excess fibrous tissue and calcium deposition are features seen in both uterine fibroids and cardiovascular disease.”
He added that metabolic risk factors often overlap. Women with obesity, diabetes, or metabolic syndrome are at higher risk of developing fibroids, and these same conditions significantly increase the risk of coronary artery disease. “So, in many patients, the risk profile for both conditions is strikingly similar,” he said.
Dr Kumar highlighted the issue of underdiagnosis in India. He noted that many women in India are unaware they have fibroids due to limited screening and low awareness. “Screening for uterine fibroids is not yet prioritised, and awareness remains poor. As a result, many women continue to live with the condition without knowing it,” he said.
Despite these gaps, Dr Kumar believes the findings are applicable in the Indian context. “The risk factors and the underlying pathophysiology are largely the same. That makes this study relevant for Indian women as well,” he said, while cautioning that larger, population-specific studies are still needed.
“At the same time, there is no harm in being proactive,” he added. “Even if one well-conducted study suggests a higher cardiovascular risk, it makes sense to take preventive measures and monitor this group of patients more closely. As cardiologists, we would certainly consider a more detailed cardiac evaluation for women diagnosed with fibroids.”
‘Early detection is the key to prevention’
Supporting this view, Dr Rahul Gupta, Director and Cardiologist at Gleneagles Hospital, Mumbai, said the biological and lifestyle factors highlighted in the study are increasingly evident among Indian women.
“Even though the study was conducted in the United States, our lifestyles in India are increasingly moving in the same direction,” Dr Gupta said. “Women today are working, managing families, dealing with stress, and leading far more active lives than earlier generations. This is no longer the traditional lifestyle women had a hundred years ago, and we are already seeing similar cardiovascular disease patterns in India.”
He pointed out that heart disease rates are already higher in the Indian population, and Indian women are no exception. “In fact, Indian women tend to develop cardiovascular disease at a younger age. So when we look at conditions like uterine fibroids in this context, the demographic findings of this study are very much applicable to our population,” he said.
Dr Gupta explained that uterine fibroids may reflect a deeper metabolic and hormonal imbalance in the body. “Fibroids are often a manifestation of neuro-hormonal dysregulation,” he said. “This is similar to what we see in conditions like polycystic ovarian disease (PCOD), which is closely linked to insulin resistance. Insulin resistance itself is a well-known risk factor for cardiovascular disease.”
While he acknowledged that Indian data directly linking fibroids to cardiovascular disease is limited, Dr Gupta said clinical experience does suggest an association. “Until recently, we were not actively correlating fibroids with heart disease. But when I reflect on patients I’ve seen, there are women who were being treated for fibroids and were later found to have high blood pressure or other cardiac issues during evaluation,” he said. “Further tests like echocardiography or treadmill stress tests often revealed underlying cardiovascular disease.”
He cautioned that without large India-specific studies, it is difficult to establish a definitive causal link. “We don’t yet have our own data, so we cannot say this conclusively. But this study does strengthen the possibility of a correlation, especially considering the shared metabolic risk factors seen in women with fibroids,” he added.
On prevention, Dr Gupta emphasised that awareness and regular health screening are crucial. “Most cardiovascular risk factors are silent killers. The only way to detect them early is through regular health check-ups,” he said.
He noted that many routine health packages already include abdominal ultrasound or sonography, which can help detect fibroids early. “If a woman is diagnosed with uterine fibroids, there is no harm in being more vigilant about heart health,” Dr Gupta said. “Annual checks of blood pressure, blood sugar, lipid profile, and cholesterol levels should be taken seriously.”
“Risk factors do not cause disease overnight,” he added. “If we identify and control them at an early stage, the chances of developing cardiovascular disease reduce significantly. Regular monitoring allows us to intervene before these risks turn into serious illness.”
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
