Summary of Fibroid Research findings for Women with Fibroids and Black Women related Health Issues

Uterine fibroids are non-cancerous tumors on the uterine muscle . 99.95% of fibroids are benign & remain benign, even if they grow in size. Not all fibroids become very large & they vary in size from microscopic sizes to Watermelon size. The Authors grew to 8 months pregnancy size & weighed 11 pounds when it was removed. It was 22cm high & 33cm in diameter. It is not unusual for women to have more than 1 fibroid . (The author had 4). One US Doctor informed me that he’d removed 200 from 1 patient & still managed to retain preserve her womb. A myomectomy is the removal of just the fibroids, its similar to shelling peas from a pod if they are numerous. This article is an overview of Fibroid Research in relation to Diet, Treatments, Black women & fibroids, statistics, fertility and social issues involving fibroids.

Because of the size, location & number of fibroids the traditional myomectomy , can take longer to perform than a hysterectomy. This has led some Drs to prefer the quicker option of a hysterectomy, as it solves in their minds , all of the women’s problems, they can clear their waiting lists quicker & perform more operations per day, & for newly qualified Junior Doctors it provides, useful live anatomy education, which they could not obtain if the womb remained in the body. I attended a Fibroid conference for Drs in approx. 2000, where a Senior consultant Obstetrician was complaining that the Junior Drs couldn’t persuade as many women as previously to undertake hysterectomies, so they were having to send them to Third World Countries to get their training. In the same conference the Dr also complained that there were some feminist women who wanted to keep their wombs for no reason.

The National Institutes of Health in America have carried out very large studies of Black Women in Fibroids, involving reviewing the patient details of over 50,000 women. This has provided a lot of information on issues for Black Women & Fibroids. In the US, it is a requirement of research to include the race of participants. It is not a requirement in the UK, which is why in the last 8 years, information on specific UK Black Women’s health statistics is limited. However, the findings should mirror the US experience as Black women have similar concerns & lifestyles in the both continents .There is also specific government funding to carry out this research. In the research that was done for the Heavy Menstrual Bleeding Guideline, which I help develop with NICE (National Institute for Clinical Institute for the NHS), we had the same statistics in the UK but obviously the research groups were smaller. Fibroids are still the leading reason for hysterectomies for Black women in the UK.

UK Fibroid Statistics:
In the UK in NHS hospitals during 2012-3, there were 30,929 diagnosed with fibroids by hospital consultants. It is estimated that 50 % of UK women have fibroids at some point in their childbearing years, however up to 80% of Black women will develop fibroids. Many women have complained to our organisation & Femisa (a voluntary org, advising women re fibroid embolization) that they are ony offered “castration” (Hysterectomy) as a solution to their fibroids & they’re not being offered less invasive treatments which preserve the womb, whether or not they intend to have children. Women expressed the desire not to have the option of having to go into an early surgical menopause because Hysterectomy is still being offered by some Drs as the 1st resort, rather than the last.

Frequency of Fibroids

The vast majority of hysterectomies are performed for benign indications & thus to improve the quality of life rather than save lives.

Patients have indicated however that hysterectomies are the Dr’s choice rather than the patients choice

50% of women with fibroids have no symptoms.

Those with Symptoms include:
Heavy menstrual bleeding
Period pain
Bloated Sensations
Increased urinary frequency
Bowel disturbance

Black women are more likely to have symptomatic fibroids, which may be why they are diagnosed more frequently.

Hysterectomy

Fibroids is the most common reason for a Hysterectomy. 40 % of Hysterectomies are for fibroids.

Black-white differences in factors related to hysterectomy. 53,159 hysterectomies were reviewed in Maryland, USA
Findings:
The average annual age-adjusted hysterectomy rate was higher for black women (49.5 per 10,000) than for white women (41.2 per 10,000). For 65.4% of the hysterectomies in black women, the principal diagnosis was uterine fibroids, compared to 28.5% for white women. In comparison to white women, black women having hysterectomy were found to have an increased risk of one or more complications of surgical or medical care (odds ratio 1.4, 95% confidence interval [CI] 1.3-1.5), a length of stay of more than 10 days (odds ratio 2.7, 95% CI 2.5-3.1), and in-hospital mortality (odds ratio 3.1, 95% CI 2.0-4.8).
CONCLUSIONS:
In a study of more than 53,000 hysterectomies, black women were more than twice as likely to have a diagnosis of uterine fibroids as white women, were more likely to have complications, had a longer hospitalization, and had more than three times the in-hospital mortality rate. (Hysterectomy and race study).
A 2013 study by Dr Elizabeth Stewart of nearly 1,000 women with fibroids responded to the Harris Interactive survey, and close to one-third of those with jobs said they missed work because of symptoms, including heavy or prolonged menstrual bleeding, cramping and fatigue.
Many of the women expressed concern about fibroid treatment. More than three-quarters said they would prefer noninvasive approaches, more than half wanted to preserve their uterus, and younger women were often focused on preserving their fertility.
“I was impressed by how strongly women felt about uterine preservation,” said study author Dr. Elizabeth Stewart, a professor of obstetrics and gynecology at the Mayo Clinic in Rochester, Minn. “For many women, even if they don’t want fertility, preservation of their uterus is an important goal.” Fortunately, fibroids won’t necessarily require a hysterectomy, especially if women get medical care early, she said.
The 968 women surveyed were aged 29 to 59 and had reported fibroid symptoms. Fibroids often present no symptoms, but one-quarter of women with fibroids say their day-to-day life is affected by the growths.
Among the other findings: 24 percent of the working women said fibroid symptoms kept them from reaching their career potential, and 41 percent of women saw two or more health care providers before getting a diagnosis.
A sub-study found that black women are more likely than whites to have severe symptoms, and 32 percent of black women waited more than five years before seeking medical treatment compared to 17 percent of whites.

Physical Risk factors

Black women are more likely to be diagnosed with fibroids than other races. They are also more likely to diagnosed with larger & more numerous fibroids, at a younger age. Ie some studies show they are often diagnosed 10-15 yrs earlier. They are more likely to have symptomatic fibroids

Psyhological studies

Uterine Fibroids incidence, was higher among women who reported child abuse, particularly sexual abuse.. No associations were found for teen or adult abuse. Wise L, Palmer JR, and Rosenberg L. Lifetime abuse victimization and risk of uterine leiomyomata in Black Women. Am J Obstet Gynecol 2013;208:272.e1-13.
In a cross-sectional study of Black Women , a positive association was found between Fibroids prevalence and both the number of major life events and stress intensity.16 There was a higher Fibroid prevalence in women who felt racial discrimination & in the Black Women’s Health Study (BWHS), a prospective cohort study. UF incidence was positively associated with greater levels of “everyday” racism and lifetime occurrences of major discrimination, with weaker associations found among those with higher coping skills.17 A positive association between early-life abuse victimization and UF was found in the Nurses’ Health Study II.18 Results were attenuated among those reporting high childhood emotional support,18 which like this study,17 supports the hypothesis may buffer the negative impact of stress on health.

Endocrine Disruptors

Environmental Exposures

General Research on fibroids

Exposure to plastic products, cosmetics, & other chemicals including BPA Bisphenol A, consumption of soybean milk, food additives, sweetener & preserved foods may be risk factors for fibroids (Environmental exposure & risk of uterine leiomyoma: an epidemiologic survey). China 2013

Black women research currently being reviewed
Hair relaxer may increases fibroid risk. ( Hair relaxer use & risk of uterine leiomyomata in African-American Women 2012.)

Fibroids & Pregnancy

Women wishing to preserve their fertility are opting for womb preservation and minimally invasive procedures, IF, they are made aware of them,

The majority of women with uterine fibroids will have normal pregnancy outcomes.

Miscarriage rates are significantly reduced after myomectomy

Over 80% of fibroids observed during pregnancy remain the same size or reduce during pregnancy (Muram & El Toaffe)
Pregnancy rate after Myomectomy was 50-68% & a Live birth rate of 57-93%. Caeserian birth was more likely after a myomectomy. Fibroids , Infertility & pregnancy wastage (2000) N.Bajekal

50% of women with infertility/reproductive wastage , conceive after myomectomy. (Verkauf 1992. Vercellini 1998)

The presence of uterine fibroids did not increase the risk of preterm birth in a study population Women with fibroids are as fertile as the general population of women ie approximately 70% of all women. The presence of fibroids did not increase the risk of pre-term birth, however, subserous and submucosal fibroids slightly increased the risk of an earlier pre-term birth. The mean time to conception was similar between women with and without uterine fibroids. African American women were more likely to have a uterine fibroid, to have more than one fibroid, and to have a larger uterine fibroid than their Caucasian counterparts.

Diet & Exercise

General Fibroid Studies
Vitamin D reduces the risk of fibroids. A US Womens’ study found that Only 10% of blacks & 50% of white women with fibroids had sufficient levels of Vitamin D. (Halder, , NIEHS Uterine Fibroid Study).

Eating Fruit & Vegetables, particularly fruit lowers the risk of Fibroids

Exercise reduces the risk of fibroids.
In the Black Womens Health Study involving 21,885 african american women. Risk of fibroids was positively associated with years of alcohol consumption and current consumption of alcohol, particularly beer.
Red Meat , particularly beef & ham consumption increases the risk of fibroids.
Ealy Life Exposures
Data from 3,534 black women was analysed aged 35–59 , in the Sister Study, who self-reported information on early-life and childhood exposures. Early-onset fibroids were assessed based on self-report of a physician diagnosis of fibroids by the age of 30 years

Results: Factors most strongly associated with early-onset fibroids were in utero diethylstilbestrol (DES; RR = 2.02; 95% CI: 1.28, 3.18), maternal pre-pregnancy diabetes or gestational diabetes (RR = 1.54; 95% CI: 0.95, 2.49), and monozygotic multiple birth (RR = 1.94; 95% CI: 1.26, 2.99). We also found positive associations with having been taller or thinner than peers at the age of 10 years and with early-life factors that included being the firstborn child of a teenage mother, maternal hypertensive disorder, preterm birth, and having been fed soy formula.
Conclusions: With the exception of monozygotic multiple birth and maternal hypertensive dis¬order, early-life risk factors for early-onset fibroids for black women were similar to those found for white women. However, in contrast to whites, childhood height and weight, but not low socioeconomic status indicators, were associated with early-onset fibroids in blacks. The general consis¬tency of early-life findings for black and white women supports a possible role of early-life factors in fibroid development.

 

Bibliography
Racial differences in women who… [Womens Health Issues. 2009 May-Jun] – PubMed – NCBI.

Early-life exposures and early-onset Uterine Leiomyomata in Black Women in the Sister Study [Environ Health Perspect. 2012] – PubMed – NCBI.

Risk of uterine leiomyomata in relation to tobacco… [Hum Reprod. 2004] – PubMed – NCBI.

Comparison of characteristics of fibroids in A… [Fertil Steril. 2013] – PubMed – NCBI.

Uterine leiomyoma among women who conceive. [Arch Gynecol Obstet. 2005] – PubMed – NCBI.

The burden of uterine fibroids for… [J Womens Health (Larchmt). 2013] -Elizabeth Stewart PubMed – NCBI.

Lifetime abuse victimization and risk of… [Am J Obstet Gynecol. 2013] – PubMed –

Uterine leiomyomas. Racial differences in severity. [J Reprod Med. 1996] – PubMed – NCBI.

Early-Life Exposures and Early-Onset Uterine Leiomyomata in Black Women in the Sister Study.

Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations.

Diet & Uterine Myoma . Parazzini 1999.

 

Other Weblinks for more info:

FEMME Trial link on their website:

Author: Bridgette York
Fibroid Network http://www.fibroid.network
Twitter UK @fibroidsupport @fibroidinfo