Uterine fibroids: What every woman should know

UTERINE FIBROIDS (leiomyomas) are the most common non-cancerous tumours that affect women of childbearing age. Uterine fibroids usually grow inside the uterus (womb), but in some instances, they can grow on the surface of the uterus or in the uterine cavity. Fibroids vary in size, from as small as a pea to as large as a basketball, and are the leading cause of hysterectomies (surgical removal of the uterus) globally.

The cause of fibroids remains unknown. However, research suggests that their growth is driven by the female hormones oestrogen and progesterone. As such, some women of reproductive age develop fibroid when oestrogen levels are at their highest; and fibroids shrink in postmenopausal women when their oestrogen levels decline. Some common risk factors for the development of fibroid include a family history of fibroids, starting your period at an early age, high blood pressure, vitamin D deficiency, obesity, alcohol consumption, and a diet high in processed red meat.

According to the American College of Obstetricians and Gynaecologists, about one in every four women over the age of 35 have uterine fibroids. Global statistics show that as many as 40 to 80 per cent of women have fibroids, but it disproportionately affects black women, who are three times more likely to be diagnosed than white women. Fibroids occur more frequently in black women than in any other ethnic group. The National Institute of Environmental Health Sciences projected that as many as 70-80 per cent of black women will develop fibroids before they reach age 50. Black women are usually affected by fibroids at a much younger age, which usually grow to larger sizes and usually presents more severe symptoms than other ethnic groups. Black women are also three times more likely to have recurrent fibroids, and are twice as likely to undergo hysterectomy than white women. It is not clear why black women are mostly affected. Even though fibroids are not life-threatening, they can significantly affect a woman’s quality of life, and fibroid diagnosis is usually accompanied by a lot of financial implications. Some women have also reported anxiety and depression, but despite these glaring challenges, this condition has not received much public health attention.

WHAT ARE THE SYMPTOMS OF FIBROIDS?

Despite the large number of women affected by fibroids, most women have small fibroids and do not experience any symptoms. However, larger fibroids are associated with symptoms such as:

· Enlargement of abdomen, which causes you to look pregnant.

· Heavy and prolonged menstrual bleeding, which can lead to anaemia.

· Severe menstrual cramps.

· Painful intercourse.

· Pressure on the bladder, causing frequent urination.

· Pressure on the rectum, causing constipation.

· Severe lower-back pain.

Some women with fibroids can also experience infertility and problems during their pregnancy. Some studies have reported that uterine fibroids are associated with high risk for obstetric complications, such as miscarriages, Caesarean section and placenta previa (blockage of the opening of the cervix by the placenta). However, your healthcare provider will advise you if you have fibroids during your pregnancy.

MANAGING AND LOWERING YOUR RISK FOR FIBROIDS

It is important to note that lifestyle modifications and diet may help to either manage your fibroids or reduce your risk. Consumption of alcohol may increase your risk for fibroids, as it increases the level of hormones required for fibroids to grow. Research evidence shows that many women with symptomatic fibroid have high blood pressure. Therefore, it is necessary to lower your blood pressure by exercising regularly, managing stress, and limit high-sodium processed foods. Avoid a diet high in red processed meat, as some have added hormones that may increase your risk of fibroids. It is important to maintain a healthy body weight, as there is increased production of oestrogen in obese women, which enhances the growth of fibroids. Finally, try to get enough vitamin D, as studies have shown a significant link between the development of fibroids and vitamin D deficiency. Your body can make enough vitamin D following exposure to sunlight, but if you spend most of your time indoors, it is recommended that you get your vitamin D from your diet. Foods such as egg yolks, fortified cereals, salmon, tuna, mackerel and vitamin D supplements may raise your vitamin D levels.

If you experience any fibroid symptoms or discover a firm, irregular mass in your abdomen, it may indicate the presence of fibroids and you should consult your healthcare provider for diagnosis and treatment. Some doctors may suggest watchful waiting by closely monitoring your symptoms and doing ultrasounds to check for significant changes. Others may suggest more invasive approaches based on your symptoms and factors such as age, location and size of fibroids, as well as your desire for pregnancy.

Melisa Anderson Cross is a clinical chemistry lecturer in the College of Health Sciences at the University of Technology, Jamaica.