Skip Navigation LinksHome > March 2005 - Volume 105 - Issue 3 > Age-Specific Incidence Rates for Self-Reported Uterine Leiom...
Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000154161.03418.e3
Original Research

Age-Specific Incidence Rates for Self-Reported Uterine Leiomyomata in the Black Women's Health Study

Wise, Lauren A. ScD*; Palmer, Julie R. ScD*; Stewart, Elizabeth A. MD†; Rosenberg, Lynn ScD*

Free Access
Article Outline
Collapse Box

Author Information

From the *Slone Epidemiology Center, Boston University and †Center for Uterine Fibroids, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Supported by National Cancer Institute grant CA58420.

Address reprint requests to: Dr. Lauren A. Wise, Slone Epidemiology Center, Boston University, 1010 Commonwealth Avenue, Boston, MA, 02215; e-mail: lwise@slone.bu.edu.

Received September 2, 2004. Received in revised form November 22, 2004. Accepted December 2, 2004.

Collapse Box

Abstract

OBJECTIVE: Uterine leiomyomata represent a major public health problem for black women in the United States, but limited data are available on age–incidence curves in this high-risk population. We estimated overall and age-specific incidence rates for self-reported uterine leiomyomata in a large cohort of African-American women in the United States.

METHODS: Data were derived from the Black Women's Health Study, an ongoing prospective cohort study of 59,000 black women from across the United States who were aged 21–69 years at baseline (ie, 1995). From March 1997 through March 2001, we followed up 22,895 premenopausal women with no prior diagnosis of uterine leiomyoma. Poisson regression was used to estimate overall and age-specific incidence rates and 95% confidence intervals (CIs) for self-reported uterine leiomyoma. In a subset of 248 patients who were selected randomly from the total case group, the self-reported diagnosis was verified in 96% of cases who released their medical records.

RESULTS: During 76,711 woman-years of follow-up, 2,637 incident cases of uterine leiomyomata reported as confirmed by pelvic examination (n = 358), ultrasonography (n = 2,006), or hysterectomy (n = 273) were observed. Incidence rates per 1,000 woman-years were 34.4 (95% CI 33.1–35.7) for all cases combined, 29.7 (95% CI 28.5–30.9) for cases confirmed by ultrasonography or hysterectomy, and 3.6 (95% CI 3.2–4.0) for cases confirmed by hysterectomy. The incidence rate peaked at ages 40–44 years for all cases combined (incidence rate 45.6, 95% CI 42.0–49.5) and for cases confirmed by ultrasonography or hysterectomy (incidence rate 39.8, 95% CI 36.5–43.4), and peaked at ages 45–49 years for cases confirmed by hysterectomy (incidence rate 8.3, 95% CI 6.4–10.7).

CONCLUSION: Overall incidence rates for self-reported uterine leiomyomata were consistent with other U.S studies in black women and confirmed a high burden of disease in this population. Age-specific incidence rates showed a later peak incidence than that observed among U.S. black women in previous studies.

LEVEL OF EVIDENCE: II-2

Uterine leiomyomata are the most common tumors of the female reproductive tract and the leading indication for hysterectomy among women in the United States.1 Black women are disproportionately affected by this condition. The incidence of uterine leiomyomata is greater in black women than in white women,2–4 and black women have more severe disease at the time of diagnosis.5

Incidence rates of uterine leiomyoma diagnoses in U.S. populations are based largely on data from the National Hospital Discharge Survey,2,6 the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study,4 and the Nurses' Health Study II.3 Estimated rates vary according to case definition,7 ranging from 9.2 per 1,000 woman-years for diagnoses confirmed by ultrasonography or hysterectomy3 to approximately 2.0 per 1,000 woman-years for diagnoses confirmed by hysterectomy.2–4 Rates among women hospitalized for gynecologic conditions unrelated to pregnancy (3.0 per 1,000 woman-years) are similar to rates for hysterectomy-confirmed diagnoses.6 Regardless of case definition, rates of uterine leiomyomata increase with age throughout the reproductive years.2,3,6,8,9

Incidence rates among black women are 2 to 3 times higher than rates among white women,2–4 and the higher rates among black women are evident at all ages.3,6 Cumulative incidence data derived from a U.S. cross-sectional study that screened all participants with ultrasonography also suggest higher rates for black women.9 One question that has emerged from the incidence data and from earlier case-series data5,10 is whether black women have an earlier peak age at diagnosis than white women. To date, the most definitive data on race-specific incidence rates come from the Nurses' Health Study II, which suggests that self-reported diagnoses confirmed by ultrasonography or hysterectomy peak earlier among black women (35–39 years) than among white women (40–44 years).3 However, the Nurses' Health Study II rates were based on only 140 black cases (5% of total case group). Using data from the Black Women's Health Study, a large prospective cohort study of black women in the United States, we estimated overall and age-specific incidence rates of self-reported uterine leiomyomata according to age and method of diagnostic confirmation.

Back to Top | Article Outline

MATERIALS AND METHODS

The Black Women's Health Study is an ongoing prospective cohort study that was established in 1995, when approximately 59,000 black women in the United States aged 21–69 years were enrolled through self-administered questionnaires mailed to subscribers of Essence magazine, members of black professional organizations, and friends and relatives of early respondents.11 The baseline questionnaire elicited information on demographic and behavioral characteristics, health care use, and medical conditions. On the 1997 questionnaire, participants were asked “what is your race?” and to select all that applied from the following categories: “black,” “white,” “Asian or Pacific Islander,” or “American Indian or Alaskan Native.” Those who selected “black,” regardless of any other group selected, were retained in the cohort. Six percent of the sample was foreign-born (54% Caribbean, 7% Africa, 39% South or North America/Europe/Asia/other), and less than 2% reported Hispanic ethnicity. The cohort is followed every 2 years by postal questionnaire, and more than 80% of the original cohort has completed a questionnaire in each follow-up cycle. Respondents in the Black Women's Health Study represent various geographic regions of the United States, with most residing in California, New York, Illinois, Michigan, Georgia, and New Jersey. The study protocol was approved by the institutional review boards of Boston University Medical Center and Howard University Cancer Center.

Follow-up for the present analysis began in 1997, the start of the second questionnaire cycle, because self-reported method of confirmation for uterine leiomyoma was first elicited on the 1999 questionnaire. Of the 53,279 women who completed the 1997 questionnaire, we restricted the sample to premenopausal women because uterine leiomyomata are rare after menopause.12 We therefore excluded women who reported natural menopause (n = 5,143), hysterectomy (n = 6,625), bilateral oophorectomy (n = 4,175), medication-induced menopause (n = 218), or unknown menopausal status (n = 522). We further excluded women who reported a diagnosis of uterine leiomyomata before 1997 (n = 10,450), who reported the condition without information on year of diagnosis (n = 99) or method of confirmation (n = 208), who did not complete a follow-up questionnaire (n = 2,193), or who had missing data on key stratification variables (n = 751). The remaining 22,895 women were followed for incidence of uterine leiomyomata during the subsequent 4-year period. The small proportion of women who were lost to follow-up or who had incomplete covariate data had lower educational attainment than respondents but were similar with respect to age, parity, body mass index, and other risk factors for uterine leiomyomata.

On the 1999 and 2001 follow-up questionnaires, women were asked whether they had been diagnosed with “fibroids in uterus” in the previous 2-year interval, the calendar year in which they were first diagnosed, and whether their diagnosis was confirmed by “pelvic exam” and/or by “ultrasound/hysterectomy.” Among cases reporting confirmation by “ultrasound/hysterectomy,” a diagnosis was considered “hysterectomy-confirmed” if the woman reported hysterectomy on the same questionnaire and “ultrasonography-confirmed” otherwise. A diagnosis was considered “confirmed by pelvic examination” if only that method was reported.

Incident cases were defined as women who self-reported a first diagnosis of leiomyomata that was confirmed by pelvic examination, ultrasonography, or hysterectomy. In the present study, “incident” refers to the initial diagnosis rather than the true onset of uterine leiomyomata, which could differ by an extended time period if tumors were present before they became palpable or symptomatic.12 The diagnosis of uterine leiomyoma often is suspected when an enlarged irregular uterine contour is palpable on pelvic examination. Ultrasonography is the standard used to confirm diagnoses.12 Ultrasonography has high sensitivity (99%) and specificity (91%) relative to histologic evidence.13,14 Because histologically confirmed cases represent only 10–30% of cases for whom ultrasonography evidence is available and studies restricted to histologically confirmed cases may spuriously identify risk factors associated with large tumor size, symptoms, or treatment preference,15 we examined all 3 methods of confirmation. For comparisons of peak age at diagnosis across studies, however, we restricted our case group to cases confirmed by ultrasonography or hysterectomy because diagnoses confirmed only by pelvic examination may represent other pathology.13 This definition also was used by the Nurses' Health Study II, a prospective study with similar methodology to the Black Women's Health Study.3

We assessed the accuracy of self-report in a random sample of 248 ultrasonography- or hysterectomy-confirmed cases. These cases were mailed supplemental surveys regarding their initial date of diagnosis, method of confirmation, symptoms, and treatment, and they were asked for permission to review their medical records. We obtained medical records from 126 of the 128 women who gave us permission and verified the self-report by medical record in 121 (96%). Among the 188 (76%) cases who completed the supplemental survey, 71% reported leiomyoma-related symptoms before being diagnosed with the condition. This proportion was higher among hysterectomy-confirmed cases (79%). When cases were asked how their diagnosis came to clinical attention, 55% of cases reported they were diagnosed because they sought medical care for leiomyoma-related symptoms; 32% were diagnosed during a routine pelvic examination, and the remaining 13% were diagnosed while receiving care for some other condition (with more than 85% citing “pregnancy” as the other condition).

No statistically significant differences were observed between cases who did and did not release their medical records with respect to important demographic and lifestyle factors (age, body mass index, education, oral contraceptive use, recency of Pap test, and health insurance coverage: χ2 test P > .2); self-reported method of confirmation (64% ultrasound examination compared with 71% hysterectomy, P = .55); the report of symptoms before the initial diagnosis (73% compared with 66%, P = .31); the type of presenting symptoms (menorrhagia: 56% compared with 47% [P = .28]; pelvic pain: 48% compared with 42% [P = .47]; frequent urination: 21% compared with 25% [P = .53]; infertility: 10% compared with 12% [P = .89]); or how initial diagnosis was made (sought care for leiomyoma-related symptoms: 57% compared with 46% [P = .18]; diagnosed during a routine pelvic examination: 31% compared with 34% [P = .64]; diagnosed while receiving care for another condition: 10% compared with 14% [P = .42]). Therefore, the cases who released their medical records appeared to be representative of the larger case group.

Woman-years at risk were calculated from the start of follow-up (March 1997) until the diagnosis of uterine leiomyomata, menopause, death, loss to follow-up, or end of follow-up (March 2001), whichever came first. Age was updated at the start of each questionnaire cycle. Incidence rates for each age category were computed as the number of incident cases divided by the woman-years accumulated. Poisson regression16 was used to estimate overall and age-specific incidence rates and 95% confidence intervals (95% CIs) for self-reported uterine leiomyomata confirmed by pelvic examination, ultrasonography, or hysterectomy. Analyses were repeated within strata of education (≤12, 13–16, 17+ years), oral contraceptive use (current compared with never), cigarette smoking (current, former, never), body mass index (< 25, 25–29, 30+ kg/m2), and geographic region of residence (West, Midwest, South, Northeast). All analyses were conducted using SAS statistical software (SAS Institute, Cary, NC).

Back to Top | Article Outline

RESULTS

Baseline characteristics of the sample are shown in Table 1. Participants of the Black Women's Health Study represented all geographic regions of the United States. Nearly 50% were college-educated, 30% had a body mass index of 30 or greater, and more than 90% reported a recent Pap test. Fifty-seven percent were parous, and 23% were current users of oral contraceptives. During 76,711 woman-years of follow-up, 2,637 incident cases of uterine leiomyomata reported as confirmed by pelvic examination (n = 358), ultrasonography (n = 2,006), or hysterectomy (n = 273) were observed. Incidence rates of uterine leiomyomata per 1,000 woman-years were 34.4 (95% CI 33.1–35.7) for all cases combined, 29.7 (95% CI 28.5–30.9) for diagnoses confirmed by ultrasonography or hysterectomy, and 3.6 (95% CI 3.2–4.0) for diagnoses confirmed by hysterectomy (Table 2).

Table 1
Table 1
Image Tools
Table 2
Table 2
Image Tools

Regardless of self-reported method of confirmation, incidence rates tended to increase with age (Table 2). Age-specific incidence rates for diagnoses confirmed by ultrasonography or hysterectomy peaked at ages 40–44 years and then declined. Rates among hysterectomy-confirmed cases peaked at ages 45–49 years. Restriction of the sample to women with a recent Pap test (91%), a marker for pelvic examination, produced the same age-incidence peaks as the full sample (data not shown). Results were similar when we stratified analyses by oral contraceptive use, cigarette smoking, body mass index, and geographic region (data not shown). However, the peak age at diagnosis appeared to vary across levels of education. Compared with all other education groups, women with 17+ years of education had an earlier peak age of diagnosis (35–39 years) among cases confirmed by ultrasonography or hysterectomy (n = 553) and a later peak age of diagnosis (50+ years) among cases confirmed by hysterectomy (n = 43).

Overall incidence rates for uterine leiomyomata according to self-reported method of confirmation were similar to rates found for black women in other U.S. studies (Fig. 1). However, age-specific incidence rates (Fig. 2) showed a later peak age at diagnosis in the Black Women's Health Study (40–44 years) than that observed for black women in the Nurses' Health Study II (35–39 years). Rather, the peak age at diagnosis in the Black Women's Health Study was consistent with the peak observed for white women in the Nurses' Health Study II (40–44 years).

Fig. 1
Fig. 1
Image Tools
Fig. 2
Fig. 2
Image Tools
Back to Top | Article Outline

DISCUSSION

The present study estimated incidence rates for self-reported uterine leiomyomata from a large and heterogeneous cohort of black women in the United States. Overall incidence rates were consistent with data from other U.S. studies that included black women.2,3,6 Age-specific incidence rates increased throughout the reproductive years and peaked at ages 40–44 years for cases reported as confirmed by ultrasonography or hysterectomy and at ages 45–49 years for cases reported as confirmed by hysterectomy. The peak age of diagnosis among ultrasonography- or hysterectomy-confirmed cases in the Black Women's Health Study did not agree with data on black women from the Nurses' Health Study II (35–39 years). Both studies enrolled convenience samples and used the same outcome definition, but the Black Women's Health Study, with 2,279 ultrasonography- or hysterectomy-confirmed cases, had a substantially greater number of black cases than the Nurses' Health Study II, which had 140 cases. Discrepant results also may be attributable to differences in disease awareness, screening practices, and the prevalence of key risk factors.

The Black Women's Health Study is not a nationally representative sample of black women from the United States. However, prevalence estimates of suspected risk factors for uterine leiomyomata—age at menarche,17 parity,17 body mass index18—are similar to those found in nationally representative studies, with the exception of educational attainment, which is higher in the Black Women's Health Study relative to the general population. Whereas 85.1% of U.S. black women aged 25–44 years had graduated from high school as of March 1995,19 98.3% of the same-aged participants in the Black Women's Health Study had graduated from high school. Because the Black Women's Health Study overrepresents women with higher education and because education is positively associated with ultrasonography confirmed uterine leiomyomata, we may have overestimated incidence rates compared with the general population. Participants in the Black Women's Health Study with 17+ years of education had an earlier peak incidence (35–39 years) than other education groups, but we found the same peak incidence among the total sample (40–44 years) as we did for all education groups other than 17+ years, providing reassurance that these findings may extend to the general population of U.S. black women.

We validated the self-report of uterine leiomyomata through a detailed supplementary questionnaire and review of medical records. We were able to verify the diagnosis in 96% of the cases from whom we obtained medical records. We cannot rule out the possibility that women who released their records reported with greater accuracy than those who did not, although comparisons made with available data did not show any significant differences between groups with respect to reported symptomatology, method of diagnosis, or demographic and lifestyle factors.

Because of the large size of the cohort and the geographic distribution of its participants, it was not feasible to screen all women for uterine leiomyomata. The use of self-reported diagnoses could have resulted in the underestimation of rates because some women with asymptomatic tumors may have been missed. However, it is likely that data from the Black Women's Health Study more accurately represent the number of women with symptomatic tumors because most cases on the validation survey (71%) reported symptoms before the initial diagnosis of the disease and because a low percentage of cases (13%) were detected incidentally.

Symptomatic disease represents the health burden in reproductive-aged women and has the greatest impact on a woman's reproductive health, quality of life, and health care use. The high incidence rates for uterine leiomyomata observed in the Black Women's Health Study are compatible with other U.S. studies3,9 and provide additional evidence that black women are disproportionately affected by the condition. The estimated rates from the present study translate into approximately 3% of premenopausal black women being diagnosed with the condition each year. Uterine leiomyomata are a major pubic health problem for black women in the United States, and efforts toward primary prevention of this condition are needed.

Back to Top | Article Outline

REFERENCES

1. Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 2002;99:229–34.

2. Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988–1990. Obstet Gynecol 1994;83:549–55.

3. Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997;90:967–73.

4. Brett KM, Marsh JV, Madans JH. Epidemiology of hysterectomy in the United States: demographic and reproductive factors in a nationally representative sample. J Womens Health 1997;6:309–16.

5. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM. Uterine leiomyomas: racial differences in severity, symptoms, and age at diagnosis. J Reprod Med 1996;41:483–90.

6. Velebil P, Wingo PA, Xia Z, Wilcox LS, Peterson HB. Rate of hospitalization for gynecologic disorders among reproductive-age women in the United States. Obstet Gynecol 1995;86:764–9.

7. Schwartz SM, Marshall LM. Uterine leiomyomata. In: Goldman MB, Hatch MC, eds. Women and health. San Diego (CA): Academic Press; 2000. p. 240–52.

8. Ross RK, Pike MC, Vessey MP, Bull D, Yeates D, Casagrande JT. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives [published erratum in Br Med J (Clin Res Ed) 1986;293:1027]. Br Med J (Clin Res Ed) 1986;293:359–62.

9. Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188:100–7.

10. Kjerulff K, Langenberg P, Guzinski G. The socioeconomic correlates of hysterectomies in the United States. Am J Public Health 1993;83:106–8.

11. Rosenberg L, Adams-Campbell L, Palmer JR. The Black Women's Health Study: a follow-up study for causes and preventions of illness. J Am Med Womens Assoc 1995;50:56–8.

12. Stewart EA. Uterine fibroids [review]. Lancet 2001;357:293–8.

13. Loutradis D, Antsaklis A, Creatsas G, Hatzakis A, Kanakas N, Gougoulakis A, et al. The validity of gynecological ultrasonography. Gynecol Obstet Invest 1990;29:47–50.

14. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol 2002;186:409–15.

15. Schwartz SM. Epidemiology of uterine leiomyomata [review]. Clin Obstet Gynecol 2001;44:316–26.

16. Frome EL. The analysis of rates using Poisson regression models. Biometrics 1983;39:665–74.

17. Abma JC, Chandra A, Mosher WD, Peterson LS, Piccinino LJ. Fertility, family planning, and women's health: New data from the 1995 National Survey of Family Growth. Vital Health Stat 23 1997;19:1–114.

18. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002;288:1723–7.

19. Educational Attainment in the United States: March 1995. P20-489. August 1996. U.S. Bureau of the Census. Washington, DC: U.S. Department of Commerce.

Cited By:

This article has been cited 38 time(s).

American Journal of Obstetrics and Gynecology
Lifetime abuse victimization and risk of uterine leiomyomata in black women
Wise, LA; Palmer, JR; Rosenberg, L
American Journal of Obstetrics and Gynecology, 208(4): -.
ARTN 272.e1
CrossRef
American Journal of Epidemiology
African Ancestry and Genetic Risk for Uterine Leiomyomata
Wise, LA; Ruiz-Narvaez, EA; Palmer, JR; Cozier, YC; Tandon, A; Patterson, N; Radin, RG; Rosenberg, L; Reich, D
American Journal of Epidemiology, 176(): 1159-1168.
10.1093/aje/kws276
CrossRef
Balkan Medical Journal
Evaluation of Cardiovascular Risk Factors in Women with Uterine Leimyoma: Is There a Link with Atherosclerosis?
Sivri, N; Yalta, T; Sayin, C; Yalta, K; Ozpuyan, F; Tastekin, E; Yetkin, E
Balkan Medical Journal, 29(3): 320-323.
10.5152/balkanmedj.2012.002
CrossRef
American Journal of Obstetrics and Gynecology
The impact of uterine leiomyomas: a national survey of affected women
Borah, BJ; Nicholson, WK; Bradley, L; Stewart, EA
American Journal of Obstetrics and Gynecology, 209(4): -.
ARTN 319.e1
CrossRef
Best Practice & Research in Clinical Obstetrics & Gynaecology
Medical management of fibroids
Sankaran, S; Manyonda, IT
Best Practice & Research in Clinical Obstetrics & Gynaecology, 22(4): 655-676.
10.1016/j.bpobgyn.2008.03.001
CrossRef
Fertility and Sterility
Activating transcription factor 3 gene expression suggests that tissue stress plays a role in leiomyoma development
Payson, M; Malik, M; Morris, SSN; Segars, JH; Chason, R; Catherino, WH
Fertility and Sterility, 92(2): 748-755.
10.1016/j.fertnstert.2008.06.030
CrossRef
American Journal of Clinical Nutrition
Dietary glycemic index and load in relation to risk of uterine leiomyomata in the Black Women's Health Study
Radin, RG; Palmer, JR; Rosenberg, L; Kumanyika, SK; Wise, LA
American Journal of Clinical Nutrition, 91(5): 1281-1288.
10.3945/ajcn.2009.28698
CrossRef
Fertility and Sterility
The selective progesterone receptor modulator CDB4124 inhibits proliferation and induces apoptosis in uterine leiomyoma cells
Luo, X; Yin, P; Coon, JS; Cheng, YH; Wiehle, RD; Bulun, SE
Fertility and Sterility, 93(8): 2668-2673.
10.1016/j.fertnstert.2009.11.031
CrossRef
New England Journal of Medicine
Uterine Fibroid Embolization
Goodwin, SC; Spies, JB
New England Journal of Medicine, 361(7): 690-697.

Journal of Cellular and Molecular Medicine
Differential expression of microRNAs in myometrium and leiomyomas and regulation by ovarian steroids
Pan, Q; Luo, XP; Chegini, N
Journal of Cellular and Molecular Medicine, 12(1): 227-240.
10.1111/j.1582-4934.2007.00207.x
CrossRef
Journal of Obstetrics and Gynaecology
The incidence of uterine leiomyoma and other pelvic ultrasonographic findings in 2,034 consecutive women in a north London hospital
Selo-Ojeme, D; Lawal, O; Shah, J; Mandal, R; Pathak, S; Selo-Ojeme, U; Samuel, D
Journal of Obstetrics and Gynaecology, 28(4): 421-423.
10.1080/01443610802149863
CrossRef
Environmental Health Perspectives
Association of Intrauterine and Early-Life Exposures with Diagnosis of Uterine Leiomyomata by 35 Years of Age in the Sister Study
D'Aloisio, AA; Baird, DD; DeRoo, LA; Sandler, DP
Environmental Health Perspectives, 118(3): 375-381.
10.1289/ehp.0901423
CrossRef
Journal of the National Medical Association
Leiomyomata uteri: Hormonal and molecular determinants of growth
Blake, RE
Journal of the National Medical Association, 99(): 1170-1184.

Fertility and Sterility
Proceedings from the Conference on Reproductive Problems in Women of Color
Fujimoto, VY; Jain, T; Alvero, R; Nelson, LM; Catherino, WH; Olatinwo, M; Marsh, EE; Broomfield, D; Taylor, H; Armstrong, AY
Fertility and Sterility, 94(1): 7-10.
10.1016/j.fertnstert.2009.12.068
CrossRef
Reproductive Biology and Endocrinology
Reproductive biology and Endocrinology
Luo, X; Pan, Q; Liu, L; Chegini, N
Reproductive Biology and Endocrinology, 5(): -.
ARTN 35
CrossRef
Contemporary Clinical Trials
Recruitment and retention of women for clinical leiomyoma trials
McCarthy-Keith, D; Nurudeen, S; Armstrong, A; Levens, E; Nieman, LK
Contemporary Clinical Trials, 31(1): 44-48.
10.1016/j.cct.2009.09.007
CrossRef
Postgraduate Medical Journal
Reporting of ethnicity in research on chronic disease: update
O'Loughlin, J; Dugas, E; Maximova, K; Kishchuk, N
Postgraduate Medical Journal, 82(): 737-742.
10.1136/pgmj.2005.048074
CrossRef
American Journal of Obstetrics and Gynecology
Lycopene and other carotenoid intake in relation to risk of uterine leiomyomata
Terry, KL; Missmer, SA; Hankinson, SE; Willett, WC; De Vivo, I
American Journal of Obstetrics and Gynecology, 198(1): -.
ARTN 37.e1
CrossRef
Archives of Dermatology
Association of Germline Mutations in the Fumarate Hydratase Gene and Uterine Fibroids in Women With Hereditary Leiomyomatosis and Renal Cell Cancer
Stewart, L; Glenn, GM; Stratton, P; Goldstein, AM; Merino, MJ; Tucker, MA; Linehan, WM; Toro, JR
Archives of Dermatology, 144(): 1584-1592.

Human Reproduction Update
Fibroids and female reproduction: a critical analysis of the evidence
Somigliana, E; Vercellini, P; Daguati, R; Pasin, R; De Giorgi, O; Crosignani, PG
Human Reproduction Update, 13(5): 465-476.
10.1093/humupd/dmm013
CrossRef
Proceedings of the National Academy of Sciences of the United States of America
Growth of uterine leiomyomata among premenopausal black and white women
Peddada, SD; Laughlin, SK; Miner, K; Guyon, JP; Haneke, K; Vahdat, HL; Semelka, RC; Kowalik, A; Armao, D; Davis, B; Baird, DD
Proceedings of the National Academy of Sciences of the United States of America, 105(): 19887-19892.
10.1073/pnas.0808188105
CrossRef
American Journal of Epidemiology
A Prospective Study of Dairy Intake and Risk of Uterine Leiomyomata
Wise, LA; Radin, RG; Palmer, JR; Kumanyika, SK; Rosenberg, L
American Journal of Epidemiology, 171(2): 221-232.
10.1093/aje/kwp355
CrossRef
American Family Physician
Uterine fibroid tumors: Diagnosis and treatment
Evans, P; Brunsell, S
American Family Physician, 75(): 1503-1508.

Environmental Health Perspectives
Association of Exposure to Phthalates with Endometriosis and Uterine Leiomyomata: Findings from NHANES, 1999-2004
Weuve, J; Hauser, R; Calafat, AM; Missmer, SA; Wise, LA
Environmental Health Perspectives, 118(6): 825-832.
10.1289/ehp.0901543
CrossRef
Obstetrics and Gynecology Clinics of North America
Epidemiology of myomas
Payson, M; Leppert, P; Segars, J
Obstetrics and Gynecology Clinics of North America, 33(1): 1-+.
10.1016/j.ogc.2005.12.004
CrossRef
Seminars in Reproductive Medicine
The Expression and Potential Regulatory Function of MicroRNAs in the Pathogenesis of Leiomyoma
Luo, X; Chegini, N
Seminars in Reproductive Medicine, 26(6): 500-514.
10.1055/s-0028-1096130
CrossRef
Journal of Minimally Invasive Gynecology
The Effect of a Gynecologist-Interventional Radiologist Relationship on Selection of Treatment Modality for the Patient with Uterine Myoma
Zurawin, RK; Fischer, JH; Amir, L
Journal of Minimally Invasive Gynecology, 17(2): 214-221.
10.1016/j.jmig.2009.12.015
CrossRef
Journal of Womens Health
The incidence of repeat uterine surgery following myomectomy
Reed, SD; Newton, KM; Thompson, LB; McCrummen, BA; Warolin, AK
Journal of Womens Health, 15(9): 1046-1052.

Fertility and Sterility
Polycystic ovary syndrome and risk of uterine leiomyomata
Wise, LA; Palmer, JR; Stewart, EA; Rosenberg, L
Fertility and Sterility, 87(5): 1108-1115.
10.1016/j.fertnstert.2006.11.012
CrossRef
Reproductive Biology and Endocrinology
Genomic and proteomic profiling I: Leiomyomas in African Americans and Caucasians
Pan, Q; Luo, XP; Chegini, N
Reproductive Biology and Endocrinology, 5(): -.
ARTN 34
CrossRef
Annals of Epidemiology
Association of intrauterine and early life factors with uterine leiomyomata in black women
Wise, LA; Radin, RG; Palmer, JR; Rosenberg, L
Annals of Epidemiology, 22(): 847-854.
10.1016/j.annepidem.2012.09.006
CrossRef
European Journal of Obstetrics & Gynecology and Reproductive Biology
Progesterone and progesterone receptor modulators in the management of symptomatic uterine fibroids
Talaulikar, VS; Manyonda, I
European Journal of Obstetrics & Gynecology and Reproductive Biology, 165(2): 135-140.
10.1016/j.ejogrb.2012.07.023
CrossRef
Journal of Womens Health
The Burden of Uterine Fibroids for African-American Women: Results of a National Survey
Stewart, EA; Nicholson, WK; Bradley, L; Borah, BJ
Journal of Womens Health, 22(): 807-816.
10.1089/jwh.2013.4334
CrossRef
American Journal of Epidemiology
Is the Observed Association Between Dairy Intake and Fibroids in African Americans Explained by Genetic Ancestry?
Wise, LA; Palmer, JR; Ruiz-Narvaez, E; Reich, DE; Rosenberg, L
American Journal of Epidemiology, 178(7): 1114-1119.
10.1093/aje/kwt091
CrossRef
Epidemiology
Perceived Racial Discrimination and Risk of Uterine Leiomyomata
Wise, LA; Palmer, JR; Cozier, YC; Hunt, MO; Stewart, EA; Rosenberg, L
Epidemiology, 18(6): 747-757.
10.1097/EDE.0b013e3181567e92
PDF (388) | CrossRef
Menopause
Aromatase inhibitor therapy for uterine bleeding in a postmenopausal woman with leiomyomata
Kaunitz, AM
Menopause, 14(5): 941-943.
10.1097/gme.0b013e318054e2be
PDF (41) | CrossRef
Current Opinion in Obstetrics and Gynecology
The role of myomectomy in fertility enhancement
Somigliana, E; Vercellini, P; Benaglia, L; Abbiati, A; Barbara, G; Fedele, L
Current Opinion in Obstetrics and Gynecology, 20(4): 379-385.
10.1097/GCO.0b013e3283073ac9
PDF (125) | CrossRef
Epidemiology
Influence of Body Size and Body Fat Distribution on Risk of Uterine Leiomyomata in U.S. Black Women
Wise, LA; Palmer, JR; Spiegelman, D; Harlow, BL; Stewart, EA; Adams-Campbell, LL; Rosenberg, L
Epidemiology, 16(3): 346-354.
10.1097/01.ede.0000158742.11877.99
PDF (329) | CrossRef
Back to Top | Article Outline

© 2005 The American College of Obstetricians and Gynecologists

Login

Article Tools

Images

Share