African American Women & Uterine Fibroids: Why More Awareness Is Needed to Overcome This Health Disparity
By Alicia Armeli

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African American women are nearly three times more likely to develop uterine fibroids and suffer with more severe symptoms like heavy menstrual bleeding, anemia, and pelvic pain.1,2 From interfering with daily activities to negatively affecting intimate relationships, fibroids have a much more dramatic impact on black women in comparison to women of other races.

Given these realities, many are left questioning why fibroid research has lagged in the past and what’s being done now to overcome this all-too-common health disparity.

“One of the issues with fibroid research is that, because it’s built as a disease process that mostly affects black women, in the sphere of research there just aren’t that many people who will consider it an immediate problem they face every day like heart attack or stroke,” explained Dr. Janice M. Newsome, MD, Interventional Radiologist, Assistant Professor of Radiology at Emory University, and Director of Interventional Services at Emory University Hospital Midtown in Atlanta, Ga.

And studies show, when it comes to racial diversity, fibroid research has taken a backseat. To examine racial diversity in fibroid clinical studies, Taran and a team of researchers at the Mayo Clinic in Rochester, Minn., reviewed available literature between 2000 and 2006.3 The results may surprise you.

Their analysis showed that more than 75 percent of fibroid studies didn’t even report race. Most of the studies that did look at race were based exclusively on African American women—but mainly consisted of prospective studies focusing on risk factors taken from a single larger follow-up study (i.e., the Black Women’s Health Study4). Of the remaining studies that addressed race, African American women represented only 15 percent of the populations examined.

Although prospective studies can be useful in following disease development and targeting things that might increase risk—the data has limitations.

“The truth is, we don’t know enough about why fibroids affect African American women,” Dr. Newsome clarified. “For example, is it scientifically sound to link the use of hair relaxers and fibroids in African American women or is it simply a correlation because African American women tend to use hair relaxers? Yes, the science shows that these women are affected disproportionately than all other women. But just because a black woman carries a certain amount of melanin in her skin doesn’t answer why it’s happening.”

Understanding the cause and finding a cure for fibroids requires public awareness, which is growing—but has been stifled in the past. A study published in the Journal of Women’s Health showed that despite severe fibroid symptoms, African American women reported taking an average of almost four years to seek treatment.2 According to Dr. Newsome, this hesitation could be mistaken for passivity and minimize public awareness of an important issue.

“Among African American women, having fibroids is almost considered the norm,” Dr. Newsome told Ask4UFE. “We develop fibroids at an earlier age and have more severe symptoms so it’s difficult to know what’s unacceptable when you’re a black girl who has a 10-day long period just like your mom, aunt, and cousins—then what’s really abnormal?”

Unintentionally normalizing fibroids also runs the risk of accepting unnecessary treatments. Hysterectomy rates among African American women are more than double in comparison to any other ethnic group, with the majority performed to treat noncancerous conditions like fibroids.5

High hysterectomy rates among black women are multifaceted. These rates could be attributed to the fact that fibroid tumors tend to be larger and numerous among African American women, therefore requiring surgical treatment.5 But it also may be the only option black women are given.

“It’s 2016 and as a black doctor myself who treats fibroids, I see a lot of women who come in and say their doctor told them they needed a hysterectomy and that it was their only choice,” Dr. Newsome said. “We, as the medical community, need to change this—especially since black women are more likely to experience complications after surgery.”

With this in mind, Dr. Newsome and a team of healthcare providers at Emory University Hospital Midtown are forming a fibroids clinic that partners interventional radiologists with gynecologists so that women with abnormal symptoms can receive specialized care. “Our goal is that patients from all walks of life and from any doctor can make an appointment and have their fibroids managed in a way that is tailored to meet their needs,” Dr. Newsome described.

Progress also involves women speaking out, educating themselves about fibroids, and not accepting surgery as the only option. Thanks to grassroots advocacy groups like The White Dress Project that have worked tirelessly with legislators around the nation, July has recently been deemed Fibroids Awareness Month in Georgia, Florida, Virginia, Maryland, New York, and the city of New Orleans.

As word gets out, more doors are opening for new avenues of fibroid research at the cellular level. “This is an important area of research that’s developing,” Dr. Newsome encouraged. “When we look at the cells in a uterine wall that has fibroids versus one that doesn’t, we see that there’s an abundance of extracellular matrix (the structural substance that surrounds cells). We’re now finding that fibroids grow mainly because of excess production of disorganized extracellular matrix.”

By studying the intricate makeup of fibroid cells, Dr. Newsome has high hopes that this area of research will help find the underlying cause of fibroids and lead to effective, comprehensive treatment options especially among African American women.

“Fibroids are such a common problem,” Dr. Newsome reasoned. “If we start to put our collective heads together, this is one problem we can treat more scientifically than we have in the past.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

ABOUT THE DOCTOR Janice M. Newsome, MD, (https://www.youtube.com/watch?v=RqrLky_YCBY) is a board certified Interventional Radiologist, Assistant Professor of Radiology at Emory University, and Director of Interventional Services at Emory University Hospital Midtown in Atlanta, Ga. With 15 years of experience, Dr. Newsome strives to improve patient care by combining her knowledge of the latest research with cutting-edge radiology procedures. By collaborating regularly with fellow physicians, Dr. Newsome ensures women know all of their fibroid treatment options. An advocate in the African American community, Dr. Newsome works to overcome complicated health disparities.

REFERENCES
1. Jacoby, V. L., Fujimoto, V. Y., Giudice, L. C., Kuppermann, M., & Washington, E. A. (2010). Racial and ethnic disparities in benign gynecologic conditions and associated surgeries. American Journal of Obstetrics and Gynecology, 202(6): 514-521. doi: 10.1016/j.ajog.2010.02.039

2. Stewart, E. A., Nicholson, W. K., Bradley, L., & Borah, B. J. (2013). The burden of uterine fibroids for African-American Women: Results of a national survey. Journal of Women’s Health, 22(10): 807-816. doi: 10.1089/jwh.2013.4334

3. Taran, F. A., Brown, H. L., & Stewart, E. A. (2010). Racial diversity in uterine leiomyoma clinical studies. Fertility and Sterility, 94(4): 1500-1503. doi: 10.1016/j.fertnstert.2009.08.037

4. Wise, L. A., Palmer, J. R., Harlow, B. L., Spiegelman, D., Stewart, E. A., Adams-Campbell, L. L., & Rosenberg, L. (2004). Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. American Journal of Epidemiology, 159(2): 113-123.

5. Eltoukhi, H. M., Modi, M. N., Weston, M., Armstrong, A. Y., & Stewart, E. A. (2014). The health disparities of uterine fibroid tumors for African American women: a public health issue. American Journal of Obstetrics and Gynecology, 210(3): 194-199. doi: 10.1016/j.ajog.2013.08.008

High Glycemic Diets May Increase Risk for Uterine Fibroids
By Alicia Armeli

GlycemicIndex

As if we need one more reason to eat healthy, a study published in The American Journal of Clinical Nutrition1 found that long-term high glycemic diets might put women at greater risk for developing uterine fibroids.

Using questionnaires, Rose G. Radin, PhD, MPH, and a team of researchers from the Slone Epidemiology Center at Boston University in Boston, Mass. and the Department of Biostatistics & Epidemiology at the University of Pennsylvania School of Medicine in Philadelphia, Pa. gathered information from over 21,000 premenopausal women between 1997 and 2007 who were enrolled in the Black Women’s Health Study.

During the follow-up, the authors of the study found 5,800 cases of physician-diagnosed uterine fibroids. It was further discovered that women who had higher glycemic diets were more likely to be at risk for fibroids—particularly college-educated women and those younger than 35.

To accomplish this, Radin and her team used glycemic index and glycemic load—both dietary tools that help measure the potential effect carb-containing foods have on raising blood sugar.

Foods with a higher glycemic index or glycemic load (i.e., white rice, white bread, processed cereals, soda pop and sugary desserts) are common sources of simple carbs that the body quickly absorbs, resulting in a spike in blood sugar.

When this happens, the body releases insulin to help absorb the sugar, causing blood sugar levels to fall. Frequently eating these foods over time, however, could result in prolonged high blood sugar and insulin levels—as seen with insulin resistance. In this state, the body “resists” insulin and no longer responds to its effects.

What does this have to do with fibroids?

When this occurs, Radin and her team explained, increased levels of insulin-like growth factor I (IGF-I), a type of growth protein in the body found circulating in the blood, could encourage fibroid cells to multiply, as seen in laboratory studies. IGF-I genes have also been seen expressed at higher levels in fibroid cells in comparison to normal cells found in the uterine wall.

High insulin also correlates with increased levels of circulating estrogen sex hormones, the authors mentioned. Heightened sex hormone levels could affect hormone-driven tumors like fibroids.

Whether high glycemic diets are truly connected to fibroid risk is still unclear. Since this is the first and only study so far that focuses on this facet of women’s health, more research is needed to confirm these findings.

Regardless of existing fibroid-related theories, studies2 show that lower glycemic diets could have other health benefits like fighting inflammation that leads to chronic disease.

Lower glycemic foods include:3,4

  • Dried beans and legumes
  • Nuts
  • Non-starchy vegetables like leafy greens
  • Some starchy vegetables like yams
  • Unsweetened dairy products
  • Most fruits
  • Various whole grains like pearled barley and quinoa
  • Meats and fats aren’t significant sources of carbs and therefore don’t have glycemic values to consider.

Until more literature is published in this area, focusing on a lower glycemic diet could be worth a try and might help in long-term fibroid prevention.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

REFERENCES

  1. Radin, R. G., Palmer, J. R., Rosenberg, L., Kumanyika, S. K., & Wise, L. A. (2010). Dietary glycemic index and load in relation to risk of uterine leiomyomata in the Black Women’s Health Study. The American Journal of Clinical Nutrition, 91(5): 1281-1288. doi: 10.3945/ajcn.2009.28698
  2. Goletzke, J., Buyken, A. E., Joslowski, G., Bolzenius, K., Remer, T., Carstensen, M., Egert, S., Nothlings, U., Rathmann, W., Roden, M., & Herder, C. (2014). Increased intake of carbohydrates from sources with a higher glycemic index and lower consumption of whole grains during puberty are prospectively associated with higher IL-6 concentrations in younger adulthood among healthy individuals. Journal of Nutrition, 144(10): 1586-1593. doi: 10.3945/jn.114.193391
  3. Harvard Medical School. (2015). Harvard Health Publications: Glycemic Index and Glycemic Load for 100+ Foods. Retrieved May 2, 2016, from http://www.health.harvard.edu/diseases-and-conditions/glycemic_index_and_glycemic_load_for_100_foods
  4. American Diabetes Association. (2014). Glycemic Index and Diabetes. Retrieved May 2, 2016, from http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html
Do Uterine Fibroids Increase the Risk of Cesarean Birth?
By Alicia Armeli

C-Section

Approximately 11 percent of pregnant women have uterine fibroids. And while these benign growths may pose no trouble at all, clinical literature suggests they may be responsible for a 27 percent increased risk of delivering cesarean section.

A paper published in the Annals of Epidemiology1 further investigated this link. Between December 2000 and June 2010, Velez Edwards of the Department of Obstetrics and Gynecology at Vanderbilt University Medical Center in Nashville, Tenn., and a team of researchers enrolled 2,635 African American and Caucasian pregnant women in the Right from the Start study.

Through first trimester ultrasounds, the team verified the presence of fibroids along with number, type, and size. Interviews were performed and medical records collected to gather information such as reproductive history and route of delivery.

Results showed that 11.2 percent of the women enrolled had fibroids and 29.8 percent gave birth through cesarean section. These numbers indicated that women with fibroids had a 27 percent increased risk of delivering cesarean section in comparison to women who were fibroid-free.

The authors also found that this risk was heightened in women with fibroids larger than 3 centimeters in diameter and women with the largest total fibroid volumes. Although this study supports the link between larger fibroids and cesarean delivery, other studies have disputed the association.

Along with size, fibroid location and type may also present a risk.

“Fibroids can, depending on their location in the uterus, block the baby’s descent when the baby is up high in the abdomen and passing through the vagina for delivery,” said Dr. Linda Bradley, Gynecologic Surgeon, Professor of Surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio, who wasn’t involved in the study. “When this happens, it’s called an obstruction of labor and might give reason for a cesarean section.”

Further studies have shown that women with fibroids in the lower part of the uterus are more likely to have a cesarean section than those with fibroids in other locations.2

Dr. Bradley went on to explain that the type of fibroid could also indicate risk. “Intramural fibroids that grow within the muscular wall of the uterus or subserosal fibroids that grow on the outer wall of the uterus might be the ones that cause problems,” she explained. “These types can basically create a distortion of the uterus and a malpositioning of the fetal head as it’s descending into the vagina.”

Although there are concerns regarding complications associated with cesarean birth, current guidelines don’t suggest surgically removing fibroids during pregnancy, or as a preventative action before conceiving, as the complications related to fibroid removal may outweigh the risks linked to cesarean delivery.1

That being said, the odds of fibroids actually obstructing natural delivery are low.

“Data suggest that there’s a much higher prevalence—around 60 to 80 percent—of women with fibroids who deliver vaginally. Through ultrasound we see that most of these fibroids don’t grow large enough to create a disturbance in labor,” Dr. Bradley emphasized. “There’s nothing a patient has to do except the prenatal care that is normally recommended during pregnancy.”

 

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Linda Bradley, MD is an internationally recognized gynecologic surgeon, professor of surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. As founder of the Celebrate Sisterhood program and recipient of the American College of Obstetricians and Gynecologists Pete and Weesie Hollis Community Service Award, Dr. Bradley is dedicated to empowering multicultural women to take charge of their health, embracing self-care, and creating positive change in the world.

REFERENCES

  1. Michels, K. A., Velez Edwards, D. R., Baird, D. D., Savitz, D. A., & Hartmann, K. E. (2014). Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging. Annals of Epidemiology, 24(2):122-126. doi: 10.1016/j.annepidem.2013.10.017
  2. Cook, H., Ezzati, M., Segars, J. H., & McCarthy, D. (2010). The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecologica, 62(3):225-236.