Medically reviewed by Dr. Kimberly Langdon Cull, M.D. on Sept. 22, 2023 Increased expression of hypoxia-inducible factor and altered expression of its dependent genes orchestrate the development of uterine fibroids. The pathways implicated in the development of uterine fibroids include proliferation, vessel morphogenesis, cell growth, adhesion, metabolic changes, migration, and myoblast differentiation. Uterine fibroids are benign...