Adverse childhood events and health-related quality of life among women undergoing hysterectomy for uterine leiomyoma

Abstract

Background and Aim Psychosocial stress may increase fibroid risk, but associations with symptom severity, which often influence clinical management decisions, have been underexamined. Our objective is to examine associations between adverse childhood experiences (ACE) and symptom severity and symptom impact on health-related quality of life (HRQL) among women undergoing hysterectomy for treatment of their leiomyomas (fibroids). Methods We recruited 103 premenopausal women into the Fibroids, Observational Research on Genes and the Environment (FORGE) study who were seeking evaluation of fibroids at the Medical Faculty Associates in Washington D.C. and intending to undergo hysterectomy at the George Washington University Hospital. For exposure classification, we assessed eight ACE categories related to child abuse and household challenges. For outcome classification, we used the Uterine Fibroid Symptom and Quality of Life (UFS-QOL). The five-level Likert scale responses were summed to create composite scores; a lower symptom severity score indicated fewer symptoms, while a higher HRQL score indicated better quality of life. We ran quasi-poisson regressions (log-link) to examine associations between ACE scores and UFS-QOL composite scores adjusting for age, race/ethnicity, and education (N=89). Results The majority of participants were Black (73%); about half had private insurance (55%) and a college degree (49%). Cumulative ACE and symptom severity scores were higher among Black compared to non-Black women (p ≤ 0.03). History of substance abuse in the household was associated with greater symptom severity (relative risk (RR) = 1.31, 95% CI: 1.07, 1.61), and worse HRQL (RR = 0.74, 95% CI: 0.55, 1.00). History of sexual abuse was also associated with worse HRQL (RR = 0.67, 95% CI: 0.48, 0.92). Conclusions Our study adds to the growing evidence that early life exposures to chronic stress may influence gynecologic health, including symptom-related quality of life. Keywords. Women’s health, gynecological health, health disparities, social-structural stressors