Fibroid uterus is more common in

Appeared in: UPPSC 2017

Explanation

Uterine fibroids (leiomyomas) are benign tumors whose growth is stimulated by hormones, particularly estrogen.
Nulliparity, the state of never having completed a pregnancy, results in prolonged and uninterrupted exposure to estrogen throughout a woman's reproductive life.
This continuous estrogenic environment promotes the development and growth of fibroids.
In contrast, each pregnancy provides a significant hormonal shift that interrupts this continuous exposure, making multiparity a protective factor.

Option B: Fibroids are estrogen-dependent. After menopause, estrogen levels drop significantly, which typically causes fibroids to stop growing or shrink. New fibroids are very unlikely to develop post-menopause.
Option C: Multiparity (having multiple pregnancies) is a known protective factor against fibroids. The hormonal changes during pregnancy interrupt the cumulative, lifelong exposure to estrogen, thereby reducing the risk.
Option D: While the prevalence of fibroids is highest in women over 35, this is a demographic observation representing the cumulative effect of hormonal exposure over time. Nulliparity is a more direct and fundamental risk factor related to the underlying pathophysiology of unopposed estrogen.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Risk factors for uterine fibroids (leiomyomas) as background academic context rather than a clinical decision trigger.
Nurses should be aware of fibroid risk factors to identify patients who may need screening or education.
Common symptoms of fibroids include heavy menstrual bleeding (menorrhagia), pelvic pain or pressure, and frequent urination. These can lead to complications like anemia and may significantly impact a patient's quality of life.
Patient education is key, covering topics like symptom management, treatment options (medical vs. surgical), and reassurance that fibroids are typically benign.

How to Approach the Question

First, identify the core concept of the question, which is the risk factors for uterine fibroids.
Recall the key pathophysiological feature of fibroids: they are estrogen-dependent tumors.
Evaluate each option based on this principle. Ask yourself: 'Does this condition increase or decrease lifetime estrogen exposure?'
Eliminate 'Post-menopausal women' because menopause involves a decrease in estrogen.
Eliminate 'Multiparity' because pregnancy interrupts continuous estrogen exposure, making it a protective factor.
You are left with 'Nulliparous women' and 'After 35 years of age'. Both are associated with fibroids.

Concept Tested & Keywords

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E6 Gynecology Williams pp. 216-260, 285-349

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