Bacterial Vaginosis and Prospective Ultrasound Measures of Uterine Fibroid Incidence and Growth

Epidemiology. 2022 May 1;33(3):415-421. doi: 10.1097/EDE.0000000000001463.


Background: Uterine fibroids often cause intolerable symptoms leading to invasive treatments, most commonly hysterectomy. Reproductive tract infections are hypothesized to influence uterine fibroid development, but few studies exist, especially for the highly prevalent condition bacterial vaginosis (BV). Both fibroids and BV have documented racial-ethnic disparities, with higher burden in Blacks.

Methods: With prospective data from a community-based study (four standardized ultrasound examinations over 5 years) in young Black women, we examined baseline BV associations with fibroid incidence and growth. We computed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incidence comparing BV and no BV (Nugent score ≥7 vs. <7) using Cox proportional hazards models among 1027 women fibroid-free at baseline. Fibroid growth associations were based on linear mixed models estimating volume change between ultrasounds indexed to 18 months. We then expressed BV association as estimated percent difference in growth per 18 months, comparing exposed and unexposed.

Results: There were n = 247 incident fibroids and 1181 growth measures; average fibroid growth per 18 months was a 78% (95% CI: 69 to 87) increase in volume. BV prevalence was 51% and not associated with fibroid incidence (aHR: 1.0, 95% CI: 0.80 to 1.4) or growth (estimated % difference in growth, -3% (95% CI: -12 to 6).

Conclusions: In this first study (to our knowledge) of ultrasound-monitored fibroid development and Nugent-assessed BV, we found no evidence to support the hypothesis that BV increased risk of fibroid incidence or growth or BV's role in the high burden of fibroids in Black women.

MeSH terms

  • Female
  • Humans
  • Incidence
  • Leiomyoma* / diagnostic imaging
  • Leiomyoma* / epidemiology
  • Prospective Studies
  • Uterine Neoplasms* / diagnostic imaging
  • Uterine Neoplasms* / epidemiology
  • Vaginosis, Bacterial* / diagnostic imaging
  • Vaginosis, Bacterial* / epidemiology