Uterine Fibroids, Who Suffers Most and Treatment Options

Uterine fibroids
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If you are an African-American woman, you are three times more likely to develop uterine fibroids than are white women, and at a younger age, according to a new report in the Journal of Women’s Health. Here is what you and all women should know about uterine fibroids and how to treat them.

What are uterine fibroids?

Uterine fibroids (also known as leiomyomas) are benign growths that form in the uterus of up to 75 percent of women during their childbearing years. Along with the fact that leiomyomas nearly never develop into cancer, the other good news is that many women never even know they have these growths because they don’t experience any symptoms.

Among women who do have symptoms, they can include prolonged and/or heavy menstrual periods, frequent need to urinate, trouble emptying your bladder, leg or back pain, feeling of pressure or pain in the pelvic region, and constipation. Uterine fibroids are the main reason why women undergo a hysterectomy.

What the new study shows
A team of experts from Mayo Clinic and Mayo Medical School (Rochester), University of North Carolina School of Medicine (Chapel Hill), and Cleveland Clinic, reviewed data collected from an online survey of US women (573 white, 268 African-American) aged 29 to 59 who had symptomatic uterine fibroids. The participants were similar regarding overall health, education, number of children, and employment, but the African-American women were significantly younger, of different marital status, and had lower incomes.

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The authors found that compared with white women, African-American women were:

  • More likely to develop uterine fibroids in their late 20s rather than in their 30s, on average
  • Significantly more likely to experience severe or very severe symptoms, including anemia (nearly three times more likely) and abdominal protrusion (twice as likely)
  • 77% more likely to miss days from work
  • Significantly more likely to say that having uterine fibroids had a negative impact on their relationships with family and friends and on their physical activities
  • More likely to seek health information from their family and friends and from health brochures
  • Nearly three times more likely to be concerned about future fertility and pregnancy after undergoing treatment for fibroids

Uterine fibroid treatment
Uterine fibroids can grow to various sizes and at different rates. Some are not detectable by the human eye while others grow to the size of a baseball. Often uterine fibroids disappear or shrink considerably after pregnancy, and they also tend to shrink after menopause.

Women who need symptom relief have a number of options, some of which are noted here. If you have uterine fibroids that are causing significant problems, you can talk to your healthcare provider about treatment options.

  • Available medications cannot cure fibroids, but they may cause them to shrink or at least control menstrual flow because of their hormone activity. The drugs include gonadotropin-releasing hormone agonists such as Lupron and oral contraceptives or progestins. Nonsteroidal anti-inflammatory drugs can be taken to manage pain.
  • Use of an intrauterine device (IUD) that releases progestin may provide some symptom relief
  • Focused ultrasound surgery (FUS) is a noninvasive procedure in which women are placed into a magnetic resonance imaging (MRI) scanner and the uterine fibroids are treated with high-energy ultrasound that destroys fibroid tissue. The MRI helps clinicians locate the fibroids.
  • Uterine artery embolization, in which the blood supply to the fibroids is cut off, which causes them to die.
  • Laparoscopic or robotic myomectomy, a minimally invasive procedure in which a surgeon makes tiny incisions in the abdomen and removes the fibroids. If the surgeon uses a camera to get a 3D view of the uterus during the procedure, that is a robotic myomectomy.
  • Abdominal myomectomy is typically for women who have large and/or many fibroids. This technique is an option for women who have been told they should have a hysterectomy
  • Hysterectomy is the most radical treatment option for fibroids, but it does eliminate the problem and is the only procedure that guarantees new fibroids will not develop. At the same time, it ends the ability to get pregnant. Most women who choose hysterectomy for uterine fibroids keep their ovaries to avoid going into early menopause.

The authors of this study concluded that uterine fibroids are a more significant challenge for African-American women than for white women than previously reported. This finding has several implications, including cost for both women and the healthcare system, family relationships, and jobs and career advancement, among other impacts. Women who have symptoms of uterine fibroids should consult a healthcare professional to discuss possible treatment options.

SOURCE:
Stewart EA et al. The burden of uterine fibroids for African-American women: results of a national survey. Journal of Women’s Health 2013 Oct; 22(10): 807-16

Image: Morguefile

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