Recent research suggests that black women suffer these benign growths in silence
Fibroids, benign tumors found in the wall of a woman’s uterus, can grow as a single tumor or as a cluster. Though many fibroids don’t have symptoms, women who do experience symptoms may have heavy bleeding, pain during sex, iron deficiency and complications during pregnancy and labor. Black women are three times more likely to have fibroids than their white peers. They also are more likely to be diagnosed with the growths at an earlier age, to have larger fibroids that grow quickly and to experience symptoms that significantly affect the quality of life, including some so severe they cause women to miss work.
Elizabeth A. Stewart, M.D., of the Mayo Clinic and a researcher for a study about fibroids and their effect on quality of life, spoke to Black Health Matters about the importance of educating sufferers about their options.
Black Health Matters: Why this study?
Elizabeth A. Stewart, M.D.: Ideally, this is something we would have done 10, even 20 years ago. It’s way overdue that we understand how important fibroids are for African-American women. And how many disparities still exist for black women with this disease. I’m delighted that it’s finally made it into the scientific literature, but I think it speaks to the fact that this is still an area that deserves much more study.
Do we have any idea what causes fibroids? Any idea why black women get them more and at earlier ages?
No. We have some hints about what may be causing fibroids, but given how widespread the problem is, we clearly don’t have as much information as we should. I like to think of fibroids like heart disease; it’s not a simple story. There are multiple things that contribute to risk, including genetics, environmental factors and lifestyle factors.
In fact, the studies that have looked at risk factors say the things we know about that we can control for don’t explain the difference in terms of the difference in the risk. If we adjust for those differences, it doesn’t explain why fibroids are so severe for black women in this country.
I know several women who have had major fibroids issues—heavy bleeding, etc.—all African American, and nearly all of them were pushed toward hysterectomies. I’m thinking of five off the top of my head. Two of the five pushed back and had uterus-sparing procedures, but the other three finally relented and had complete hysterectomies.
Why are women pushed toward hysterectomy—especially when other treatments exist?
Hysterectomy definitely cures the problem of fibroids, so that’s the one major advantage hysterectomy has. There’s no risk of new fibroids forming. That being said, there are many reasons to avoid hysterectomy. For women in general, and African Americans in particular, preserving the uterus, even if they’re not trying to achieve pregnancy, is a critical goal.
Some women aren’t told about all of their options. Not every physician that performs hysterectomies is skilled in all of the alternatives, so that may present some biases. Some alternatives to hysterectomy are not even primarily performed by gynecologists. So you need a multidisciplinary approach to fibroids these days to be aware of all of the options.
Let’s talk about the other treatments.
It’s important for women to know that they have fibroids and to educate themselves prior to seeing a doctor. If you know going in what some of your options are, then you’re going to be able to ask clearer questions and be more likely to get you to the right treatment option. There are a lot of Internet-based resources—American College of Obstetrics and Gynecology, the Society for Reproductive Health—and medical resources—mayoclinic.org—which give a comprehensive list of treatments. There are books available that can discuss these options. Empowering women is key.
We can also do a better job of educating providers. Most providers, even if they didn’t train in these procedures, can learn the new techniques.
It’s clear fibroids are really common. Why don’t doctors initiate conversation about them with women? Why do doctors wait until the women come in and complain of problems, usually after years of suffering?
That is a problem. Trying to educate women of the signs of fibroids is important. The main reason why we don’t see that is that doctors are reluctant to define a problem if there’s not a good treatment option. We can educate women that if you have heavier, long menstrual periods, that could be a sign of fibroids. Make sure your blood count stays in a healthy range. Take iron if necessary. That doesn’t commit you to an option.
Many primary care providers, as well as gynecologists, should be having that conversation, particularly with women of reproductive age, particularly with African-American women.
What can we do, if anything, to prevent fibroids in the first place?
We do have some clues—a lot of the important clues have come from the Black Women’s Health Survey over the years. The Black Women’s Health Survey does suggest dietary factors are associated with fibroid risk. Consumption of low-fat dairy products is associated with decrease in risk. Fruits and veggies—especially citrus—are associated with decreased risk. But there are a lot more myths than evidence-based medicine.
People are worried often about hormonal contraceptives and risk of fibroids, but most of research suggests hormones are associated with decreased risk. It’s necessary to inform women of the literature that does exist.
What else should we know about fibroids?
Being an advocate is important. Many women with fibroids assume that suffering is their lot in life. They don’t become more proactive in terms of advocating for themselves. I would encourage women not to be embarrassed by the symptoms and the disease and to really try to bring to people’s attention the significant issues surrounding uterine fibroids. We need to try to get the kind of visibility that other diseases have gotten over the past decade.
Fibroids are a major cause of suffering. They are not a cause of death. They don’t put women at a high risk for cancer, but there is significant impact on women’s lives. I think maybe that’s why they haven’t gotten a lot of attention. But quality of life is a huge goal in every disease these days.