Risk factors for surgically removed fibroids in a large cohort of teachers

Objective: To describe reproductive and lifestyle correlates of surgically confirmed fibroids. Design: Prospective cohort study. Setting: The California Teachers Study, an ongoing prospective study of more than 133,000 female teachers and school administrators identified through the California State Teachers Retirement System. Patient(s): California Teachers Study cohort members, reporting no previous history of fibroids, were ascertained prospectively for surgical diagnosis of fibroids using hospital patient discharge records. Main Outcome Measure(s): Multivariable Cox proportional hazards regression methods were used to assess the association of self-reported menstrual, reproductive, and lifestyle characteristics with fibroids, using ages at the start and end of follow-up (in months) to define time on study. Hazard rate ratios, presented as relative risks (RR) with 95% confidence intervals (CI), were estimated. Result(S): The strongest risk factor we identified was African-American race/ethnicity, as compared to non-Latina white women. We observed a reduced risk of fibroids for postmenopausal women in comparison to premenopausal women, but use of hormone replacement therapies (regardless of formulation) were associated with an increased risk. Other risk factors included race, a family history of fibroids, being overweight, and drinking alcohol, Smoking and diabetes were associated with a decreased risk of fibroids. Conclusion(s): These observations provide a more detailed epidemiologic profile of women with surgically managed fibroids. (Fertil Steril (R) 2009;92:1436-46. (C) 2009 by American Society for Reproductive Medicine.)