Untreated Hypertension Increases Fibroid Diagnosis Risk

Patients with untreated and new-onset hypertension have an increased risk for newly reported fibroid diagnosis, according to a study published online April 16 in JAMA Network Open.

Susanna D. Mitro, Ph.D., from Kaiser Permanente Northern California in Oakland, and colleagues examined associations of hypertension, antihypertensive treatment, anthropometry, and blood biomarkers with the incidence of reported fibroid diagnosis in midlife using data from the Study of Women’s Health Across the Nation. Participants were enrolled in 1996 to 1997 and followed through 13 semiannual visits from 1998 to 2013. Fibroid diagnosis was reported at each visit.

The researchers found that 20 percent of the 2,570 participants without a history of diagnosed fibroids reported a new fibroid diagnosis during follow-up. Risk varied based on category of hypertension treatment, with an increased risk seen for participants with untreated hypertension versus those with no hypertension (hazard ratio, 1.19; 95 percent confidence interval, 0.91 to 1.57) and a reduced risk for those with treated hypertension (hazard ratio, 0.80; 95 percent confidence interval, 0.56 to 1.15). The risk for newly diagnosed fibroids was lower among eligible participants with hypertension taking antihypertensive treatment (hazard ratio, 0.63; 95 percent confidence interval, 0.38 to 1.05). Participants with new-onset hypertension had an increased risk for newly diagnosed fibroids compared with never-hypertensive patients (hazard ratio, 1.45; 95 percent confidence interval, 0.96 to 2.20). No associations were seen for anthropometric factors or blood biomarkers with fibroid risk.

“Investigation into mechanisms and health implications is warranted; if the associations are causal, antihypertensive medication use where indicated may present an opportunity to prevent clinically apparent fibroid development at this high-risk life stage,” the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

Abstract/Full Text

What are fibroids?

Fibroids are the most common benign (noncancerous) tumors of the female reproductive system. They can vary greatly in size, ranging from microscopic to growths exceeding several centimeters. Fibroids can occur as single masses or in clusters, and their location within the uterus can influence symptoms. They can develop within the uterine wall, inside the uterine cavity, or project outwards from the uterus.

Many women with fibroids experience no symptoms at all. However, when symptoms do occur, they can significantly impact the quality of life. Common symptoms include:

• Heavy or prolonged menstrual bleeding
• Pelvic pain or pressure
• Frequent urination or difficulty emptying the bladder
• Pain during intercourse
• Back pain or leg pain
• Difficulty getting pregnant

Fibroids and Black women

The reasons for the increased risk of fibroids in Black women are complex and not fully understood. Here are some potential contributing factors:

• Genetic predisposition likely plays a role, with certain gene variations being more common in Black women.
• Fibroids are influenced by estrogen and progesterone. Black women tend to have higher lifetime exposure to these hormones due to factors like earlier menstruation and later menopause.
• Vitamin D may have a protective role against fibroids. Research suggests Black women may have lower vitamin D levels on average.
• Stress, environmental exposures, and access to health care may contribute to the disparity. Systemic inequities and social determinants of health can place Black women at a disadvantage.

Black women experience a greater burden of fibroids compared to other racial/ethnic groups. They are:

• More likely to develop fibroids: Studies show Black women have up to three times the risk of developing fibroids compared to white women.
• Diagnosed at younger ages: Fibroids often appear earlier in life for Black women, potentially leading to longer exposure to symptoms.
• Experience more severe symptoms: Black women tend to have larger, more numerous fibroids, resulting in more severe bleeding, pain, and other debilitating symptoms.
• Face disparities in treatment: Black women are less likely to receive appropriate treatment for fibroids, possibly due to implicit bias, lack of access to specialists, or socioeconomic factors.

Fibroids are a significant health concern for women, especially Black women who experience a disproportionate burden. Understanding the increased risk factors and addressing potential connections between fibroids and hypertension is crucial for better management.

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