Black women and fibroids
Black women and fibroids
Fibroids are the most common growths in a woman’s reproductive system. Many women with fibroids have no symptoms at all, while others have symptoms ranging from heavy bleeding and pain to in-continence or infertility. These information pages explain what fibroids are, how they can affect your health and what your options are for treatment. For more information on heavy bleeding or hysterectomy, visit our pages on these topics.
What are fibroids?
Fibroids are tumors that grow in the uterus (womb). They are benign, which means they are not cancerous, and are made up of muscle fibers. Fibroids can be as small as a pea and can grow as large as a melon. It is estimated that 20-50 percent of women has, or will have, fibroids at some time in their lives. They are rare in women under the age of 20, most common in women in their 30s and 40s, and tend to shrink after the menopause.
Although the exact cause of fibroids is unknown, they seem to be influenced by estrogen. This would explain why they appear during a woman’s middle years (when estrogen levels are high) and stop growing after the menopause (when estrogen levels drop).
According to US studies, fibroids occur up to nine times more often in Black women than in white women, and tend to appear earlier. The reason for this is unclear. Also women who weigh over 70kg may be more likely to have fibroids. This is thought to be due to higher levels of estrogen in heavier women.
In the past, the contraceptive pill was thought to increase the risk of fibroids, but that was when the pill contained higher levels of estrogen than it does today. Some studies suggest that the newer combined pill (estrogen and prmmgestogen) and the mini pill (progestogen only) may actually help prevent or slow the growth of fibroids.
Types of fibroids
Fibroids are categorized by where they grow in the uterus:
Intramural — these grow in the wall of the womb and are the most common type of fibroid.
Sub serous— these fibroids grow from the outer layer of the womb wall and sometimes grow on stalks (called pedunculated fibroids). Sub serous fibroids can grow to be very large.
Sub mucous — sub mucous fibroids develop in the muscle underneath the inner lining of the womb. They grow into the womb and can also grow on stalks which, if long enough, can hang through the cervix.
Cervical — cervical fibroids grow in the wall of the cervix (neck of the womb) and are difficult to remove without damaging the surrounding area. If you have fibroids, you may have one or many. You may also have one type of fibroid or a number of different types.
As the cause of fibroids is still unknown, there are no clear guidelines for preventing them. However, there are some things you could do that may help reduce your risk:
Keep your weight in check. This will minimize estrogen levels in your body.
· Eat green vegetables and fruit, and avoid red meat.
An Italian study found that women who eat little meat but a lot of green vegetables and fruit seem to be less likely to develop fibroids than women who eat a lot of red meat and few vegetables.
· Some studies suggest the combined pill may protect against fibroids by keeping hormone levels from peaking and falling. The pill comes with its own set of side effects, however, so talk to your doctor about whether it’s right for you.
It is estimated that 75% of women with fibroids do not have symptoms, therefore many women don’t know they have fibroids. Whether or not you have symptoms depends on the size of the fibroids and where they are in your womb. This also affects the types of symptoms you are likely to have. For example, a small fibroid in the wall of your womb probably won’t cause any problems, whereas a large fibroid growing outward from your womb might press against your
bladder, causing bladder problems. The most common symptom of fibroids is heavy menstrual bleeding. Other symptoms include abdominal pain or pressure, changes in bladder and bowel
patterns and, in some cases, infertility.
Heavy menstrual bleeding (menorrhagia)
Heavy bleeding may involve flooding (a sudden gush of blood), long periods or passing large clots of blood. Heavy bleeding is not always due to fibroids, but when it is, it is usually associated with fibroids that grow into the womb (submucous). Although it is unclear exactly why fibroids cause bleeding, it may be that they stretch the lining of the womb, creating more lining to be shed during a period.
Heavy bleeding can be distressing and can make every day activities difficult. You will need to use extra sanitary protection and will probably need to change towels or tampons frequently. Some women with heavy bleeding feel they need to stay near a toilet during their periods. This can greatly restrict activity and may be frustrating or tiring.
Anemia (iron deficiency)
Some women with fibroids and heavy bleeding develop anemia as a result of blood loss. Anemia can make you feel weak, dizzy and tired. If blood tests show that you have anemia, ask your doctor about supplements or changes in your diet that might help. Foods such as liver, leafy green vegetables, dried fruit and even red wine can help boost your iron levels.
Pain and pressure
Some women with fibroids experience painful periods, dull aches in their thighs, back pain or constant pressure in the abdominal area that feels like bloating or fullness.
Pain during your period may be due to large clots of blood pushing through your cervix. Cramps could also be caused by the womb trying to force out a sub mucous fibroid that is growing on a stalk in the cavity of the womb. Large fibroids can make the womb big and bulky, which can lead to lower back pain or pelvic discomfort. Some women with fibroids feel a dull ache in their thighs or develop varicose veins in their legs. This happens when fibroids become so large they press on nerves and blood vessels that extend to the legs.
Occasionally, fibroids can cause sudden severe pain in the pelvic area or lower back. This may be due to a fibroid on a stalk (pedunculated) that has become twisted. This kinks the blood vessels in the stalk and cuts off the blood supply to the fibroid. If you feel sudden severe pain and also have a fever or feel sick, you should see your doctor. The fibroid may need to be removed or your doctor may recommend bed rest and painkillers until the pain stops on its own.
Pain during sex
Fibroids that press on the cervix or hang through the cervix into the vagina can make penetrative sex painful and can also cause bleeding during sex.