Psychosocial Stress and the Risk of Uterine Fibroids

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DESCRIPTION (provided by applicant): Significant morbidity due to uterine leiomyomata ("fibroids") affects one of every four to five women in reproductive life. Many women experience severe discomfort that ultimately results in a hysterectomy, an invasive procedure. African American women tend to be at a 2 to 9-fold higher risk of being diagnosed at a younger age and/or with larger more advanced fibroids than white women. The objective of this application is to examine the association between measures of stress and the risk of fibroids among a randomly selected group of premenopausal women between the ages of 35 and 49 years. The literature on known risk factors and the etiology of fibroids is slowing increasing with research suggesting that fibroids are hormonally dependent. Psychosocial stress has been shown to be associated with mental and other physical health outcomes such as obesity and hypertension among women. Evidence of stress causing fluctuations in reproductive hormone levels has been reported in both animal and human studies. The central hypothesis is that fibroids result from an increase in hormone levels as a result of increased levels of stress. Using data from the National Institute of Environmental Health Sciences, Uterine Fibroid Study (UFS), a secondary data analyses is proposed to address four specific aims: 1) Describe the measures of stress (i.e. psychosocial, cortisol, and perceived racism); 2) Examine the association between qualitative measures (i.e. perceived stress and life events stress) psychosocial stress and fibroids; 3) Examine the association between urinary cortisol, a biomarker of stress, and fibroids; and 4) Examine the association between perceived racism and the risk of fibroids among African American women using data from the Perceived Racism Study, an ancillary study to the UFS. Multiple Logistic and Polytomous regression analyses will be used to determine the risk of fibroids associated with stress while controlling for factors such as nulliparity, age at menarche, and increasing age. This research is significant because it is expected to advance and expand our understanding of how stress may manifest in the body and influence fibroid development. The proposed research is an under-investigated area of women's health that has the potential to inform reproductive epidemiology as well as improve our understanding of the pathogenesis of uterine fibroids.