Uterine Fibroids ‐ Why Aren't We Talking About Them?

Abstract

ProblemUterine fibroids (UFs) are smooth muscle tumors that are located in the uterus. Even though these tumors are mostly benign, they are the most common gynecological disorder; estimated to affect 70‐80% of women by the age of 50. Black women are disproportionately affected by UFs as UFs appear earlier in black women, the symptoms are often more severe and black women often wait longer to receive treatment and have more surgical complications relative to non‐black women. The epidemiology for UFs is unclear, however being of black race, hypertensive, obese, and pre‐menopausal increases the risk of developing UFs.DataData from the COMPARE‐UF (Comparing Options for Management: Patient‐centered Results for UF) multi‐site observational registry indicated that black women with UFs who received hysterectomy’s (uterus removal) for treatment had a lower health related quality of life (HRQoL) compared to white women receiving the same procedure. In a separate analysis from this same population we also published data indicating that black women with UFs were more likely to have a surgery that was not a hysterectomy, unless they were treated in Mississippi (MS). We have previously published data from patients treated for UFs in MS and have reported that relative to women with abnormal uterine bleeding but no UF’s, women with UFs had significantly more hypertension but no change in body mass index. We also reported that circulating factors associated with hypertension (ET‐1 and sFlt‐1) were significantly increased among women with UF's relative to women with abnormal uterine bleeding.RationaleAs MS ranks among the highest in the nation for hypertension, and black people per capita the likelihood for an increased prevalence of UFs is high. The combination of these studies and our own studies indicate that black women with UFs who reside in the rural South may be more affected and have lower HRQoL to black women with UFs who live in more urban areas. While the medical and surgical options are limited for UFs, data is beginning to emerge indicating geographical differences that elude to a different problem.Proposed SolutionHere in MS, we have proposed a patient navigator program (EMPOWER‐UF) to help educate women on the different treatment options available and to help women navigate the health care system. It is our belief that the combination of a patient navigator and a patience decision aid, adapted for women with UFs, could increase health literacy and improve the shared decision making process. The combination of these events will lead to an increased satisfaction in decision making regarding UF treatment choice and an increase in HRQoL.