Vitamin D and Physiopathology of Uterine Leiomyomas: Systematic Review in Animal Models, In Vitro Studies, And Clinical Observations
Abstract:
Background: Fibroids are benign tumors found in women of reproductive age and are associated with hormonal, genetic, and molecular variables.
Methods: A systematic review was elaborated to search for the mechanisms by which vitamin D influences the development of fibroids. Electronic databases were searched from January 2009 to October 2019. The Internet search tool includes the PUBMED, COCHRANE, and EMBASE search engines. Scientific articles, meta-analyses, therapeutic guidelines, reviews, and research articles were consulted, and the most recent guidelines on the subject, according to the Brazilian Society of Gynecology. The inclusion criteria were publications in the last ten years in English, Portuguese, and Spanish; publications that met the proposed objective described in PICO: a. Randomized trials; B. Observational studies (including cohort and case-control studies). Exclusion criteria included: articles published before 2009; languages other than English, Portuguese, and Spanish; articles that did not meet the research objectives; ongoing studies and abstracts. For data collection and analysis, the selected studies were divided into: 1. Newcastle-Ottawa Scale-Case-Control Studies and Cohort Studies; 2. COCHRANE manual for systematic intervention reviews.
Results: 12 out of 15 studies were non-randomized studies (80%) with Kappa values above six. Kappa agreement was 0.615, suggesting good or substantial agreement.
Conclusion: Vitamin D (1,25(OH)2 D3) plays a significant role in cell growth control, programmed cell death, and DNA damage. Low levels of Vitamin D seem to be an essential factor in the etiopathogenesis of uterine fibroids.
