When it comes to your health, it's important to know your risk factors for fibroids--plus what it means for your health if you get this diagnosis. Many women have heard about fibroids (benign tumors that develop in or on a woman's uterus) but don't know much more than the name. Here is our quick cheat sheet for really understanding these tumors:
Before we get started, we have to be clear: we still don't the exact reason why women get fibroids. However, we do know that, by the age of 50, 70% of women will develop these tumors. And, of those women, between 20-25% will experience disruptive fibroid symptoms. Plus now, thanks to recent studies, we also have a clearer picture of what raises women's fibroid risk.
First, we know that race plays a major role in your fibroid risk. While any woman can develop fibroids, the ones at highest risk: have a family history, are Black or Hispanic, and/or have a higher Body Mass Index (BMI). In fact, according to a recent study in the BJOG Journal, black women have a two-threefold higher fibroid risk. That's why about 70% of black women develop fibroids, according to the study. (The Society for Interventional Radiology estimates 80% of black women will develop fibroids by the time they turn 50.) And it may be why European women have a lower fibroid risk than women in the U.S.: the racial mix in populations is very different.
Additionally, especially for Black women, family history plays a role in fibroid risk. If your mother had fibroids, particularly if she was diagnosed at a relatively young age, you are also more likely to develop these tumors. Furthermore, the fibroids you do have are likely to grow larger, according to this study in JAMA Network Open.
Still, as more Caucasian women present with elevated BMIs, their fibroid risk has also increased. And we know, thanks to this study, 11 other factors that increase your fibroid risk. These include your age (risk decreases as you get older), premenopausal state, hypertension, family history and the time since your last birth. (Having more full-term pregnancies seems to decreases your fibroid risk. Breastfeeding could also impact your fibroid risk. That's because your ovarian hormones decrease when you nurse. ) Smoking or consuming certain food additives or soybean milk may also increase your chances of getting fibroids.
In some cases, the use of oral contraceptives or the injectable contraceptive depot medroxyprogesterone acetate increased your fibroid risk. That's not necessarily surprising, since we know that two things make fibroids grow: hormones, especially estrogen, and blood supply.
But, while some forms of birth control increase your fibroid risk, we can also often control fibroid growth with birth control pills. And, we can shrink the tumors by cutting off their blood supply using a procedure called UFE (uterine fibroid embolization.)
Recently, we've learned something about fibroid risk and your environment from this study in Fertility and Sterility. When pregnant women expecting daughters were exposed to endocrine-disrupting chemicals, the babies seemed to have a higher rate of developing fibroids. While researchers aren't sure why, it seems that these hormones change the developing uterus in ways that make fibroid growth more likely.
What are endocrine-disrupting chemicals (EDCs)? Well, they can be man-made or natural. Either way, these are chemicals that interfere with your endocrine system. As a result, they can harm your developmental reproductive, neurological and immune health. BPA and phthalates are some of the best-known EDCs.
In fact, reviews in 2017 and 2019 found that exposure to phthalates at any point in your life increases your risk for fibroids. In the first study, researchers in China discovered that having more of the phthalate DEHP in your urine (it's often added to plastic to make it flexible) translated to a higher risk for fibroids. And in the second study, Black women with higher phthalate levels in their urine had both larger fibroids and enlarged uteruses.
Now, these are just the risks associated with one kind of EDC. But many others exist. And now we can say that any exposure ups your fibroid risk, as does having diabetes; being obese; suffering from cardiovascular disease or reproductive tract disorders; being over the age of 40; having no children; or having neurodevelopmental disorders.
We are constantly discovering other fibroid risk factors, and recently, scientists from the University of Helsinki uncovered a genetic link. After monitoring 728 women with 2263 tumors, researchers grouped their fibroids by genetic variants.
For most women, these fibroids fell neatly into one of three. But a number of the fibroids didn't fit into previously identified categories. Instead, they showed variations that cells' histone activity. (Histones help shape and control genes.activity.)
After seeing this variation, the researchers discovered an inherited fibroid risk. Women with certain genetic mutations have a higher risk of developing tumors. As a result, with more research, women with these mutations could receive counseling and regular fibroid screening. In that way, it could be easier to detect and diagnose any developing growths in their earliest stages.
A new study in Human Genetics identified certain gene combinations that point towards your risk factors for fibroids. After identifying these genes, they can assign screened women a uterine fibroid polygenic risk score (PRS). The idea? The higher your PRS, the more likely you are to develop fibroids. Now, doctors can screen patients for these genes and determine each woman's PRS score. After receiving an elevated PRS score, women could place their symptoms in context if they appear. Then, they could avoid delaying a fibroid diagnosis. So that women wouldn't have to suffer for years without relief.
After studying the test results of almost 500 women with fibroids, researchers compared their genetic markers to women without these growths. Here's what they found. There are 30 specific genetic chromosomal locations that can be linked to an increased fibroid development risk. Now that we know their connection, if your mother or grandmother had fibroids, you can ask doctors to screen you for these markers. Then, if you have any, you may reach a fibroid diagnosis faster if you start displaying any symptoms.
If you are experiencing fibroid symptoms like heavy periods, pelvic pain, incontinence or constipation, your doctor may check you for fibroids. Unfortunately, many women will face physicians who dismiss their pain, so you may have to self-advocate or see several doctors to be taken seriously. We hope that's not the case, but you should be prepared...and persistent.
Once you find a doctor who listens, you'll usually receive a pelvic exam and a pelvic sonogram; together, they should deliver a fibroids diagnosis. Still, you may need a transvaginal sonogram to determine if the fibroid has affected your uterine lining.
As soon as you've been diagnosed, you'll need to consider your treatment options. And remember that you do have options: not all fibroid diagnoses will end in surgery. In fact, there are minimally invasive fibroid treatments that can help you find relief. But the option you choose will largely depend on the type of symptoms you're currently experiencing.
Once you know you have fibroids, you have lots of options. If you aren't bothered by symptoms, you may just monitor the tumor(s). With fibroids that are small, birth control, diet and exercise may keep them from causing you pain. However, fibroids can lead to hypertension when you have fibroids in your 40s, and that can take a greater toll on your overall health. Plus, if pregnancy is important to you, the location of your fibroids will also be important. Fibroids that grow in the uterine cavity or block the fallopian tubes may affect your fertility.
If symptoms or infertility send you in search of relief, it's important to research all your treatment options. While some doctors may recommend surgery (myomectomy or hysterectomy), we like to explore less invasive options. To learn more about non-surgical fibroid treatments click here to request an appointment with our Houston area fibroid experts.
Sources: International Journal of Fertility and Sterility, BJOG: An International Journal of Obstetrics and Gynecology
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