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FIBROIDS
MORE than half of all Black women have uterine fibroids, which are
non-cancerous tumors that grow in the muscular wall of the uterus.
Sisters are three times more likely to have fibroids and are diagnosed
at younger ages, between 20 and 50. Black women also tend to have more
fibroids that grow faster and larger than women of other groups.
Among the major symptoms of fibroids are heavy periods, anemia, pain,
frequent urination, discomfort during intercourse, distortion of the
uterus, infant malnutrition during pregnancy and infertility.
There is no known cause for fibroids, which tend to be hereditary and
which are associated with obesity and increased estrogen levels. Women
who have fibroids, which shrink at menopause when the estrogen levels
drop, should get regular checkups to make sure the tumors aren't getting
larger and that more of them haven't developed.
The location, size, the woman's age, number of fibroids and whether she
wants to become pregnant are factors considered to determine what
treatment, if any, is necessary. Only 10 to 20 percent of women require
treatment. Most doctors don't recommend treatment unless the fibroids
cause excessive bleeding or pain.
Previously, women were given few treatment options to remove fibroids,
with the most effective procedure being a hysterectomy, which is major
surgery that removes the uterus and sometimes the ovaries--consequently
ending fertility. Nearly half of all hysterectomies are related to
fibroids.
Today, there are other treatment options to shrink or remove fibroids
and spare the uterus. One method of reducing the size of fibroids is
called uterine fibroid embolization, during which a catheter is inserted
into a small incision in the upper thigh and guided by x-ray to arteries
that feed the fibroids, thus causing fibroids to shrink. One-third of
patients who had the procedure and tried to have children were able to
conceive, and the pregnancies were carried to term.
Some women opt for a myomectomy to remove fibroids, while others choose
to shrink fibroids through myolysis, during which a needle is inserted
through an incision in the abdomen to cauterize or seal the fibroids
from blood vessels, so they shrink. Medical officials say because it is
a relatively new procedure, it is not clear how it affects fertility.
Another choice is a hysteroscopy, a procedure in which a surgeon removes
fibroids using a tube inserted into the vagina. Patients usually go home
the same day and recovery time is short. The treatment shouldn't impair
fertility, doctors say.
It should be noted, however, that about 15 to 30 percent of fibroids
grow back within 10 years after removal.
STRESS
EVERYONE feels the physical and mental strains of stress at some point
in their lives. But the lives of African-Americans are
disproportionately impacted by stress, spurred in part by financial
worries and racial discrimination, experts say.
Although stress is a natural phenomenon, it is the heightened degree of
stress that can cause some serious problems. Doctors say too much stress
could be linked to heart disease, hypertension and cancer, including
breast cancer, because stress apparently affects the body's immune
system.
Stress means different things for different people, according to the
National Mental Health Association, and occurs when people are unable to
handle daily life events, some of which are related to finances.
University of Michigan sociology and epidemiology professor Dr. David says Blacks are more susceptible to stress caused by financial
concerns because African-Americans generally fall into a lower income
bracket and earn approximately 40 cents less in income to every dollar
that White families earn.
Additionally, too much stress can contribute to such conditions such as
insomnia, headaches and chronic fatigue. Stress can also lead to
detrimental coping methods, such as excessive eating, alcohol and drug
use, and not adhering to medical recommendations that have been
successful, Williams says.
There is ongoing research to find more effective ways to deal with the
potentially deadly condition. Meanwhile, experts continue to encourage
everyone to develop stress-coping regimens that include getting ample
rest, exercising routinely and maintaining a balanced diet.
DIABETES
IN the midst of increased focus on the severity of diabetes, the disease
continues to attack the African-American community, including women, at
alarming and increasing rates. Currently, one in four African-American
women over 55 has diabetes. And with the life-threatening problem of
obesity, especially among Black children, the numbers are expected to
grow rapidly, with the disease striking people at a much younger age.
According to a recent study presented at the American Diabetes
Association annual meeting, obese girls are at a higher risk of
adult-onset Type 2 diabetes than their male counterparts. And insulin
resistance, a pre-diabetic condition in which the body doesn't respond
to insulin properly, was significantly more common in girls than boys.
To make matters worse, doctors say this pre-diabetes condition also is
associated with adult-onset cardiovascular disease.
Recognizing diabetes in its early stages is one way medical experts are
hoping to decrease the increasing numbers of diabetes cases. In
anticipation of the disease's development, many doctors have begun
preventive measures that include treating people who don't yet have
diabetes, but show signs that they could be victimized later.
Pre-diabetes, a condition in which a person's blood-glucose levels are
higher than normal, but not high enough to be considered diabetic,
affects at least 16 million people in the U.S. Although medications can
help people diagnosed with pre-diabetes, doctors say diet and exercise
have proven to work better, with some people being able to return their
blood glucose levels to the normal range.
Although diabetes can be a devastating, life-altering and sometimes
fatal disease, there is some good news-the disease is manageable. But
for those affected, information is vitally important. Recent data have
shown that millions of diabetes sufferers don't know that diabetes
increases the risk for heart disease and stroke, which are the leading
causes of death in people with diabetes. Additionally, doctors say most
diabetics don't know that two out of three people with diabetes die from
heart disease or stroke.
So, the African-American Program of the American Diabetes Association
has been highlighting a new initiative that works in conjunction with
the American College of Cardiology. It's called "Make the Link! Diabetes,
Heart Disease and Stroke," which is an education campaign that's
designed to change people's thinking about diabetes--that it's not only
about controlling blood sugar, but managing blood pressure and
cholesterol as well.
DEPRESSION
FIRST things first. Black people do get depressed, and women are twice
as likely as men to suffer some form of depression. But according to the
experts, recognizing the symptoms and admitting to the depression are
the first steps toward getting the necessary treatment.
Roughly 19 percent of the U.S. population suffers some form of
depression. "Major" or "clinical" depression can last anywhere from two
weeks to several months, several times in a lifetime. A milder form is "dysthymia,"
which can last at least two years. "Manic-depression" or "bipolar
disorder," is less common and is marked by, among other things, a series
of lows and highs--racing thoughts, increased energy, excessive
risk-taking.
Spotting the symptoms--the more common "lows"--is key. Besides sadness,
excessive crying and irritability, there are other symptoms--too much or
too little sleep, weight gain or loss, concentration problems,
forgetfulness, indecision and physical problems like chronic pain or
headaches--that are all signs of major depression. A lack of enthusiasm
for life and constant fatigue might be signs of dysthymia.
For women, reproductive or hormonal changes can cause biochemical
changes in the brain that can lead to depression. That's why postpartum
mood swings can be especially acute, causing tragic depression in some
women. Researchers point to particular stresses for women, like
child-rearing, even parental care, that can lead to depression.
Furthermore, some experts say, the unique problems Black women
face--struggling with racism, traditional notions of beauty, as well as
economic issues--can create their own special kinds of stresses.
Admitting the existence of a problem is a big part of the problem itself.
Black people--specially women--have been taught to be strong, according
to Dr. Marilyn medical director at Maryland Health Partners in
Columbia, Md., author of Saving Our Last Nerve: The Black Woman's Path
to Mental Health.
Typically, antidepressant drugs or therapy--or even a combination--can
help, doctors say. As experts observe, belief that a solution is
possible is a big part of the solution itself. Often it is difficult to
get treatment, simply because of urban challenges in accessing health
care. That is why some have argued that it is important to understand
the kinds of challenges young Black women face in order to provide
comprehensive treatment--including transportation and child care--to
make sure that Sisters not only have access to treatment, but that they
also can get it.
LUPUS
AFRICAN-AMERICAN women are fighting an uphill battle against lupus. They
are two to three times more likely to be afflicted, are diagnosed at an
earlier age, often suffer kidney damage and die more often from the
chronic inflammatory autoimmune disease.
Lupus, which usually develops between ages 15 to 44, inexplicably forces
the body's immune system to attack cells and tissues such as the kidneys
and lungs. One in 250 Black women suffers from lupus, compared to one in
400 White women.
It gets worse. Women of all ages are 10 to 15 times more likely than men
to get lupus. Death rates are five times higher in women than men and
Blacks die three times more often from systemic lupus, according to the
Centers for Disease Control and Prevention (CDC). Systemic lupus, the
most common and serious form, affects any system or organ including the
lungs, kidneys, central nervous system and heart.
From 1979 to 1998, the annual number of deaths from systemic lupus
increased almost 60 percent, but climbed to almost 70 percent among
Black women ages 45 to 64 years old, according to the CDC study.
Symptoms vary, but common symptoms include ongoing mild fevers,
prolonged fatigue and skin rashes, especially in the shape of a
butterfly across the cheeks and nose bridge. Early diagnosis is one key
to controlling lupus, which affects more than a million people,
according to the Lupus Foundation of America.
Treatments include non-steroidal anti-inflammatory drugs, immune
suppressive drugs and corticosteroids. Although no new treatments for
the baffling disease have been discovered in more than a decade, doctors
say there have been advances in medical research and they believe they
on the brink of breakthroughs.
Rheumatologists at the Medical University of South Carolina discovered a
gene earlier this year that they believe predisposes African-American
women to develop lupus, according to Dr. Gary of the school's
division of Rheumatology and Immunology. "We are moving forward by leaps
and bounds," Dr. says.
INFERTILITY
IF you have actively tried to get pregnant for at least a year, then you
may be infertile. But you're not alone. One in five couples in the
United States is infertile, and this is becoming a larger problem as
people wait longer to marry and have children.
"Many couples wait too late to seek help," says Dr. Ervin Ph.D.,
MD, professor and director of assisted reproduction at Yale University
School of Medicine and chief of the school's in-vitro fertilization
program. "By the age of 35, the ability to have children starts to
flatten out," Dr. says. "By the time women reach 39 that curve is
headed downward fast. By the time women reach 44 the chances of getting
pregnant are quite low, no matter what technology is used. That is the
natural biology of ovarian aging."
Dr. Jones recommends that women in their mid-30s and older not wait for
a year in trying to get pregnant. They should see a fertility specialist
after six months of trying. But women are not always the problem. Some
50 percent of couples who have trouble conceiving have a male factor
involved as well. For men, infertility can result from a defect in the
pituitary gland, the testicles, sperm, hormones or ejaculatory duct, Dr.
says. Habits such as smoking, drug use, poor diet, heavy alcohol
consumption and lack of exercise can all decrease the sperm count,
according to the Department of Urology at the University of Iowa
Hospitals and Clinics. There is also a gradual decrease in fertility in
males in their mid-30s.
"People assume because a man fathered a child in the past that he is
fertile, but things happen to men just like women," Dr. Jones says. In
women, tubal damage, endometriosis, fibroid location, ovulatory defects,
cervical defects, mucus in the cervix and antibodies can interfere with
fertilization.
But there are treatments to help both men and women. As many as 60
percent of couples who have not conceived after a year eventually do get
pregnant, sometimes with medical treatment, according to The Merck
Manual of Medical Information.
Treatments for infertility include giving women fertility drugs based on
the specific problem. And there's in-vitro (test tube) fertilization,
which involves retrieving and fertilizing eggs and growing the resulting
embryos in a laboratory, then implanting the embryos into the woman's
uterus. The chances of producing a full-term baby are only about 18 to
25 percent each time eggs are placed into the uterus.
Gamete intrafallopian tube transfer can be done if the fallopian tubes
are working normally. Full-term births have the same chances as with
in-vitro fertilization.
Additionally, certain drugs can assist biology and possibly lead to
pregnancy. Then there's sperm donation. If the male is not producing
enough sperm, donor sperm can be used. Also, there's intracytoplasmic
sperm injection, a process where sperm is injected into an egg, which is
then implanted into a woman's uterus. The chances of producing a
full-term baby are the same as with in-vitro fertilization.
STROKE
THE death rate from a stroke is 79.8 percent higher in African-American
women than in White women and can create severe physical impairments,
loss of function and mobility for its Black female survivors.
In a recent study that outlined the relationship between cholesterol and
stroke death in American women, researchers found cholesterol levels to
be a primary indicator of stroke death in women under age 55. Among
African-American women with the highest cholesterol levels, the risk of
stroke nearly doubled. Because high cholesterol contributes to clot
formation and plaque build-up in the blood vessels, high cholesterol
levels may prove detrimental in stroke cases.
But research suggests that a lack of social resources, transportation
and supplemental in-home care contribute to the failure of some Black
women who don't recover fully from stroke. The failure to accurately
diagnose the warning signs--dizziness, loss of balance, severe headache,
numbness or weakness of the face, slurred speech--may also decrease a
woman's chances to fully recover. However, Black women who receive
lifesaving medication within the recommended three-hour time frame,
doctors say, and those who receive medical attention up to three days
later, can significantly decrease their recovery time, disability and
death rates.
"What is clear is that we can reduce the number of stroke patients who
will require rehabilitation if more patients recognize their symptoms,
get to the hospital and are treated rapidly," says Dr. John associate director for clinical trials at the National Institute of
Neurological Disorders and Stroke.
In preventing stroke, aspirin, as an alternative to ticlopidine, was
found less expensive and more effective in preventing some
stroke-producing clots from forming, according to a report by the
Journal of the American Medical Association. Researchers say comparisons
with other agents indicate that it may be difficult to outperform
aspirin as a stroke prevention therapy.
HORMONE REPLACEMENT THERAPY
THE news sent shock waves throughout the country. Reports by the Women's
Health Initiative, sponsored by the National Institutes of Health,
suggested that long-term combination hormone replacement therapy (HRT)
for post-menopausal women may increase the risk of heart attacks, blood
clots, strokes, breast cancer and dementia. The obvious question that
has arisen is whether HRT is worth the risks.
Some 10 million women in the United States take HRT--usually estrogen
pills, or a combination of estrogen and progesterone or the synthetic
progestin--to replace the hormones that are lost during the period of
menopause, and to treat the problems (including hot flashes, night
sweats, sleeplessness) that many women experience. HRT also has been
used for prevention of long-term and serious postmenopausal problems,
like osteoporosis.
According to reports, even short-term HRT for severe hot flashes might
pose some risk. Overall benefits also are being questioned as a result
of the Women's Health Initiative reports. Although low levels of
estrogen in postmenopausal women have been linked to osteoporosis, there
is some evidence that short-term use of estrogen might not be as
effective in preventing loss of bone mass and density. Some studies
suggest that longer use of estrogen might be needed to protect women
from bone fractures in later years. The risks of long-term estrogen use
are still being questioned, according to the National Cancer Institute (NCI).
Women should consult their physicians about the alternatives to HRT that
are being considered, including lower doses of HRT pills, and even use
of other drugs that might help reduce bone loss. But NCI indicates more
research will be needed to determine the right balance between treating
the symptoms of women going through the change of life, and minimizing
the health risks they might face later in life.
HEART DISEASE
HEART disease, the leading cause of death among African-American women
in the United States, takes the lives of 40 percent of the Black women
who are stricken with the illness. Compared to White women, the death
rate for Black women is 69 percent higher, with risk factors such as
obesity (50 percent of African-American women), high cholesterol (46
percent of African-American women), high blood pressure (31 percent of
African-American women) and diabetes contributing to the alarming
increase.
Yet, a recent study presented at the American Heart Association's Annual
Conference on Cardiovascular Disease Epidemiology offers hope to some.
The 11-year study, which polled some 7,000 women, found that employed
African-American women were almost 33 percent less likely to have a
coronary event than were African-American homemakers. "Given that
African-American women have been more reliant on the economic
contributions from a job outside of the home, they may have benefited
both economically and socially from it," says April L. Perry, M.S.P.H.,
and lead investigator of the study.
Despite these findings, heart disease statistics remain alarmingly high
among Black women. "Widespread cardiovascular disease prevention
education programs should be ubiquitous in African-American communities,
similar to the media campaigns and intervention programs for AIDS and
childhood immunizations," says Dr.
The Association of Black Cardiologists' new educational initiative, "Heart
Health for the Generations: A Guide for African-American Women,"
includes a video, a guidebook and features Maya Angelou in its
prevention and treatment campaign.
As research continues to unlock the secrets of heart disease and as more
people consciously take steps to avoid becoming victims, health care
providers still say the best way to avoid heart disease is with a
combination of diet, exercise and regular medical examinations.
SEXUALLY TRANSMITTED DISEASES
LAST year, some 15 million unsuspecting Americans received an
uncomfortable gift from a lover--a sexually transmitted disease (STD).
And according to the Centers for Disease Control and Prevention (CDC),
Black women are bearing the brunt of new STDs.
The most common STDs are gonorrhea, herpes and chlamydia; the most
deadly STD is HIV, the virus that causes AIDS.
Gonorrhea is a bacterial infection that, in some cases, can also infect
the bloodstream, resulting in joint arthritis and heart damage.
Penicillin or injected antibiotics are routinely used to treat the
infection.
Chlamydia is an infection that has virtually no outward symptoms, yet if
left untreated, can lead to inflammation of the urethra, and pelvic
inflammatory disease. The infection is routinely treated with
antibiotics.
Unlike gonorrhea and chlamydia, herpes can be transmitted through
unprotected sex and skin-to-skin contact. Symptoms include swollen
glands, headache and painful sores or blisters. There is no cure for
herpes, but antiviral medications can lessen the symptoms.
According to the CDC, HIV is the second leading cause of death for young
Black women, ages 25-44. It impairs the cells of the human immune
system, thus weakening the body's ability to defend itself against
everyday infections and cancers.
There is no cure for HIV infection, but research is continuing and a
number of antiviral drugs have been developed to combat the virus.
According to health professionals, taking a three-pronged proactive
approach is the best means of protecting yourself against STDs:
1). Avoid engaging in at-risk behavior by practicing abstinence or by
limiting the number of sex partners, and you must use a condom properly
during each intimate encounter. Reportedly, a new wonder product,
microbicide, is in the works, promising to make condoms obsolete.
According to microbicide.org, the product, potentially in gel, cream,
film or suppository form, is being developed to prevent the transmission
of sexually transmitted infections and an unwanted pregnancy when
applied topically.
2). Get screened for STDs along with your annual checkup because many
STDs have no outward symptoms and are only detectable when it has done
irreversible damage. One of the latest methods in detecting HIV is the
FDA-approved Calypte HIV-I urine antibody test. Magic Johnson, a
spokesman for the new test, says that the fear of the blood test is one
of the major reasons why many people refuse to get tested.
3). Improve your overall health by getting into shape, and maintaining a
proper diet to boost your body's natural defenses to infections. |
