Can Uterine Fibroids Cause Polycythemia?
Yes, uterine fibroids can cause polycythemia, though this is an extremely rare complication, particularly with large fibroids in postmenopausal women. 1
Mechanism of Fibroid-Associated Polycythemia
The development of polycythemia from uterine fibroids occurs through three postulated mechanisms 1:
Intratumoral hypoxia and shunting: Large fibroids develop complex vascular networks that may create hypoxic conditions within the tumor, triggering compensatory erythropoietin production 1
Ureteral compression: Massive fibroids can compress the ureters, leading to inappropriate excessive erythropoietin production by the kidneys in response to perceived renal hypoxia 1
Ectopic erythropoietin production: The fibroid tumor itself may directly produce erythropoietin 1
Clinical Context and Rarity
This is an exceptionally uncommon presentation that contrasts sharply with the typical hematologic manifestation of fibroids:
The overwhelming majority of symptomatic fibroids cause anemia, not polycythemia, with iron deficiency anemia affecting approximately 10% of women in the United States due to heavy menstrual bleeding (≥80 mL/month) 2
Polycythemia associated with fibroids has been documented primarily in postmenopausal women with very large tumors 1
The case literature describes fibroids that increased in size over time in postmenopausal women, which itself raises concern for malignancy until proven otherwise 1
Critical Clinical Pitfall
When encountering a postmenopausal woman with an enlarging fibroid and polycythemia, leiomyosarcoma must be excluded. 3, 1
Postmenopausal fibroid growth or persistent abnormal bleeding significantly increases suspicion for malignancy 3
Leiomyosarcomas comprise only 0.1% of all uterine tumors, but incidence increases to 1.7% in women undergoing hysterectomy for fibroids in their seventh decade 3
Definitive histopathologic examination is essential to confirm benign leiomyoma versus sarcomatous transformation 1
Management Approach
For a woman presenting with polycythemia and uterine fibroids 1:
Treat the polycythemia symptomatically with therapeutic phlebotomy (venesection) while evaluating the fibroid 1
Perform definitive surgical management with total abdominal hysterectomy and bilateral salpingo-oophorectomy, particularly in postmenopausal women 1
Obtain complete histopathologic examination of all specimens to exclude malignancy 3, 1
Resolution of polycythemia typically occurs after removal of the causative fibroid 1