Uterine fibroids as an underrecognized risk factor for venous thromboembolism: a narrative review

BACKGROUND: Uterine fibroids are a prevalent gynecologic condition traditionally associated with heavy menstrual bleeding and pelvic pressure. However, emerging evidence suggests that large uterine fibroids may also contribute to venous thromboembolism (VTE) by causing mechanical compression of pelvic veins and the inferior vena cava, leading to venous stasis and subsequent thrombosis. This narrative review aims to consolidate current knowledge, discuss diagnostic strategies and management approaches for fibroid-associated VTE, and raise clinical awareness about this often-overlooked complication. METHODS: A comprehensive literature search was conducted across PubMed, PubMed Central, Embase, Scopus, and Google Scholar from January 2000 to April 2024. Studies examining the relationship between uterine fibroids and VTE, including case reports, observational studies, reviews, and management guidelines, were included. A descriptive synthesis of findings was performed. RESULTS: Twenty-four studies were included, demonstrating a consistent association between large uterine fibroids and increased VTE risk. Key mechanisms included venous compression, hormonal influences, and a fibroid-associated hypercoagulable state. Clinical presentations ranged from isolated deep vein thrombosis (DVT) to life-threatening pulmonary embolism (PE). Early diagnosis often relied on pelvic imaging such as ultrasound and MRI. Management strategies involved prompt anticoagulation, individualized surgical planning (primarily hysterectomy), and multidisciplinary coordination. In select cases, prophylactic anticoagulation was suggested for high-risk patients pending surgery. CONCLUSION: Uterine fibroids should be recognized as a potential etiology for unexplained VTE, particularly in women without classic risk factors. Early imaging, anticoagulation, and surgical intervention, when appropriate, can optimize outcomes. Further research is needed to establish standardized screening and management guidelines for this underrecognized cause of thromboembolic disease.