Lifetime Abuse Victimization and Risk of Uterine Leiomyomata in Black Women.

Slone Epidemiology Center, Boston University, Boston, MA, 02215. Electronic address: .
American journal of obstetrics and gynecology (Impact Factor: 4.7). 01/2013; 208(4). DOI: 10.1016/j.ajog.2012.12.034
Source: PubMed


Uterine leiomyomata (UL) are a major contributor to gynecologic morbidity and medical costs, and black women are disproportionately affected by the condition. Previous studies have linked UL to psychosocial stress, including child abuse. We assessed the association between lifetime abuse victimization and UL among 9910 premenopausal women.

Study design:
Data were derived from the Black Women's Health Study, a prospective cohort study. In 2005, participants reported their experiences of physical and sexual abuse within each life stage (childhood, adolescence, adulthood). Biennial follow-up questionnaires from 2005 through 2011 ascertained new UL diagnoses. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using Cox regression.

There were 1506 incident UL cases diagnosed by ultrasound or surgery. UL incidence was higher among women who reported child abuse, particularly sexual abuse. Relative to no abuse across the life span, RRs were 1.16 (95% CI, 1.02-1.33) for physical abuse only, 1.34 (95% CI, 1.09-1.66) for sexual abuse only, and 1.17 (95% CI, 0.99-1.39) for both physical and sexual abuse in childhood. RRs for 1-3 and 4 or more incidents of child sexual abuse were 1.29 (95% CI, 1.04-1.61) and 1.41 (95% CI, 1.07-1.85), respectively, whereas the RRs for low, intermediate, and high frequencies of child physical abuse were 1.19, 1.04, and 1.23, respectively. The association was strongest for the highest category of child abuse severity (RR, 1.57; 95% CI, 1.19-2.07). No associations were found for teen or adult abuse.

In the present study, child sexual abuse was an independent risk factor for UL, supporting the hypothesis that childhood adversity increases UL risk.

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    ABSTRACT: Uterine leiomyomata (UL) are a major source of gynecologic morbidity and the primary indication for hysterectomy. Depression can cause dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which may affect the synthesis of reproductive hormones involved in UL pathogenesis. We assessed the association between depressive symptoms and UL among 15,963 premenopausal women. Data were derived from the Black Women's Health Study, a prospective cohort study. In 1999 and 2005, the Center for Epidemiologic Studies Depression Scale (CES-D) was used to ascertain depressive symptoms. On biennial follow-up questionnaires from 1999 through 2011, women reported physician-diagnosed depression, antidepressant use, and UL diagnoses. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using multivariable Cox regression. There were 4,722 incident UL cases diagnosed by ultrasound (n=3,793) or surgery (n=929) during 131,262 person-years of follow-up. Relative to baseline CES-D scores <16, IRRs were 1.05 (95% CI, 0.98-1.13) for CES-D scores 16-24 and 1.16 (95% CI, 1.06-1.27) for CES-D scores ≥25 (P-trend=0.001). IRRs for current and past physician-diagnosed depression relative to no depression were 1.15 (95% CI: 0.98, 1.34) and 1.25 (95% CI: 1.13, 1.39), respectively. Results persisted after further control for antidepressant use. IRRs for current and past use of antidepressants (any indication) relative to never use were 1.11 (95% CI: 0.97, 1.28) and 1.32 (95% CI: 1.14, 1.52), respectively. In this cohort of black women, greater depressive symptoms were associated with UL, independent of antidepressant use, supporting the hypothesis that dysregulation of the HPA axis increases UL risk. Copyright © 2014 Elsevier Inc. All rights reserved.
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