Sickle Cell Disease and Uterine Fibroids: Evaluation of the Prevalence of Fibroids across Sickle Cell Genotypes

Abstract

Introduction: Uterine fibroids are known to affect >80% of premenopausal American women of African descent, and sickle cell disease is known to disproportionately affect people of varying geographical ancestries, particularly those of sub-Saharan African descent. However, previous studies have suggested the two pathologies less frequently co-occur. This study aims to evaluate the prevalence of uterine fibroids in patients with sickle cell disease across a large metropolitan area in the United States. Methods: African American women with sickle cell disease (including HbSS, HbSC, and sickle cell trait genotypes) underwent pelvic imaging (CT/MRI/ultrasound) between February 2011 and August 2018 at two large hospital systems within a single academic institution. Based on retrospective review, the prevalence of uterine fibroids among this cohort was analyzed and compared to published data of fibroid prevalence amongst African American patients without sickle cell disease. Results: Prior data estimates that the prevalence of uterine fibroids in African American women is about 32 to 40% for those aged 32 to 35 years and up to >80% in premenopausal African American women overall. When compared to the expected prevalence in this cohort, with a median age of 31 years, women with HbSS or HbSC sickle cell disease had a significantly decreased prevalence of uterine fibroids (9.6 to 10.3%), while those with sickle cell trait reflected a prevalence (44.4%) like that of the general population. Conclusion: There was a significantly lower prevalence of uterine fibroids in premenopausal American women of African heritage with sickle cell disease in the study cohort when compared to premenopausal American women of African heritage in the general population. This suggests a higher threshold to ascribe dysfunctional uterine bleeding in premenopausal African-American women with sickle cell disease to uterine fibroids, and a lower threshold to pursue an alternative diagnosis.