Uterine Fibroids are benign tumors that originate in the woman’s uterus. Diagnosed by a pelvic exam and ultrasound, they are usually round and are often described based upon their location within their uterus. This medical condition has effected many different women, but the one group it has impacted the most are African-American women.
Why does it seem to be more common in black women than in any other female group? Dr. Michelle Luthringshausen OB/GYN, Director of Robotics at Northwest Community Hospital talked to Brandi Walker about this issue, the symptoms and causes of fibroids and the best treatment methods of it.
1. How common are uterine fibroids in black women compared to other women? African American women suffer with uterine fibroids more than any other ethnic group. Up to 80 percent of African American Women will develop uterine fibroids in their lifetime, but fortunately only half of those women (40 percent of African American women) will have health issues related to the fibroids. In comparison, 30 percent of Caucasian American women and 20 percent of Asian American women will have uterine fibroid issues.
2. Why is it more common in black women? No one knows exactly why uterine fibroids are more common in African American women, but there are theories and there are likely multiple reasons. The most likely reason is genetics – the women inherit the risk. Any woman (African American, Caucasian, or Asian) with a sister or mother with uterine fibroids are 2-3 times more likely to have fibroids than women without them in the family. African American women likely have a higher incidence of the genes that cause fibroids.
3. What are its symptoms and causes? Fibroids are non-cancerous growths that arise from a single cell in the muscle of the uterus. One fibrous cell is stimulated by estrogen and progesterone and begins dividing abnormally, over and over again, forming a ball of rubbery tissue that grows and pushes on the tissues around it. Most fibroids grow about 1 or 2 cms in diameter per year. Fibroids can usually be seen on pelvic ultrasound when they reach the size of marbles, and can grow to be the size of watermelons. Other than genetic risk, there are other risk factors for developing symptomatic uterine fibroids. They are African descent, bearing no children, obesity, high blood pressure, diabetes, polycystic ovarian syndrome, and young age at first menstruation. Dietary risk factors have also been identified – a diet higher in red meat and carbohydrates, low in green vegetables and fruit, and drinking alcohol appear to increase the risk of developing fibroids. Half of uterine fibroids cause no symptoms. When they do cause symptoms, the woman may have heavy or irregular uterine bleeding, bloating, pressure or pain in the pelvis, urinary frequency, constipation, and pain with sex or exercise. Women with fibroids can develop varicose veins, and may have fertility problems. Sometimes, fibroids can cause life-threatening bleeding or completely obstruct the bowels, bladder, or outflow from the kidneys, requiring emergency surgery.
4. What are the best treatment methods for fibroids? Although many treatment options exist, there is no cure for uterine fibroids other than hysterectomy (removal of the uterus) and perhaps, but not always, menopause. The treatment chosen for symptomatic uterine fibroids is dependent upon many factors: the age and fertility desires of the woman, the specific symptoms being treated, and the size and location of the uterine fibroids. Hormonal therapies like oral contraceptive pills and progesterone IUDs are best for symptoms of bleeding and do not stop fibroid growth nor decrease bulk-related symptoms. Medicines that block estrogen and progesterone production by the ovary, or block estrogen and progesterone receptors, can shrink fibroids. Unfortunately, these medications have other side effects that limit their use, and the fibroids return to their prior size shortly after stopping the medication. These medications are primarily used in women to stop bleeding and increase blood counts in preparation for surgery, in women on the brink of menopause to try to avoid surgery, or in women too sick to undergo surgery for life-threatening fibroid symptoms. For women who want to get pregnant, iron supplementation and non-steroidal anti-inflammatory medications like ibuprofen and naproxen can control mild symptoms of fibroids. MRI-focused ultrasound ablation achieves a modest reduction in fibroid size and bleeding. Laparoscopic radiofrequency “melting” or myomectomy (surgical removal of the fibroids) are the only other options available. The surgical route of myomectomy depends upon the location and size of the fibroids and can be performed by hysteroscopy (from inside the uterus), laparoscopy (minimally invasive) with or without robotic assistance, or by laparotomy (open incision on abdomen). For women whose main complaint is heavy bleeding and who have small to moderate-sized fibroids and do not desire future pregnancy, surgical options are removal of the uterine lining (endometrial ablation), uterine artery blockage (embolization), or hysterectomy (removal of the uterus). For women who no longer desire pregnancy and who have larger fibroids causing bulk symptoms or bleeding, hysterectomy is advised. Hysterectomy does not equal menopause, as the ovaries can be left behind to continue to produce hormones. The type of hysterectomy recommended will depend upon the woman’s body type, history of childbearing and prior surgeries, family history of cancers, size of the uterus, and the surgeon’s skill set. Most women should be candidates for a minimally invasive approach to hysterectomy, even with large fibroids. Minimally invasive approaches to hysterectomy (vaginal, laparoscopic, and robotic assisted laparoscopic) result in less complications, less postoperative pain and faster recoveries than open incision hysterectomies.
5. What are its risk factors during pregnancy? Although uterine fibroids are common and usually cause no problems in pregnancy, they do double the risk of postpartum hemorrhage, and triple the risk of c-section. Fibroids located inside the cavity of the uterus may prevent pregnancy implantation or cause recurrent miscarriages, and can cause bleeding in pregnancy. 30 percent of fibroids grow early in the pregnancy. Fibroids may grow rapidly in pregnancy and cause severe pain and sometimes cause preterm labor or premature rupture of membranes. Fibroids can also crowd the fetus and at time of delivery can prevent the normal “head down” position of the baby or obstruct the birth canal. These women must undergo c-section for delivery. Fibroids can prevent delivery of the placenta, or cause the placenta to implant abnormally causing premature or incomplete separation of the placenta during labor and delivery leading to hemorrhage. Life-threatening bleeding prior to delivery puts both the baby and mother at risk, and bleeding following delivery may require procedures to block the uterine arteries or even hysterectomy. Although some of these complications are severe, fortunately, most pregnancies in women with fibroids are uneventful.
For more information on Dr. Luthringshausen, visit Northwest Community Hospital website www.nch.org.