A Systematic Review of Vitamin D and Fibroids: Pathophysiology, Prevention, and Treatment

• Published in: Reproductive sciences (Thousand Oaks, Calif.) Calif.), 2023-04, Vol.30 (4), p.1049-1064
• Main Authors: Combs, Abigail, Singh, Bhuchitra, Nylander, Elisabeth, Islam, Md Soriful, Nguyen, Ha Vi, Parra, Elissa, Bello, Ameerah, Segars, James
• Format: Article
• Language: English
• Subjects: Embryology; Female; Humans; Leiomyoma - complications; Leiomyoma - drug therapy; Leiomyoma - prevention & control; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Pilot Projects; Reproductive Medicine; Review; Uterine Neoplasms - drug therapy; Uterine Neoplasms - pathology; Uterine Neoplasms - prevention & control; Vitamin D - therapeutic use
• ISSN: 1933-7191; 1933-7205
• DOI: 10.1007/s43032-022-01011-z

Uterine fibroids are the most common tumor of reproductive-age women worldwide and cause significant morbidity in affected women. Vitamin D has emerged as a potential therapy for uterine fibroids based on experimental and epidemiologic evidence. The objective of this systematic review was to evaluate the role of vitamin D in the pathophysiology of uterine fibroids and its efficacy for prevention and treatment of fibroids. A comprehensive search was conducted of Cochrane Library, Embase, PubMed, Scopus, and Web of Science from inception to March 2022. English-language publications that evaluated vitamin D and uterine fibroids in humans, whether experimental or clinical, were considered. The search yielded 960 publications, and 89 publications met inclusion criteria: 23 preclinical studies, 25 clinical studies, and 41 review articles. Preclinical studies indicated that the vitamin D receptor was decreased in fibroid cells. Vitamin D treatment of fibroid cells decreased proliferation, extracellular matrix protein expression, and Wnt/β-catenin signaling. Fourteen clinical studies ( n  = 3535 participants) assessed serum vitamin D level in women with ultrasound-proven fibroids, and all found an inverse correlation between serum vitamin D level and presence of fibroids. Five clinical studies ( n  = 472 patients) evaluated treatment of fibroids with vitamin D. Four of five studies showed vitamin D significantly inhibited fibroid growth. One pilot study ( n  = 109 patients) of vitamin D for secondary prevention of fibroids demonstrated smaller recurrent fibroids in the treated group. These studies provide evidence for vitamin D as a therapy for uterine fibroids and underscore the need for well-designed, randomized, placebo-controlled clinical trials.