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Diseases & Resources

 

Uterine Fibroids
Endometriosis
Cervical Cancer
Infertility
Polycystic Ovarian Syndrome (PCOS)
Uterine or Endometrial Cancer
Ovarian Cancer
Breast Cancer


                                       Uterine Fibroids 






female-reproductive-system
  

Uterine fibroids are non-cancerous tumors which can also be called fibromyomas, leiomyomas or myomas, They are growth of muscle within the uterine wall.  The size of a fibroid can range from a small seed to larger than a grapefruit before they're discovered. There can be multiple fibroids or one single growth and can be located on the surface of the uterus, in the wall of the uterus, or in the uterine cavity.

Fibroids are made of muscle cells and other tissues that grow within and around the muscular wall of the uterus.  They are also composed of extracellular matrix (i.e., collagen, proteoglycan, fibronectin).

Uterine fibroids are the most common, non-cancerous tumors in women of childbearing age causing symptoms in approximately 25% of women. 

The cause of uterine fibroids is unknown, however, their growth has been linked to the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.

Prevalence of Fibroids in Black women

Uterine fibroids occur more often in black women than in any other ethnic group. The fibroids tend to occur at earlier ages and grow to larger sizes in black women than they do in non-black women.  70% to 80% of black women will develop benign uterine fibroid tumors by their late forties, according to the National Institute of Environmental Health Sciences.  Recent medical research suggests that at least 1 in 3 black women will have clinically recognized fibroids.  Uterine fibroids constitute a major public health issue for black women in the United States (Wise, 2005). The reason as to why black women are more at risk for fibroids is unknown. 

Fibroids are often described by their location in the uterus

*    Myometrial -- in the muscle wall of the uterus

*    Submucosal -- just under the surface of the uterine lining

*    Subserosal -- just under the outside covering of the uterus

*    Pendunculated -- occurring on a long stalk on the outside of the uterus or inside the cavity of the uterus

 

Fibroids are highly dependent on the hormone estrogen, so the size may increase during pregnancy when estrogen levels are higher.  Fibroids tend to shrink after menopause when estrogen levels drop.

 

 

 

What are the symptoms of Fibroids?

While not cancerous, uterine fibroids can cause problems that affect a women’s overall health.  Depending on the size, location and number of fibroids, common symptoms can include:

  •  Pelvic pain and pressure
  •  Excessive bleeding, including prolonged periods and passage of clots, which can lead to severe anemia
  •  Abdominal swelling
  • Pressure on the bladder, leading to frequent urination
  • Pressure on the bowel, leading to constipation and bloating
  • Multiple miscarriages or early labor 
  • Infertility--- Research from 2006 indicates that incidence of infertility is higher in African American women than in Caucasian women, and that infertility among black women has steadily been increasing, whereas it is decreasing among white women (Chandra, and Stephen 2006).  

Treatments Available for fibroids

Treatment depends on several things, including:

  •  Age
  • General health
  • Severity of symptoms
  • Type of fibroids
  • Whether a woman is pregnant
  • If she wants children in the future

 

Uterine Artery Embolization:  Uterine artery embolization (UAE), also called uterine fibroid embolization (UFE) is an endovascular procedure.   It is done through the arterial system.  It is non-surgical and minimally invasive.  It does not require general anesthesia- the groin is numbed and the patient is sedated, but still conscious enough to respond to a question.  This is a new, non-surgical uterine fibroid treatment. It is safer than uterine fibroid treatments that require surgery and a highly effective alternative for some women who strongly desire to avoid hysterectomy.

*    Hormone Therapy:  GnRH agonists are drugs that block estrogen production, starving uterine fibroids of estrogen and causing them to shrink.

*    Endometrial Ablation and Resection:  A gynecologist places a scope through the cervix into the uterine cavity to burn and scrape the lining of the uterus. The procedure also is used to burn and cut out uterine fibroid tumors that can be reached through the scope. The removal of the lining (endometrial ablation) stops bleeding, but not all uterine fibroid tumors can be removed with this technique. Like a hysterectomy, this fibroid treatment causes permanent infertility. A heated balloon may also be used.

 

*    Magnetic Resonance-guided Focused Ultrasound (MRgFUS).  A magnetic resonance-guided focused ultrasound (MRgFUS)—a minimally invasive procedure.  It uses high-energy ultrasound waves to generate heat at a specific point to destroy uterine fibroid tissue and relieve symptoms. The MR scanner allows the Interventional Radiologist to see where the fibroid is and what has been treated and to monitor temperature changes inside the body.  Only a small spot is treated at a time and the process is repeated, usually about 50 times per session, until the fibroid is destroyed.  The technology is limited to symptomatic women not interested in childbearing who have only a few fibroids. Large fibroids and multiple smaller fibroids are difficult to treat.  One caution is that, because this is a new technology, the long-term effects are not yet clear.

  •  Hysterectomy:  Uterine fibroids can be treated with surgery, including hysterectomy, which removes the entire uterus, and myomectomy, which removes the fibroids but leaves the uterus. Both are major surgeries that require 4 days in the hospital and a 6-week recovery period. Myomectomy can preserve fertility, but carries the additional risk of recurrence, since most women have multiple fibroids and it is impossible to cut them all out.

Myolysis or Cryomyolysis:  These are uterine fibroid treatments in which uterine fibroids are burned or frozen via laparoscopic surgery.

For more information about uterine fibroids, please contact the following organizations:

Reference/sources 

*http://www.cdc.gov/uscs)

*http://www.nih.gov

*http://www.womenshealth.gov/minority/africanamerican /uterine-fibroids.cfm

*Chandra, A. Stephen E. H. (2006).  Declining estimates of infertility in the United States: Fertile Sterile. Vol. 86:516–23.

*Wise, A. Lauren et al. 2007. Perceptions of racial discrimination and risk of uterine leiomyomata. Journal of Epidemiology. Vol. 18;47-757.

 

Medical Disclaimer

The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information. 

 
 Endometriosis 

Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. In endometriosis, endometrial cells attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, although less commonly than other locations in the pelvis.

Figure. Endometriosis and distribution of adhesions. Pelvic pain and menstrual irregularities are common symptoms of endometriosis, an abnormal distribution of endometrial tissue in the reproductive tract. Severity of symptoms is not always related to the
(Image by Mayo Clinic)

  • Endometriosis affects women in their reproductive years. Most cases of endometriosis are diagnosed in women who are 25-35 years old.  However, endometriosis has been reported in girls as young as 11 years of age.
  • The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. Endometriosis is estimated to affect from 3% to 18% of women in the United States.
  • It is estimated that 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain may be affected with endometriosis.
  • Endometriosis is a chronic condition that has reproductive and health consequences: 
  • it is also among the leading cause in infertility in black women (NIH, DHHS, CDC,   NIAID, 1999).

Prevalence of Endometriosis in Black Women

  • A great number of Black women are affected by endometriosis. The Endometriosis Association (1999) suggests that endometriosis, which is symptomatically characterized by pelvic pain, dysmenorrhea, infertility, and abnormal vaginal bleeding, has often been   misdiagnosed in black women as Pelvic Inflammatory Disease (PID) a sexually transmitted diseases. 
  • A study by the American Journal of Obstetrics and Gynecology reported that 40% African American women who were told they had PID in reality had endometriosis (1996).

What are the Symptoms of Endometriosis?

*    Most common symptoms are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience painful sexual intercourse (dyspareunia) or cramping during intercourse, and/ or pain during bowel movements and/or urination. Even pelvic examination by a doctor can be painful.  Other symptoms may include: lower abdominal pain, diarrhea and/or constipation, low back pain, irregular or heavy menstrual bleeding, or blood in the urine.

Endometriosis and Infertility

  •             Between 20% and 50% of women who are infertile have endometriosis. Some women may have more than one possible cause of infertility.

  •             Doctors/researchers believe that the endometrial implants may change the chemical and hormonal makeup in the fluid that surrounds the organs in the abdominal cavity.

  •             Such a change can: Interfere with or prevent the release of eggs from the ovaries (ovulation). Some women with endometriosis do not ovulate at all.

How is endometriosis diagnosed?

  • Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office.  Occasionally, during a rec

    tovaginal, the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.
  •  Neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but still cannot definitively diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.
  •  Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia, or in some cases under local anesthesia. It is usually performed as an out-patient procedure (the patient goes home the same day).

How is Endometriosis Treated?

Endometriosis can be treated with medi

cations and/or surgery. The goals of endometriosis treatment may include pain relief and/or enhancement of fertility.

Endometriosis Fact Sheet

No one knows for sure what causes this disease, but experts have a number of theories:

*    Since endometriosis runs in families, it may be carried in the genes, or some families may have traits that make them more likely to get it.

  • Endometrial tissue may move from the uterus to other body parts through the blood system or lymph system.

*    If a woman has a faulty immune system it will fail to find and destroy endometrial tissue growing outside of the uterus. Recent research shows that immune system disorders and certain cancers are more common in women with endometriosis.

*    The hormone estrogen appears to promote the growth of endometriosis. Researchers are looking at whether it is a disease of the endocrine system -the body’s system of glands, hormones, and other secretions.

*    New research shows a link between dioxin exposure and susceptibility to endometriosis. Dioxin is the name given to a group of 200+ chemicals that are formed as unwanted by-products of industrial manufacturing and burning activities. Dioxin is a powerful hormone-disrupting chemical (EDCs). More research is needed to find out whether man-made chemicals cause endometriosis.

*    Endometrial tissue may back up into the abdomen through the fallopian tubes during a woman's monthly period; this is usually referred to as “retrograde menstruation.”


For more information about endometriosis please contact the following organizations:

*    Endometriosis Association 


Phone: 414-355-2200

*    http://womenshealth.gov:  call 800-994-9662 (TDD: 888-220-5446)

*    Endometriosis Research Center 
Phone: 561-274-7442

*    The American College of Obstetricians and Gynecologists 
Phone: 202-638-5577; 202-863-2518 (for publication requests only)

*    Eunice Kennedy Shriver National Institute of Child Health and Human Development :Phone: 800-370-2943

*    http://www.cdc.gov/uscs)

*    http://www.nih.gov


Medical Disclaimer

The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information. 

 

Cervical Cancer

Cervical cancer is cancer that starts in the cervix, which is the lower part of the uterus.  It starts in the cells on the surface of the cervix which is comprised of two types of cells: squalors and columnar. Most cervical cancers are from squamous cells. It is a slow growing cancer that usually starts as a pre-cancerous condition calls dysplasia.  Cervical Cancer is comprised of four stages: carcinoma in Situ which is referred to as Stage 0, Stage I denotes the presence of abnormal cells that may become cancerous, Stage II is reached when cancer spreads just beyond the cervix, Stage III develops as cancer spreads to the vagina, pelvic wall and/or kidneys, Stage IV when cancer spread to the bladder rectum and other parts of the body (WHO).

What is the Cervix?


















The cervix is the lower part of the uterus, which is the female reproductive organ that holds a baby during pregnancy. The cervix connects the uterus and the vagina. The vagina leads to the outside of the body. Both the uterus and the cervix are located in the pelvis. They are in close contact with other pelvic organs, such as the ovaries, the upper part of the vagina, the bladder, and the rectum.

Black Women and Cervical Cancer

While black women are not disproportionately affected by cervical cancer; however, they experience a higher mortality and morbidity from this cancer than any other ethnic group.  According to the Centers for Disease Control and prevention (CDC), over 2,000 black women are diagnosed yearly with cervical cancer in the US; over 40% of them will die from it. A 2012 study by National Institute on Minority Health and Health Disparities reveals that black women seem to have more trouble clearing Human Papilloma Virus (HPV)—the virus that causes cervical cancer.

*    Cervical cancer occurs most often in women between the ages of 35 and 55. It accounts for more than 85% of cancer cases and deaths in developing countries (WHO, 2008).  Another 2008 report from the World Health Organization states that cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide, accounting for 9% (529,800) of the total new cancer cases and 8% (275,100) of the total cancer deaths among females.  Latin America and the Caribbean have some of the highest cervical cancer incidence and mortality rates in the world, surpassed only by East Africa and Melanesia (PAHO, 2004). 

 *   Cervical cancer is caused by persistent infection with certain high-risk, oncogenic types of Human Papilloma Viruses (HPVs), of which type16 is the most prevalent. HPV types 16 and 18 account for 65-70 percent of cervical cancers.

 *  The Human Papilloma Virus (HPV) is known to cause most cervical cancer worldwide and is a common virus that is spread through sexual intercourse (Schiffman et al., 2000).  HPV is the leading cause of almost all cervical cancers. Women generally are infected with HPV in their teens, 20s, or 30s; it can take as long as 20 years after HPV infection for the cancer to develop (Sherris et al., 2001).  HPV is asymptomatic, without screening most women are unaware of it and its life-threatening consequences.

What are the Risk Factors of Cervical Cancer?

  •  Human Papillomavirus (HPV) infection: Certain strain of HPV put women at higher risk for cervical cancer. These viruses can be transmitted by sexual contact. HPV infection is a major risk factor for cervical cancer.
  • Smoking: A woman who smokes has a higher chance of getting cervical cancer.
  • Weak immune systems. Women who have the virus HIV, which causes AIDS, have a greater risk of getting cervical cancer. This is because HIV makes the immune system weaker, so the body will not effectively clear the HPV infection.
  • Family history of cervical cancer: If your mother or sister has or had cervical cancer your risk is higher than a woman without a family history.
  • Chlamydia infection: This is a sexually-transmitted bacterial infection that may increase your risk of developing cervical cancer.
  • Diet. A diet low in fruits and vegetables, as well as obesity, may increase the risk for cervical cancer.
  • Oral contraceptives: A woman who has taken oral contraceptives for a long time may have a higher risk.
  • Multiple pregnancies: A woman who has had many full-term pregnancies may be at greater risk.
  • DES: If a woman's mother took the drug diethylstilbestrol (DES) when she was pregnant, she has a greater chance of getting cervical cancer.
  •  Socioeconomic status: Many low income or uninsured women still lack or have limited    access to healthcare which may prevent regular screenings and increase their risk of cervical cancer.

What Can a Woman Do to Decrease her Risk of Getting Cervical Cancer?

Regular Pap tests are very important in detecting cancerous cervical cells, when they are more treatable.

*    Talk to a doctor about when to go for checkups. It is generally recommended for women who are sexually active or 18 years and older to have a regular Pap test and a gynecologic exam each year.

*    Quit smoking.

*    Avoid intercourse at a young age.

*    Use condoms during intercourse.

*    Limit the number of sexual partners.

*    Get vaccinated with the HPV vaccines.  The HPV vaccines offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. That’s why HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years.  HPV vaccines are recommended for all teen girls and women through age 26, who did not get all three doses of the vaccine when they were younger.  The HPV vaccine is recommended for all teen boys and men through age 21, who did not get all three doses of the vaccine when they were younger (CDC).

What is the Pap test?

The Pap test is a very simple and important test. The doctor uses the Pap test to see if there are any changes in the cervix. The best time for a woman to have a Pap test is 10 to 20 days after her period. A Pap test can be done in a doctor's office or a health clinic. The doctor or nurse practitioner uses a tool called a speculum to hold the vagina open to see the upper part of the vagina and the cervix. Then the doctor uses a wooden scraper or a small brush to get some cells from the cervix and vagina. He or she puts these cells on a glass slide or in a solution and sends it to a laboratory to be looked at under a microscope to check for abnormal cells.

Who should get the Pap Tests and how Often?

Women should begin the test when they turn 21. The Pap test is recommended every 2-3 years until a woman has 3 or more normal exams. Then, a doctor may recommend doing the test less often. Women should talk to their doctors about how often they need the test.

What are the Symptoms of Cervical Cancer?

Cervical cancer and cervical pre-cancers usually have no symptoms. That is why it is important to have Pap tests. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs.

Here some are common symptoms in women with fully developed cervical cancer:

  •    Vaginal discharge
  •    Abnormal vaginal bleeding
  •    Vaginal odor
  •    Pain

These symptoms may be caused by the cancer or by other health problems. It is important for a woman to see her doctor if she is having any of these symptoms.

 How Should I prepare for my Cervical Cancer Screening Tests?

  • Don't take the tests if you're having your menstrual period
  • Don't douche for 2 days before the tests
  • Don't have sexual intercourse for 2 days before the test
  • Don't use tampons or birth control foams, jellies, or other vaginal creams or vaginal medicines for 2 days before the test

 How is Cervical Cancer Diagnosed?

The doctor asks questions about the woman's medical history and family history. The doctor will also do a pelvic exam and Pap test. If the doctor finds something suspicious, other tests can help determine if the woman has cervical cancer. It is very important to know the extent of the cancer--how deeply it has invaded tissues. The treatment can be quite different depending upon this.

 

A doctor may order one or more of these tests to help make a diagnosis:

Depending upon the extent or location of the cancer, the biopsy may be done in a variety of ways.

 

Should Everyone Get a Second Opinion?

Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including:

  •    Not feeling comfortable with the treatment decision
  •    Being diagnosed with a rare type of cancer
  •    Having several options for how to treat the cancer
  •    Not being able to see a cancer expert

 

When do I Need to See a Specialist?

If you have cervical cancer, you'll likely be treated by one or more of the following specialists: a gynecologic oncologist, a radiation oncologist and a medical oncologist. An oncologist is a doctor specially trained in diagnosing and treating cancer.

If you have been diagnosed with precancerous changes, it's not essential that you see an oncologist. Depending on the degree of the change seen, your gynecologist or your primary care doctor may monitor your condition and provide treatment.

How Can Someone Get a Second Opinion?

These are some of the many ways to get a second opinion.

  • Ask a primary care doctor. He or she may be able to suggest a specialist. This may be a gynecologic oncologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
  • Call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
  • Consult The Official ABMS Directory of Board Certified Medical Specialists. This book, from the American Board of Medical Specialists, lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries and you can also view it online at www.abms.org.
  • Seek other options. Check with a local medical society, a nearby hospital/medical school, or support group to get names of doctors who can give you a second opinion. Or ask other people who've had cancer for their recommendations.

What are the Treatments for Cervical Cancer?

Treatment for cervical cancer is often surgery, especially for cancers that have not spread. Surgery is used to remove as much cancer cells as possible. It is called a local treatment. Local treatments fight cancer cells in one area. Another type of local treatment used for cervical cancer is high-energy X-rays, called radiation therapy. Chemotherapy is the use of drugs to kill cancer. It is called systemic treatment. It travels throughout the body. It may be combined with radiation, either before or after surgery.

What Check-ups should a Woman Have after Treatment for Cervical Cancer?

In the first year after treatment, most women are advised to see their doctors every 3 months. Pap tests may be performed every 3 months. Also, women may have chest X-rays and computed tomography (CT scans) regularly. Until the fifth year, women may have check-ups regularly, at least every 6 months. After 5 years, a woman will most likely go back to yearly checkups. Women who have been treated for cervical cancer should tell their doctors about any vaginal discharge, bleeding, bone pain, weight loss, bowel or bladder problems. They should quit smoking and use protection during intercourse to prevent further problems.

What's New in Cervical Cancer Research?

Researchers are working on many fronts to better prevent, diagnose, and treat cervical cancer. For example, researchers have recently developed vaccines to prevent HPV infection. They are also working on vaccines to treat cervical cancer. And they are developing surgical techniques that will cure localized cancers while preserving as much tissue as possible.

What Are Clinical Trials?

Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are the ones that work better or have fewer side effects than the current treatments. People who participate in these studies have access to these treatments before the U.S. Food and Drug Administration (FDA) approves them. People who join trials also help researchers learn more about cancer and help future cancer patients.

*Squamous cell carcinoma is cancer of cells that line the outer part of the cervix. These cells are squamous epithelial cells. They line the outer part of the cervix that is closest to the vagina, called the ectocervix.  Squamous cell cancers have flat, thin cells. They cover the surface of the ectocervix. This type of cancer most commonly occurs where the ectocervix meets the endocervix, which is the inner part of the cervix.

*Adenocarcinoma is cancer of the cells lining the inner part of the cervix. These cells are * columnar epithelial cells. They are some of the most prolific cells in the body, mainly because they can fulfill so many functions. They are found throughout the body's organ system, including the digestive tract and the female reproductive system.  They line the inner part of the cervix that is closest to the uterus, called the endocervix.

 

Resources and References:

*    PAHO:  www.paho.org

*    World health Organization (WHO):  www.who.int/

*    Womenshealth.gov at 800-994-9662 (TDD: 888-220-5446)

*    American Cancer Society 
Phone: 800-ACS-2345

*Schiffman M and Castle PE. 2005. The promise of global cervical-cancer prevention. New England Journal of Medicine. Vol. 17;353(20):2101-4.

*Sherris, Jacqueline et al. 2001.  Beyond Our Borders: Cervical cancer in the developing world.

Western Journal of Medicine. Volume 175;231-233.

 

Medical Disclaimer

The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information.

 
 

                                            Infertility

The National Institutes of Health (NIH) defines infertility as the inability for women between the ages of 15 – 44 to get pregnant after at least one year of actively trying to conceive, and for men, the inability to impregnate a woman. The NIH also states that women who can become pregnant but who cannot carry a pregnancy to term (birth) may also be considered infertile. The cause of infertility can rest with a woman or a man.  Infertility has been recognized by the medical community as a disease. It has no single cause because successful pregnancy is a chain of events (NIH).  Infertility is a common problem, in 2009, the Centers for Disease Control (CDC) reported that 10 % of women (6.1 million) in the United States ages 15–44 years have difficulty getting pregnant or staying pregnant. According to the American Society of Reproductive Medicine, infertility affects men and women equally.

Black Women and Infertility

Many people are usually taken aback to hear that in the U.S.  black women suffer a much higher rate of infertility than white women. Research from 2006 indicates that incidence of infertility is higher in black women than in Caucasian women, and that infertility among black women has steadily been increasing, whereas it is decreasing among white women (Chandra, and Stephen 2006).  

What Causes Infertility in Women?

Some cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems are often caused by polycystic ovary syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman's ovaries stop working normally before she is 40. POI is not the same as early menopause.

Other causes of infertility problems in women include:

*    Blocked fallopian tubes due to pelvic inflammatory disease (PID)

*    Endometriosis, or surgery for an ectopic pregnancy

*    Uterine fibroids

*    Polycystic Ovary syndrome (PCOS)

 

New reproductive technologies offer choices and hope to infertile individuals or couples who desire to become parents.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include:

*     In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

*     Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

*     Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.

*     Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.

For more information on infertility, please contact the following resources:

*    InterNational Council on Infertility Information Dissemination, Inc. 

               Phone: 703-379-9178

*    RESOLVE: The National Infertility Association 

              Phone: 703-556-7172. www.resolve.org

*    The Families of Color Initiative http://www.infertilityeducation.org/infertilityresources.html

*    Fertility Partnership:  African Americans and Infertility http://www.fertilitypartnership.com/View-by-tag/African-American+infertility/

 

References and other Resources

*    National Institutes of Health (NIH):
http://health.nih.gov

*   
Center for Disease Control and prevention:
http://www.cdc.gov/uscs.

*   
Endometriosis Association
:
www.EndometriosisAssn.org


Medical Disclaimer:
The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information.



 
 Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is characterized by immature follicles in the ovaries

PCOS is a health disorder in which a woman’s hormones are out of balance. There may be one or more causes for the hormone level changes. PCOS is common disease of the reproductive system that affects teenage girls and adult women. According the NIH, approximately 5 million women of reproductive-age in the United States are affected by this syndrome.  Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.

For reasons that are not well understood, in PCOS the hormones get out of balance.  One hormone change triggers another, which changes another.  PCOS is linked to changes in the level of certain hormones: Estrogen and progesterone, the female hormones that help a woman's ovaries release eggs and Androgen, a male hormone found in small amounts in women.

Women who are affected with this disorder often have a mother or sister who also suffer or has symptoms similar to PCOS.

Black Women and PCOS

Black women are disproportionately affected by PCOS. This can be attributed to obesity and overall poor access to health care as well as other social determinants of health.

What are the symptoms for PCOS?

Symptoms tend to be mild at first. A woman may have only a few symptoms or a lot of them. The most common symptoms are:

*    Acne

*    Weight gain/trouble losing weight. Obesity seems  to worsen this condition

*    Extra facial hair on the face/body, thicker and darker facial hair, hair on the chest, belly, and back.  This condition is  called hirsutism

*    Hyperpygmentation --- from removal of facial/neck hair

*    Thinning hair on the scalp

*    Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding

*    Infertility

*    Depression

*    The body may have a problem using insulin—leading to insulin resistance or diabetes.

 

PCOS seems to run in families, so a woman’s chance of having it is higher if other women in her family have PCOS, irregular periods, or diabetes.  PCOS can be passed down from either the mother's or father's side.

Diagnosis of PCOS

See a doctor who ask questions about past health, symptoms, and menstrual cycles.  A doctor will look and/or perform:

  • Physical exam to look for signs of PCOS
  • Look for extra body hair and high blood pressure
  • Check height and weight for a healthy body mass index (BMI)
  • Do a number of lab tests to check blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms
  • Pelvic ultrasound to look for cysts on ovaries

Doctors may be able to tell that a woman has PCOS without an ultrasound but it helps rule out other health problems.

Treatment

Early diagnosis and treatment are crucial to avoid and reduce the long-term complications, such as diabetes and heart disease.

  • Regular exercise and stress reduction: such as moderate activity on a regular basis such as walking, yoga, meditation, or acupuncture are highly advisable.  Most women who have PCOS can benefit from losing weight.  Even losing 10 lbs may help get the hormones in balance and regulate menstrual cycle.
  • PCOS—can make it hard to lose weight, so professional help might be helpful.
  • Smoking—women who smoke have higher androgen levels that may contribute to PCOS symptoms Smoking also increases the risk for heart disease
  • Nutrition—eat a heart-healthy diet with lots of vegetables, fruits, nuts, beans, and whole grains.  Limits foods that are high in saturated fat, such as meats, cheeses, and fried foods. Eating healthy foods and weight control are among the key treatments for PCOS

Medicines—birth control pills can help regulate periods and reduce symptoms such as excess facial hair and acne.

  • Medicines to balance hormones may be used.
  • Androgen-lowering medicine also known as spironolactone, may be used with birth control pills to help reduce symptoms.

Treatment can reduce unpleasant symptoms and help prevent long-term health problems.  These medicines cannot be used if a woman is trying to get pregnant.


References and Sources

Mayo Clinic:

http://www.mayoclinic.com/health/polycystic-ovary-syndrome/DS00423

Womenshealth.gov:

 http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.cfm#a

Teens Health:

http://kidshealth.org/teen/diseases_conditions/sexual_health/pcos.html#

NIH:

http://www.nlm.nih.gov/medlineplus/ency/article/000369.htm

 

Medical Disclaimer:

The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information.

  

  Uterine Cancer or Endometrial Cancer


Uterine cancer starts in the uterus. The uterus is also referred to as the womb.  The most common type of uterine cancer is also called endometrial cancer because it forms in the lining of the uterus, called the endometrium. Uterine cancer is the fourth most common cancer in women in the United States and the most commonly diagnosed gynecologic cancer.

In 2008 (the most recent year numbers are available)—43,134 women in the United States were diagnosed with uterine cancer, which resulted in 7,675 deaths.

Risk actors and prevalence of uterine cancer in black women

There is no way to know for sure who will get uterine cancer. Some women get it without being at high risk. However, the following factors may increase a woman’s risk for uterine cancer:

 

*    Uterine cancer is more common in white women than black women.  However, medical research found that black women patients are significantly more likely than Caucasian patients to have advanced stages of the disease and more aggressive tumor types, even when they receive similar treatment regimens. Black women die at much higher rate than white women from uterine cancer.

 

*    Obesity is a major risk for developing uterine cancer as well as abnormal precancerous changes of the uterus.

 

Other risk factors include: 

*    Taking estrogen by itself

*    Diabetes

*    Having had trouble getting pregnant

*    Early onset of menstrual periods at a young age

*    Fewer than five periods in a year at any time in your life before starting menopause

*    A late menopause

*    Family history of early onset colorectal cancer or other reproductive cancers

  

Symptoms

*    Abnormal vaginal bleeding or postmenopausal bleeding—which occurs in 90% of endometrial cancer cases 

*    Pelvic pressure, a pelvic mass, or abnormal discharge

*    Difficulty and pain during urination

*    Painful intercourse

 

Uterine Cancer

Preventive Measures

Some uterine cancer can be prevented by:

*    maintaining a normal weight

*     Diabetes prevention

*    Awareness of risk factors for this cancer

*    Avoid continual estrogen stimulation of the uterine lining, also called "unopposed        estrogen."

*    Promptly see a health professional for any abnormal bleeding

 

It is important to know that the Pap test does not screen for uterine cancer. It only screens for cervical cancer.

Treatment

  • The most common treatment for uterine cancer is a total hysterectomy in which the uterus, fallopian tubes, ovaries and lymph nodes in which the tumor commonly spreads are all removed.
  • Other therapies include: radiation, chemotherapy, or hormone therapy.

References/Sources

U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2008 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services,

 

Centers for Disease Control and Prevention, and National Cancer Institute; 2012. Available at: http://www.cdc.gov/uscs.

 

Centers for Disease Control and Prevention: 1-800-CDC-INFO or www.cdc.gov/cancer

National Cancer Institute: 1-800-4-CANCER or www.cancer.gov

http://www.healthywomen.org/condition/uterine-cancer

 

Learn more by downloading the Inside Knowledge campaign's uterine cancer fact sheet

http://www.cdc.gov/cancer/uterine/pdf/uterine_facts.pdf

 

Medical Disclaimer

The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information.

 

 
 Ovarian Cancer

 
Women have two ovaries that are located in the pelvis, one on each side of the uterus. The ovaries make female hormones and produce eggs. Ovarian cancer develops from cells found in the ovaries that become malignant and grow out of control. It is the deadliest form of cancer affecting the female reproductive system.  Ovarian cancer accounts for only about 3% of all cancers in women; however, it causes more deaths than any other gynecologic cancer in the U.S.

Over 21,000 new cases of ovarian cancer are reported each year in the US–resulting in over 15,000 deaths.  Ovarian cancer is the eighth most common cancer.  It ranks fifth in cancer deaths among women.

Who Gets Ovarian Cancer?

According to the CDC, all women are at risk for ovarian cancer, but older women are more likely to be affected by this disease than younger women. About 90% of women who get ovarian cancer are older than 40 years of age, with the greatest number of cases occurring in women aged 60 years or older.

Prevalence of ovarian cancer in black women

White women are more likely to die of ovarian cancer than any other group. Black women have the second highest rate of deaths from ovarian cancer, followed by American Indian/Alaska Native women and Asian/Pacific Islander women. Black women are less likely to receive the appropriate diagnosis, treatment, referral, surgery, radiation, and hormone treatments they need for this type of cancer.

 
Inside Knowledge: Get the Facts About Gynecologic Cancer:  http://www.cdc.gov/cancer/knowledge/

Symptoms of Ovarian Cancer

Ovarian cancer may cause one or more of these signs and symptoms—

  • Vaginal bleeding or discharge from the vagina that is not normal
  • Pain in the pelvic or abdominal area (the area below the stomach and between the hip bones)
  • Back pain
  • Bloating in the area below your stomach, which swells or feels full
  • Feeling full quickly while eating
  • A change in one’s bathroom habits, such as having to pass urine very frequently, constipation, or diarrhea.

Unfortunately, ovarian cancer is often diagnosed too late when treatments may not be as successful. There are no early screening tests for ovarian cancer.  Medical experts state that symptoms, such as bloating, pelvic pain, an urgent need to urinate, fatigue and an upset stomach, can be vague and mistaken for other conditions.  In 2011, The National Ovarian Cancer Coalition reported that doctors initially misdiagnosed two-thirds of the women surveyed.

Most risks factors for ovarian cancer are still unknown. Doctors/researchers believe that endometriosis, a family history of ovarian cancer, and increased age, are factors that may contribute to ovarian cancer. The American Cancer Society states that obesity and poor diet can increase the risk as well

When ovarian cancer is found in its early stages, treatment is most effective!

Presidential Proclamation--National Ovarian Cancer Awareness Month

 Last year, President Barack Obama declared September National Ovarian Cancer Awareness Month and pledged his support for increased awareness and scientific research.

“While we have made great strides in the battle against ovarian cancer, this disease continues to claim more lives than any other gynecologic cancer.  During National Ovarian Cancer Awareness Month, we honor all those lost to and living with ovarian cancer, and we renew our commitment to developing effective screening methods, improving treatments, and ultimately defeating this disease.”

Read more….http://www.whitehouse.gov/the-press-office/2010/08/31/presidential-proclamation-national-ovarian-cancer-awareness-month-0

References and Sources

http://thegrio.com/2011/09/28/ovarian-cancer-still-a-mystery-especially-for-black-women/

CDC:  http://www.cdc.gov/features/dsovariancancer/index.html

 

Medical Disclaimer: The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information.

  

Breast Cancer                                                                                                                         

The National Cancer Institute reports that among women, breast cancer is the most commonly diagnosed cancer after nonmelanoma skin cancer, and it is the second leading cause of cancer deaths after lung cancer. In 2012, an estimated 229,060 new cases will be diagnosed, and 39,920 deaths from breast cancer will occur.

Black women and breast cancer

Black women have the highest breast cancer death rates of all racial and ethnic groups and are 40% more likely to die of breast cancer than white women (CDC).

*    African American women are twice as likely as White women to develop “triple negative” breast cancer—a  subtype of the disease

*    Triple negative breast cancer is a type of aggressive breast cancer that primarily affects young African American women

*    Triple negative breast cancer tests negative for estrogen receptors (ER), progesterone receptors (PR), and the HER-2 gene.

*     Women with triple negative breast cancer don’t benefit from the most common treatments, such as tamoxifen or Herceptin, which are designed to affect cancers driven by estrogen, progesterone, or the protein called human epiderm.

The CDC states that breast cancer is the second leading cause of cancer deaths among women in the United States. Breast cancer deaths are decreasing fastest among white women. Black women are more likely to die of breast cancer than other women.  More black women have breast cancer that has spread beyond the breast compared with white women when the cancer is found. Black women have higher numbers of advanced stage breast cancer (45 percent) compared with white women (35 percent). Fewer black women start treatment in a timely way compared with white women. Also, fewer black women get the surgery, radiation, and hormone treatments they need compared with white women.

During a recent interview, Thomas R. Frieden, M.D., M.P.H, CDC Director explains that, “Although we are making progress reducing deaths from breast cancer, we have much work to do to reduce preventable deaths, particularly among African-American women.”  He went on to say, “Only when every woman receives adequate screening, timely follow-up, and high-quality treatment, will the full benefit of breast cancer screening be achieved.”

Factors Associated with Increased Risk of
Breast Cancer Hormone therapy

Based on solid evidence, combination hormone therapy (HT; estrogen-progestin) is associated with an increased risk of developing breast cancer. The evidence concerning the association between estrogen-only therapy and breast cancer incidence is mixed. ( National Cancer Institute).

Obesity

Based on solid evidence, obesity is associated with an increased breast cancer risk in postmenopausal women who have not used HT. It is uncertain whether reducing weight would decrease the risk of breast cancer.

Alcohol

Based on solid evidence, exposure to alcohol is associated with an increased breast cancer risk in a dose-dependent fashion. It is uncertain whether decreasing alcohol exposure would decrease the risk of breast cancer

Major inheritance susceptibility

Based on solid evidence, women who inherit gene mutations associated with breast cancer have an increased risk.

Other risk factors for breast cancer include:  age, family history, reproductive and menstrual history.

We also believe that medical, socioeconomic inequities and other social determinants of health can be contributing factor towards the development of breast cancer.

Prevention

You can help lower your risk of breast cancer in the following ways—

*    Get screened for breast cancer regularly

*    Control your weight and exercise

*    Know your family history of breast cancer

*    Limit the amount of alcohol you drink

*    Breast-feeding ---based on solid evidence, women who breast-feed have a decreased risk of breast cancer

There are different types of treatment for patients with breast cancer. Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment

For more comprehensive information for breast cancer treatment, please go to: http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page5.

References and Sources:

http://www.cdc.gov/vitalsigns/

CDC:  http://www.cdc.gov/features/vitalsigns/breastcancer/

CDC: Breast cancer prevention:  http://www.cdc.gov/cancer/breast/basic_info/prevention.htm

CDC:  http://www.cdc.gov/vitalsigns/

Breast Cancer Action:  http://bcaction.org/cancer-policy-perspective/

 

Medical Disclaimer

The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment.  We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information.