Uterine Fibroids: History and Discovery

Uterine fibroids — known in medicine as leiomyomas or myomas — are benign tumours of the smooth muscle of the uterine wall, and they are the most common tumours found in women. They are also among the oldest growths described in the written record: Hippocrates, in the fifth century BCE, called them "stones" of the womb, and hardened, calcified fibroids ("womb stones") have been recovered from ancient and early-modern human remains. This page traces the long arc from those antique observations — through the nineteenth-century pathologists who proved fibroids arise from muscle, the bold early surgeons who first cut them out, and into the modern era of artery embolization, focused ultrasound, and hormone-targeting drugs — while keeping faith with one principle: every named discoverer, date, and "first" below has been checked against the medical-historical literature, and where the science is still uncertain it is labelled as such.

Table of Contents

  1. Antiquity: "Stones of the Womb"
  2. Naming the Tumour: Fibroid, Myoma, Leiomyoma
  3. Virchow and the Pathologists: A Muscle, Not a Fibre
  4. The Atlee Brothers and the First Myomectomies
  5. Hysterectomy: From Disaster to Cure
  6. Ravina and Uterine Artery Embolization
  7. Focused Ultrasound and Modern Medical Therapy
  8. Hormone Dependence and the Burden in Black Women
  9. Legacy: An Old Tumour, a Changing Toolkit
  10. Research Papers and References
  11. Connections

Antiquity: "Stones of the Womb"

Fibroids are old enough to have left physical traces in human remains, and old enough to appear in the very first medical texts of the Western tradition. The Greek physician Hippocrates (c. 460–370 BCE), working on the island of Kos, is traditionally credited with describing hard masses of the uterus as "stones" of the womb — an apt lay image for the firm, sometimes gritty feel of these growths. Centuries later Galen (second century CE) referred to similar uterine masses as scleromas, meaning hardened tumours. Neither physician could know what we know now — that the "stone" is a knot of smooth muscle — but both recognised it as a distinct, palpable thing.

The "womb stone" image is more than metaphor. Fibroids that outlive their blood supply or persist after menopause often calcify, turning genuinely stony, and such calcified leiomyomas have been recovered from archaeological contexts. A documented example is a calcified uterine leiomyoma from an eighteenth-century nunnery in northern Italy, reported in the paleopathology literature, and radiographic studies of preserved remains have identified pelvic calcifications consistent with fibroids. These hardened relics are the literal "stones" that ancient observers were describing.

What antiquity could offer was recognition, not understanding. Physicians from Hippocrates onward could feel a mass, note the heavy bleeding and pressure it caused, and watch it grow or harden — but they had no concept of its cellular origin and, for more than two thousand years, no safe way to remove it. That double story — early, accurate observation paired with long therapeutic helplessness — defines the history of fibroids until the nineteenth century.

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Naming the Tumour: Fibroid, Myoma, Leiomyoma

The names we use today were coined in the nineteenth century, and they encode a small scientific argument about what the tumour actually is. The word "fibroid" — literally "fibre-like," implying a fibrous (connective-tissue) growth — is generally attributed to the pathologists Carl von Rokitansky (1860) and Julius Klob (1863). The term stuck in everyday and clinical English and remains the standard lay word, even though, as the next section explains, it slightly misnames the tumour's true tissue of origin.

The more precise term is "myoma" — a muscle tumour — and its fuller form "leiomyoma," built from the Greek roots leio- (smooth) + myo- (muscle) + -oma (tumour), i.e. a tumour of smooth muscle. Because the uterine wall (the myometrium) is made of smooth muscle, "uterine leiomyoma" is the anatomically exact name pathologists prefer. In practice the words coexist: patients and clinicians say fibroid, pathology reports say leiomyoma, and the older literature often says myoma or fibromyoma as a compromise reflecting that the tumours contain both muscle and a fibrous matrix.

This terminological layering is a useful historical fossil. "Fibroid" preserves the mid-nineteenth-century belief that the growth was essentially fibrous; "leiomyoma" records the correction that followed when microscopy showed the growth was essentially muscular. The everyday survival of the older, less accurate term is simply a matter of habit and familiarity — a reminder that medical language often keeps a word long after the science behind it has moved on.

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Virchow and the Pathologists: A Muscle, Not a Fibre

The decisive scientific advance came from the microscope and from the founder of modern cellular pathology, Rudolf Virchow. Virchow is widely credited with demonstrating, around 1854, that these uterine tumours originate from the smooth muscle of the uterus — that is, they are myomas, not merely fibrous overgrowths. This reframing matters: it located the tumour's biology in the contractile muscle of the womb itself, which helps explain why fibroids can distort the uterine cavity, interfere with its contractions, and cause the heavy, sometimes disabling bleeding for which they are notorious.

Virchow worked within a wider nineteenth-century effort to classify tumours by their tissue of origin. Carl von Rokitansky, the great Viennese pathologist, and his contemporary Julius Klob described the growths pathologically and supplied the "fibroid" terminology; Virchow's contribution was to insist, on histological grounds, on the smooth-muscle (myomatous) nature of the lesion. Out of this collective work emerged the modern understanding of the fibroid as a clonal, benign proliferation of myometrial smooth-muscle cells embedded in an abundant extracellular matrix of collagen — the fibrous element that had so impressed earlier observers and given the tumour its common name.

It is worth being careful with attributions here, because popular accounts sometimes compress this history. The honest summary is that the smooth-muscle origin of uterine fibroids was established by mid-nineteenth-century microscopic pathology, with Virchow the name most consistently associated with that demonstration and Rokitansky and Klob credited with the descriptive pathology and the "fibroid" term. The precise division of credit among them is a matter of historical record rather than of any single dramatic discovery, and is reported here accordingly.

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The Atlee Brothers and the First Myomectomies

Knowing what a fibroid was did not make it safe to remove one. Surgery on the nineteenth-century abdomen meant operating without anaesthesia (before the mid-1840s) and without antisepsis (before the 1860s and 1870s), against constant threats of haemorrhage and fatal infection. Against this backdrop, two American brothers from Lancaster, Pennsylvania — Washington Lemuel Atlee and his older brother John Light Atlee — became central figures in the birth of myomectomy, the operation that removes a fibroid while sparing the uterus.

Washington Atlee is credited with performing an early myomectomy in the United States in the mid-1840s, with a landmark case reported in the American medical literature around 1845: through a long midline abdominal incision — and, in that pre-anaesthetic era, against extraordinary odds — he removed a large pedunculated (stalked) uterine fibroid, ligated the stalk, closed the abdomen, and the patient survived. In 1853 he pressed the case for surgical attack on fibroids before the American Medical Association in a prize-winning essay on the surgical treatment of fibrous tumours of the uterus "heretofore considered beyond the resources of art" — a deliberate challenge to the prevailing therapeutic fatalism. The Atlee brothers, who had trained and practised together, are remembered jointly as pioneers of bold abdominal gynaecological surgery in the era just before modern anaesthesia and antisepsis transformed the field.

The significance of these operations is best understood in context: they were rare, dangerous, and controversial, undertaken when no safer option existed. Yet they proved a crucial point — that a fibroid could be surgically removed and the patient could live — and they planted the idea of uterine-sparing surgery that, refined over the next century and a half by anaesthesia, antisepsis, sutures, blood transfusion, and eventually laparoscopy, remains central to fibroid care for women who wish to keep their uterus.

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Hysterectomy: From Disaster to Cure

Running parallel to myomectomy was the more radical operation of hysterectomy — removal of the uterus itself — which became, and in many cases remains, a definitive cure for symptomatic fibroids. Its early history is sobering. The first abdominal hysterectomies in the 1840s were largely catastrophes: Charles Clay of Manchester, England, is credited with an early attempt around 1843, but his patients died, in part because the pathology was misjudged. For two decades the operation killed nearly everyone who underwent it, the usual causes being haemorrhage, peritonitis, and exhaustion.

The turning point came in 1853 in Lowell, Massachusetts. Walter Burnham is credited with the first patient to survive an abdominal hysterectomy (in a case where the preoperative diagnosis had again been wrong), and later that same year his fellow Lowell surgeon Gilman Kimball is credited with the first deliberately planned and executed abdominal hysterectomy for a correctly diagnosed uterine fibroid, with the patient surviving. These cases marked the operation's transition from near-certain fatality toward a survivable, intended procedure.

What turned the corner for hysterectomy — and for abdominal surgery generally — was Joseph Lister's introduction of antiseptic technique in the 1860s, which dramatically reduced the post-operative infections that had made opening the abdomen so lethal. Combined with anaesthesia (from the mid-1840s), improving control of haemorrhage, and later blood transfusion, antisepsis converted hysterectomy from an act of desperation into a routine, life-improving operation. Hysterectomy for fibroids became, and long remained, one of the most commonly performed major operations in women — a definitive cure, at the cost of fertility, that the less radical modern options were later developed to avoid.

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Ravina and Uterine Artery Embolization

For nearly 150 years after the Atlees and Kimball, the surgical choices for a troublesome fibroid were essentially myomectomy or hysterectomy — both major operations. The next conceptual leap came from interventional radiology rather than the operating theatre, and it arrived almost by accident. In the late 1980s the French gynaecologist Jacques-Henri Ravina grew interested in using embolization — deliberately blocking the blood vessels feeding the uterus — as a way to reduce bleeding during planned fibroid surgery.

The unexpected observation changed everything. When the uterine arteries were embolized before surgery, a number of patients found that their fibroid symptoms eased so much, in the days or weeks before the scheduled operation, that they declined surgery altogether. Ravina and his colleagues realised that cutting off the fibroids' blood supply could itself be the treatment, shrinking the tumours and relieving heavy bleeding and pressure. In 1995 the group published their landmark report — "Arterial embolisation to treat uterine myomata" in The Lancet — describing this uterine artery embolization (UAE), also called uterine fibroid embolization, in their first patients.

UAE was a genuine turning point because it offered, for the first time, an effective minimally invasive, uterus-sparing alternative to open surgery: performed through a small catheter in an artery, with no large incision, it allowed many women to avoid both myomectomy and hysterectomy. In the decades since, UAE has been studied in randomised trials against surgery and has become an established mainstream option, expanding the menu of fibroid treatments well beyond the knife.

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Focused Ultrasound and Modern Medical Therapy

The decades around the turn of the twenty-first century brought two further non-surgical approaches. The first was magnetic-resonance-guided focused ultrasound surgery (MRgFUS), which uses tightly focused, high-intensity ultrasound waves — aimed and monitored in real time by MRI — to heat and destroy fibroid tissue through the intact skin, with no incision at all. The ExAblate system received US Food and Drug Administration approval in October 2004 for ablation of symptomatic uterine fibroids in women wishing to spare the uterus, and the labelling was later broadened (in 2015) to consider women who wished to preserve fertility. MRgFUS remains a niche but real option, valued for its non-invasiveness and quick recovery.

The second front was medical (drug) therapy aimed at the fibroid's hormone dependence. Because fibroids grow under the influence of estrogen and progesterone, drugs that lower or block these hormones can shrink them and curb their bleeding. GnRH agonists such as leuprolide were used for years to shrink fibroids temporarily before surgery, though their menopause-like side effects (hot flushes, bone-density loss) limited long-term use. More recently, oral GnRH antagonist combinations — which suppress ovarian hormone output while adding back low-dose hormones to limit side effects — have been approved specifically for fibroid-related heavy menstrual bleeding: elagolix/estradiol/norethindrone (Oriahnn) in 2020 and relugolix/estradiol/norethindrone (Myfembree) in 2021 in the United States.

Taken together, these developments transformed fibroid care from a binary surgical choice into a graded menu — watchful waiting, hormone-targeting drugs, embolization, focused ultrasound, uterus-sparing myomectomy, and, when needed, definitive hysterectomy — allowing treatment to be matched to a woman's symptoms, age, and wish for future fertility. As always, the right choice is an individual one made with a clinician; this page is historical and educational, not medical advice.

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Hormone Dependence and the Burden in Black Women

Two facts run through the modern understanding of fibroids and deserve to stand on their own. The first is their hormone dependence. Fibroids are fuelled by the ovarian sex steroids estrogen and progesterone: they tend to grow during the reproductive years and during pregnancy, and they characteristically shrink after menopause when ovarian hormone production falls — which is also when older fibroids commonly calcify into the "womb stones" of antiquity. This hormonal biology is precisely what the GnRH-based drugs and other endocrine therapies exploit.

The second fact is a stark and well-documented health disparity: fibroids disproportionately affect Black women. Compared with white women, Black women experience roughly two-to-threefold higher incidence of fibroids, develop them at younger ages, and tend to have more numerous, larger, and more symptomatic tumours. By around age 50, a large majority of women overall develop fibroids, but the burden falls earlier and harder on Black women — estimates commonly cited put the lifetime figure above 80% in Black women versus roughly 70% in white women, with correspondingly higher rates of complications and of surgery such as hysterectomy.

The reasons for this disparity are not fully understood and remain an active area of research — investigators point to a mix of genetic, hormonal, vitamin-D-status, and structural/social factors rather than any single proven cause, and any specific mechanism should be treated as a hypothesis under study rather than settled fact. What is not in doubt is the disparity itself, which is consistently documented and clinically important. It is included here because an honest history of fibroids must record not only how the disease was named and treated, but who has borne the heaviest share of it.

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Legacy: An Old Tumour, a Changing Toolkit

Few diseases connect the deep past to the present quite so directly as uterine fibroids. The same growth that Hippocrates called a "stone" of the womb, that hardened into the calcified relics recovered from ancient and early-modern remains, and that Virchow proved to be a tumour of muscle, is the one a woman today might treat with a catheter, a focused ultrasound beam, or a daily pill. The tumour has not changed; the toolkit has been transformed almost beyond recognition.

The trajectory is unusually clean. Antiquity could recognise the mass but not explain or remove it. The nineteenth century supplied both the science (Virchow's smooth-muscle origin; the fibroid/myoma/leiomyoma vocabulary of Rokitansky, Klob, and Virchow) and the first daring surgery (the Atlee brothers' myomectomies; Burnham and Kimball's survivable hysterectomies), made survivable by anaesthesia and Lister's antisepsis. The late twentieth and early twenty-first centuries added uterus-sparing, minimally invasive, and medical options — Ravina's 1995 embolization, focused ultrasound, and hormone-targeting drugs — that aim to treat the disease without removing the organ.

Two threads remain unfinished. The biology of why fibroids form, and why they burden Black women so disproportionately, is still being worked out. And the goal of care has shifted decisively toward preserving fertility and the uterus wherever possible. For a tumour first noted more than two thousand years ago, that is a remarkable amount of progress — and a reminder that the history of a disease is also the history of the people who studied it and the patients who lived with it.

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Research Papers and References

The references below combine peer-reviewed historical and clinical reviews of uterine fibroids (with DOIs or PubMed/PMC identifiers where available) with curated PubMed topic-search links into the historical, surgical, and treatment literature. Named historical figures and dates — Hippocrates, Galen, Virchow, Rokitansky, Klob, the Atlee brothers, Burnham, Kimball, Lister, and Ravina — are corroborated across these secondary sources. Each link opens in a new tab.

  1. Tapisiz OL, et al. Fibroids through the ages: a historical journey and future prospects in myomectomy. Gynecology and Pelvic Medicine. — AME Gynecology and Pelvic Medicine: Fibroids through the ages
  2. Calcified uterine leiomyoma from an 18th-century nunnery in North Italy (paleopathology). International Journal of Paleopathology. 2024. — doi:10.1016/j.ijpp.2024.01.005
  3. The history of myomectomy at the Medical School of the University of São Paulo. Clinics (São Paulo). — PubMed: history of myomectomy (uterine fibroid)
  4. Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolisation to treat uterine myomata. The Lancet. 1995;346(8976):671-672. — doi:10.1016/S0140-6736(95)92282-2
  5. Uterine artery embolization: state of the art. Seminars in Interventional Radiology. — PMC: Uterine Artery Embolization — State of the Art
  6. History of embolization of uterine myoma (book chapter), in Uterine Fibroids (Cambridge University Press). — PubMed: uterine artery embolization (Ravina) history
  7. Hysterectomy: a historical perspective. Baillière's Clinical Obstetrics and Gynaecology. — PubMed PMID: 9155933
  8. Hysterectomy: evolution and trends. Best Practice & Research Clinical Obstetrics & Gynaecology. — PubMed PMID: 15985249
  9. Updates on MR-guided focused ultrasound for symptomatic uterine fibroids. Seminars in Interventional Radiology. — PMC: MR-guided focused ultrasound for uterine fibroids
  10. Schlaff WD, et al. Elagolix for heavy menstrual bleeding in women with uterine fibroids. New England Journal of Medicine. 2020;382(4):328-340. — doi:10.1056/NEJMoa1904351
  11. Al-Hendy A, et al. (LIBERTY trials) Relugolix combination therapy for uterine fibroids. New England Journal of Medicine. 2021;384(7):630-642. — doi:10.1056/NEJMoa2008283
  12. Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA. The health disparities of uterine fibroid tumors for African American women: a public-health issue. American Journal of Obstetrics & Gynecology. 2014;210(3):194-199. — doi:10.1016/j.ajog.2013.08.008
  13. Racial disparities in uterine fibroids and endometriosis: a systematic review and application of social, structural, and political context. Fertility and Sterility. — PMC: Racial disparities in uterine fibroids and endometriosis
  14. Stewart EA. Uterine fibroids (clinical review). — PubMed: Stewart EA — uterine fibroids review
  15. Estrogen and progesterone dependence of uterine leiomyoma growth — PubMed: uterine leiomyoma estrogen/progesterone dependence

External Authoritative Resources

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Connections

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