Health & Fitness

The Fibroid Epidemic
By Evelyn C. White

These uterine tumors affect many Black women. Here's how to recognize them.
Reprinted from Essence, Dec., 1990

Carletta Wilson never thought twice about her heavy and lengthy periods. The excessive bleeding sapped her energy, but she kept stepping - as many Black women do.
Then one day she passed a huge blood clot. Alarmed she visited a gynecologist who told her she had uterine fibroid tumors. Last year after a two-year medical odyssey during which she became so anemic she could barely make it to work, Wilson under went major surgery to have the fibroids removed.

"My body was telling me about this problem for years, but I didn't listen," says Wilson, 39. "If I had, chances are I could have avoided the knife. What I tell sisters now is that we've got to pay attention to the messages we get from our bodies. Having the fibroids has changed my consciousness about taking my health for granted."

No More Fibroids
Early detection and treatment of fibroids can lessen their dangerous effects. Symptoms to watch for are:

The best protection from fibroids is to pay close attention to your body and get regular gynecological exams. Also, it can't hurt to stay as healthy and balanced as possible. Here are some tips:

WHAT ARE FIBROIDS?

Fibroids are benign tumors (doctors refer to them as myomas) that form in the uterus of 40 percent of women in their mid-thirties to early forties. Bundles of smooth muscle and connective tissue with their own blood supply, fibroids can slowly develop on the outer or inner surface of the uterine wall or within it, often changing its size and shape. The single or multiple growths range from the size of a pea to as large as a grapefruit. Experts aren't sure why, but they are three times more common in Black than in White women says Dr. Bill Jean-Pace, a gynecologist who practices near Orlando, Florida.

While little is known about what causes fibroids, doctors believe the tumors thrive on estrogen because they seem to enlarge during childbearing years and usually shrink after menopause when the production of estrogen decreases. For the majority of women, fibroids are harmless, especially if they are small, causing no symptoms at all, says Ezra C. Davidson, Jr., M.D., president of the American college of Obstetricians and Gynecologists. For others, the growths can create a domino-like effect of reproductive health problems that account for 580,000 hysterectomies and 45,000 Myomectomies (the tumor-removal procedure that Wilson underwent) each year.

If the fibroids grow, heavy or prolonged menstrual bleeding is one of its early warning signs. In fact, the bleeding can be so severe that some women have to be transfused. "We're not just talking heavy periods: some women hemorrhage so badly that they go into shock," explains Pace. "It's dangerous because anemia leaves one susceptible to all kinds of infectious disease and in the AIDS era, no doctor wants to give a patient a transfusion if it can be avoided."

Large tumors can also cause abdominal swelling, pain and lower-back discomfort, depending on their location. Or a large tumor may exert pressure on the bladder and cause frequent urination, or on the bowel, causing constipation.

If left unchecked, these tumors will distort the uterine cavity and may lead to recurrent miscarriage or infertility." Anyway you look at it, fibroids can develop into a very bad disease says Davidson, who practices in Los Angeles at the Martin Luther King, Jr./Charles Drew Medical Center.

Davidson says there is no medical evidence to support the theory that Black women are genetically predisposed to fibroids. Rather he believes that Black women suffer more complications from the disease because we do not get routine checkups early or often enough. "Far too many Black women delay getting basic gynecological exams," he says, "By the time they get into a doctor’s office their presentation of fibroid tumors is often dramatic." Pace agrees noting, "I recently removed a 9-pound, 6-once fibroid from a Black women who hadn’t seen a doctor in three years. Our women do tend to be more fearful of dealing with the issue."

It is important to respond quickly to fibroid symptoms because early diagnosis can give you more time to investigate treatment options. A pelvic ultrasonic scan, which produces a sound-wave picture can be useful in monitoring and identifying fibroid growths that may cause trouble. A blood test for iron deficiency or anemia is also used to diagnose fibroids.

TREATING FIBROIDS

Sometimes fibroids cause few or no complications. At other times doctors must weigh several forms of treatment. For smaller growths (less than the size of a 12-week pregnancy). Microsurgery might be preformed with a laser. These tiny instruments allow the doctor to vaporize or remove the fibroids through an intercession just above the navel.

If the fibroids have caused the uterus to swell to the size it would be in a 12-week pregnancy or larger, myomectomy or hysterectomy has traditionally been recommended. Myomectomy, a surgical procedure that removes fibroids but leaves the uterus intact, is generally recommended for women of childbearing age. Hysterectomy (removal of the uterus) is often suggested as a treatment for fibroids in women past childbearing age or who do not want more children. This procedure is easier than myomecomy, an operation that can leave internal scarring that may lead to painful intercourse, backaches and abnormal bleeding.

However a growing number of physicians are getting off the hysterectomy bandwagon for fibroids. "A woman should run, not walk away from a doctor who offers hysterectomy as the first option," says Trissa Baden, M.D., a Minneapolis gynecologist. "There are other methods of treatment. Studies show that a drug called Lupron can reduce fibroids by suppressing the release of estrogen. One of the drawbacks of the drug is that by cutting off the hormone, Lupron also induces a temporary menopausal state with such side effects as hot flashes, vaginal dryness and mood swings. "Lupron can bring some relief, but is not a cure" cautions Davidson. "To date there is no drug therapy that will completely remedy fibroids."

Some women have found success with holistic treatment. Paul Goss, N.D., a naturopathic physician who practices in Compton, California recommends an herb called damiana, available in many health-food stores, to shrink fibroids.

Damiana contains natural plant estrogen and seems to be the best herb for this problem," notes Goss. He suggests taking 1500 to 2000 milligrams a day in raw form. You can buy capsules or blend the herb with water.

As the old saying goes, an ounce of prevention is worth a pound of cure when dealing with fibroids. Nan Kathryn Fuchs, Ph.D., author of The Nutrition Detective: Treating Your Health Problems Through the Food You Eat (J.P. Tarcher, Paperback $9.95), suggests that changes in diet can help manage or reduce the size of fibroids. She urges women to eliminate coffee, chocolate, red meat and refined carbohydrates from their diet and to include more whole grains, vegetables, chicken and fish, Goss recommends reducing intake of whole milk dairy products especially cheese.

According to Pace, stress reduction, regular exercise and vitamins A, B and E will also help balance estrogen levels, which in turn may keep fibroids in check.

Wilson also stresses prevention. Since her surgery, she has started keeping a journal in which she documents her mental, physical and spiritual health. If she notes anything unusual, she checks it right away with more than one doctor. Overall, she says, her experience with fibroids has taught her an important lesson that she is eager to share with other Black women, "The best advice I can give is to stay on the case." Wilson says emphatically, "Fibroids will creep up on you gradually, Black women have to be very aware of this disease."

Evelyn C. White is the editor of the Black Women’s Health Book: Speaking for Ourselves.