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Environmental Factor, November 2015

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Battling uterine fibroids

By Tara Ann Cartwright

Erica Marsh and Janet Hall

Marsh, left, shown with Hall, is a gynecologist, consultant, researcher, and lecturer on women’s health. She is a researcher on a national study that examines treatment outcomes in women who have fibroids. (Photo courtesy of Steve McCaw)

Uterine leiomyomas, also known as fibroids, are the leading cause of hysterectomies in the United States and account for up to an estimated $34 billion annually in costs. 

On Oct. 10, Erica Marsh, M.D., a renowned uterine fibroid expert, addressed NIEHS scientists in her seminar, “‘There Will be Blood’: A Patient-centered View of Uterine Leiomyomas.” Marsh's talk was hosted by NIEHS researcher Janet Hall, M.D.

Origins unclear

According to Marsh, 65-70 percent of women have uterine fibroids by the age of 50, yet the origin of uterine fibroids remains unknown. She suggested that research and clinical experience have implicated several factors in fibroid development and growth, including race, obesity, genetics, and hormones such as estrogen and progesterone.

Marsh said that women often suffer for years before seeking medical treatment to relieve their symptoms. She advocated for greater attention by researchers and more public health outreach. “There is a lot of work to be done, and I hope some of you will engage in it,” she told the packed room.

The impact of a fibroid diagnosis

Marsh, an assistant professor at Northwestern University Feinberg School of Medicine, and her team have qualitatively assessed the burden of uterine fibroids on women’s emotional health. Of the 60 women with symptomatic uterine fibroids recruited for her study, including African-Americans, Caucasians, Hispanics, and Asians, the majority exhibited a significant emotional response, including fear, anxiety, anger, and depression.

Many women also felt helpless and believed that they had no control over their fibroids. More importantly, some women felt they lacked adequate support in handling these serious issues. The title of her talk came from a comment by one patient who, discussing the variability of symptoms, said, “I know one thing — there will be blood.”

Nutritional factors

Ultrasound studies have demonstrated that African-American women exhibit a higher fibroid incidence than Caucasian women. This prevalence is driven by an earlier age of initiation and a longer growth window. Moreover, said Marsh, African-American women are more likely to be deficient in vitamin D than Caucasian women.

She cited several studies by Donna Baird, Ph.D., lead researcher in the NIEHS Epidemiology Branch. For instance, Baird’s work has provided evidence that sufficient vitamin D may be associated with a reduced risk of uterine fibroids.

Racial disparities and health inequities

The remainder of Marsh’s presentation focused on racial disparities and health inequities, including the fact that women are more likely to face health inequities because their biological makeup demands more care and attention. “We need to do better for women,” Marsh emphasized.

She and her team have found that African-American women often exhibit larger fibroids, which entails different treatment options and risks. Disparities in prevalence and treatment may lead not only to an altered perception of what is normal, but also to different recovery scenarios and greater dissatisfaction with care and treatment. “If all of your sisters have this experience, and your mother and aunts have this experience, you start to think this is normal,” Marsh said.

A diagnosis of uterine fibroids is not something women should accept without diligent examination of lifestyle and options, she stressed. There are many approaches to treating uterine fibroids, including medications, hysterectomy, myomectomy, uterine artery embolization, and MRI-guided focused ultrasound surgery.

The patient and doctor must choose a treatment based on preferences, reproductive plans, and other medical considerations. Perhaps more importantly, new and effective therapies for this chronic condition must be developed. “I hope that I have convinced at least some of you to drop what you’re doing immediately and look at uterine fibroids,” she said. “We’re talking about a serious public health issue.”

(Tara Ann Cartwright, Ph.D., is a former postdoctoral fellow in the NIEHS Intracellular Regulation Group).

Citations: Ghant MS, Sengoba KS, Recht H, Cameron KA, Lawson AK, Marsh EE. 2015. Beyond the physical: a qualitative assessment of the burden of symptomatic uterine fibroids on women's emotional and psychosocial health. J Psychosom Res. 78(5):499-503.

Baird DD, Hill MC, Schectman JM, Hollis BW. 2013. Vitamin d and the risk of uterine fibroids. Epidemiology. 24(3):447-453.

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