Risk Assessment in Leiomyoma: An Important Tool in Midlife Women

Uterine leiomyomas are the most common benign tumors of the female reproductive tract and represent a major cause of gynecological morbidity in midlife women.Although the majority of leiomyomas remain asymptomatic and can be managed conservatively, a subset demonstrates rapid growth, significant symptomatology, or rare malignant transformation into leiomyosarcoma.Differentiating low-risk from high-risk cases is therefore critical for individualized patient management, particularly during the perimenopausal period when clinical decision-making is often challenging.This review highlights the evolving concept of risk assessment and stratification in leiomyomas, with emphasis on identifying clinical, biochemical, inflammatory, genetic, and metabolomic predictors of fibroid growth.Emerging evidence suggests that age, body mass index, lipid metabolism, gonadotropins, and systemic inflammatory markers-particularly the neutrophil-to-lymphocyte ratio (NLR)-play important roles in determining growth potential.Advances in prediction modeling, including multivariate nomograms derived from large population-based studies, offer promising tools for early identification of patients at risk for rapid fibroid progression, even in asymptomatic individuals.The review also explores molecular and genetic determinants, such as MED12 mutations, chromosomal rearrangements, and dysregulated metabolomic pathways, which provide mechanistic insights into leiomyoma proliferation and potential therapeutic targets.In addition, recognized risk factors for leiomyosarcoma, including advanced age, prior pelvic irradiation, prolonged tamoxifen exposure, immunodeficiency, and hereditary cancer syndromes, are summarized to aid in distinguishing benign growth from malignant transformation.Incorporating systematic risk stratification into routine clinical practice may facilitate timely intervention, optimize surveillance strategies, and reduce longterm morbidity.A personalized, evidence-based approach to leiomyoma management is essential for improving outcomes in midlife women.