Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths of the uterus that often appear during childbearing years. These benign tumors originate from the smooth muscle layer of the uterus and can vary significantly in size, number, and location within the uterine cavity. Although they are typically non-malignant, uterine fibroids can cause a range of symptoms, including heavy menstrual bleeding, prolonged periods, pelvic pain, frequent urination, and complications in pregnancy and fertility. In some cases, fibroids can be asymptomatic and are only discovered during routine gynecological examinations.^1-3

The prevalence of uterine fibroids is notably high among women of reproductive age, with studies suggesting that up to 70-80% of women may develop fibroids by the age of 50. Despite their commonality, the exact etiology of fibroids remains unclear, though factors such as hormonal imbalances, genetic predisposition, obesity, and diet are believed to play a significant role. Given their widespread occurrence and potential impact on women's health, it is crucial for women to be aware of and understand the symptoms, risk factors, and available treatment options for uterine fibroids.^4-7

In rural and semi-urban areas like District Bilaspur in Himachal Pradesh, the challenges of healthcare access and education are pronounced. Traditional beliefs, limited healthcare infrastructure, and low levels of health literacy can impede the timely recognition and management of gynecological conditions such as uterine fibroids. Understanding the level of awareness and knowledge about uterine fibroids among women of reproductive age in Bilaspur is essential for designing effective educational interventions that can improve health outcomes.

Despite the significant prevalence and impact of uterine fibroids, research focusing on public awareness and knowledge in rural Indian settings is sparse. This study aims to address this gap by evaluating the awareness and knowledge levels of uterine fibroids among the general population of women of reproductive age in Bilaspur. Identifying areas of misconception and knowledge deficits will enable the development of targeted public health strategies and educational initiatives to enhance community understanding of uterine fibroids.

By providing an in-depth analysis of the current awareness levels, this study seeks to inform and guide future educational interventions aimed at early diagnosis and effective management of uterine fibroids. This approach is essential to reducing the health burden associated with this condition and improving overall community health outcomes in Bilaspur. Through this research, we aim to contribute valuable insights into public health education and emphasize the need for focused awareness campaigns in areas with limited healthcare access.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Uterine Fibroids among women of reproductive age group in District Bilaspur ,Himachal Pradesh. 

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area: District Bilaspur , Himachal Pradesh

• Study duration- between January  2024 to May 2024

• Study population: The study's target population encompassed all women of reproductive age group who had been residents of District Bilaspur Himachal Pradesh for a minimum of 12 months

• Sample size- A robust sample size of 400  women of reproductive age group was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Uterine Fibroids, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

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

• Description of Tool- 

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

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Uterine Fibroids. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. 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 among women of reproductive age group who were the residents of District Bilaspur Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin 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 study assessed the socio-demographic characteristics and the awareness and knowledge of uterine fibroids among women of reproductive age in District Bilaspur, Himachal Pradesh. A total of 400 participants were surveyed, providing a comprehensive view of the population's understanding of uterine fibroids.

The socio-demographic profile of the study population, as summarized in Table 1, reveals a well-distributed sample across various age groups and other demographic categories. Participants ranged from 18 to over 50 years old, with 27.0% aged 18-25, 32.8% aged 26-35, 25.8% aged 36-45, and 14.5% aged 46-50. Gender distribution was not applicable as the study focused on women. In terms of marital status, 39.8% were single, 52.8% were married, and 7.5% fell into other categories. The majority of participants were Hindus (78.0%), followed by Muslims (13.3%), Sikhs (7.3%), and others (1.5%). Employment status showed that 45.3% were employed, 34.3% were unemployed, and 20.5% were students. Educational attainment varied, with 17.3% having education below high school, 27.0% completing high school, 37.8% holding a graduate degree, and 18.0% having postgraduate or higher education. This diverse socio-demographic profile ensures a broad perspective on the awareness levels within the community.

Table 1: Socio-Demographic Variables of the Study Population (N=400)

Table 2 highlights the participants' knowledge regarding the symptoms of uterine fibroids. A significant portion of the population had heard of uterine fibroids (79.5%) and knew that fibroids can cause heavy menstrual bleeding (78.0%). Additionally, 71.8% of participants were aware that fibroids can cause pelvic pain, 68.3% knew that fibroids can cause frequent urination, and 62.0% recognized that fibroids can cause complications in pregnancy. These findings suggest a relatively high level of awareness regarding the common symptoms associated with uterine fibroids. However, there is still room for improvement, particularly in recognizing all symptoms consistently.

Table 2: Knowledge Regarding Symptoms of Uterine Fibroids (N=400)

Table 3 presents the knowledge regarding the causes and risk factors of uterine fibroids. Participants' awareness that hormonal imbalances can cause fibroids was relatively high (69.5%). Knowledge about other risk factors was also notable, with 67.3% aware that genetic predisposition is a risk factor, 64.3% knowing that obesity can increase the risk of fibroids, 60.3% understanding that diet can affect the development of fibroids, and 57.3% aware that age is a risk factor for fibroids. These results highlight the need for increased education on the various risk factors associated with uterine fibroids to promote better prevention strategies.

Table 3: Knowledge Regarding Causes and Risk Factors of Uterine Fibroids (N=400)

Table 4 shows the participants' awareness of the preventive measures for uterine fibroids. Awareness that maintaining a healthy weight can help prevent fibroids was moderate (59.8%), and 57.8% knew that a balanced diet can help in prevention. Additionally, 54.8% were aware that regular exercise can help prevent fibroids, 52.3% recognized that managing stress can help prevent fibroids, and 50.3% knew that avoiding hormone therapies can help prevent the condition. These findings indicate a need for improved public education on lifestyle modifications that can prevent uterine fibroids.

Table 4: Knowledge Regarding Prevention of Uterine Fibroids (N=400)

Table 5 details the participants' knowledge about the treatment and management of uterine fibroids. Awareness of medication as a treatment for uterine fibroids was 52.3%, and 51.8% knew that surgery can be a treatment option for fibroids. Additionally, 50.5% were aware that lifestyle changes can help manage fibroids, 47.3% knew about non-invasive methods to treat fibroids, and 44.8% understood that untreated fibroids can lead to complications. These findings suggest that while there is some awareness of treatment options, comprehensive knowledge about all available treatments is insufficient.

Table 5: Knowledge Regarding Treatment and Management of Uterine Fibroids (N=400)

Table 6 categorizes the overall knowledge scores of the participants regarding uterine fibroids. A significant portion of the population demonstrated high knowledge levels, with 24.3% falling into the Very Good category (scores between 16-20) and 29.0% in the Good category (scores between 12-15). The Fair category (scores between 8-11) included 29.8% of respondents, while 17.0% had Poor knowledge (scores below 8). These results underscore the variability in knowledge levels within the community and highlight the areas where educational interventions are most needed.

Table 6: Overall Knowledge Score Categories for Uterine Fibroids (N=400)

This study aimed to assess the awareness and knowledge of uterine fibroids among women of reproductive age in District Bilaspur, Himachal Pradesh. The findings provide a comprehensive understanding of the current knowledge levels and highlight significant gaps that need to be addressed through targeted educational interventions.

The socio-demographic data collected from the 400 participants revealed a well-distributed and diverse sample. Participants ranged from 18 to over 50 years old, with 27.0% aged 18-25, 32.8% aged 26-35, 25.8% aged 36-45, and 14.5% aged 46-50. Marital status showed that 39.8% were single, 52.8% were married, and 7.5% fell into other categories. The majority of participants were Hindus (78.0%), followed by Muslims (13.3%), Sikhs (7.3%), and others (1.5%). Employment status showed that 45.3% were employed, 34.3% were unemployed, and 20.5% were students. Educational attainment varied significantly, with 17.3% having education below high school, 27.0% completing high school, 37.8% holding a graduate degree, and 18.0% having postgraduate or higher education. This diverse socio-demographic profile ensures a broad perspective on the awareness levels within the community.

The knowledge of uterine fibroid symptoms among the participants was relatively high. As shown in Table 2, 79.5% had heard of uterine fibroids, and 78.0% knew that fibroids can cause heavy menstrual bleeding. Awareness of specific symptoms was also substantial, with 71.8% identifying pelvic pain, 68.3% recognizing frequent urination, and 62.0% aware that fibroids can cause complications in pregnancy. These findings indicate that basic awareness of uterine fibroid symptoms is relatively good among the general public. However, the data also suggest room for improvement, particularly in recognizing all symptoms consistently.

Table 3 highlights the participants' understanding of the causes and risk factors of uterine fibroids. While 69.5% knew that hormonal imbalances can cause fibroids, awareness of other risk factors was moderate. Specifically, 67.3% were aware that genetic predisposition is a risk factor, 64.3% knew about the impact of obesity, 60.3% recognized the role of diet, and 57.3% were aware that age is a risk factor. These findings underscore the need for increased education on the various risk factors associated with uterine fibroids, as a comprehensive understanding of these factors is crucial for effective prevention and management.

The knowledge of uterine fibroid prevention, as shown in Table 4, was moderate. Awareness that maintaining a healthy weight can help prevent fibroids was 59.8%, and 57.8% knew that a balanced diet can help in prevention. Additionally, 54.8% were aware that regular exercise can prevent fibroids, 52.3% recognized the importance of managing stress, and 50.3% knew that avoiding hormone therapies can help prevent the condition. These findings indicate a need for improved public education on lifestyle modifications that can prevent uterine fibroids.

Table 5 details the knowledge about the treatment and management of uterine fibroids. Awareness of medication as a treatment for uterine fibroids was 52.3%, and 51.8% knew that surgery can be a treatment option for fibroids. Additionally, 50.5% were aware that lifestyle changes can help manage fibroids, 47.3% knew about non-invasive methods to treat fibroids, and 44.8% understood that untreated fibroids can lead to complications. These findings suggest that while there is some awareness of treatment options, comprehensive knowledge about all available treatments is insufficient.

The overall knowledge scores, categorized in Table 6, reveal significant variability in the participants' understanding of uterine fibroids. While 24.3% demonstrated very good knowledge (scores between 16-20) and 29.0% had good knowledge (scores between 12-15), a considerable portion (29.8%) had fair knowledge (scores between 8-11), and 17.0% had poor knowledge (scores below 8). These results highlight the disparities in knowledge levels within the community and indicate that a substantial number of individuals lack essential information about uterine fibroids.

Comparing these findings with similar studies conducted in other regions reveals a consistent pattern of knowledge gaps concerning uterine fibroids. Studies from various rural and semi-urban areas have shown that while there is general awareness of uterine fibroids, detailed knowledge about symptoms, risk factors, prevention, and treatment remains limited. This consistent gap underscores the universal need for enhanced public health education and awareness programs.

The findings of this study underscore the critical need for targeted educational interventions to improve public awareness and knowledge of uterine fibroids in Bilaspur. Public health campaigns should focus on increasing awareness about the symptoms, causes, risk factors, preventive measures, and treatment options for uterine fibroids. Leveraging digital platforms, community meetings, and local health workers could enhance the reach and effectiveness of these campaigns. Educational programs should emphasize the importance of early diagnosis and treatment, the role of lifestyle changes in managing uterine fibroids, and the potential complications of untreated fibroids.

This study reveals critical insights into the awareness and knowledge of uterine fibroids among women of reproductive age in Bilaspur, Himachal Pradesh. While basic awareness is relatively high, significant gaps exist in understanding the symptoms, causes, risk factors, prevention, and treatment of uterine fibroids. These findings highlight the urgent need for comprehensive educational interventions to enhance public health literacy. Targeted public health campaigns, utilizing digital platforms, community meetings, and local health workers, are essential to address these knowledge deficits. By focusing on the various aspects of uterine fibroids, these initiatives can promote early diagnosis, effective management, and prevention, ultimately reducing complications and improving the quality of life for affected women. Continuous public health education in rural and semi-urban areas is vital to ensure better health outcomes and effective management of common gynecological conditions like uterine fibroids.

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