Uterine fibroids, or leiomyomas, are benign smooth muscle tumors of the uterus and represent one of the most common gynecological conditions affecting women of reproductive age. While fibroids are non-cancerous, they can significantly impact women's health and quality of life, leading to symptoms such as heavy menstrual bleeding, pelvic pain, pressure symptoms, infertility and recurrent pregnancy loss. Despite their high prevalence—affecting up to 70% of women by the age of 50—awareness of fibroids remains surprisingly low, particularly in rural and semi-urban settings where reproductive health issues are often shrouded in silence and stigma [1-3].

In regions like Himachal Pradesh, socio-cultural taboos, lack of comprehensive health education and misconceptions about reproductive health further complicate the recognition and timely management of uterine fibroids. Symptoms are frequently normalized or misattributed to general menstrual irregularities, delaying diagnosis and effective    treatment.    Moreover,    myths   surrounding   the causes and outcomes of fibroids—such as beliefs linking fibroids to moral failings or inevitable infertility—exacerbate fear and discourage women from seeking medical attention. The consequence is not only prolonged suffering but also an increased risk of complications requiring more invasive interventions [3,4].

Timely diagnosis and appropriate management of fibroids are critical to preserving fertility, improving quality of life and reducing the burden on healthcare systems. However, treatment-seeking behavior is heavily influenced by public awareness, access to healthcare and cultural attitudes toward gynecological diseases. Despite increasing global attention to women's reproductive health, there remains a significant gap in community-level understanding of fibroid symptoms, available treatments and the importance of early medical consultation [5,6].

This study seeks to assess public awareness of uterine fibroids among women in Himachal Pradesh, with a particular focus on knowledge of symptoms, prevailing myths and treatment-seeking behavior. By identifying gaps in awareness and the socio-cultural factors influencing health behaviors, this research aims to inform educational interventions and support early diagnosis and comprehensive care for women affected by uterine fibroids.

Study Design

A descriptive, cross-sectional online survey was conducted to assess public awareness of uterine fibroids, focusing on symptom recognition, prevalent myths and treatment-seeking behavior among women in Himachal Pradesh.

Study Area and Population

The study targeted women aged 18-50 years residing across various districts of Himachal Pradesh. Eligible participants were those who could read and comprehend Hindi or English, had access to an internet-enabled device and consented to participate voluntarily.

Study Duration

The data collection took place over a three-month period, from January to March 2025.

Sample Size and Sampling Technique

Assuming a 50% awareness prevalence of uterine fibroids (due to limited existing rural data), with a 95% confidence level and a 5% margin of error, the calculated minimum sample size was 384. To account for potential incomplete responses, a final target sample size of 420 participants was set. Convenience sampling was employed by disseminating the survey link via digital platforms including WhatsApp groups, Facebook health forums, Instagram pages and community-based women’s networks in Himachal Pradesh.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Women aged 18-50 years

• Residents of Himachal Pradesh

• Ability to read and understand Hindi or English

• Access to an internet-connected smartphone, tablet, or computer

• Willingness to provide informed electronic consent

Exclusion Criteria

• Women with a prior confirmed diagnosis of uterine fibroids (to focus on general public awareness)

• Pregnant women at the time of participation

• Participants unable or unwilling to complete the questionnaire

Data Collection Instrument

A structured, bilingual (Hindi and English) and pre-validated questionnaire was developed and hosted on Google Forms. The questionnaire consisted of four sections:

1. Socio-Demographic Details: Age, educational qualification, marital status, occupation and healthcare access

2. Symptom Awareness: Knowledge of common fibroid symptoms such as heavy bleeding, pelvic pain and infertility

3. Beliefs and Myths: Exploration of misconceptions regarding causes and outcomes of fibroids

4. Treatment-Seeking Behavior: Patterns of medical consultation, preferred treatment modalities and barriers to accessing care

The questionnaire was pilot-tested on 30 women (excluded from final analysis) to ensure clarity, cultural appropriateness and ease of digital administration. Revisions were made based on feedback.

Data Collection Procedure

Participants accessed the survey through a link distributed via social media and community groups. An introductory page explained the study objectives, emphasized confidentiality and anonymity and included an electronic informed consent form. Only one response per participant was permitted to avoid duplication. No personally identifiable information was collected.

Scoring and Categorization

Responses to knowledge-based questions were scored as follows:

• One point awarded for each correct answer.

• Total scores were categorized as:

• Very Good Awareness: ≥80% correct answers

• Good Awareness: 60-79% correct answers

• Fair Awareness: 40-59% correct answers

• Poor Awareness: <40% correct answers

Separate analyses were performed for knowledge of symptoms, myths and healthcare-seeking behavior patterns.

Data Analysis

Data were exported from Google Forms into Microsoft Excel and subsequently analyzed using IBM SPSS version 26.0. Descriptive statistics such as frequencies, means and percentages were used to summarize socio-demographic profiles and awareness levels. 

Ethical Considerations

Electronic informed consent was obtained from all participants prior to enrollment. Ethical principles of voluntary participation, confidentiality and anonymity were strictly adhered to throughout the study.

The socio-demographic analysis of the 420 participants revealed that the majority of women were aged between 26-35 years (38.6%), followed by 18-25 years (31.9%), 36-45 years (24.5%) and a smaller group aged 46-50 years (5.0%). Marital status distribution showed that most participants were married (57.6%), while 36.0% were single and 6.4% were divorced or widowed. Educational attainment varied, with a significant proportion holding an undergraduate degree (36.7%) or completing secondary school education (33.8%), while 11.7% had postgraduate degrees, 11.9% had only primary education and 6.0% had no formal schooling. Regarding occupation, 30.5% were homemakers, 23.1% worked in the private sector, 16.9% were self-employed, 13.3% were government employees and 16.2% were unemployed. In terms of healthcare access, 68.8% reported regular access to healthcare services, whereas 31.2% faced limitations, suggesting potential barriers to timely diagnosis and treatment (Table 1).

Table 1: Socio-demographic characteristics of participants

Awareness levels regarding uterine fibroids were encouraging, with 77.9% correctly identifying fibroids as benign uterine growths and 81.7% recognizing heavy menstrual  bleeding  as  a  common  symptom.  Knowledge  about pelvic pain (75.2%), fertility impacts (71.0%) and the non-cancerous nature of fibroids (78.8%) was substantial. However, awareness regarding risk factors such as family history (65.2%) and obesity (66.9%) was comparatively lower. Myths remained prevalent, with 80.0% refuting moral causes and 80.7% rejecting associations with witchcraft, yet a notable minority still held onto such beliefs. Awareness about non-surgical treatments (61.7%) and fibroid asymptomatic cases (62.6%) was moderate, indicating room for improvement. Encouragingly, a strong majority (84.5%) emphasized the need for prompt medical consultation and 82.4% identified gynecologists as the appropriate specialists for diagnosis and management (Table 2).

Table 2: Awareness and knowledge of uterine fibroids and their management among participants

The classification of participants based on their knowledge scores showed that 45.0% achieved a "Good" level of awareness (60-79% correct responses), while 27.9% demonstrated "Very Good" awareness (≥80%), reflecting a substantial baseline understanding among the surveyed women. However, 20.7% of participants fell into the "Fair" category (40-59%) and 6.4% had "Poor" awareness (<40%), highlighting the existence of significant informational gaps. These results underscore the critical need for broader educational outreach and targeted awareness programs to ensure early recognition, destigmatization and proactive management of uterine fibroids across the population.

Table 3: Knowledge score classification

This study provides crucial insights into the level of public awareness, misconceptions and healthcare-seeking behavior regarding uterine fibroids among women in Himachal Pradesh. Despite uterine fibroids being one of the most common gynecological conditions globally, affecting a significant proportion of women of reproductive age, they continue to be surrounded by misinformation,  stigma,  and  delayed  treatment-seeking, particularly in rural and semi-urban communities. The findings of this research reflect both encouraging progress in basic awareness and alarming gaps that require urgent attention through community education and health system strengthening.

The socio-demographic analysis revealed that a substantial portion of participants were in the most reproductive age groups (18-35 years) and more than half were married, emphasizing the importance of focusing on reproductive health education for this demographic. Educationally, a large proportion had achieved secondary or undergraduate education, which theoretically should facilitate better health literacy; however, the persistence of misinformation suggests that reproductive health topics may still be underemphasized in formal education or overshadowed by cultural taboos. Additionally, nearly one-third of participants reported limited healthcare access, a structural barrier that could exacerbate delays in diagnosis and management, particularly in rural areas where specialty gynecological services may be scarce.

Encouragingly, the awareness that uterine fibroids are benign growths (77.9%) and that they commonly cause heavy menstrual bleeding (81.7%) and pelvic pain (75.2%) was relatively high among participants. Most respondents also correctly acknowledged the non-cancerous nature of fibroids and their potential impact on fertility. These findings suggest a growing recognition of fibroids as a medical condition requiring attention rather than a tabooed topic. However, knowledge about risk factors such as family history (65.2%) and obesity (66.9%) was moderate, indicating that while symptomatic awareness has improved, understanding of underlying risk factors remains inadequate. This partial knowledge could contribute to a false sense of security among at-risk women who are asymptomatic, thereby delaying preventive consultations.

A notable concern was the persistence of cultural myths. Although the majority refuted misconceptions linking fibroids to moral failings (80.0%) or witchcraft (80.7%), the very need for such questions highlights that stigmatizing beliefs still exist in segments of the community. Such myths not only delay medical help-seeking but also exacerbate feelings of guilt, shame and fear among affected women, potentially pushing them towards ineffective traditional remedies rather than evidence-based medical care. Awareness about asymptomatic fibroids was moderate (62.6%), implying that women without overt symptoms might unknowingly harbor fibroids, missing opportunities for early intervention.

Treatment knowledge also showed mixed patterns. While 83.8% correctly recognized the need for gynecological monitoring of fibroids and 84.5% emphasized the importance of seeking prompt medical care for symptoms, only 61.7% were aware that non-surgical management options exist. Additionally, 70.0% understood that surgery is not the only treatment choice. These figures highlight the need for public education campaigns that demystify fibroid management, explaining not just surgical but also hormonal, non-invasive and minimally invasive treatment options such as uterine artery embolization. A lack of knowledge about treatment choices may deter women from seeking care due to fear of surgery or loss of fertility.

The overall knowledge score classification further reinforced the dual reality observed in this study. While 45.0% of women exhibited "Good" awareness and 27.9% demonstrated "Very Good" awareness, a significant 27.1% fell into the "Fair" or "Poor" knowledge categories. This under-informed segment of the population remains particularly vulnerable to delayed diagnosis, progression of disease and avoidable complications such as severe anemia, infertility, or the need for radical surgeries. These findings call for targeted educational interventions that
not only spread basic awareness but also dispel myths, build trust in healthcare systems and emphasize preventive care.

Limitations of the study must be acknowledged. The online nature of the survey likely favored inclusion of women with better internet access and literacy, potentially excluding the most marginalized groups, who may have even lower awareness. Additionally, self-reported knowledge may be subject to social desirability bias, wherein participants provide answers they perceive to be socially acceptable rather than reflecting true understanding.
 

In conclusion, while awareness about uterine fibroids among women in Himachal Pradesh shows encouraging trends, significant knowledge gaps and persistent myths continue to hinder early diagnosis and comprehensive management. There is an urgent need for culturally sensitive, community-driven educational programs that address not only symptoms but also risk factors, treatment options and the importance of timely medical consultation. Health educators, community health workers and gynecological services must collaborate to dismantle stigma, promote reproductive health literacy and empower women to advocate for their own uterine health. Only then can we ensure that whispers of the womb are no longer silenced by fear, but are met with informed action and compassionate care.

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