Finally, focus on fibroids

March 27, 2001

Heather Heilman

Uterine fibroids won't kill you, which is probably the only good thing you can say about them, and one of the few things anyone can say with certainty on the topic. No one knows for sure how many women have fibroids, which are non-cancerous growths in the uterus, because no one knows how many silent, undiagnosed cases there may be.

Estimates of the percentage of women who will have fibroids in their lifetime range from 25 to 40 percent. Black women seem to be more likely to get fibroids than white women. No one knows why.

"There seems to be a strong genetic component, but we don't know wherein lies that component," said Valerie Petit Wilson, deputy director of the Tulane-Xavier Center for Bioenvironmental Research, who oversees the CBR's day-to-day work on fibroids.

Many women who have fibroids have no symptoms, but others experience heavy bleeding, pain, infertility, loss of pregnancy or other symptoms. Fibroids account for approximately half the hysterectomies performed in the United States. There are other, less drastic options, like removal or embolization of the fibroids, but many women don't know about them. One of the reasons fibroids caught the attention of the CBR is because hormones play a role in their growth.

Fibroids tend to grow during the reproductive years, get bigger during pregnancy, and recede after menopause. There is a possibility that environmental hormones may influence the growth of fibroids. Last year, the CBR began a project to study fibroids and share what it learns with the community. Researchers started by looking at the records at Charity Hospital, and were lucky enough to get their hands on a paper published in 1924 about fibroid cases at Charity in 1921.

"Even then they had identified that black women had a higher incidence of fibroids," noted Wilson. Another thing that hasn't changed is that hysterectomy is still the standard treatment for fibroids in poor women. "That might not be the only thing that can be done for these individuals, but it's now become an economic choice," Wilson said.

Researchers have begun to compile a fibroids database, looking at recent cases at Charity and comparing them with those of a private physician who offers uterine-sparing treatment options. Now they are beginning to generate hypotheses for further investigation. One of the things they'd like to look at is whether or not obesity contributes to fibroids. They're also curious about the possible effect the use of birth control pills has had on the number of women with fibroids, and if exposure to pesticides and industrial pollution plays a role. Those relationships, however, can be hard to tease out.

"One of the complications in looking at women's health issues is that response to stimuli occurs over a lifetime, and women have different sensitivities at different times in their lives. A single exposure to something at the time you're 8 years old may have a profoundly different impact than the same exposure when you're 18 or 48," Wilson said.

Researchers at the CBR hope to be able to share data with studies that are taking place in Washington, D.C., Washington state, and Puerto Rico, which will allow the development of a broader, more comprehensive picture of which ethnic groups in which places seem more susceptible to the condition. Scientists at the CBR are looking at which estrogen receptors seem to be most active in fibroids, and what the genetic markers for fibroids might be.

Their research is currently being funded through a grant from the Greater New Orleans Foundation, but they are also looking for other sources of grants. The CBR is also actively working to share its knowledge with the community.

"We want to make sure that as we learn through research, we're communicating that knowledge with people," Wilson said. She has been involved in organizing a series of "hormone salons" that give women a chance to learn and ask questions about fibroids and other issues related to women's environmental health. "Women don't talk about fibroids over coffee," Wilson said. "It's not the kind of thing that comes up in conversation. But when they have information, they're empowered to make their own decisions about treatment."

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