Why are uterine fibroids especially common in black women?

ChristaMarie Coleman, MD, has had heavy periods for a long time. But 4 years back he started noticing other things that weren’t right. He felt an unusual pressure in his stomach. She used to go to the bathroom frequently. The abdominal exercises that were part of her fitness routine had become more difficult. The combination of symptoms prompted Coleman, a family practitioner in Orlando, to see her doctor.

The diagnosis: uterine fibroids. These are tumors in the uterus that are almost always not cancerous. Uterine fibroids are common. Experts estimate that up to 80% of women develop them by age 50. No one knows exactly what causes it; There’s probably a mix of factors involved.

Some women have uterine fibroids and don’t know it because they don’t have any symptoms. For others it is much more difficult. Symptoms may include heavy bleeding, painful periods, pain during sex, fertility issues, and other problems.

Coleman suspected she might have fibroids. “But it doesn’t run in my family,” she says. When she was diagnosed, “I was a little surprised but not totally shocked because we know that black women are more likely to be diagnosed with fibroids,” Coleman says.

John J. of Obstetrics and Gynecology at Northwestern University. Black women tend to develop fibroids 10 years earlier than white women and are four to five times more likely to have one or more tumors, says Serdar Bulun, MD, of Sciarra.

The reasons for this are not clear. While uterine fibroids are very common, they haven’t been studied enough, says Bulun.

While fibroids are almost never cancerous, “the symptoms can be very devastating, even if they are not cancerous,” says Bulun. She directs the only National Institutes of Health-funded basic science research program in the U.S. focused on uterine fibroids.

What’s behind the inequality?

This is a question that has no easy answer. complicating factors play a role here Common Disease, Erica Marsh, MD, says, Professor of Obstetrics and Gynecology at the University of Michigan Medical School.

Genes and hormones probably play a role in who develops uterine fibroids. For example, fibroids often stop growing or even shrink in menopause, when hormone levels are low.

There are also some other common patterns: According to the U.S. Department of Health and Human Services Office, your chances of fibroids are also higher if you have a family history of fibroids, if you are overweight, or if you eat a lot of red meat or ham. women’s Health. and sMuch research shows that women with uterine fibroids are more likely to experience depression and anxiety than women without fibroids. It is not clear why that is or which comes first.

According to Marsh and Ballun, the disparity in uterine fibroids may be partly influenced by the following factors:

chronic stress, It is stress that persists over a long period of time. It has long been linked to a number of health problems. And that can include stress from racism. “We know that racism is one of the main forms of chronic stress for black people,” says Marsh.

Marsh and colleagues reviewed studies of racial differences in who gets fibroids and another condition, endometriosis. Their findings, published in the journal Fertility and Sterility March 2023 to demonstrate a link between certain life experiences, including exposure to racism, and fibroids in black women.

It is not possible to prove that racism causes fibroids. But “there is at least some evidence, be it epidemiological or preliminary data, that there is an association between exposure to racism and an increased risk of fibroids,” Marsh says.

In a separate study, Bulun and his team analyzed fibroids in the uterus of white American, black American and Japanese patients. The biggest differences were between uterine fibroids Black American women and Japanese women. “We found that the fibroids of black patients have increased estrogen production and they made more estrogen, and this also contributes to fibroid growth,” he says.

Bulun adds that genes and heredity play a role in this, and that it is “entirely plausible that chronic stress may increase the body’s production of estrogen.”

exposure to phthalates, Phthalates are chemicals found in a variety of products, including chemical hair straighteners. Bulun’s team analyzed the levels of a particular phthalate in 712 uterine fibroid patients. They found a strong association between that phthalate and uterine fibroids. Their study, published in Proceedings of the National Academy of Science November 2022, The source of phthalates in women has not been traced and it has not been proven that those chemicals cause fibroids. But Bulun and colleagues previously reported a possible link between chemical hair straighteners and uterine fibroids. “We believe that phthalates are more common in hair straighteners,” says Bulun. “These products are used more frequently by Black women than other populations.”

MED12 genetic mutation, Finnish researchers found that about 70% of fibroid tumors are associated with a genetic mutation called MED12. Bulun says this mutation occurs during the second half of a woman’s menstrual cycle when cells in the myometrium, or smooth muscle of the uterus, multiply in preparation for pregnancy.

The Finnish study did not specify the racial or ethnic background of the women whose fibroids were studied. “It is possible that black women of sub-Saharan descent are more susceptible to genetic alterations or mutation formation in that MED12 gene, for reasons we do not understand,” says Bulun. He notes that it’s also possible that chronic stress stimulates tumors to grow large enough for doctors to find. More research is needed to know whether this happens and how it unfolds.

Having lived with fibroids herself, Coleman has this advice for women: “I would advise anyone reading this story not to wait, not to doubt yourself. If they feel like something isn’t right, they notice a change, they notice certain symptoms, I would encourage them to seek help, even if it’s just their doctor. [or] care team. They should not ignore its symptoms.

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