Submucosal uterine fibroids are associated with bacterial vaginosis

Uterine fibroids and bacterial vaginosis reduce the quality of life for millions of women. Though the etiology of bacterial vaginosis is unclear, it is characterized by dysbiosis in the vaginal microbiome facilitated by uterine bleeding. Submucosal fibroids can cause abnormal uterine bleeding. The possibility that submucosal fibroids might promote a state of bacterial vaginosis has not been rigorously evaluated. Thus, we sought to determine if there was an association between submucosal fibroids and a subsequent diagnosis of bacterial vaginosis. We performed an IRB-approved retrospective cohort study of 189 participants with a prior diagnosis of uterine fibroids who had imaging studies sufficient to permit characterization of fibroid location. The primary outcome was the association between fibroid location and a subsequent diagnosis of bacterial vaginosis. Categorical variables were analyzed using Pearson’s chi-squared or Fisher’s exact test and nonparametric continuous variables were analyzed using Wilcoxon Rank-Sum test. Multivariate logistic regression models were used to assess the adjusted relationship between uterine fibroids and bacterial vaginosis. Of the 189 participants, 40 (21.16%) had at least one submucosal fibroid and 113 (59.79%) developed bacterial vaginosis following a fibroid diagnosis. Women with bacterial vaginosis were more likely to have submucosal fibroids compared to women without (28.32% vs 10.53%, P = 0.003). After adjusting for covariates, the odds of a subsequent diagnosis of bacterial vaginosis were higher among women with submucosal fibroids, compared to those without (OR: 3.04, 95% CI: 1.29–7.14). Both women with submucosal fibroids and women with bacterial vaginosis demonstrated higher likelihoods of experiencing menorrhagia (77.5% vs 42.3%, P < 0.001; 65.5% vs 26.3%, P < 0.001) and anemia (57.5% vs 39.6%, P = 0.043; 52.2% vs 30.3%, P = 0.003), undergoing fibroid-related surgeries (72.5% vs 37.6%, P < 0.001; 62% vs 19.7%, P < 0.001), and taking medications for fibroid-related bleeding (52.5% vs 26.9%, P = 0.002; 44.3% vs 14.5%, P < 0.001), compared to women without submucosal fibroids and women without bacterial vaginosis, respectively. We detected a strong association between submucosal fibroids and bacterial vaginosis.