July is fibroids awareness month, and given the health disparities associated with fibroids, it is important that we bring awareness to this condition during this time of the year. In particular, African American women and women of African descent have the highest lifetime risk of developing fibroids.
According to a study published in the American Journal of Obstetrics and Gynecology, Black women have a lifetime risk of 80% compared to 70% for white women. African American patients are also at increased risk of having larger fibroids requiring intervention at a younger age.
While there is not a clear genetic link for fibroids, a family history of fibroids does appear to increase risk. Other factors that increase risk in patients are being overweight or obese, alcohol intake, and having a diet that is high in red meat and low in green leafy vegetables. Maintaining a healthy weight and diet is key, and clinicians should be sure to educate their patients on these factors.
Fibroids can be so small that they are unable to be felt or seen on ultrasound, and they can grow to be so large that they change the size and shape of the abdomen. Many patients will develop fibroids by the age of 50. However, fibroids develop earlier in Black women. Some patients will have just one. Others may have too many to count.
Many patients can go for months or years without being diagnosed. Driving awareness helps physicians to advocate for patients, especially the many Black women who experience fibroids at higher rates.
Fibroids may be the cause of heavy bleeding even if they are not large. So a patient with heavy bleeding can often benefit from a pelvic and transvaginal ultrasound even if there is not a palpably enlarged uterus on physical exam.
Submucosal fibroids cause heavy bleeding and are usually either numerous in quantity or located in or near the cavity of the uterus. These types of fibroids can also be identified using saline ultrasound or sonohysterogram to determine what percentage of the fibroids are submucosal versus intramural.
This information can help with management decision-making. Fibroids can also cause pelvic pressure, urinary frequency, and chronic constipation. All of those symptoms, and even worsening nocturia, should prompt investigation into the size and contents of a patient’s uterus. Furthermore, if a patient is having fertility issues, fibroids, depending on the location, can partially contribute to these issues, and removal may be a part of treatment.
Dr. Wendy Goodall McDonald, also known as Dr. Every Woman, is a board-certified Obstetrician and Gynecologist and founder of The Gyneco-blogic, a health blog that combines education and fun. She also doubles as an author, singer, and rapper who makes fun and informative parodies about healthcare topics. Dr. Wendy has spent years making a name for herself as the doctor who raps (#doctaraps). Connect with Dr. Wendy on Instagram, Twitter, and Facebook @dreverywoman.