Managed Care Perspectives: Optimizing Women’s Reproductive Health - Episode 5
Ayman Al-Hendy, MD, PhD identifies risk factors for development of US and endometriosis.
Neil Minkoff, MD: Let me bring Dr Ayman back for a second. As the expert on the medical side, if you were advising someone like me, Dr [Maria] Lopes, or Dr [Kevin] Stephens about who we should be looking for or the risk factors that we should be looking for to stratify these patients, what would you advise us to look for in terms of who needs a GYN referral right away as opposed to a primary care work-up, and so on?
Ayman Al-Hendy, MD, PhD: With endometriosis, 1 major unmet need is early diagnosis. Many research groups, including ours, are trying to look for a biomarker, something you can measure in the blood or urine, because unfortunately imaging doesn’t show most cases of endometriosis. The imaging would basically be normal.
As far as risk factors, that’s very well developed for fibroid, probably more than the other conditions. Women of color have higher risk of uterine fibroids, probably 3 to 4 times higher in African American women compared with European Americans. Latinos are in between. There’s 2 or 2½ times more risk in Latinos than in European American women. Family history is almost always there in fibroids. Obesity or increased BMI [body mass index] is another risk factor of uterine fibroids. We’ve identified vitamin D deficiency relatively recently. We published this in 2010, and it has been confirmed since then by many other groups.
Vitamin D deficiency is a risk factor for fibroids, which probably connect to the African ancestry risk, because we get vitamin D from the sun. Using unopposed estrogen in any form will also increase your risk of uterine fibroids. Parity is another factor. High parity, when you’ve had multiple pregnancies, decreases your risk for fibroids. Low parity, or nulligravida, those who never got pregnant, is associated with increased risk. So is an early age of menorrhea. Girls who have menorrhea at 9 or 10 years old vs 12 or 13 unfortunately have higher risk of developing fibroids.
With endometriosis, the risk profile isn’t as developed. I want to stress the ethnicity because there’s a myth out there. Some of more senior attendings used to say that endometriosis is a disease of White women and fibroids is a condition of Black women. There are absolutely no data to support that. Fibroids, for sure, but there are no data to support that endometriosis is less frequent in Black women. I want to put this out there. It’s maybe part of some of the perception from many years ago about pain perception. There are absolutely no reliable data out there that Black women have less risk of endometriosis. They can develop endometriosis like anybody else.
You see family history in endometriosis a lot. Having multiple prior pregnancies is also protective against endometriosis. But that’s about it. We don’t have a very good understanding of the risk profile of endometriosis at this point.
Transcripts edited for clarity.