December 1, 2014 • 29 mins
As many as 75 percent of women develop uterine fibroids, yet few are aware of this women's health issue. Cristen and Caroline break down what fibroids are, when they should be treated and why African-American women are at a higher risk of developing them.
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Speaker 1 (00:00):
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Head on over to stuff Mom Never told you dot
spreadshirt dot com and get your sminty swag on. Welcome
to stuff Mom Never Told You. From how Stuff Works
dot com. Hello, and welcome to the podcast. I'm Kristen
(01:08):
and I'm Caroline, and today we're talking about a health
issue requested by a number of listeners that a lot
of listeners probably have not heard of before. And frankly,
I was not aware of this either before we started researching,
and that is uterine fibroids. Yeah, I actually am ashamed
(01:30):
to say that I did not know about this either
until a former co worker of mine told me about
her experience with fibroids and said, well, you know, Caroline,
you should do a podcast on this because it affects
so many women, and a lot of the women it
effects are women who haven't had children. And so to
my former co worker and to our listeners out there
(01:52):
who were hoping to learn more about this, this is
for you. We're going to tell you today about uterine
fibroids a k a. Lie o mioma's which just makes
me think of lego my ego. Not to reduce that
to a catch phrase, but laomoma literally means growth of
smooth muscle. So fibroids are non cancerous, brain important, non
(02:16):
cancerous growth in the uterus that typically appeared during a
woman's childbearing years. And it bears repeating these are non
cancerous growth. In most cases, your chances of developing a
cancerous fibroid are super small. They're somewhere between one and
four hundred and one in a thousand cases, and just
(02:36):
having a fibroid or fibroids plural does not increase your
risk or your chances of developing cancer. And they develop
from uterine tissue when a cell divides repeatedly, which then
forms this firm mass, and the mass can be so
small that it's undetectable to the eye, but it also
can grow large enough in some cases that it distorts
(02:59):
the size of the uterus. In fact, there are some
women with fibroids so large that it distends their stomach right.
And so let's talk about how common this actually is
and the symptoms that you might experience, because I think
when we tell you a little bit about these issues,
you'll understand why maybe more people don't know about it
or don't know whether they have it, and how we
(03:21):
should know about it. My mind is blown that I
didn't know about this. I know this is exactly another
issue like endometriosis, where so it's so common for so
many women out there, and so many women do go
through the pain of fibroids, but not a lot of
people know about it. So estimates as to how common
fibroids are range from about women up to about seventy five.
(03:46):
So that's like a that's a huge window not how
many women potentially suffer from five fibroids. But many of
these women are unaware that they have them because they
don't have symptoms, or they miss stake their symptoms for
something else, and it's easy to see why you might
not get diagnosed because the symptoms aren't exactly a fibroid
(04:07):
specific Yeah, this totally reminded me two of our episode
on polycystic ovarian syndrome, where you have all sorts of
symptoms that could be anything. So a lot of women
go through a number of medical exams before they get
an actual diagnosis. So these symptoms can include things like
heavy or prolonged periods, pelvic pressure or pain, frequent urination,
(04:30):
difficulty emptying your bladder, constipation, back ache, or leg pains.
Um It can also cause acute pain, which has caused
when a fibroid outgrows its blood supply, then it dies
and in bits and pieces from the dying fibroid can
make their way into surrounding tissue. And another thing that
causes acute pain is something that really gave me pause
(04:54):
when I was reading these sources. But it's the issue
of when a fibroid that does grow ing from a
type of stock can end up twisted, thereby cutting off
the blood supply, and so that leads to very acute
pain as well. So again just to keep in mind,
because I had to keep reminding myself of this as
we were reading about fibroids, is that they are very common.
(05:19):
Most of the time they come with no symptoms whatsoever.
This is more talking about what happens when they do
enlarge or they grow in such a way that do
lead to very painful symptoms. Um. So there are different
kinds of uterine fibroids as well. There are three main classifications,
(05:40):
and your symptoms will depend on the type. So you
have submucosal fibroids which grow into the inner cavity of
the uterus, and these are likelier to cause prolonged heavy periods.
Then you have sub crusal fibroids, which project to the
outside of the uterus, and these are likelier to cause
urinary symptoms because they can press on your bladder and
(06:03):
also bulging from the back of the uterus can press
on your rectum causing a pressure sensation, or on your
spinal nerves causing back ache. Yeah, and of course I
feel like I've said this on every health episode we've
ever done that I automatically assume I have whatever it
is that we're talking about, and so of course my
back was killing me yesterday and it's still kind of
hurting today, and I was like, oh no, oh, no,
(06:25):
I have subsruscial Oh no, way. I went to the
gym for the first time and forever and my back
is killing me. Okay. But so the third and final
type is intramural fibroids, which grow in the uterine wall
itself and can distort the shape of the uterus and
cause prolonged heavy periods and pain and pressure sensation. So
there's no winning. Thanks a lot fibroids. These a lot
(06:47):
of body and we've been treating these fibroids for a
long time, even though today doctors are still kind of
scratching their heads about them. Um. In eighteen o nine,
President Lincoln's cousin, Jane Todd Crawford, became the first person
to undergo surgery to remove a fibroid, and a procedure
called a laparotomy, which involves a large cut through the
(07:11):
abdominal wall. And it wasn't necessarily just to remove a fibroid,
because at this time doctors probably weren't entirely sure what
was wrong with Jane Todd Crawford. Yeah, I mean, she
had some some distention of the stomach and everything like that,
and they had some theories about what was wrong with her,
and they went in and they removed this thing and
(07:32):
it was a fibroid. It turns out it was a fibroid. Uh.
And in eighteen forty we have the first successful myomectomy,
which is a surgery for fibroids whose goal is just
to remove the masses themselves and leave the uterus intact.
And this surgery was specifically to remove fibroids. It wasn't
just exploratory. And it's interesting that after the eighteen fifties
(07:55):
this procedure was largely abandoned. There were some safety issues,
some healthy shoes. Uh. It was picked up again in
two when a British surgeon actually improved methods, so it
became another option again. And today the most common surgery
used to treat fibroids is a hysterectomy, which is the
full removal of the uterus, and it's the only proven
(08:17):
permanent solution for uterine fibroids. And some women will choose
to also have their ovaries removed, a lot of women
will choose to keep them because if you also remove
the ovaries as you would imagine it immediately induces menopause, right,
And so myomectomy is still a surgical option today, and
that's like we said, removing just the growth itself, not
(08:38):
the entire uterus. And luckily it can actually be performed
as a laparoscopic or minimally invasive procedure today. It doesn't
have to be the radical opening of the entire abdominal cavity.
And speaking of minimally invasive options, women do have some
things open to them to choose from things like injecting
small particles into the arteries that supply blood to the uterus,
(09:01):
which ends up cutting off blood flow to the fibroids
as well. You can also use an electric current or
a laser to destroy them, which in my mind, I'm like,
why wouldn't you just do that all the time, But
obviously there are other issues. Um, and then there's a
very controversial option of power more selation, which involves using
a very tiny rotating power blade to slice uterine growths
(09:24):
into strips that can be removed through a small incision.
And that doesn't sound controversial, that seems like okay, cool
advancements in science. However, it may cause small benign tumors
to form in the abdominal cavity or in rare cases
when the fibrod actually is cancerous, to spread cancer cells. Yeah,
(09:47):
because essentially when they're removing those strips, they might sometimes
leave stuff behind which can migrate. And there was a
very recent case where UM a woman underwent the surgery
and she developed stage for cancer because of that, and
so power more sulation is now a procedure very much
under review. There are also some medications out there to
(10:11):
temporarily treat fibroids. You have gnatotropin releasing hormone agonists of
course you know. Of course this blocks the production of
estrogen and progesterone and it stops menstruation, thereby shrinking the
fibroids and improving anemia. Anemia is something commonly associated with
this UM. Then there's also the Marina, which is a
(10:33):
progestin releasing intra uarine device or i u D, and
it can also relieve heavy bleeding associated with fibroids, but
it doesn't shrink the actual fibroids. And in a fascinating
twist myth of priss Stone a k A are you
for eight six can also shrink fibroids. And if it's
(10:54):
ringing a bell in your brain, that's because myth of
PRIs stone is an abortiveation. It's often for two as
the abortion pill because it's a drug used to end pregnancies,
and it can shrink those fibroids, like I said, but
only in postman apozzle women, and once you stopped taking it,
the fibroids grow back. It's so interesting, so very very
(11:16):
interesting and scary distressing. Yeah, and and you know we've
listed a whole bunch of treatments basically for the express
purpose of illustrating that. Well, yes, there are a ton
of options out there. They're all sort of uh leading
us to what we're about to talk about, which is
that even though we've known about fibroids for a long time,
(11:38):
we're still not exactly sure the best way to treat them,
nor are we exactly sure the exact cause. And so
we're gonna talk way more about that when we come
right back from a quick break and now back to
the show. So when we left off, we were talking
about all of these different treatment options, the only one
(12:01):
of which that's proven to be permanent is a hysterectomy,
which is a pretty aggressive surgery. I mean, it's removing
having your uterus and possibly your ovaries as well removed. Um.
But the thing that left both Caroline and me saying
what is the fact that we've known about them for
a long time, and yet even today doctors aren't really
(12:23):
sure what causes it. And I feel like this is
a common refrain through so many of the women's health
related podcasts that we've done. I mean, and when we
say we've known about them for a long time, we're
talking about going back to ancient Greece when Hippocrates called
them uterine stones, and then in the second century Greek
physician Galen referred to them as scleromas, and more recently
(12:45):
in the nineteenth century. In eighteen fifty four, German doctor
Rudolph Virtuow introduced the term myoma, which means a benign
tumor of muscular tissue, after demonstrating that those fibroid masses
were composed from smooth muscles and speaking of fibroids. It
wasn't until eighteen sixty that the term fibroid was actually
(13:07):
introduced by Baron Carl von Roka Tanski. Carl, I just
like that, Carl Dr carl Um. But so, despite the
fact that even Hippocrates was talking about these things, nobody
knows exactly why they happened. They do know that there
are two main factors at play, one hormones to genetics.
(13:32):
And so let's look at some of these interesting hormonal clues. Yeah,
and of course the hormones implicated in this are estrogen
and progesterone. As with everything, is it everything here? I
think it's everything. I think that some days. Um. So
the hormonal clues are the fact that they do tend
to grow rapidly during pregnancy when hormone levels are running high.
(13:57):
But the more pregnancies a woman has, the lower her risk.
The risk is also lower for women who take oral contraceptives,
and they tend to shrink when you take anti hormone medicine.
They actually stop growing and shrink once you hit menopause. Yeah,
and there's also a link where women who get their
(14:19):
periods at a young age also appear to be at
a higher risk. And there's a higher incidents among women
whose mothers took d e S, which is a synthetic
estrogen and endocrine disruptor UH during their pregnancy. And the
link between in utero d e S exposure and early
onset fibroids is actually particularly pronounced among African American women,
(14:42):
and there are other factors as well. A diet has
been talked about, especially diets high in red meat and
low in green veggies and fruit, so people eat your veggies.
Another reason to do that a drinking alcohol, and also
age because it's more common as we age, especially once
we hit our thirties and forties. And obesity is also
(15:03):
a big risk factor. It actually amplifies your risk two
to three times higher um if you are obese. But
the biggest risk factor that we need to talk about
that a lot of doctors are looking into is this
very strong connection between uterine fibroids and African American women.
They disproportionately affect Black women and they're more likely to
(15:26):
experience symptoms longer before they seek help, which could be
contributed to a number of different factors. But just for instance,
fortent of women waited over four years to go to
the doctor and seek out a diagnosis, which again who
knows how many doctor visits that takes right exactly. And
(15:46):
fibroids also tend to strike African American women earlier. On average,
it hits in their late twenties as opposed to their thirties,
so it's more likely to impact their childbearing plans, especially
if it took them a long time time to get
a diagnosis. And then there was a survey in the
Journal of Women's Health that found that Black women were
(16:08):
significantly more likely to have severe symptoms like heavier, prolonged periods, cramping,
and anemia. They were more likely to report that fibroids
interfered with physical activities and relationships. They were also more
likely to miss work for fibroid related reasons and more
likely to seek out health information about fibroids but then
(16:29):
report feeling like they couldn't find good answers. Forty percent
of these women said that they visited two or more
specialists before doctors detected fibroids, and the incidents in relative
risk grade for uterine fibroids, according to the study, was
three times greater for black women, and that was compared
(16:50):
to uh their study population of white women who had
the same levels of education, employment status, and overall health status.
So all other factors being equal, you still have this
much much higher risk. And on top of that, there
are two point four times likelier to have a hysterectomy
as a result, and six point eight times likelier to
(17:12):
have a myomectomy, which is the procedure where they go
in to remove the fibroid, but they leave the uterus intact.
And we're gonna hit more on the whole the significance
of those surgery numbers in just a second. But what
I thought was very interesting was this study in the
American Journal Epidemiology linking hair relaxing chemicals with fibroids. Uh.
(17:36):
They write that these chemicals are used by millions of
black women, possibly exposing them to various chemicals through scalp
lesions and burns, and they found that the instances of
fibroids were linked to higher reports of frequency and duration
of use and number of burns, but the risk was
not related to age at first use or the type
(17:57):
of formula. That's a huge deal. The blog is sphere
kind of exploded around this time, talking about the fact
that like something that so many African American women use
as part of a beauty routine could potentially have horrific
health effects. And when we talk about the broader significance
of this condition, and its treatment and the need for
(18:20):
more attention to it, just even having women like us
being aware that this is something that could happen, that
that could very well be existing in our bodies right now.
Um is the fact that fibroids are the biggest indication
for women in the US to get hysterectomys, which is
a major surgical procedure that has equally major life and
(18:41):
economic effects, not to mention all of the different symptoms
and how that pain and discomfort, um and bleeding or
nemia can lead to just difficult lifestyle, hindrances of affecting
relationships and missed work or school whatever it might be. Right,
(19:02):
And so if we look at the numbers, fibroids lead
to two hundred thousand hysterectomies in the United States each year,
not to mention thirty thousand myomectomies each year. And granted,
the time spent healing is reduced if you go for
a minimally invasive type of hysterectomy or myomectomy, but even so,
(19:23):
we need to talk about the very real costs of
that many women experiencing that big of surgery every year.
There is a two thousand twelve study publishing the American
Journal of Obstetrics and Gynecology which adjusted up the previously
reported costs four fibroids to five point nine to thirty
four point four billion dollars annually in the United States,
(19:47):
and that includes not only the medical costs, but also
the cost of lost work productivity attributable to uterine fibroids.
And again going back to African American women, they a
seventy seven percent likelier to miss work because of this
health condition. And for an even further cost breakdown from
(20:10):
that study, UM the estimated annual direct costs that includes
things like surgery, hospital admissions, outpatient visits, and medications. They
put it between four point one and nine point four
billion dollars, So no chump change, right, And in terms
of that whole lost work productivity thing, Christians absolutely right
that African American women are seventy seven percent more likely
(20:32):
to miss work UM and in general, when you look
at the numbers UH that survey found that more than
one quarter of women report lost work days and more
than one fifth reported actual concerns about losing their job
due to the whole situation stemming from uterine fibroids um
and so the estimated lost work our costs is between
(20:54):
one and a half and seventeen point two billion, and
of course the estimated cost of obstetric outcomes that are
attributed to those fibroid tumors fall between two hundred and
thirty eight million and seven point seven billion dollars. That's
a lot of lost money and lost time. Yeah, And
(21:14):
I mean, in no way, like none of the statistics
that we've signed throughout this podcast minimize the importance of
knowing about this very real health issue. And it's startling
to me that it is isn't talked about very much
at all. Um. I feel like it's indicative of a
(21:34):
lot of issues with women's health in general, where there
are a lot of things that we usually aren't aware
of in terms of how our bodies work and can work.
And again, in a lot of these situations, if you
have fibroids, you durn fibroids you don't even know and
that's totally fine. This isn't Ladies, go to your doctor's
right now and find out if you have fibroids. Half
(21:54):
the time, it's totally fine, But they can grow into
these tumors can cause all of these symptoms, and in
much less likely circumstances, they can become cancerous. Right, And
so this definitely ties in issues of doctors not listening
to women, of women having to spend so much time
(22:15):
and money going from doctor to doctor to seek out
a diagnosis of what's wrong with me. I'm in this
pain or I'm having these issues with my period, and
maybe not even knowing that those kinds of symptoms are
worth a doctor visit, or maybe not being able to
afford or to have insurance to be able to go
to a doctor, or not being able to take time
off work. I mean, there's so many different factors they
(22:36):
can go into this very real health care issue. Um,
but I hope that this was a p s A
for listeners of at least, you know, validating the health
issues of women out there who have had to deal
with uterine fibroids, and also news for listeners who might
not have been aware of this condition of Hey, if
(22:58):
these kinds of symptoms start crop being up, this could
be something to talk to your doctor or nurse practitioner about.
So I have a feeling that there are listeners whom
this is very much resonating with and we want to
hear from you. Were you able, have you been able
to get treatment for it? Um? What has been your
(23:19):
experience when it comes to this. Mom Stuff at house
Stuff Works dot Com is our email address. You can
also tweet us at mom Stuff podcast or messages on Facebook.
And we've got a couple of messages to share with
you when we come right back from a quick break
and now back to the show. So I've gotta let
(23:41):
her here from Rosie about our episode on domestic violence,
and she writes, I wanted to share with you some
constructive work that's taking place in Australia in terms of
supporting victims of domestic violence. The trade union movement spearheaded
by my Union, the Victorian branch of the Australian Services Union,
has been pushing to get a special category of leave
(24:02):
included in employment agreements. This domestic violence leave is a
special category of paid leave to allow victims of domestic
violence time to attend court and other appointments, move houses,
or other urgent requirements that being a victim of domestic
violence may cause. This additional category of leeve allows people
to not have to use their holiday time undecidedly unpleasant
(24:23):
tasks like getting a restraining order. It also keeps employers
mindful that their employees have lives outside the office that
can interrupt or impact their work. The first employment agreement
to include this category of leeve was negotiated by a
city council in two thousand eleven. I think while it's
absolutely imperative to work hard on preventing domestic violence, the
sad fact is that it's an ongoing issue and I
(24:45):
don't see that changing any time. For all the pledges,
fundraising and education programs about not committing violent acts, we
as a society also need defined ways to support the
people who are affected by this. Money issues and stability
are often reasons that women will not leave an abusive partner.
For workplaces to be supportive of women who are trying
to leave abusive relationships, additional leave is an excellent way
(25:07):
to empower women to be able to make the choices
they want to make. The Australian Council of Trade Unions
is lodging a claim at the Fair Work Commission to
secure ten days paid domestic leave as a minimum entitlement
for all employees. As a unionist and a feminist, I'm
very proud to be part of a movement that is
doing something to support people in abusive relationships and allow
(25:29):
them to get things done so they can continue to
live their lives. So thanks so much, Rosie for letting
us know about that very important work that the Council
of Trade Unions is doing. Okay, I have a letter
here from Jenny. She says, I worked on the domestic
violence field for five years before I returned to school
to get my master's degree in social work. During that time,
(25:49):
I accompanied survivors to court and at the hospital during
forensic exams. I was often the first and last person
they saw as they attended to leave situations of intimate
partner violence. I say intimate partner rather than stick because
it addresses the fact that nine point four percent of
high school students report being hit, slapped, or physically hurt
on purpose by their boyfriend or girlfriend in the twelve
months prior to the survey, and she cites the Centers
(26:11):
for Disease Control and Prevention Youth Risk Behavior Survey. Unfortunately,
many states, including Kentucky where I practice, do not offer
legal production to people in dating relationships, which makes teens
particularly vulnerable. And then she has a couple of other
things that she says she wants to address. She says, well,
you addressed how there are many types of domestic violence.
You forgot two types that strongly contribute to the difficulty
(26:33):
of leaving an abusive relationship, economic abuse and reproductive abuse.
Economic abuse involves withholding money, ensuring that no property or
credit cards are in the victim's name, or refusing to
allow the victim to work. Reproductive abuse involves replacing or
sabotaging birth control, forcing the partner to obtain an abortion
or preventing her from getting one, or lying about the
(26:53):
methods of birth control. Both of these categories can affect
straight and gay couples differently. One category people for get
about is victims of domestic violence who are disabled. Women
with disabilities are more likely to experience domestic violence and
sexual assault than non disabled women, simply due to the
fact that women with disabilities have particular vulnerabilities that non
disabled women do not have, such as meeting assistance with
(27:15):
self care and day living activities, and requiring medical assistance.
Research from Michael Johnson, who I believe you quoted at
one point, differentiates intimate terrorism from situational couple violence and
his research, he separates the cycle of violence that includes
planning for future violence from violence between couples that is
frequently mutual and more often than not fueled by drug
and or alcohol abuse, economic difficulties, and youth. It is
(27:38):
the latter group of offenders who are most frequently successful
in batterers treatment programs. As most programs teach people alternative
conflict resolution skills, people who fit the category of intimate
terrorists will use treatment groups to learn new ways of
concealing or getting away with violence. They may also use
the participation in the group as further ammunition to gas
light their partners. I can't be to be, so if
(28:00):
I'm in a group, you should see the other guys.
And Jenny goes on to say that she hopes that
more attention is brought to domestic violence through the promotion
of Domestic Violence Month in October every year. And so, Jenny,
I just want to thank you so much for all
of your incredible points, and thanks to everybody who's written
into us. Mom Stuff at how stuff works dot com
is our email address, and I just want to put
(28:21):
a word out there speaking of domestic violence. Since we
just read a couple of letters about it um. There
is a new ish Now documentary called Private Violence UM
produced by hbo UM that is very difficult to watch
but very much worth watching to learn more about this issue,
particularly in the US, and if you want to learn
(28:42):
more about it, go to private violence dot com. Um
And if you want to learn more about us, you
can find all of our social media links as well
as all of our blogs, videos, and podcasts, including this
one with links to all of our sources so you
can read along with us over at stuff mom Never
Told You You dot com For more on this and
(29:05):
thousands of other topics. Is that how stuff Works dot com.
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(00:22):
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Head on over to stuff Mom Never told you dot
spreadshirt dot com and get your sminty swag on. Welcome
to stuff Mom Never Told You. From how Stuff Works
dot com. Hello, and welcome to the podcast. I'm Kristen
(01:08):
and I'm Caroline, and today we're talking about a health
issue requested by a number of listeners that a lot
of listeners probably have not heard of before. And frankly,
I was not aware of this either before we started researching,
and that is uterine fibroids. Yeah, I actually am ashamed
(01:30):
to say that I did not know about this either
until a former co worker of mine told me about
her experience with fibroids and said, well, you know, Caroline,
you should do a podcast on this because it affects
so many women, and a lot of the women it
effects are women who haven't had children. And so to
my former co worker and to our listeners out there
(01:52):
who were hoping to learn more about this, this is
for you. We're going to tell you today about uterine
fibroids a k a. Lie o mioma's which just makes
me think of lego my ego. Not to reduce that
to a catch phrase, but laomoma literally means growth of
smooth muscle. So fibroids are non cancerous, brain important, non
(02:16):
cancerous growth in the uterus that typically appeared during a
woman's childbearing years. And it bears repeating these are non
cancerous growth. In most cases, your chances of developing a
cancerous fibroid are super small. They're somewhere between one and
four hundred and one in a thousand cases, and just
(02:36):
having a fibroid or fibroids plural does not increase your
risk or your chances of developing cancer. And they develop
from uterine tissue when a cell divides repeatedly, which then
forms this firm mass, and the mass can be so
small that it's undetectable to the eye, but it also
can grow large enough in some cases that it distorts
(02:59):
the size of the uterus. In fact, there are some
women with fibroids so large that it distends their stomach right.
And so let's talk about how common this actually is
and the symptoms that you might experience, because I think
when we tell you a little bit about these issues,
you'll understand why maybe more people don't know about it
or don't know whether they have it, and how we
(03:21):
should know about it. My mind is blown that I
didn't know about this. I know this is exactly another
issue like endometriosis, where so it's so common for so
many women out there, and so many women do go
through the pain of fibroids, but not a lot of
people know about it. So estimates as to how common
fibroids are range from about women up to about seventy five.
(03:46):
So that's like a that's a huge window not how
many women potentially suffer from five fibroids. But many of
these women are unaware that they have them because they
don't have symptoms, or they miss stake their symptoms for
something else, and it's easy to see why you might
not get diagnosed because the symptoms aren't exactly a fibroid
(04:07):
specific Yeah, this totally reminded me two of our episode
on polycystic ovarian syndrome, where you have all sorts of
symptoms that could be anything. So a lot of women
go through a number of medical exams before they get
an actual diagnosis. So these symptoms can include things like
heavy or prolonged periods, pelvic pressure or pain, frequent urination,
(04:30):
difficulty emptying your bladder, constipation, back ache, or leg pains.
Um It can also cause acute pain, which has caused
when a fibroid outgrows its blood supply, then it dies
and in bits and pieces from the dying fibroid can
make their way into surrounding tissue. And another thing that
causes acute pain is something that really gave me pause
(04:54):
when I was reading these sources. But it's the issue
of when a fibroid that does grow ing from a
type of stock can end up twisted, thereby cutting off
the blood supply, and so that leads to very acute
pain as well. So again just to keep in mind,
because I had to keep reminding myself of this as
we were reading about fibroids, is that they are very common.
(05:19):
Most of the time they come with no symptoms whatsoever.
This is more talking about what happens when they do
enlarge or they grow in such a way that do
lead to very painful symptoms. Um. So there are different
kinds of uterine fibroids as well. There are three main classifications,
(05:40):
and your symptoms will depend on the type. So you
have submucosal fibroids which grow into the inner cavity of
the uterus, and these are likelier to cause prolonged heavy periods.
Then you have sub crusal fibroids, which project to the
outside of the uterus, and these are likelier to cause
urinary symptoms because they can press on your bladder and
(06:03):
also bulging from the back of the uterus can press
on your rectum causing a pressure sensation, or on your
spinal nerves causing back ache. Yeah, and of course I
feel like I've said this on every health episode we've
ever done that I automatically assume I have whatever it
is that we're talking about, and so of course my
back was killing me yesterday and it's still kind of
hurting today, and I was like, oh no, oh, no,
(06:25):
I have subsruscial Oh no, way. I went to the
gym for the first time and forever and my back
is killing me. Okay. But so the third and final
type is intramural fibroids, which grow in the uterine wall
itself and can distort the shape of the uterus and
cause prolonged heavy periods and pain and pressure sensation. So
there's no winning. Thanks a lot fibroids. These a lot
(06:47):
of body and we've been treating these fibroids for a
long time, even though today doctors are still kind of
scratching their heads about them. Um. In eighteen o nine,
President Lincoln's cousin, Jane Todd Crawford, became the first person
to undergo surgery to remove a fibroid, and a procedure
called a laparotomy, which involves a large cut through the
(07:11):
abdominal wall. And it wasn't necessarily just to remove a fibroid,
because at this time doctors probably weren't entirely sure what
was wrong with Jane Todd Crawford. Yeah, I mean, she
had some some distention of the stomach and everything like that,
and they had some theories about what was wrong with her,
and they went in and they removed this thing and
(07:32):
it was a fibroid. It turns out it was a fibroid. Uh.
And in eighteen forty we have the first successful myomectomy,
which is a surgery for fibroids whose goal is just
to remove the masses themselves and leave the uterus intact.
And this surgery was specifically to remove fibroids. It wasn't
just exploratory. And it's interesting that after the eighteen fifties
(07:55):
this procedure was largely abandoned. There were some safety issues,
some healthy shoes. Uh. It was picked up again in
two when a British surgeon actually improved methods, so it
became another option again. And today the most common surgery
used to treat fibroids is a hysterectomy, which is the
full removal of the uterus, and it's the only proven
(08:17):
permanent solution for uterine fibroids. And some women will choose
to also have their ovaries removed, a lot of women
will choose to keep them because if you also remove
the ovaries as you would imagine it immediately induces menopause, right,
And so myomectomy is still a surgical option today, and
that's like we said, removing just the growth itself, not
(08:38):
the entire uterus. And luckily it can actually be performed
as a laparoscopic or minimally invasive procedure today. It doesn't
have to be the radical opening of the entire abdominal cavity.
And speaking of minimally invasive options, women do have some
things open to them to choose from things like injecting
small particles into the arteries that supply blood to the uterus,
(09:01):
which ends up cutting off blood flow to the fibroids
as well. You can also use an electric current or
a laser to destroy them, which in my mind, I'm like,
why wouldn't you just do that all the time, But
obviously there are other issues. Um, and then there's a
very controversial option of power more selation, which involves using
a very tiny rotating power blade to slice uterine growths
(09:24):
into strips that can be removed through a small incision.
And that doesn't sound controversial, that seems like okay, cool
advancements in science. However, it may cause small benign tumors
to form in the abdominal cavity or in rare cases
when the fibrod actually is cancerous, to spread cancer cells. Yeah,
(09:47):
because essentially when they're removing those strips, they might sometimes
leave stuff behind which can migrate. And there was a
very recent case where UM a woman underwent the surgery
and she developed stage for cancer because of that, and
so power more sulation is now a procedure very much
under review. There are also some medications out there to
(10:11):
temporarily treat fibroids. You have gnatotropin releasing hormone agonists of
course you know. Of course this blocks the production of
estrogen and progesterone and it stops menstruation, thereby shrinking the
fibroids and improving anemia. Anemia is something commonly associated with
this UM. Then there's also the Marina, which is a
(10:33):
progestin releasing intra uarine device or i u D, and
it can also relieve heavy bleeding associated with fibroids, but
it doesn't shrink the actual fibroids. And in a fascinating
twist myth of priss Stone a k A are you
for eight six can also shrink fibroids. And if it's
(10:54):
ringing a bell in your brain, that's because myth of
PRIs stone is an abortiveation. It's often for two as
the abortion pill because it's a drug used to end pregnancies,
and it can shrink those fibroids, like I said, but
only in postman apozzle women, and once you stopped taking it,
the fibroids grow back. It's so interesting, so very very
(11:16):
interesting and scary distressing. Yeah, and and you know we've
listed a whole bunch of treatments basically for the express
purpose of illustrating that. Well, yes, there are a ton
of options out there. They're all sort of uh leading
us to what we're about to talk about, which is
that even though we've known about fibroids for a long time,
(11:38):
we're still not exactly sure the best way to treat them,
nor are we exactly sure the exact cause. And so
we're gonna talk way more about that when we come
right back from a quick break and now back to
the show. So when we left off, we were talking
about all of these different treatment options, the only one
(12:01):
of which that's proven to be permanent is a hysterectomy,
which is a pretty aggressive surgery. I mean, it's removing
having your uterus and possibly your ovaries as well removed. Um.
But the thing that left both Caroline and me saying
what is the fact that we've known about them for
a long time, and yet even today doctors aren't really
(12:23):
sure what causes it. And I feel like this is
a common refrain through so many of the women's health
related podcasts that we've done. I mean, and when we
say we've known about them for a long time, we're
talking about going back to ancient Greece when Hippocrates called
them uterine stones, and then in the second century Greek
physician Galen referred to them as scleromas, and more recently
(12:45):
in the nineteenth century. In eighteen fifty four, German doctor
Rudolph Virtuow introduced the term myoma, which means a benign
tumor of muscular tissue, after demonstrating that those fibroid masses
were composed from smooth muscles and speaking of fibroids. It
wasn't until eighteen sixty that the term fibroid was actually
(13:07):
introduced by Baron Carl von Roka Tanski. Carl, I just
like that, Carl Dr carl Um. But so, despite the
fact that even Hippocrates was talking about these things, nobody
knows exactly why they happened. They do know that there
are two main factors at play, one hormones to genetics.
(13:32):
And so let's look at some of these interesting hormonal clues. Yeah,
and of course the hormones implicated in this are estrogen
and progesterone. As with everything, is it everything here? I
think it's everything. I think that some days. Um. So
the hormonal clues are the fact that they do tend
to grow rapidly during pregnancy when hormone levels are running high.
(13:57):
But the more pregnancies a woman has, the lower her risk.
The risk is also lower for women who take oral contraceptives,
and they tend to shrink when you take anti hormone medicine.
They actually stop growing and shrink once you hit menopause. Yeah,
and there's also a link where women who get their
(14:19):
periods at a young age also appear to be at
a higher risk. And there's a higher incidents among women
whose mothers took d e S, which is a synthetic
estrogen and endocrine disruptor UH during their pregnancy. And the
link between in utero d e S exposure and early
onset fibroids is actually particularly pronounced among African American women,
(14:42):
and there are other factors as well. A diet has
been talked about, especially diets high in red meat and
low in green veggies and fruit, so people eat your veggies.
Another reason to do that a drinking alcohol, and also
age because it's more common as we age, especially once
we hit our thirties and forties. And obesity is also
(15:03):
a big risk factor. It actually amplifies your risk two
to three times higher um if you are obese. But
the biggest risk factor that we need to talk about
that a lot of doctors are looking into is this
very strong connection between uterine fibroids and African American women.
They disproportionately affect Black women and they're more likely to
(15:26):
experience symptoms longer before they seek help, which could be
contributed to a number of different factors. But just for instance,
fortent of women waited over four years to go to
the doctor and seek out a diagnosis, which again who
knows how many doctor visits that takes right exactly. And
(15:46):
fibroids also tend to strike African American women earlier. On average,
it hits in their late twenties as opposed to their thirties,
so it's more likely to impact their childbearing plans, especially
if it took them a long time time to get
a diagnosis. And then there was a survey in the
Journal of Women's Health that found that Black women were
(16:08):
significantly more likely to have severe symptoms like heavier, prolonged periods, cramping,
and anemia. They were more likely to report that fibroids
interfered with physical activities and relationships. They were also more
likely to miss work for fibroid related reasons and more
likely to seek out health information about fibroids but then
(16:29):
report feeling like they couldn't find good answers. Forty percent
of these women said that they visited two or more
specialists before doctors detected fibroids, and the incidents in relative
risk grade for uterine fibroids, according to the study, was
three times greater for black women, and that was compared
(16:50):
to uh their study population of white women who had
the same levels of education, employment status, and overall health status.
So all other factors being equal, you still have this
much much higher risk. And on top of that, there
are two point four times likelier to have a hysterectomy
as a result, and six point eight times likelier to
(17:12):
have a myomectomy, which is the procedure where they go
in to remove the fibroid, but they leave the uterus intact.
And we're gonna hit more on the whole the significance
of those surgery numbers in just a second. But what
I thought was very interesting was this study in the
American Journal Epidemiology linking hair relaxing chemicals with fibroids. Uh.
(17:36):
They write that these chemicals are used by millions of
black women, possibly exposing them to various chemicals through scalp
lesions and burns, and they found that the instances of
fibroids were linked to higher reports of frequency and duration
of use and number of burns, but the risk was
not related to age at first use or the type
(17:57):
of formula. That's a huge deal. The blog is sphere
kind of exploded around this time, talking about the fact
that like something that so many African American women use
as part of a beauty routine could potentially have horrific
health effects. And when we talk about the broader significance
of this condition, and its treatment and the need for
(18:20):
more attention to it, just even having women like us
being aware that this is something that could happen, that
that could very well be existing in our bodies right now.
Um is the fact that fibroids are the biggest indication
for women in the US to get hysterectomys, which is
a major surgical procedure that has equally major life and
(18:41):
economic effects, not to mention all of the different symptoms
and how that pain and discomfort, um and bleeding or
nemia can lead to just difficult lifestyle, hindrances of affecting
relationships and missed work or school whatever it might be. Right,
(19:02):
And so if we look at the numbers, fibroids lead
to two hundred thousand hysterectomies in the United States each year,
not to mention thirty thousand myomectomies each year. And granted,
the time spent healing is reduced if you go for
a minimally invasive type of hysterectomy or myomectomy, but even so,
(19:23):
we need to talk about the very real costs of
that many women experiencing that big of surgery every year.
There is a two thousand twelve study publishing the American
Journal of Obstetrics and Gynecology which adjusted up the previously
reported costs four fibroids to five point nine to thirty
four point four billion dollars annually in the United States,
(19:47):
and that includes not only the medical costs, but also
the cost of lost work productivity attributable to uterine fibroids.
And again going back to African American women, they a
seventy seven percent likelier to miss work because of this
health condition. And for an even further cost breakdown from
(20:10):
that study, UM the estimated annual direct costs that includes
things like surgery, hospital admissions, outpatient visits, and medications. They
put it between four point one and nine point four
billion dollars, So no chump change, right, And in terms
of that whole lost work productivity thing, Christians absolutely right
that African American women are seventy seven percent more likely
(20:32):
to miss work UM and in general, when you look
at the numbers UH that survey found that more than
one quarter of women report lost work days and more
than one fifth reported actual concerns about losing their job
due to the whole situation stemming from uterine fibroids um
and so the estimated lost work our costs is between
(20:54):
one and a half and seventeen point two billion, and
of course the estimated cost of obstetric outcomes that are
attributed to those fibroid tumors fall between two hundred and
thirty eight million and seven point seven billion dollars. That's
a lot of lost money and lost time. Yeah, And
(21:14):
I mean, in no way, like none of the statistics
that we've signed throughout this podcast minimize the importance of
knowing about this very real health issue. And it's startling
to me that it is isn't talked about very much
at all. Um. I feel like it's indicative of a
(21:34):
lot of issues with women's health in general, where there
are a lot of things that we usually aren't aware
of in terms of how our bodies work and can work.
And again, in a lot of these situations, if you
have fibroids, you durn fibroids you don't even know and
that's totally fine. This isn't Ladies, go to your doctor's
right now and find out if you have fibroids. Half
(21:54):
the time, it's totally fine, But they can grow into
these tumors can cause all of these symptoms, and in
much less likely circumstances, they can become cancerous. Right, And
so this definitely ties in issues of doctors not listening
to women, of women having to spend so much time
(22:15):
and money going from doctor to doctor to seek out
a diagnosis of what's wrong with me. I'm in this
pain or I'm having these issues with my period, and
maybe not even knowing that those kinds of symptoms are
worth a doctor visit, or maybe not being able to
afford or to have insurance to be able to go
to a doctor, or not being able to take time
off work. I mean, there's so many different factors they
(22:36):
can go into this very real health care issue. Um,
but I hope that this was a p s A
for listeners of at least, you know, validating the health
issues of women out there who have had to deal
with uterine fibroids, and also news for listeners who might
not have been aware of this condition of Hey, if
(22:58):
these kinds of symptoms start crop being up, this could
be something to talk to your doctor or nurse practitioner about.
So I have a feeling that there are listeners whom
this is very much resonating with and we want to
hear from you. Were you able, have you been able
to get treatment for it? Um? What has been your
(23:19):
experience when it comes to this. Mom Stuff at house
Stuff Works dot Com is our email address. You can
also tweet us at mom Stuff podcast or messages on Facebook.
And we've got a couple of messages to share with
you when we come right back from a quick break
and now back to the show. So I've gotta let
(23:41):
her here from Rosie about our episode on domestic violence,
and she writes, I wanted to share with you some
constructive work that's taking place in Australia in terms of
supporting victims of domestic violence. The trade union movement spearheaded
by my Union, the Victorian branch of the Australian Services Union,
has been pushing to get a special category of leave
(24:02):
included in employment agreements. This domestic violence leave is a
special category of paid leave to allow victims of domestic
violence time to attend court and other appointments, move houses,
or other urgent requirements that being a victim of domestic
violence may cause. This additional category of leeve allows people
to not have to use their holiday time undecidedly unpleasant
(24:23):
tasks like getting a restraining order. It also keeps employers
mindful that their employees have lives outside the office that
can interrupt or impact their work. The first employment agreement
to include this category of leeve was negotiated by a
city council in two thousand eleven. I think while it's
absolutely imperative to work hard on preventing domestic violence, the
sad fact is that it's an ongoing issue and I
(24:45):
don't see that changing any time. For all the pledges,
fundraising and education programs about not committing violent acts, we
as a society also need defined ways to support the
people who are affected by this. Money issues and stability
are often reasons that women will not leave an abusive partner.
For workplaces to be supportive of women who are trying
to leave abusive relationships, additional leave is an excellent way
(25:07):
to empower women to be able to make the choices
they want to make. The Australian Council of Trade Unions
is lodging a claim at the Fair Work Commission to
secure ten days paid domestic leave as a minimum entitlement
for all employees. As a unionist and a feminist, I'm
very proud to be part of a movement that is
doing something to support people in abusive relationships and allow
(25:29):
them to get things done so they can continue to
live their lives. So thanks so much, Rosie for letting
us know about that very important work that the Council
of Trade Unions is doing. Okay, I have a letter
here from Jenny. She says, I worked on the domestic
violence field for five years before I returned to school
to get my master's degree in social work. During that time,
(25:49):
I accompanied survivors to court and at the hospital during
forensic exams. I was often the first and last person
they saw as they attended to leave situations of intimate
partner violence. I say intimate partner rather than stick because
it addresses the fact that nine point four percent of
high school students report being hit, slapped, or physically hurt
on purpose by their boyfriend or girlfriend in the twelve
months prior to the survey, and she cites the Centers
(26:11):
for Disease Control and Prevention Youth Risk Behavior Survey. Unfortunately,
many states, including Kentucky where I practice, do not offer
legal production to people in dating relationships, which makes teens
particularly vulnerable. And then she has a couple of other
things that she says she wants to address. She says, well,
you addressed how there are many types of domestic violence.
You forgot two types that strongly contribute to the difficulty
(26:33):
of leaving an abusive relationship, economic abuse and reproductive abuse.
Economic abuse involves withholding money, ensuring that no property or
credit cards are in the victim's name, or refusing to
allow the victim to work. Reproductive abuse involves replacing or
sabotaging birth control, forcing the partner to obtain an abortion
or preventing her from getting one, or lying about the
(26:53):
methods of birth control. Both of these categories can affect
straight and gay couples differently. One category people for get
about is victims of domestic violence who are disabled. Women
with disabilities are more likely to experience domestic violence and
sexual assault than non disabled women, simply due to the
fact that women with disabilities have particular vulnerabilities that non
disabled women do not have, such as meeting assistance with
(27:15):
self care and day living activities, and requiring medical assistance.
Research from Michael Johnson, who I believe you quoted at
one point, differentiates intimate terrorism from situational couple violence and
his research, he separates the cycle of violence that includes
planning for future violence from violence between couples that is
frequently mutual and more often than not fueled by drug
and or alcohol abuse, economic difficulties, and youth. It is
(27:38):
the latter group of offenders who are most frequently successful
in batterers treatment programs. As most programs teach people alternative
conflict resolution skills, people who fit the category of intimate
terrorists will use treatment groups to learn new ways of
concealing or getting away with violence. They may also use
the participation in the group as further ammunition to gas
light their partners. I can't be to be, so if
(28:00):
I'm in a group, you should see the other guys.
And Jenny goes on to say that she hopes that
more attention is brought to domestic violence through the promotion
of Domestic Violence Month in October every year. And so, Jenny,
I just want to thank you so much for all
of your incredible points, and thanks to everybody who's written
into us. Mom Stuff at how stuff works dot com
is our email address, and I just want to put
(28:21):
a word out there speaking of domestic violence. Since we
just read a couple of letters about it um. There
is a new ish Now documentary called Private Violence UM
produced by hbo UM that is very difficult to watch
but very much worth watching to learn more about this issue,
particularly in the US, and if you want to learn
(28:42):
more about it, go to private violence dot com. Um
And if you want to learn more about us, you
can find all of our social media links as well
as all of our blogs, videos, and podcasts, including this
one with links to all of our sources so you
can read along with us over at stuff mom Never
Told You You dot com For more on this and
(29:05):
thousands of other topics. Is that how stuff Works dot com.
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