The most frequent benign pelvic tumors in women are uterine fibroids (UFs). It is challenging to estimate prevalence of UFs because many of them are asymptomatic.  Depending on the study population and methodology, prevalence estimates range from 4.5 to 68.6%, dropping after menopause after increasing with age [1-3].

Uncertainty surrounds the pathogenesis of UF. There are a number of risk factors that have been found, from genetic susceptibility to a variety of lifestyle choices. An important risk factor for developing UF is a favorable family history. Smoking, obesity, using contraceptives, dyslipidemia, and vitamin D deficiency are all modifiable lifestyle variables that may have a major impact on the occurrence of UF [3,4].

UF symptoms can have a negative effect on daily functioning and quality of life (QoL). Patients' symptoms differ however many UF-afflicted women experience many symptoms. The most prevalent symptom, heavy menstrual bleeding (HMB), affects roughly one-third of individuals and can cause life-threatening anemia.  Menstrual pain is affected by the size and placement of the UF, but not premenstrual discomfort or pain experienced during sexual activity. Fibroid size, which frequently exceeds 10 cm in diameter, can, however, cause additional "direct" or "bulk" symptoms such abdominal protrusion, pelvic pressure, urine urgency, frequency, or incontinence, as well as constipation and/or tenesmus [5-8].

Unsurprisingly, UFs are linked to a number of poor reproductive outcomes. In 1 to 3% of patients, they are the only known cause of infertility and are linked to 10% of infertility cases.  The extent to which this association is causal rather than confounded by other factors associated with these outcomes, such as black race and older maternal age,  is  unclear.  UFs  are  also  linked  to  a  number of pregnancy-related complications, spontaneous abortion, preterm delivery, and caesarean delivery [8,9].

Chronic UF symptoms can ultimately have a significant negative influence on a patient's daily life, making it difficult for them to maintain their emotional and psychological well-being.  A common emotional response to UF is the concern of self-image and worth, which can contribute to difficulties in relationships. Fatigue and missing work due to UF are reported by many women [9,10].

For many women, lack of awareness regarding UF may lead to living with the condition chronically without seeking care.  Numerous researches have been conducted on uterine fibroids in various regions of India, but very few of these studies have been conducted in the state of Himachal Pradesh. Therefore, the aim of this study was to investigate the extent to which women in the state were aware of Uterine fibroids. 

Objectives of the Study

To evaluate the awareness about Uterine fibroids among women of reproductive age group in Himachal Pradesh.

Research Methodology

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area:  Whole state of Himachal Pradesh

• Study duration- between January 2023 to March 2023

• Study population: All women of reproductive age group who were staying in the Himachal Pradesh for 12 months or more. 

• Sample size: 400 women of reproductive age group assuming 50% have adequate knowledge regarding Uterine fibroids, 5% absolute error, 95% confidence level, and 5% nonresponse rate.

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and Uterine fibroids was created. The questionnaire was initially pre-tested on a small number of women of reproductive age group to identify any difficulty in understanding by the respondents. 

Description of Tool

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

• Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about Uterine fibroids having three options i.e. Yes, No & Don’t Know.  The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero in each category. Scoring was done on the basis of marks as >80% (16-20) = very good,60-79 % (12-15) =Good,41-59% (8-11) = Fair, <40% (< 8) = poor

• Validity of tool - by the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn among women of reproductive age group in both rural and urban area of Himachal Pradesh till the 400 responses were collected.

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage.

• Ethical Considerations: Participants confidentiality and anonymity was maintained.

The goal of the current study was to assess the awareness about Uterine fibroids among women of reproductive age group in Himachal Pradesh through a non-experimental descriptive survey.

Table-1: Knowledge regarding uterine fibroids among study participants

Table 2: Knowledge score regarding Uterine fibroids among study participants

A total of 400 respondents took part in the study, including 248 (62%) coming from rural areas and 152 (38%) from urban areas.

In the present study 15.5% (62) participants had very good knowledge (16-20 marks) towards Uterine fibroids, 31.25% (125) had good knowledge (12-15 marks), 34.5% (138) had fair knowledge (8-11 marks) and 18.5% (75) having poor knowledge (<8 marks).

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Uterine fibroids are benign tumors that grow in the uterus of women of childbearing age. Fibroids are not cancerous and are not thought to be able to become cancerous. However, it can sometimes be difficult to determine if a mass in the uterus is a common fibroid or a rare cancerous tumor [3,4].

Fibroids are very common. Approximately 80 percent of females will have fibroids in their lifetime, although not everyone has bothersome symptoms. While most fibroids do not cause any symptoms, some common symptoms include abdominal pain, heavy bleeding, enlargement of the lower abdomen, frequent urination, complications with pregnancy, reproductive problems and more. Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility. Fibroids typically resolve after menopause, but it is a leading reason for hysterectomy (surgical removal of the uterus) when they cause severe symptoms [4-7].

Uterine fibroids affect a large segment of the population and can negatively impact daily living and QoL of those affected, resulting in severe occupational and economic costs [7,8].

In the present study 15.5% (62) participants had very good knowledge (16-20 marks) towards Uterine fibroids, 31.25% (125) had good knowledge (12-15 marks), 34.5% (138) had fair knowledge (8-11 marks) and 18.5% (75) having poor knowledge (<8 marks). Our results show that the study's participant women in Himachal Pradesh who were of reproductive age had insufficient awareness of Uterine fibroids. We need to encourage all women to talk to their healthcare providers about uterine fibroids to help understand the risk, diagnosis, managing symptoms and treatment options. 

The results of this study have revealed information regarding women's understanding about Uterine fibroids in the study area, which may be used to develop effective interventions and as a foundation for additional large-scale studies in other regions of the nation.

Limitations of the study 

The present study has certain limitations such as cross sectional in nature, and small sample size that made difficult to generalize the findings. Future research should be focused on larger sample and qualitative studies such as focus group interviews to identify barriers to promote appropriate knowledge about Uterine fibroids.

These results indicate that most of the women participated in our study were not aware about Uterine fibroids. Therefore, adequate and substantial measures should be taken to health educate women on symptoms and treatment modalities of Uterine fibroids. Additional research is needed to further assess women's knowledge of fibroids and to develop interventions for patient education.

1. Al-Hendy, et al. "Uterine Fibroids: Burden and Unmet Medical Need." Seminars in Reproductive Medicine, vol. 35, no. 6, Nov. 2017, pp. 473–480.

2. Healthline. "Fibroid Pain." Available at: https://www. healthline.com/health/womens-health/fibroid-pain. Accessed 7 Apr. 2023.

3. Healthdirect. "Uterine Fibroids." Available at: https:// www.healthdirect.gov.au/uterine-fibroids. Accessed 7 Apr. 2023.

4. Mount Sinai. "Uterine Fibroids." Available at: https:// www.mountsinai.org/health-library/diseases-conditions/uterine-fibroids. Accessed 8 Apr. 2023.

5. UpToDate. "Uterine Fibroids: Beyond the Basics." Available at: https://www.uptodate.com/contents /uterine-fibroids-beyond-the-basics/print. Accessed 9 Apr. 2023.

6. WomensHealth.gov. "Uterine Fibroids." Available at: https://www.womenshealth.gov/a-z-topics/uterine-fibroids. Accessed 9 Apr. 2023.

7. Cleveland Clinic. "Uterine Fibroids." Available at: https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids. Accessed 10 Apr. 2023.

8. Healthline. "Uterine Fibroids." Available at: https://www .healthline.com/health/uterine-fibroids#:~:text=Fibroids%20are%20abnormal%20growths%20that,are%20typically%20benign%2C%20or%20noncancerous. Accessed 11 Apr. 2023.

9. MedlinePlus. "Uterine Fibroids." Available at: https:// medlineplus.gov/ency/article/000914.htm. Accessed 12 Apr. 2023.

10. Mayo Clinic. "Uterine Fibroids: Symptoms and Causes." Available at: https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288#:~:text=In%20women%20who%20have%20symptoms,Pelvic%20pressure%20or%20pain. Accessed 13 Apr. 2023.