Abuse during childhood linked to uterine fibroids in African-American women

According to a new study from the Slone Epidemiology Center (SEC) at Boston University, African-American women who reported sexual or physical abuse before age 11 had a greater risk of uterine fibroids in adulthood compared with women who had no such abuse history. The association was strongest for women who experienced sexual abuse.

The study, which is published online in the American Journal of Obstetrics and Gynecology, was led by Lauren A. Wise, ScD, senior epidemiologist at SEC and associate professor of epidemiology at the Boston University School of Public Health.

This study followed 9,910 premenopausal African-American women from the Black Women's Health Study. In 2005, participants provided information on lifetime experiences of physical and sexual abuse during childhood (up to age 11), adolescence (ages 12-18), and adulthood (19 and older). The incidence of fibroids was ascertained from 2005 through 2011.

The results indicate that the incidence of uterine fibroids was increased by 16 percent among women who had been physically abused during childhood and by 34 percent among women who had been sexually abused during childhood. The risk of fibroids increased with increasing severity of child abuse. The results were weaker among women who reported high levels of coping, which is consistent with previous research showing that emotional support may buffer the negative health effects of violence. There was also little indication that abuse during adolescence and adulthood increased the risk of fibroids.

"This is the second prospective study to show an association between childhood abuse and uterine fibroids diagnosed during adulthood," said Wise. She noted that mechanisms might involve the influence of psychosocial stress on the biosynthesis or metabolism of sex steroid hormones, which are thought to be involved in fibroid development and growth. In addition, child sexual abuse is associated with sexually transmitted infections, which may also increase fibroid risk.

The lifetime risk of clinically-relevant uterine fibroids is 30 percent and they are a major contributor to gynecologic morbidity, including heavy menstrual bleeding, pelvic pain and infertility. In the U.S., fibroids account for more than $9.4 billion in health care costs annually and black women are two to three times more likely to be affected by the condition.

"Given the high prevalence of fibroids in African-American women, the association is of public health importance," Wise added.
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The Black Women's Health Study (BWHS) is the largest follow-up study of the health of African American women in the U.S. Led by researchers at the SEC, the study has followed 59,000 African-American women through biennial questionnaires since 1995 and has led to a better understanding of numerous health conditions that disproportionately affect African-American women.

Co-authors of the study include Lynn Rosenberg, ScD, principal investigator of the BWHS and professor of epidemiology at BUSPH, and Julie R. Palmer, ScD, professor of epidemiology at BUSPH.