Abstract

Background
Uterine fibroids represent the most common benign gynecological tumors globally, yet management pathways differ substantially across health systems. Observational evidence demonstrates marked divergence between the United Kingdom (UK) and Sub-Saharan Africa (SSA), particularly Nigeria, in treatment access, surgical thresholds, and fertility-preserving strategies.

Objective
To synthesize biological, structural, and health-system determinants underpinning divergent fibroid management pathways between the UK and SSA, and to construct a multi-domain explanatory framework with equity implications.

Methods
A comparative narrative analysis was conducted using SANRA quality standards to guide critical appraisal and reporting. Elements of the PRISMA 2020 checklist informed transparent reporting of the search strategy. Databases were searched for epidemiological, clinical, policy, and systems-level literature comparing fibroid prevalence, genetic predisposition, treatment modalities, and institutional frameworks across regions.

Results
SSA populations demonstrate earlier age of onset, larger tumor burden at presentation, and higher surgical rates. In contrast, UK management is characterized by guideline-directed conservative pathways, wider access to MRI, uterine artery embolization, minimally invasive surgery, and fertility-preserving pharmacotherapy. Determinants of divergence include genetic susceptibility, delayed presentation, financing constraints, imaging availability, workforce distribution, and national guideline enforcement. The review identifies an emerging pattern of reverse reproductive medical tourism, wherein UK-resident African-ancestry women seek cross-border surgical intervention due to system-level unmet need.

Conclusion
Divergent fibroid management reflects not merely biological variation but structural inequities embedded within health systems. Addressing disparities requires integrated policy reform, workforce investment, patient-stratified clinical decision-making, and context-adapted guideline implementation. Future prospective comparative studies are warranted to quantify outcome differentials and inform equity-driven global gynecological practice.