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Female Trouble: Understanding Fibroids
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Edgar G. Mathis, of Manor Texas, wrote in 1900 that he had operated on a Black woman to remove a large uterine fibroid and felt to the need to document the condition, “noting the meager literature concerning this rare form of neoplasm” among African Americans. Mathis’ operational notes – now more than a century old – read like the constant stream of articles, blogs, and research related to Black women and fibroids. That rare condition is shared, according to recent data from the Black Women’s Health Imperative (BWHI) and Hologic, by
more than 26 million Americans. “Because of the health disparities, devastating impact, and effects of uterine fibroids -- and to save and extend the lives and well-being of Black women -- BWHI commissioned the white paper to amplify the voices of Black women to advance health equity and shift the public perception and policies for social change,” said Tammy Boyd, JD, MPH, chief policy officer and counsel for Atlanta-based BWHI. “The widespread prevalence and disabling nature of uterine fibroids among Black women often surprises some clinicians.” Boyd found the existence of disparities in diagnosis and care of uterine fibroids result in Black women waiting longer than white women before seeking treatment: normally 4 years of more – which potentially exacerbates their conditions. This results in Black women experiencing more incidents of severe pelvic pain and anemia due to heavy bleeding. “By any measure, these statistics and outcomes are dire and indicative of a pressing public health crisis,” Boyd said. Still, little is known about what causes fibroids or how to definitively treat them – without resorting to hysterectomies. In fact, many Black women still approach anything gynecological as off limits, taboo, or shameful. As a result, the “female trouble” our elders whispered about, remains a painful and hidden heritage. During a 2-day roundtable by the Society for Women’s Health Research (SWHR) in Washington, D.C., expert researchers, gynecology-focused health care providers, patients, patient advocates and policy leaders discussed key deficits in research, clinical care, and federal policies. They noted advancements in treatment, including non-hormonal medical therapies that were also fertility-friendly, and the potential if Vitamin D to provide protective effects against fibroid growth without negatively impacting ovarian function. Additionally, SWHR highlighted the research of The Study of Environment, Lifestyle, and Fibroids – the first prospective study to identify incident fibroid cases based on ultrasound screenings and is specifically designed to investigate African ancestry, vitamin D deficiency, and reproductive tract infection as risk factors for fibroid incidence. Many offerings of the discussion centered around the science of fibroids, but in equal measure were bed-side manner suggestions that would foster trust between Black women and their physicians. “We suggest reconsidering a patient’s use of the word ‘normal’ or ‘fine’ when describing menstrual flow or pain because they may not realize that their normal may actually warrant medical concern,” said SWHR Director of Science Programs Irene Aninye. “Quantifying the use of feminine products or the duration of pain and its influence on daily activities is likely to better inform an assessment.” With so much to unpack, The Washington Informer offers a quick glimpse at information and resources available to our readers to approach fibroids head on, and seek a relief from “female trouble,” without delay or embarrassment. Read, Learn, Heal. Dr. Shantella Sherman
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Female Trouble
Researchers Revisit Theories on the Origins and Prevalence of Fibroids among Black Women By Lindiwe Vilakazi WI Staff Writer While the cause of fibroids remain a mystery to most researchers, our recent steps (and missteps) with the COVID-19 pandemic have highlighted the persistence of bias and racism in medicine. Whether rooting in issues of access, policies, practices, or stereotypes, Black women appear to suffer at greater rates from fibroids than their counterparts. To address this gap in the literature, the University of Maryland proposed a study, Examining Racism as a Risk Factor for Uterine Fibroids among African American Women, to collect data from 699 African American women in the southern region of the United States. This study examined the relationship between perceived and internalized racism and uterine fibroid diagnosis among African American women. The study revealed a direct effect between perceived racism and the likelihood of a uterine fibroid diagnosis. Sherilynn Prosser was 14 when diagnosed with endometriosis – a painful condition caused by uterine material growing outside the uterus and causing cramps and excessive bleeding with monthly hormonal changes. Her gynecologist told her it was a condition most Black were predisposed to developing and that there was no exact cure or remedy. She said it felt as if her physician had simply said, “suck it up,” and moved on. It wasn’t until thirty years later when she was diagnosed with uterine fibroids, that she began asking questions. “I allotted a certain amount of time each month to suffer in silence; I never questioned the diagnosis or treatment until my husband and I were expecting our first child and a sonogram showed the baby sharing womb space with a fibroid,” Prosser said. “Suddenly I had questions about if the two conditions were connected – and if the way I’d been brushed aside as a teen kept me assuming the fibroids were just the endometriosis acting up.” Prosser is not alone. Black women are more likely
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than white women to have uterine fibroids, and the debilitating symptoms often leave them feeling fearful, depressed, helpless, and alone. Many African American fibroid sufferers say they have often had their questions or concerns brushed aside or had their fibroid symptoms misdiagnosed as sexually transmitted infections or unplanned pregnancies. One survey from October 2020, for instance, found that of 777 Black adults polled in the United States, one in five said they had experienced race-based discrimination in health care settings within the past year. Black women in particular, the study found, were most affected. Hilda Hutcherson, M.D., a professor of obstetrics and gynecology and a dean at Columbia Vagelos College of Physicians and Surgeons in New York, said stress may be related to fibroid risk. “We don’t fully know what causes fibroids or why they’re more prevalent among Black women, though research suggests that stress may be associated with an increased fibroid risk. Some researchers theorize that a lifelong exposure to racism, combined with limited access to medical resources and a lower overall quality of care, might help explain this disparity in fibroid diagnoses,” Hutcherson said. “There is also preliminary research that shows that hair relaxers — chemicals used by millions of Black women — are associated with higher incidence of fibroids.” In research first introduced in 1992, phthalates – a substance added to plastics to increase their flexibility, transparency, durability, and longevity – was also present in chemical no-lye hair relaxers. There was an association made between lesions, scalp burns, and the development of fibroids. Dr. Sophia Sparks, a Dallas-Fort Worth scientist, though, said the science simply does not support conclusively that racism or hair relaxers cause fibroids. Sparks also believes the medical community does a disservice in making racial comparatives in some research. “There are so many chemicals introduced to the body on a regular basis that it is impossible to
say when, where or how they interact with the body once internalized. Phthalates are in no-lye hair relaxers, but also in the plastics and packaging that we use every day – they are used in the chemical coating on pizza boxes to keep them from being greasy, for instance,” said Sparks, who also acknowledged the existence of compounds the FDA labeled safe by themselves, but harmful when introduced to other compounds. “Fibroids are not a Black women’s issue – they are a female and environmental issue. Instead of looking at fibroids from the position of race, it may be more accurate and logical to do so economically. The truth is that every woman is at risk for fibroids, period,” Sparks said. HS
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Healthy Pregnancy, Healthy Baby Submitted by AmeriHealth Caritas District of Columbia The birth of a baby is a life-changing event, and there’s a lot to do to get ready. One of the most important is to see your health care provider for regular checkups. These checkups are part of prenatal care — the health care you get while you are pregnant. They can help prevent problems, giving you and your growing baby the best chance for good health. They also offer a safe space in which to ask questions.1
WHAT HAPPENS AT A PRENATAL CHECKUP?
During a prenatal visit, your health care provider will check for problems that can happen during pregnancy. They will ask about your health history and perform a physical exam. They’ll check your weight and discuss how much weight gain is healthy for your body. At some visits, they may also check your
health with a blood test or imaging test. One type of imaging test is an ultrasound exam. These show how your baby is growing, which can be exciting to see.1 You may be asked to provide a urine sample. Infections of the urinary tract (UTIs) are common during pregnancy. They can increase the risk of giving birth too early. A preterm birth is when you have your baby before 38 weeks of pregnancy.1
WHEN SHOULD I GET A PRENATAL CHECKUP?
If you think you may be pregnant, call your provider to set up a visit. If you are pregnant, it’s best to have regular prenatal checkups. Most women see their provider each month during early pregnancy. As they get closer to their expected day of delivery, they usually see their provider more often.1 Ask your provider for a schedule of prenatal visits that’s best for your health and the health of your baby.
The information in this article is to help you learn more about this topic. It is not to take the place of your health care provider. If you have questions, talk with your health care provider. If you think you need to see your health care provider because of something you have read in this information, please contact your health care provider. Never stop or wait to get medical attention because of something you have read in this material. Source: 1. “Pregnancy Check-Ups,” National Institutes of Health, https:// newsinhealth.nih. gov/2021/04/pregnancy-check-ups. All images are used under license for illustrative purposes only. Any individual depicted is a model.
Giving Your Baby a Bright Start
If you are pregnant and an AmeriHealth Caritas District of Columbia (DC) enrollee, the Bright Start® maternity care program can help you make healthy choices for yourself and your baby. The program is designed to support you during your pregnancy and after you give birth. When you join Bright Start, a Care Manager will call you and work with you to help you receive and use program services. If your
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pregnancy is high risk, a team of nurses and Care Connectors will check in with you often. They can help you stay connected to care during your pregnancy. Get help with: • Creating a birth plan • Choosing the right doctor or midwife for your family • Making appointments • Finding breastfeeding support and childbirth classes • Learning about prenatal vitamins • Finding housing • Getting supplies to prepare for your baby • Getting rides to and from your appointments • Signing up for home-delivered meals and other nutrition programs To join Bright Start as an AmeriHealth Caritas DC enrollee, call 1-877-7596883. Our trained staff is ready to help you Monday through Friday, 8 a.m. to 5 p.m.
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By the Numbers: Fibroids among Black Women According to McLeod Health, a centuries-old health network, offering research and health resources found that African American women suffer fibroids 2 to 3 times more than white women.
Because Black women suffer fibroids at an earlier age, they also are 2 to 3 times more likely to undergo surgery to remedy pain or other related health issues.
Black women tend to experience fibroids at a younger age and often more severely than their counterparts.
One estimate is that 25 percent of African American women will suffer from fibroids by the age of 25 and 80 percent will have them by age 50.
Of the estimated 26 million women between age 15 and 50 who have uterine fibroids, more than half of them will experience complications from them.
In August 2020, then Senator Kamala Harris (D-CA) and Representative Yvette Clarke (D-NY) introduced companion bills in Congress that aimed to fund research and education on uterine fibroids.
Endometriosis is a condition in which the uterine-like tissue grows outside of the uterus. This growth still bleeds and sheds monthly, as it will during a typical menstrual period, but it occurs in an area where it cannot easily leave the body. As a result, this can lead to symptoms such as increased menstrual pain, pain with sex, abnormal vaginal bleeding, intestinal distress, infertility, and chronic pain in the lower back and pelvis. It can resemble endometriosis symptomatically is uterine fibroids. Uterine fibroids are different from endometriosis in that they are noncancerous growths that occur inside or around the uterus but can sometimes mimic each other in symptoms.
The proposed bill would have provided $30 million annually from 2021 through 2025 to the National Institutes of Health to expand uterine fibroids research, create a uterine fibroids public education program at the Centers for Disease Control and Prevention, expand and improve data collection on people impacted by fibroids and more.
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A Healthy, Happy Easter By Elaine Magee, MPH, RD (Safeway Corporate Dietitian)
vored mineral or seltzer water and a variety of diet sodas. Make them festive by enjoying them with a wedge of lemon or lime.
You can have your carrot cake and eat it too during the Easter season! Just a few simple switches in your diet will get you closer to your goal of feeling great and making health a priority, all while eating the foods you love. Here are some tips and recipes for a healthy Easter feast!
Make simple switches in your favorite recipes to reduce the calories, saturated fat or raise the fiber
Encourage sensible serving sizes by using small plates, bowls, and utensils whenever possible and keeping your calorie- or carb-heavy side dishes like saucy potatoes to a maximum of half a cup.
Switch to whole grains (brown rice instead of white) or choose 100 percent whole wheat rolls and switch to extra virgin olive oil or canola oil when possible. Trade high-fat dairy ingredients for lighter options like plain Greek yogurt instead of sour cream, light cream cheese instead of regular, etc. Consider cutting sugar in half by choosing recipes that call for little if any sugar.
Eat slowly
Easter desserts are non-negotiable
It’s not only what you eat but how much
Savor every bite by letting your taste buds truly taste all the flavors. It takes about 20 minutes for your brain to get the message that your stomach is officially “comfortable” and that you should stop eating, so slowing down can help you avoid overeating. You can always take a “seconds” plate home for lunch the next day.
Minimize the impact on your calorie budget by serving yourself petite portions of the desserts you love. If you have diabetes or prediabetes, count the carbs contributed by the dessert into your meal carb budget.
Beet & Bacon Deviled Eggs PREP TIME: 20 minutes TOTAL TIME: 3 hours and 20 minutes SERVINGS: 8 INGREDIENTS: 2, 15 oz. cans pickled beets 8 hardboiled eggs, shells removed 3 slices turkey bacon ¼ cup plain, nonfat Greek yogurt 1 tbsp. extra virgin olive oil 2 tsp. Dijon mustard 1 tbsp. (heaping) finely chopped scallions 2 pinches ground black pepper (more to taste) Salt to taste (optional) DIRECTIONS: 1. Open pickled beets and pour liquid into medium glass bowl. Reserve beets for another dish (optional). Add shelled hardboiled eggs, stir and refrigerate for three hours, stirring occasionally for a brighter magenta color. For a deeper color, allow to sit in liquid overnight. 2. To assemble eggs, remove from pickled beet liquid and let dry on paper towel-lined plate. Discard liquid. Cut eggs in half lengthwise and remove yolks; set aside. 3. Coarsely chop turkey bacon and cook in medium nonstick skillet over medium heat until browned and crisp. Remove bacon pieces and place on paper towels. 4. Add Greek yogurt to small bowl and drizzle in olive oil while stirring. Add egg yolks, Dijon mustard, scallions, black pepper and salt (if desired), mashing with fork until mixed.
Enjoy low- or zero-calorie beverages throughout the Easter season
5. Reserve one piece of bacon per deviled egg half for garnish and stir in bacon bits to deviled egg mixture. Spoon egg mixture into each egg white half. Top with bacon pieces. Cover and refrigerate until ready to serve. Enjoy!
There are so many options to choose from now, including assorted unsweetened hot or cold teas, fla-
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Recent & Recommended Books on Fibroids By Lee Ross WI Staff Writer
Get Covered. Stay Covered.
Invisible Visits: Black Middle-Class Women in the American Healthcare System by Tina K. Sacks Although the United States spends almost onefifth of all its resources funding healthcare, the American system continues to be dogged by persistent inequities in the treatment of racial and ethnic minorities and women. Invisible Visits analyzes how middle-class Black women navigate the complexities of dealing with doctors in this environment. Based on original research, the author shines a light on how women perceive the persistently negative stereotypes that follow them into the exam room and proceeds to illustrate that simply providing more cultural-competency or anti-bias training to doctors will not be enough to overcome the problem. Hope Beyond Fibroids: Stories of Miracle Babies & the Journey to Motherhood by Gessie Thompson, and Felicia Scott In Hope Beyond Fibroids: Stories of Miracle Babies & the Journey to Motherhood you can read Thompson’s full story of her inspiring journey to motherhood; her refusal to give up on her dream; and the heroic walk of faith she and her beloved husband Marc traveled. Rounding out the book are incredible and inspiring miracle stories of 15 other mothers, both biological and adoptive, who too continued to have hope beyond fibroids-hope that they would one day become the mothers they’d always dreamed of becoming. This book raises awareness of the fibroids epidemic and offers hope to fibroid sufferers.
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Fibroid Reversal: Doctor’s Guide to Natural Remedies by George Roberts Fibroid tumors can be an endless source of bleeding, pain, and frustration. For some 30 percent of white women and around 60 percent of Black women, these generally nonmalignant growths will cause troublesome symptoms. Fibroid is one of the most resistant health problems confronted by modern medicine, this resistant is as a result of its ability to grown or develop around the uterus. This book offers alternative treatment suggestions such as natural remedies and nutritional therapy, Chinese acupuncture, and other noninvasive methods that may help patients heal or treat their fibroid conditions. Beating Endo: How to Reclaim Your Life from Endometriosis by Iris Kerin Orbuch MD, Amy Stein DPT Approximately one out of every 10 women has endometriosis, an inflammatory disease that causes chronic pain, limits life’s activities, and may lead to infertility. Despite the disease’s prevalence, the average woman may suffer for a decade or more before receiving an accurate diagnosis. Leading gynecologist and endometriosis specialist Dr. Iris Kerin Orbuch and world-renowned pelvic pain specialist and physical therapist Dr. Amy Stein have long partnered with each other and with other healthcare practitioners to address the disease’s host of co-existing conditions—which can include pelvic floor muscle dysfunction, gastrointestinal ailments, painful bladder syndrome, central nervous system sensitization—through a whole-mind/whole-body approach. HS
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Did You Know…? Fibroid Facts
By Lee Ross WI Staff Writer
In general, the severity of symptoms varies based on the number, size, and location of the fibroids.
<Fibroids are not cancerous, and they do not turn into cancer. They are balls of muscular tissue that grow inside the uterus, on the surface of the uterus or in the muscular wall of the uterus.
<Even with a variety of treatment options available, new fibroids may grow back to some degree in the years following most treatments. The need for repeat treatments ranges from 10 percent to 25 percent, depending on the number and sizes of the fibroids initially treated.
<Fibroids usually grow slowly during the reproductive years but may increase in size with pregnancy. <At menopause, fibroids shrink because estrogen and progesterone levels decline. Using menopausal hormone therapy containing estrogen after menopause usually does not cause fibroids to grow. <More than half of the women who have fibroids never experience symptoms and require no treatment.
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<The two most common symptoms of fibroids are heavy menstrual bleeding and pelvic pressure. Normal menstrual periods last four to seven days, but if you have fibroids, your periods are likely to last longer. <The bleeding might be so heavy that you may need to change your sanitary pads or tampons as often as every hour.
<The risk from fibroids may include a higher risk of miscarriage, infertility, premature labor, and labor complications. <Extensive research shows that provider beliefs and biases about Black women are linked to racial disparities in health and health care. Often, these biases are unconscious, but they still affect the care and recommendations provided by the physician and the trust a woman has in the recommended treatment. <Fibroids are most often found during a physical exam. Your health care provider may feel a firm, irregular (often painless) lump during an abdominal or pelvic exam. <Scans – such as ultrasounds and MRIs can confirm a diagnosis.
MARCH 2022 HEALTH WELLNESS & NUTRITION SUPPLEMENT / www.washingtoninformer.com
<Ultrasound: Ultrasound is the most commonly used scan for fibroids. It uses sound waves to diagnose fibroids and involves frequencies (pitch) much higher than what you can hear. A doctor or technician places an ultrasound probe on the abdomen or inside the vagina to help scan the uterus and ovaries. It is quick, simple, and generally accurate. However, it relies on the experience and skill of the doctor or technician to produce good results.
<MRI: This imaging test uses magnets and radio waves to produce images. It allows your provider to gain a road map of the size, number and location of the fibroids. We can also distinguish between fibroids and adenomyosis, which sometimes gets misdiagnosed. We use MRI to confirm a diagnosis and help determine which treatments are best for you. MRI may also provide a better option for related conditions such as adenomyosis. HS
Committing to Your Health & Wellness Goals All Year Round Sarina Sechrist, Mental Health Coordinator, Martha’s Table
shop for fresh fruits, veggies, and shelf-stable items every day at our Lobby Food Markets.
Charlie Gussom, at cgussom@ marthastable.org to learn more and join the next session.
Did you know that, on average, 80% of New Year’s resolutions fail by the second week of February? If this applies to your 2022 resolutions, you’re not alone! But good news, Martha’s Table is committed to standing alongside you this year as you commit to healthier habits, rooted in sustainable growth and change! We have your back with ten sustainable alternatives to traditional resolutions that are more likely to be successful!
2. ‘Start a gym membership’ vs. Get 15 minutes of physical activity daily. Our lives are busy, going to the gym is not always realistic. Exercising 15 minutes a day is small enough to incorporate even during busy days and will give you the motivation to increase the time duration as you see yourself maintaining the 15-minute goal. Check out Martha’s Table’s virtual workout classes by visiting https://marthastable.org/fitness/ and find a fitness program that works for you.
4. Find a significant other vs. Develop healthy relationship skills. Finding a partner is not something that is totally within your control. However, you can increase your chances of having healthy, fulfilling relationships by improving your interpersonal and overall emotional wellness skills. Join our “Growing a Healthy Mind” workshop to maximize your own emotional wellness, before adding a partner to the equation! You can register at http:// tinyurl.com/mt-growhealthymind
TRADITIONAL VS. ALTERNATIVE
1. ‘Lose weight’ vs. Eat fruits and vegetables daily. Adding healthier foods is more manageable than restricting foods. Naturally, consumption of unhealthy foods will decrease because you will be less hungry, shifting focus from weight to health. You can
3. ‘Delete social media’ vs. Replace 15 minutes of screen time with reading or meditating each day. All-or-nothing approaches are challenging to maintain and often leave us feeling defeated if we fail. Instead, start small by replacing only 15 minutes of screen
5 Sarina Sechrist, Mental Health Coordinator, Martha’s Table
time with reading or meditation. You can stick with this smaller goal, or build your way up to a bigger target. To help support this switch you can join the Community Change Makers Book Club at Martha’s Table contact
5. Get more sleep vs. Pick one day per week to go to bed early or sleep in late. We all want more sleep, but life is busy and things just seem to get in the way. However, we can significantly improve our mood and energy levels by getting extra sleep just one day a week. Also, making this goal specific and measurable will help you hold yourself accountable. 6. Save money vs. Cancel one monthly subscription and put that money directly in savings. Memberships often go unused. This is a simple way to increase your monthly savings that will add up over the year. Financial literacy skills such as this are an integral part of economic mobility, a major pillar in Martha’s Table Strategic Plan. To learn more about Martha’s Table economic mobility program and upcoming events, email David, Deputy Chief of Programs at dlloyd@ marthastable.org 7. Volunteer more vs. Donate to one charity or attend one community event. This is a realistic, specific and measurable goal that will help you hold yourself accountable. Interested in volunteering at a Martha’s Table community event? Visit marthastable.org/volunteer to sign up for volunteer opportunities. 8. Stop overcommitting to plans/work vs. Saying “no” once per week. Saying “NO” is a gift you give to yourself, and you deserve gifts weekly, not just on holidays! Are you inter-
ested in talking to a counselor about setting healthy boundaries for yourself in 2022? Contact Sarina Sechrist at ssechrist@marthastable.org or 202-643-4016. 9. Relax more vs. One night per week with no chores or plans. Spending one night during the week recharging will prevent the “end of week burnout” we often feel. Make your mental health the priority, not the dishes and laundry! 10. Spend more time in your relationships vs. Alternate hosting/scheduling monthly get-togethers with family and friends. Balancing relationships can be overwhelming. Sharing the responsibility of planning and spending time as a group can help lighten the load, allowing you to fully enjoy the time shared with loved ones. Martha’s Table can help support this goal through our Family Engagement program. Visit https://marthastable.org/ family-engagement-program/ to learn more about our family and parent initiatives. Now that you have the ten alternative New Year’s resolutions keep these four general tips in mind to ensure goal success. 1. Avoid over-assessing progress and don’t have an all-or-nothing mindset; it’s not about each day; it’s about the pattern 2. Don’t “wait till Monday to start over.” If you missed your goal this morning, try again this afternoon. The longer you wait to “start again,” the less likely you are to resume the goal 3. If possible have an accountability partner, someone who will check in and motivate you, not judge you 4. Remember goals should add to your life, not frustrate you! To learn more about Martha’s Table emotional wellness program offerings, contact Sarina at ssechrist@ marthastable.org or 202-643-4016
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