Uterine Fibroids: From Pathogenic Signalling and Molecular Classification to Precision Diagnosis and the Evolving Landscape of Minimally Invasive Management

Uterine fibroids, or uterine leiomyomas, are the most common non-cancerous tumours, affecting women in their reproductive years. Their occurrence shows considerable variation, with prevalence estimates ranging from 4.5% to almost 70%, and notably higher rates seen in African American women. While many women with fibroids do not develop symptoms, a substantial proportion experience significant clinical issues, including heavy menstrual bleeding, persistent pelvic pain, pressure sensations, subfertility, and adverse pregnancy outcomes. The formation of these tumors is closely linked to hormonal influences and genetic alterations—especially mutations in the MED12 gene—as well as excessive extracellular matrix deposition driven by profibrotic pathways. Diagnosis relies on pelvic examination supported by imaging, with ultrasonography and magnetic resonance imaging (MRI) serving as principal tools. The FIGO classification system further assists clinicians in accurately identifying fibroid types based on anatomical location. Management is individualized, considering symptom severity, reproductive goals, and the patient’s overall clinical profile. Therapeutic options range from medical treatments such as NSAIDs, tranexamic acid, hormonal agents, progestins, and GnRH analogues, to minimally invasive techniques including uterine artery embolization and MRI-guided focused ultrasound. Surgical procedures like myomectomy and hysterectomy continue to serve as definitive interventions, particularly in complex or recurrent cases. Growing insights into molecular mechanisms and targeted therapeutic pathways are gradually transforming fibroid care toward more precise, minimally invasive, and fertility-conserving treatment strategies.