Are you worried you have risk factors for fibroids? About 70% of white women and 80% of black women will develop these non-cancerous uterine growths by the time they turn 50. But why do some women develop more or larger growths? And why are might some women be affected by symptoms--and at an earlier age--while others don't even know they have fibroids? Check out our guide to risk factors for uterine fibroids, and get a better understanding of how these tumors can impact your life.
For now, the science on why women get fibroids is still emergening. Luckily, more recent studies can point out factors that increase your risk for fibroids.
We've already noted that race plays a major role in risk for uterine fibroids. Most woman will develop fibroids at some point, but the ones at the highest risk have a family fibroid history; are Black, Asian, or Hispanic; and/or have a BMI (Body Mass Index) in the obese range.
How much of a role does race place in fibroid risk? One BJOG Journal study found that black women have a two-threefold higher fibroid risk. That’s why about 80% of black women develop fibroids, according to the Society for Interventional Radiology. And it may be why European women have a lower fibroid risk than women in the U.S.: the racial mix in populations is very different.
Still, Caucasian women now have higher average BMIs; in turn, we are noting higher fibroid rates among this population. But race and weight are not the only risk factors for fibroids. Additional factors include your age (risk decreases as you get older); premenopausal state, hypertension, family history and the time since you last gave birth. (Both full-term pregnancies and breastfeeding seem to decrease your fibroid risk by affecting your hormones.) On the negative end of the spectrum, smoking and dietary items such as processed foods and soybean milk can add to your risk of getting fibroids.
In some cases, the birth control you use--especially oral contraceptives or depot medroxyprogesterone acetate--elevate your risk. And that's because they affect your estrogen levels, possibly encouraging fibroids' growth.
But, while some forms of birth control increase your fibroid risk, we can also often control fibroid growth with birth control pills. And, we can shrink the tumors by cutting off their blood supply using a procedure called UFE (uterine fibroid embolization.)
Recently, a study in Fertility and Sterility revealed the link between fibroid risk and your environment. If your mom was exposed to endocrine-disrupting chemicals during her pregnancy, you could have a higher risk of developing fibroids. While researchers aren’t sure why, it seems that these hormones change the developing uterus in ways that make you more likely to develop fibroids down the road.
What are endocrine-disrupting chemicals (EDCs)? Whether man-made or natural, they are chemicals that interfere with your endocrine system. As a result, they can harm your developmental, reproductive, neurological and/or immune health. BPA and phthalates are some of the best-known EDCs.
In fact, reviews in 2017 and 2019 found that exposure to phthalates at any point in your life increases your risk for fibroids. In the first study, researchers in China discovered that having more of the phthalate DEHP in your urine (it’s often added to plastic to make it flexible) translated to a higher risk for fibroids. And in the second study, Black women with higher phthalate levels in their urine had both larger fibroids and enlarged uteruses.
Now, these are just the risks associated with one kind of EDC. But many others exist. And now we can say that any exposure ups your fibroid risk, as does having diabetes; being obese; suffering from cardiovascular disease or reproductive tract disorders; being over the age of 40; having no children; or having neurodevelopmental disorders.
We are constantly discovering other fibroid risk factors, and recently, scientists from the University of Helsinki uncovered a genetic link. After monitoring 728 women with 2263 tumors, researchers grouped their fibroids by genetic variants.
For most women, these fibroids fell neatly into one of three. But a number of the fibroids didn’t fit into previously identified categories. Instead, they showed variations that cells’ histone activity. (Histones help shape and control gene.activity.)
After seeing this variation, the researchers discovered an inherited fibroid risk. Women with certain genetic mutations have a higher risk of developing tumors. As a result, with more research, women with these mutations could receive counseling and regular fibroid screening. In that way, it could be easier to detect and diagnose any developing growths in their earliest stages.
A new study in Human Genetics identified certain gene combinations that point toward your risk factors for fibroids. After identifying these genes, they can assign screened women a uterine fibroid polygenic risk score (PRS). The idea? The higher your PRS, the more likely you are to develop fibroids. Now, doctors can screen patients for these genes and determine each woman’s PRS score. After receiving an elevated PRS score, women could place their symptoms in context if they appear. Then, they could avoid delaying a fibroid diagnosis. So that women wouldn’t have to suffer for years without relief.
After studying the test results of almost 500 women with fibroids, researchers compared their genetic markers to women without these growths. Here’s what they found. There are 30 specific genetic chromosomal locations that can be linked to an increased fibroid development risk. Now that we know their connection, if your mother or grandmother had fibroids, you can ask doctors to screen you for these markers. Then, if you have any, you may reach a fibroid diagnosis faster if you start displaying any symptoms.
If you are experiencing fibroid symptoms like heavy periods, pelvic pain, incontinence or constipation, your doctor may check you for fibroids. Unfortunately, many women will face physicians who dismiss their pain, so you may have to self-advocate or see several doctors to be taken seriously. We hope that’s not the case, but you should be prepared…and persistent.
Once you find a doctor who listens, you’ll usually receive a pelvic exam and a pelvic sonogram; together, they should deliver a fibroids diagnosis. Still, you may need a transvaginal sonogram to determine if the fibroid has affected your uterine lining.
As soon as you’ve been diagnosed, you’ll need to consider your treatment options. And remember that you do have options: not all fibroid diagnoses will end in surgery. In fact, there are minimally invasive fibroid treatments like uterine fibroid embolization that can help you find relief. But the option you choose will largely depend on the type of symptoms you’re currently experiencing.
Once you know you have fibroids, you have lots of options. If you aren’t bothered by symptoms, you may just monitor the tumor(s). With fibroids that are small, birth control, diet and exercise may keep them from causing you pain. But if pregnancy is important to you, the location of your fibroids will also be important. Fibroids that grow in the uterine cavity or block the fallopian tubes may affect your fertility.
If symptoms or infertility send you in search of relief, it’s important to research all your treatment options. While some doctors may recommend surgery (myomectomy or hysterectomy), we like to explore less invasive options. To learn more about non-surgical fibroid treatments schedule a consult today with our Dallas area fibroid experts.
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