The History and Epidemiology of Fibroids

  • Christopher J. G. Sutton
Part of the Medical Radiology book series (MEDRAD)


Although fibroids are the commonest tumours to afflict the pelvic organs of women and have been recognised and named since ancient times they were not amenable to treatment until the first laparotomy was performed just over 200 years ago. Without the benefit of modern imaging techniques there was considerable confusion between massive fibroids and large ovarian tumours and the diagnosis was often wrong, the mortality rate was extremely high and before the advent of anaesthesia the pain and suffering was appalling. The history of fibroid therapy is reviewed from this horrific start through safer and more conservative surgery to the modern approach using sophisticated imaging techniques and minimal access approaches to therapy. The epidemiology is reviewed with regard to clear racial differences, being much more common among those of African−Caribbean descent and a possible hypothesis is presented to try to explain this. Other factors such as age, parity, oral contraceptive use, the progesterone intra-uterine system and smoking are discussed along with medical diseases such as obesity, diabetes and hypertension and other disorders resulting in the production of unopposed oestrogen.


Uterine Artery Uterine Artery Embolisation Uterine Fibroid Laparoscopic Myomectomy Unopposed Oestrogen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alexander WA (1898) Myomectomy. Med Press Circ 14:47Google Scholar
  2. Atlee WL (1845) Removal of fibrous tumor of the uterus. Am J Med Sci 11:309–335CrossRefGoogle Scholar
  3. Bachman G (1980) Hysterectomy. A critical review. J Reprod Med 35:839–862Google Scholar
  4. Baird DD (2004) Invited commentary: uterine leiomyomata—we know so little but could learn so much. Am J Epidemiol 159:124–126PubMedCrossRefGoogle Scholar
  5. Barker-Benfield GI (2000) The horrors of the half-known life. Routledge, LondonGoogle Scholar
  6. Baron JA, La Vecchia C, Levi F (1990) The anti-oestrogenic effect of smoking in women. Am J Obstst Gynecol. 162:502–514CrossRefGoogle Scholar
  7. Baskett T (1998) On the shoulders of giants. Eponyms in obstetrics and gynaecology. Butterworths, LondonGoogle Scholar
  8. Benrubi GI (1988) History of hysterectomy. J Fla Med Assoc 75:533–542PubMedGoogle Scholar
  9. Bernhard CM (1980) Presidential address: Dr. Ephraim McDowell: father of abdominal surgery. Am Surg 46(1):1–5Google Scholar
  10. Bonney V (1923) A clamp forceps for controlling haemorrhage when performing myomectomy. J Obstet Gynaecol Br Emp 30:447–449CrossRefGoogle Scholar
  11. Bonney V (1928) The conservation of function in gynaecology. Med J Aust I:741–744Google Scholar
  12. Bonney V (1937) The fruits of conservation. J Obstet Gynaecol Br Emp 44:1–12CrossRefGoogle Scholar
  13. Bonney V (1946) Extended myomectomy and ovarian cystectomy. Cassell, LondonGoogle Scholar
  14. Chamberlain G (2000) Victor Bonney: the gynaecological surgeon of the twentieth century. Parthenon Publishing, CarnforthGoogle Scholar
  15. Chamberlain G (2003) The master of myomectomy. J R Soc Med 96:302–304PubMedCentralPubMedCrossRefGoogle Scholar
  16. Clay C (1863) Observations on ovariotomy. Statistical and practical. Trans Obstet Soc Lond 5:5874Google Scholar
  17. Cramer SF, Patel A (1990) The frequency of uterine leiomyoma. Am J Clin Path 94:435–438PubMedGoogle Scholar
  18. Day Baird D, Duncan DB, Hill MC et al (2003) High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 188(1):100–107Google Scholar
  19. Droegmueller W (1987) Benign gynaecologic lesions. In: Droegmueller W, Herbst AL, Mishell DR, Stenchever MA (eds) Comprehensive gynecology vol 17. CV Mosby, St. Louis pp 440–492Google Scholar
  20. Dubuisson JB, Chapron C, Fauconnier A (1998) Laparoscopic myomectomy. In: Sutton CJG, Diamond MP (eds) Endoscopic surgery for gynecologists, 2nd edn. WB Saunders, London, pp 272–279, Ch. 27Google Scholar
  21. Ellis H (2009) Ephraim McDowell and the first elective successful laparotomy. Br J Hosp Med 70(2):107CrossRefGoogle Scholar
  22. Faerstein E, Szklo M, Rosensheim NB (2001) Risk factors for uterine leiomyomata: a practice based case control study. II. Atherogenic risk factors and potential sources of uterine irritation. Am J Epidemiol 153:11–19PubMedCrossRefGoogle Scholar
  23. Farquhar CM, Steiner CA (2002) Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 99(2):229–234PubMedCrossRefGoogle Scholar
  24. Ferguson ILC, Taylor RW, Watson JM (1982) Records and curiosities in obstetrics and gynaecology. Bailliere Tindall, London, pp 74–75Google Scholar
  25. Gallinat A (1993) Hysteroscopic treatment of sub-mucous fibroids using the Nd: YAG laser and modern electro-surgical equipment. In: Leuken RP, Gallinat A (eds) Endoscopic surgery in gynecology. Demeter Verlag, Berlin, pp 72–77Google Scholar
  26. Goodman AL (1946) Progesterone therapy in uterine fibromyoma. J Clin Endocrinol 6:402–405CrossRefGoogle Scholar
  27. Graham H (1950) Eternal eve. W Heinemann, London, p 523Google Scholar
  28. Graham SD Jr (1981) Ephraim McDowell (1771–1830). the President’s Lithotomist. Investig Urol 19(3):216–217Google Scholar
  29. Gray L (1987) The life and times of Ephraim McDowell. VG Reid Printers, LouisvilleGoogle Scholar
  30. Haines M, Taylor CW (1975) Gynaecological pathology, 2nd edn. Churchill Livingstone, Edinburgh, pp 225–230Google Scholar
  31. Hart R (2006) The hysteroscopic management of leiomyomata. In: Brosens I (ed) Uterine leiomyomata. Pathogenesis and management. Taylor and Francis, Abingdon, pp 213–236, Ch. 16Google Scholar
  32. Hauser R, Calafat AM (2005) Phthalates and human health. Occup Environ Med 62(11):806–818PubMedCentralPubMedCrossRefGoogle Scholar
  33. Heresy trials in the diocese of Norwich. Archives of Norwich Assizes 1428Google Scholar
  34. Houlihan J, Broody C, Schwan B (2002) Not too pretty: phthalates, beauty products and the FDA. Environmental Working Group, WashingtonGoogle Scholar
  35. Istre O, Hald K, Qvigstad E (2004) Multiple myomas treated with temporary, noninvasive Doppler-directed, transvaginaluterine artery clamp. J Am Assoc Gynecol Laparosc 11:273–276PubMedCrossRefGoogle Scholar
  36. Jeffcoate TNA (1967) Tumours of the Corpus Uteri. In: Jeffcoate TNA (ed) Principles of gynaecology. Butterworth, London, pp 531–566, Ch. 25Google Scholar
  37. Kelly HA (1907) Early experience with myomectomy. Am Med Assoc Press, pp 1–2Google Scholar
  38. Kimball G (1855) Successful case of extirpation of the uterus. Boston Med Surg J 52:249–255CrossRefGoogle Scholar
  39. Kiple K (1993) The Cambridge world history of medical disease. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  40. Kjerulff KH, Langenberg P, Seidman JD et al (1996) Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod Med 41(7):483–490PubMedGoogle Scholar
  41. Klob JM (1863) Myoma. Wchblt. D. Zeit d K.K.Gesellschaft. d. Aerzte, Wien XVIII:292–298Google Scholar
  42. Knapp VJ (1999) How old is endometriosis? Late 17th and 18th Century European descriptions of the disease. Fertil Steril 72(1):10–14Google Scholar
  43. Labarge MW (1986) Women in medieval life. Hamish Hamilton, London, pp 195–218Google Scholar
  44. Liu WM (2000) Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas. J Am Assoc Gynecol Laparosc 7:125–129PubMedCrossRefGoogle Scholar
  45. Marshall LM, Spiegelman D, Barbieri RL et al (1997) Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 90:967–973PubMedCrossRefGoogle Scholar
  46. Marshall LM, Spiegelman D, Manson JE et al (1998) Rissk of leiomyomata among pre-menopausal women in relation to body size and cigarette smoking. Epidemiology 9:511–517PubMedCrossRefGoogle Scholar
  47. Matta WHM, Shaw RW, Nye M (1989) Long term follow up of patients with uterine fibroids after treatment with LHRH agonist buserilin. Br J Obstet Gynaecol 96:200–206PubMedCrossRefGoogle Scholar
  48. Matthieu A (1985) History of hysterectomy. Med Rec 8:333–349Google Scholar
  49. Mayo WJ (1922) Myomectomy editorial. Surg Gynecol Obstet 34:548–550Google Scholar
  50. McGrew R (1985) Encyclopaedia of medical history. McGraw-Hill, New YorkGoogle Scholar
  51. Morton LT (1965) Garrison and Morton’s medical bibliography. Andre Deutsch, London, pp 527–537Google Scholar
  52. Noble CP (1906) Myomectomy. A.R. Elliot Publishing Company, New YorkGoogle Scholar
  53. O’Dowd MJ, Philipp EE (1994) The history of obstetrics and gynaecology. Parthenon Publishing Group, Carnforth, pp 525–530Google Scholar
  54. Othersen Jr HB (2004) Ephraim McDowell: the qualities of a good surgeon. Ann Surg 239:648–650Google Scholar
  55. Parazzini F, Chiaffarino F (2006) The epidemiology of uterine leiomyomata. In: Brosens I (ed) Uterine leiomyomata. Pathogenesis and management. Taylor and Francis, Abingdon, pp 3–11Google Scholar
  56. Parazzini F, La Vecchia C, Negri E et al (1988) Epidemiologic characteristics if women with uterine fibroids: a case control study. Obstet Gynecol 72:853–857PubMedGoogle Scholar
  57. Parazzini F, Negri E, La Vecchia C et al (1996a) Reproductive factors and risk of uterine fibroids. Epidemiology 7:440–442PubMedCrossRefGoogle Scholar
  58. Parazzini F, Negri E, La Vecchia C et al (1996b) Uterine myomas and smoking. results from an Italian study. J Reprod Med 41:316–320PubMedGoogle Scholar
  59. Porter R (1997) The greatest benefit to mankind: a medical history of humanity. Norton, LondonGoogle Scholar
  60. Progetto Menopausa Italia Study Group (2000) Determinants of hysterectomy and oophorectomy in women attending menopause clinics in Italy. Maturitas 36:19–25CrossRefGoogle Scholar
  61. Ravina JH, Herbreteau C, Ciruru-Vigneron N et al (1995) Arterial embolisation to treat uterine myomata. Lancet 346:671–672PubMedCrossRefGoogle Scholar
  62. Ricci JV (1945) One hundred years of gynaecology 1800–1900. Bakiston Company, Philadelphia, pp 110, 157, 163, 491Google Scholar
  63. Romero-Franco M, Hernandez-Romero RU, Calafat AM et al (2011) Personal care product use and urinary levels of phthalate metabolites in Mexican women. Environ Int 37(5):867–871PubMedCrossRefGoogle Scholar
  64. Ross RK, Pike MC, Vessey MP et al (1986) Risk factors for uterine fibroids: reduced risk associated with oral contraceptives. Br Med J 293:359–362CrossRefGoogle Scholar
  65. Royal College of General Practitioners (1974) Oral contraceptives and health. an interim report from the oral contraceptive study of the royal college of general practitioners. Pitman Medical Publishing, LondonGoogle Scholar
  66. Shroen D (1690) Disputatio inauguralis medica de ulceritus ulceri. Jena, Krebs, pp 6–17Google Scholar
  67. Smellie W (1776) In: Balfour J and Smellie W (eds) Disputatio medica inauguralis in utero inflammatione ejusdem. Edinburgh University Press, Edinburgh, pp 16–22Google Scholar
  68. Speert H (1980) Obstetrics and gynecology in America, a history. Waverley Press, BaltimoreGoogle Scholar
  69. Stewart EA, Morton CC (2006) The genetics of uterine leiomyomata: what clinicians need to know. Obstet Gynecol 107(4):917–921PubMedCrossRefGoogle Scholar
  70. Stewart EA, Gedroyc WM, Tempany CM et al (2003) Focused ultrasound treatment of uterine fibroid tumors: Safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gyecol 189:48–54CrossRefGoogle Scholar
  71. Studd J (2006) Ovariotomy for menstrual madness and premenstrual syndrome—19th century history and lessons for current practice. Gynaecol Endocrinol 22(8):411–415CrossRefGoogle Scholar
  72. Summers WE, Watson RL, Wooldridge WH et al (1971) Hypertension, obesity and uterine fibromyomata as a syndrome. Arch Intern Med 128:750–754PubMedCrossRefGoogle Scholar
  73. Sutton CJG (1995) The Royal College of Obstetricians and Gynaecologists historical lecture 1993. 150 years of hysterectomy: from Charles Clay to laparoscopic hysterectomy. Year Book of the Royal College of Obstetricians and Gynaecologists, LondonGoogle Scholar
  74. Sutton CJG (1997) Hysterectomy: a historical perspective. In: Wood C, Maher PJ (eds) Bailliere’s clinical obstetrics and gynaecology. International Practice and Research, Bailliere Tindall, London 11(1) 1:1–22Google Scholar
  75. Sutton CJG (2004) Historical curiosities in the surgical management of myomas. J Am Assoc Gynecol Laparosc 11(1):4–7PubMedCrossRefGoogle Scholar
  76. Sutton CJG (2006) The history of endometriosis. In: Sutton CJG, Jones K, Adamson GD (eds) The modern management of endometriosis. Taylor and Francis, Abingdon Google Scholar
  77. Sutton CJG (2010) The past present and future of hysterectomy. J Minim Inv Gynecol Surg 17(4):421–435 (Elsevier, Holland)Google Scholar
  78. Tan SY, Wong C (2005) Ephraim McDowell (1771–1830): pioneer of ovariotomy. Singapore Med J 46(1):4–5PubMedGoogle Scholar
  79. Vollenhoven B (1998) Introduction: the epidemiology of uterine leiomyomas. Bailliere’s Clin Obstet Gynaecol 12:169–176CrossRefGoogle Scholar
  80. Von Rokitansky C (1860) Ueber uterusdrusen-neubildung in uterus and ovarialsarcoman. Z Gesellschaft Aerzte, Wien 37:577–580Google Scholar
  81. Walnut Creek Contraceptive Drug Study (1981) A prospective study of the side effects of oral contraceptives, vol 3. National Institute of Health, Bethesda Google Scholar
  82. Wilcox LS, Koonin LM, Pokras R et al (1994) Hysterectomy in the United States, 1988–1990. Obstet Gynecol 83(4):549–555PubMedCrossRefGoogle Scholar
  83. Windham GC, Elkin E, Fenster L et al (2002) Ovarian hormones in pre-menstrual women: variation by demographic, reproductive and menstrual cycle characteristics. Epidemiology 13:675–684PubMedCrossRefGoogle Scholar
  84. Wise LA, Palmer JR, Reich D et al (2012) Hair relaxer use and risk of uterine leiomyomata in African-American women. Am J Epidemiol 175(5):432–440PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Gynaecological Surgery, Faculty of Health and Social SciencesUniversity of SurreyGuildfordUK
  2. 2.Gunners Farm, Stringers CommonJacobs Well, GuildfordUK

Personalised recommendations