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Written By
Dr. Swati Mishra
BDS
Reviewed By
Dr. Rajeev Sharma
MBA, MBBS
Last updated on:
13 Jul 2023 | 12:49 PM (IST)

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Uterine fibroids

Uterine fibroids

Also known as Uterine leiomyomas, Fibromas, Leiomyomas Uterine myomas, and Fibroids

Overview

Fibroids are muscular growths that develop in the wall of the uterus. Women in their reproductive age are most likely to be affected by them. 

Fibroids are almost always benign (non cancerous) and do not increase the risk for uterine cancer. Mostly they do not cause symptoms, and a woman with a fibroid is usually unaware of its presence. However, very large fibroids may cause pressure on the bladder and other organs, leading to specific symptoms like heavy menstrual bleeding, back pain, frequent urination, and pain during intercourse. 

The risk factors that promote the growth of fibroids include a family history of fibroids, obesity, high blood pressure, early age of commencement of periods amongst others.

As the growth of most fibroids slows as menopause approaches, the health care provider may advise “watchful waiting” if the symptoms are tolerable. However, fibroids associated with significant symptoms require medical intervention.

Key Facts

Usually seen in
  • Women between 30 to 40 years of age.
Gender affected
  • Women
Body part(s) involved
  • Uterus 
  • Cervix
Prevalence
Mimicking Conditions
  • Adenomyosis (growth within the uterine wall)
  • Endometriosis
  • Ovarian cysts 
  • Polyps
Necessary health tests/imaging

 Laboratory tests

Imaging tests 
Treatment

Medications

  1. Gonadotropin-releasing hormone (GnRH) agonists

  1. Birth control

  • Oral contraceptive pills

  •  Intravaginal contraception

  •  Intrauterine devices (IUDs)

  1. Progestin-releasing intrauterine device (IUD)

  2. Iron supplements:

  1. New drugs

 Surgery 

Noninvasive procedures

  • MRI-guided focused ultrasound surgery (FUS)

Minimally invasive procedure 

  • Radiofrequency ablation (RFA)

  • Uterine artery embolization (UAE)

  • Hysteroscopic myomectomy

  • Robotic myomectomy

Traditional surgical procedures

  • Abdominal myomectomy

  • Hysterectomy

Specialists to consult
  • General physician
  • Gynecologist

Symptoms Of Uterine Fibroids 


Many women have no symptoms of fibroids. However, sometimes uterine fibroids can be associated with the following signs and symptoms:

  • Painful periods or heavy bleeding

  • Menstrual periods lasting more than a week

  • Long-term vaginal discharge

  • Frequent urination (this can happen when a fibroid puts pressure on the bladder)

  • Inability to urinate or completely empty the bladder

  • Anemia 

  • Constipation

  • Lower back pain 

  • Enlargement of the lower abdomen

  • Feeling of fullness in the lower abdomen 

  • Reproductive issues, such as infertility, multiple miscarriages, and early onset of labor during pregnancy

  • Complications during pregnancy, which increases the chances of cesarean (C-section) by multiple folds

Causes Of Uterine Fibroids 


The exact causes of fibroids are not known. Research suggests that fibroids develop from abnormal muscle cells in the uterus. High estrogen levels lead to fibroid development and growth, and low progesterone levels are not able to inhibit their growth.

Types Of Uterine Fibroids 


There are four major types of uterine fibroids: 

  • Intramural fibroids 

This is the most common type of non-cancerous tumor that grows in the muscles of the uterus. It grows within the uterine wall and can become very large if left untreated. The fibroid can grow in the front (anterior), top (fundal), or back (posterior) of the uterus.

  •  Submucosal fibroids

This is the rarest type of noncancerous uterine fibroid, which develops in the muscle layer beneath the womb's inner lining and grows into the cavity of the womb. 

  • Subserosal fibroids 

These fibroids are located outside the lining of the uterus and protrude outward. These fibroids are very common and affect the daily lives of women.

  • Pedunculated fibroids

They are the least common type of fibroids that are located outside of the uterus. They’re often depicted as mushroom-like because they have a stalk and a much wider top.

Risk Factors For Uterine Fibroids 


Fibroids usually grow in women during childbearing age, and research suggests that they may shrink after menopause. Several factors may affect a woman’s risk for having uterine fibroids, including the following: 

Age 

Fibroid development becomes more common as women age, especially during their 30s and 40s years of age. 

Family history 

Women with a family history of uterine fibroids have a higher risk of developing uterine fibroids. 

Age of menarche (first period)

Research suggests that women who start menstruation earlier are at a greater risk for uterine fibroids. This can be due to increased exposure to estrogen over the years. 

Obesity

Increased body fat, especially abdominal visceral fat enhances the risk of uterine fibroids. Women who are overweight or obese are at higher risk of having fibroids.

Do you want to know the other health risks of obesity?

Vitamin D deficiency 

Research has shown that Vit D deficiency is an important risk factor for uterine fibroids. 

Don’t let gaps in your nutrition affect your health. Check out our exclusive range of vitamin D supplements to take care of all your needs.

Diet

Certain eating habits including consuming lots of red meat and alcohol as well as not adding fruits and green vegetables in daily routine can increase the risk of fibroids.

Stress 

Stress is the body’s biochemical response to life challenges. To handle the effects of stress, the body produces extra hormones. These elevated rising hormones can stimulate fibroid growth and cause symptoms to flare up.

Read about the various effects of stress on the body.

Food additive consumption 

Food preservatives like butylated hydroxytoluene (BHT) contribute to the proliferation of uterine fibroids. This is commonly found in packet cake mixes, potato chips, salted peanuts, and dehydrated mashed potatoes.

Soybean milk 

It is well-known that soybean milk is rich in animal or plant estrogen-like substances, which may exert estrogen-like functions and if estrogen levels are too high it can lead to fibroid growth and development.

Oral contraceptives  

Women who take oral contraceptives for a long time have a higher risk of uterine fibroids.

Alcohol intake 

Drinking alcohol can increase the severity and duration of common fibroid symptoms. Many women have also reported increased fibroid pain after consuming alcohol. This is likely due to two major factors, increased inflammation and dehydration.

High blood pressure (Hypertension)

Hypertension does not directly cause fibroids. Few researchers have suggested that the use of certain anti-hypertensive medications may increase the levels of hormones in the body that can promote the growth of fibroids. It has also been seen that elevated blood pressure may cause smooth muscle wear and tear and thereby increase the risk of uterine fibroid onset or growth. 

 

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Diagnosis Of Uterine Fibroids 

Many women having uterine fibroids do not even know about it until it causes some symptoms. Uterine fibroids are frequently found incidentally during a routine pelvic examination. The medical practitioner may feel irregularities in the shape of the uterus, suggesting the presence of fibroids.

Medical history 

During the medical history clinicians first ask about the age of the person and the start of the menses at puberty (menarche). The doctor will also check whether there is any history of fibroids running in the family. 

Laboratory tests

  • Complete blood count (CBC): The doctor may suggest this test in the case of abnormal menstrual bleeding or to investigate the other potential causes of this. In heavy menstrual bleeding, CBC can help in checking for anemia. 

Note: Uterine fibroids lead to heavy menstrual bleeding which causes anemia. A study has reported a case series of life-threatening anemia with hemoglobin levels <2.0 g/dl caused by uterine fibroids and genital bleeding. 

Booking your lab tests just got easier. Get all the tests done in the comfort and safety of your home.

Imaging tests 

  • Ultrasonography: This is a noninvasive imaging test that creates a picture of the internal organs with sound waves. The sound waves help in taking pictures of the uterus, and checking whether fibroids are present or not. Depending on the size of the uterus, the ultrasound can be performed in two ways: 

    • Transvaginal:  This test is used to look at a woman's uterus, ovaries, tubes, cervix, and pelvic area. 

    • Transabdominal: This test is used to visualize the liver, gallbladder, kidneys, pancreas, intestine, bladder, uterus, and stomach. 

  • Magnetic Resonance Imaging (MRI): This is a noninvasive test that creates detailed images of your internal organs by using magnets and radio waves. This test is helpful in visualizing the size and location of fibroids, identifying different types of tumors, and helping in exploring different treatment options.

  • Computed Tomography (CT) scan: It is an imaging procedure that uses a combination of X-rays and computer technology to visualize images of the inside of the body. 

  • Hysteroscopy: It is a procedure to examine the inside of the uterus. The device used is called a hysteroscope, which is a narrow telescope with a light and camera at the end. The device is inserted through the cervix into the uterus and helps in looking the fibroids into the walls of the uterus and the openings of the fallopian tubes.

  • Hysterosonography: This test is also called a sonohysterography and saline infusion sonogram, which uses sterile salt water to expand the uterine cavity. This test uses sound waves to produce pictures of the inside of the uterus and is helpful in visualizing images of fibroids and the lining of the uterus in women.

  • Hysterosalpingography (HSG): This is an X-ray test in which contrast material is injected first and then X-rays of the uterus are taken. HSG is a thin tube that is passed through the vagina and cervix. This test is helpful in determining whether a person's fallopian tubes are open or blocked and if some submucosal fibroids are present. 

  • Laparoscopy: This procedure is also called keyhole surgery or minimally invasive surgery that allows the surgeon to visualize the inside of the abdomen and pelvis without having to make large incisions in the skin. A thin and flexible tube with a camera on the end will be inserted to look closely at your internal organs through the cut made at the lower abdomen. 

Celebs affected

Anoushka Shankar
Anoushka Sharma is a well-known sitar player. The music composer said that she had undergone a hysterectomy (removal of the uterus) to remove multiple, benign fibroids.
Bethenny Frankel
Bethenny Frankel is an American businesswoman, television personality, entrepreneur, and author. She suffered from uterine fibroids and even cited them as a cause of her miscarriage.

Prevention Of Uterine Fibroids 

Uterine fibroids can’t be prevented. However, the risk can be reduced by making healthy lifestyle choices and undergoing regular pelvic examinations. 

The following pointers can be helpful in reducing the risk of uterine fibroids:

Do’s

  • Monitor your menstrual cycle (duration and frequency)

  • Go for regular screening in case of a family history of uterine fibroids

  • Maintain a healthy weight 

  • Add whole grains, vegetables, and fruits to your diet

  • Maintain optimum Vitamin-D levels, by basking in the morning sun and if required adding supplementation

  • Drink plenty of water to flush out toxins

Don'ts

  • Eating too much red meat, processed and packaged foods

  • Eatables or drinks loaded with food additives

  • Too much stress in day-to-day life

  • Alcohol consumption

Understand how drinking water can be beneficial for your overall health.
Watch this video now

 

Specialist To Visit

Uterine fibroids remain undiagnosed until a few symptoms appear. Doctors that can help you diagnose and treat uterine fibroids include

  • General physician

  • Gynecologist 

A general physician can diagnose uterine fibroid during a pelvic examination if the uterus is enlarged or has an irregular shape. It is further confirmed by gynecologists through various diagnostic imaging exams to confirm the presence of these fibroids. 

When to see a doctor?

You should connect with your doctor if you have the following symptoms:

  • Painful periods or heavy bleeding

  • Menstrual periods lasting more than a week. 

  • Anemia 

  • Enlargement of the lower abdomen

  • Chronic vaginal discharge

If you or your loved ones are noticing any of the above symptoms, seek medical help from our trusted team of doctors.

Treatment Of Uterine Fibroids 


There's no single best approach to uterine fibroid treatment, a combination of different treatment options exists. Treatment for uterine fibroids can involve medication to manage symptoms as well as surgical procedures to remove tumors in a few cases. The best option of treatment depends upon the: 

  • The severity of the symptoms

  • The amount of fibroid tissue in the uterus

  •  Whether the individual wants to conceive in the future

1. Be watchful of the symptoms 

Many women with uterine fibroids experience no signs or symptoms, or only mild signs and symptoms that they can live with. In that case, watchful waiting could be the best option. 

The treatment plan depends on the following options:

  • Number of fibroids.

  • The size of your fibroids.

  • Location of fibroids 

  • Symptoms you are experiencing related to the fibroids

  • The desire for pregnancy.

  • The desire for uterine preservation.

2. Medications

Medications for uterine fibroids target hormones that regulate your menstrual cycle and help in treating symptoms such as heavy menstrual bleeding and pelvic pressure. Medications can temporarily ease symptoms but will not eradicate the growth of fibroids. Medicines to manage fibroid symptoms include

  • Gonadotropin-releasing hormone (GnRH) agonists: These medications act by blocking the production of estrogen and progesterone, putting the individual into a temporary menopause-like state. As a result, the menstruation stops and fibroids shrink in size. 

A few examples of GnRH agonists include 

Note: These medications are not used for more than 3-6 months because symptoms return when the medication is stopped and long-term use can cause loss of bone.

  • Birth control: Also known as hormonal birth control in general, can help alleviate fibroid symptoms like heavy bleeding and menstrual pain but not reduce the size of fibroids per se.

            A few examples of birth control options include 

  • Low-dose oral contraceptive pills

  • Intravaginal contraception

  • Progestin-releasing agents: Pills, implant, injection or intrauterine devices (IUD) release a type of the hormone progestin. This may help relieve heavy bleeding caused by fibroids. This method only provides symptomatic relief only and doesn't shrink fibroids or make them disappear. 

  • New drugs: Two new oral therapy drugs have also emerged namely:

The role of elagolix is the management of heavy uterine bleeding in people who haven't experienced menopause with symptomatic uterine fibroids. The role of tranexamic acid is an antifibrinolytic drug used for the treatment of cyclic heavy menstrual bleeding in people with uterine fibroids.

  • Analgesics and Anti-inflammatory drugs: Pain relievers known as nonsteroidal anti-inflammatory drugs may be prescribed to ease pain caused by fibroids.

         A few examples of these drugs are 

  • Ibuprofen 
  • Naproxen 
  • Iron supplements: If a woman is experiencing anemia due to heavy blood loss, doctors may recommend iron supplements. 

       A few examples of iron supplements are: 

Don’t let gaps in your nutrition affect your health. Check out our exclusive range of iron supplements to take care of all your needs.

3. Surgery 

There are several factors to consider when opting for different types of surgery for fibroid removal. The choice of surgery is dependent not only on the size, location, and number of fibroids but also on future pregnancies. Some surgeries are noninvasive, some are minimally invasive while few are conventional surgical procedures. 

Non Invasive surgeries

  • MRI-guided focused ultrasound surgery (FUS): It is a non-invasive procedure that helps in preserving the uterus and requires no incision. Focused ultrasound is not an operation, instead of surgery, high-intensity, focused ultrasound waves are used to heat and destroy fibroid tissue. 

 

Note: This procedure is performed while a person is inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment

 

Minimally invasive surgeries

Certain procedures can help in destroying uterine fibroids without actually removing them through surgery. 

 

  • Radiofrequency ablation (RFA): In this procedure, radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. It is a laparoscopic-guided procedure where laparoscopic ultrasound helps in visualizing the inside of the uterus and maps the locations of fibroids during this procedure. After locating the fibroid, the doctor uses a specialized device to heat up the fibrous tissue and hence destroy it.

 

Note: This procedure is considered to be a safer, newer, and noninvasive alternative to hysterectomy and myomectomy

 

  • Uterine artery embolization (UAE): This is a procedure that treats fibroids without surgery. This is a procedure in which tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. 

  • Hysteroscopic myomectomy: This is the most minimally invasive procedure to treat fibroids. Fibroids are removed through an instrument called a hysteroscope inserted into the uterine cavity through the cervix and vagina. 

  • Robotic myomectomy: This is a type of laparoscopic myomectomy (a small incision in or near your belly button from where a laparoscope is inserted which is a narrow tube fitted with a camera into the abdomen) is used to remove uterine fibroids. 

Note: The larger fibroids can be removed through smaller incisions by breaking them into pieces by a process called morcellation.

 

In all the above procedures, where the uterus is not removed so there is a risk that new fibroids could grow and cause symptoms.

 

Conventional surgical procedures

  • Abdominal myomectomy: This procedure is used in case of multiple fibroids, or very deep fibroids. This is an open abdominal surgical procedure to remove the fibroids but leaves the uterus intact. It involves making an incision through the skin on the lower abdomen and removing the fibroids from the wall of the uterus.

  • Hysterectomy: For women with severe symptoms, or intense fibroid growth based on the size or number of masses, a procedure known as hysterectomy is involved to remove the entire uterus. After undergoing a hysterectomy, a woman does not have a menstrual period and fails to become pregnant. 

Home Care For Uterine Fibroids 

 

Home care goes in hand with the conventional treatment of fibroids. The following pointers can be helpful in managing uterine fibroids:

Diet 

Research suggests that diets high in the following may be helpful to prevent or slow fibroid growth:

  • Fibrous fruits: Fruits that are enriched in dietary fibers and fluid content are very beneficial for curing uterine fibroids. The fiber that is enriched in the fruits helps in eliminating the toxins and the excess estrogen from the body. One should include apples, bananas, raspberries, strawberries, and blueberries in the diet. Apricots and pineapple are also very rich in anti-inflammatory properties that effectively help in managing uterine fibroids.

  • Whole grains: The grains are helpful in releasing the excess estrogen from the body. Grains like oats, brown rice, barley, and quinoa have healing effects in maintaining uterus health. 

  • Eggs: They are rich in proteins and omega-3 fatty acids. Consuming 1-2 eggs daily promotes the good health of the uterus. Eggs have healing properties that contribute to the condition of uterine fibroids.

  • Green tea: Green tea is known to contain two compounds bioflavonoid and epigallocatechin-3-gallate (EGCG). Many studies have shown that the bioflavonoid present in green tea helps in reducing the size and the number of fibroids in the uterus. 

Get to know the Eight Amazing benefits of green tea that can do wonders in your lifestyle.

Special ingredients

The following natural ingredients are known to do wonders for female reproductive health including management of uterine fibroids. However, make sure to consult your doctor before consuming them.

  • Chasteberry tincture

Chasteberry or chaste tree berry is commonly known as Vitex. It is effective in dealing with heavy menstrual flow, cramps, and some other symptoms of uterine fibroids. Taking 20-30 drops of chasteberry tincture twice a day for about two months can shrink small to medium-sized uterine fibroids.

  • Black Cohosh 

Several studies have shown that black cohosh has been used extensively in dealing with gynecological problems. It helps in lowering the estrogen level and increasing the progesterone level, therefore, reducing the development of fibroids and causing the shrinking of fibroids too. 

Black Cohosh root powder can be consumed every day in the form of tea or tablet and helps to get rid of the fibroids naturally.

Exercise 

Regularly exercising will ensure that toxins are eliminated from the uterus, hence very effective in shrinking the fibroids.

  • Since a person is working out to manage the symptoms, avoid workouts that can make the symptoms worsen. Stay away from moves that put pressure on the stomach. 

  • Stay away from lifting heavy weights, since this type of exercise can push more blood into your abdomen and lower body and increases the fibroid blood supply

  • One of the ways to manage fibroids is with cardiovascular exercises like walking, jogging, or swimming. Engaging in cardio is a great way to manage fibroids because the exercise makes you feel happy while maintaining a healthy weight.

Did you know?

A recent study has shown that women with fibroids are more likely to have cardiovascular risk factors than women without fibroids. Therefore, it is important to boost your heart health through cardiovascular exercise when you have fibroids. Engaging in cardio exercise is a great way to manage weight and maintain heart health as well.

Complications Of Uterine Fibroids 

Most women do not experience any symptoms of fibroids, but in rare cases, the fibroids can cause significant problems. 

  • Anemia:  Also called a lack of red blood cells, which can lead to fatigue, dizziness, shortness of breath, or a rapid heartbeat if left untreated. 

  • Issues during pregnancy: If fibroids are present at the time of pregnancy it can lead to problems with the development of the baby or difficulties during labor.

  • Miscarriage: In very cases, fibroids can cause miscarriage (the loss of a pregnancy during the first 23 weeks).

  • Infertility: The inability to become pregnant may occur in cases where a woman has large fibroids.

  • Cardiovascular diseases: Women with fibroids have thicker arteries and hence, the risk of cardiovascular diseases like heart attack and stroke is increased.

Alternative Therapies For Uterine Fibroids 

Acupuncture 

This procedure involves the insertion of very thin needles through your skin at strategic points on the body. It is beneficial in promoting blood flow in the uterus and helping to reduce fibroid sizes.

Yoga 

Yoga has an amazing remedial effect on uterine fibroids. The following yoga asanas are highly recommended for uterine fibroids:

  •  Bhujangasana (Cobra Pose)

  •  Paschimottanasana (Seated forward bend)

  •  Baddha Konasana (Bound Angle Pose)

Living With Uterine Fibroids 

Uterine fibroids are benign noncancerous growths in the uterus that can cause frustrating symptoms like heavy bleeding, pain, etc. These symptoms can affect the quality of life as well as mental health. Some of the tips that can help in managing the symptoms of uterine fibroids in women: 

Handle heavy menstrual flow and its effects

One of the hallmarks of uterine fibroids is heavy menstrual bleeding. High blood loss each month can deplete the body’s iron stores over time. Low iron can lead to iron-deficiency anemia, which causes weakness, and tiredness and affects the oxygen supply to the vital organs.

If a woman is undergoing heavy periods get regular blood tests to make sure the iron levels are within healthy limits. In the case of low levels iron supplements are recommended. 

Get all types of iron supplements with just a single click.

Relieve pelvic pain 

If someone is facing mild mental health symptoms some of the strategies that can help in coping with the effects are: 

  • Engage in regular exercise that can help reduce stress and fight mild or moderate depression

  • Lack of sleep can affect mental health. Make your sleep a priority and sleep for at least 7-8 hours

Struggling to fall asleep? Read about some amazing tips that will help you sleep like a baby.

  • Avoid or limit the intake of caffeine in the form of coffee, tea, and energy drinks which can make the anxiety symptoms worsen

  • Incorporate foods in the diet that can help in reducing stress and anxiety-like high in omega-3 fats and vitamin B complex.

Try these six wonderful herbs to beat stress and anxiety.

Seek medical help

Keep a close eye on the health and the menstrual cycle. Seek medical help if you experience symptoms like 

  • Bleeding between periods 

  • Pain during urination 

  • Signs of anemia

Here are a few signs of anemia that you might be ignoring. 

Do you go through the feeling of a sudden urge to eat? Do you face concentration issues? 

If your answer to all of these questions is YES, then it’s time to wake up and get your health checked!


Frequently Asked Questions

References

  1. Gao, Mei & Wang, Hui. (2018). Frequent milk and soybean consumption are high risks for uterine leiomyoma: A prospective cohort study. Medicine. 97.External Link
  2. Kawano M, Okamoto M, Yano M, Kawano Y. Life-threatening anemia due to uterine fibroids: A case series. Exp Ther Med. 2022 Sep 12;External Link
  3. Millien, C., Manzi, A., Katz, A.M. et al. Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study. Int J Equity Health 20, 1 (2021).External Link
  4. Velez Edwards DR, Baird DD, Hartmann KE. Association of age at menarche with increasing number of fibroids in a cohort of women who underwent standardized ultrasound assessment. Am J Epidemiol. 2013 Aug 1External Link
  5. Vines AI, Ta M, Esserman DA. The association between self-reported major life events and the presence of uterine fibroids. Womens Health Issues. 2010 Jul-Aug;20External Link
  6. Mohapatra S, Iqubal A, Ansari MJ, Jan B, Zahiruddin S, Mirza MA, Ahmad S, Iqbal Z. Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. Pharmaceuticals (Basel). 2022 Feb 23.External Link
  7. Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. J Womens Health (Larchmt). 2018 Nov;27(11):1359-1367.doi:10.External Link
  8. Laughlin-Tommaso SK, Fuchs EL, Wellons MF, Lewis CE, Calderon-Margalit R, Stewart EA, Schreiner PJ. Uterine Fibroids and the Risk of Cardiovascular Disease in the Coronary Artery Risk Development in Young Adult Women's Study. J Womens Health (Larchmt). 2019 Jan. External Link
  9. What are the risk factors for uterine fibroids? National Institute of Child Health and Human Development. February 2018.External Link
  10. Uterine Fibroids. Women’s Health. February 2021. External Link
  11. S Han, E K Choi, K D Han, H J Ahn, S Kwon, S R Lee, S Oh, Increased risk of atrial fibrillation in patients with uterine fibroids: a nationwide population-based study, European Heart Journal, Volume 43, Issue Supplement_2, October 2022External Link
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