Study of association between hypovitminosis D and fibroid uterus

Authors

  • Sangeeta Choudhary Department of Obstetrics and Gynecology, NDMC and Hindu Rao Hospital, Delhi, India
  • Mala Shukla Department of Obstetrics and Gynecology, NDMC and Hindu Rao Hospital, Delhi, India
  • Ruchi Joshi Department of Obstetrics and Gynecology, NDMC and Hindu Rao Hospital, Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20212188

Keywords:

Uterine fibroid, Vitamin D3, Obesity, Leiomyoma

Abstract

Background: Fibroid uterus or leiomyoma is a benign tumour composed mainly of unicellular smooth muscle cells with varying amounts of fibrous connective tissue. UF are associated with significant morbidity as it presents in form of abnormal uterine bleeding, anaemia, pelvic pain, subfertility, and obstetric complications and causes financial burden on the patient. Recent studies have shown the critical role that vitamin D plays in fibroid formation, with individual fibroids expressing lower levels of vitamin D receptors than adjacent healthy tissue, making vitamin D deficiency a crucial, yet preventable risk factor.

Methods: This was cross-sectional observational study. It was conducted on 140 female patients aged (18 to 50 years) presenting to the OPD of department of obstetrics and gynecology at NDMC & Hindu Rao Hospital during July 2019 to June 2020. 70 women had uterine fibroids on ultrasound and treated as cases and rest healthy women without fibroids served as controls. All women were subjected to ultrasound examination of uterus followed by serum vitamin D3 levels.

Results: The mean value of vitamin D levels in cases was 12.81±8.56 ng/ml and in controls it was 19.83±9.21 ng/ml with p value<0.0001. Thus, it was statistically significant lower in cases of fibroid uterus as compared to controls. Secondary incidental outcomes were found between vitamin D3 level and BMI as fibroids occur statistically significantly more often in patient having of BMI ≥25 kg/m2. Also, menorrhagia and dysmenorrhea were the major complaints in 62.5% of cases followed by lowers abdominal pain and dyspareunia.

Conclusions: Our study reached significance in the inverse correlation between fibroids and vitamin D levels at the primary outcome level. Larger prospective longitudinal studies drawing on more number and eliminating confounding variables are needed.

References

Lethaby A, Vollenhoven B. Fibroids (uterine myomatosis, leiomyomas). BMJ Clin Evid. 2011;2011:0814.

Ishikawa H, Ishi K, Serna VA, Kakazu R, Bulun SE, Kurita T. Progesterone is essential for maintenance and growth of uterine leiomyoma. Endocrinology. 2010;151(6):2433-42.

Ali M, Shahin SM, Sabri NA, Hendy A, Yang Q. Hypovitaminosis D exacerbates the DNA damage load in human uterine fibroids, which is ameliorated by vitamin D3 treatment. Acta Pharmacol Sin. 2019;40(7):957-70.

Ciebiera M, Wlodarczyk M, Zgliczynska M, Lukaszuk K, Meczekalski B, Kobierzycki C, et al. The role of tumor necrosis factor alpha in the biology of uterine fibroids and the related symptoms. Int J Mol Sci. 2018;19(12):3869

Brakta S, Diamond JS, Hendy A, Diamond MP, Halder SK. Role of vitamin D in uterine fibroid biology. Fertil Steril. 2015;104(3):698-706.

Elhusseini H, Elkafas H, Abdelaziz M, Halder S, Atabiekov I, Eziba N, et al. Diet-induced vitamin D deficiency triggers inflammation and DNA damage profile in murine myometrium. Int J Women's Health. 2018;10:503-14.

Sabry M, Hendy A. Innovative oral treatments of uterine leiomyoma. Obstet Gynecol Int. 2012;943635.

Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J Pharmacol Pharmacother. 2012;3(2):118-26.

Kalampokas T, Kamath M, Boutas I, Kalampokas E. Ulipristal acetate for uterine fibroids: a systematic review and meta-analysis. Gynecol Endocrinol. 2016;32(2):91-6.

Blauer M, Rovio PH, Ylikomi T, Heinonen PK. Vitamin D inhibits myometrial and leiomyoma cell proliferation in vitro. Fertil Steril. 2009;91(5):1919-25.

Hendy A, Diamond MP, Sohemy A, Halder SK. 1,25-dihydroxyvitamin D3 regulates expression of sex steroid receptors in human uterine fibroid cells. J Clin Endocrinol Metab. 2015;100(4):572-82.

WHO Scientific Group on the Prevention and Management of Osteoporosis‎. Prevention and management of osteoporosis: report of a WHO scientific group. Geneva: Switzerland; WHO; 2003.

Ajmani SN, Sarbhai V, Singh S, Ajmani A, Pant L. To establish the association of vitamin D levels with leiomyoma and its role as a risk factor for development of leiomyoma uterus. Indian Obstet Gynaecol. 2018;8(4):46-9.

Singh V, Barik A, Imam N. Vitamin D3 Level in Women with Uterine Fibroid: An Observational Study in Eastern Indian Population. J Obstet Gynaecol India. 2019;69(2):161-5.

Oskovi KZA, Taşçi Y, Topçu HO, Erkaya S. 25-Hydroxy vitamin D levels in premenopausal Turkish women with uterine leiomyoma. Gynecol Endocrinol. 2018;34(3):261-4.

Paffoni A, Somigliana E, Vigano P, Benaglia L, Cardellicchio L, Pagliardini L, et al. Vitamin D status in women with uterine leiomyomas. J Clin Endocrinol Metab. 2013;98(8):1374-8.

Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin d and the risk of uterine fibroids. Epidemiology. 2013;24(3):447-53.

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Published

2021-05-27

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Original Research Articles