I was in my 30s when my cousin first told me that all of the women on my mom's side of the family had hysterectomies for uterine fibroids. It never dawned on me to ask my aunts or cousins about any gynecologic conditions that they might have. My mom had a hysterectomy when I was a kid, but I didn't think much of it when I was diagnosed with fibroids. At that time, I had suffered from them since my early to mid-20s, which was also around the time that I was diagnosed with polycystic ovary syndrome (PCOS).
I had a laparoscopic fibroid removal and then a myomectomy in my 30s — hoping to preserve fertility. Little did I know that I was fighting an uphill battle. Like many Black women, we tend to experience fibroids at a younger age with more severe symptoms, including fibroids that tend to grow faster. But, I was determined to hold on to my uterus — if I could.
If I wanted children, that window was closing rapidly and, unfortunately, I hadn't married. By the time I was in my late 30s and early 40s, I couldn't hold out any longer — it was well past time for a hysterectomy. I was seeing a hematologist for severe anemia due to blood loss. I felt like I was hemorrhaging out. It had gotten so bad that my body, including my face, went numb. For a few years before making that decision, it seemed that all I did outside of work was sleep because of fatigue. And let's not talk about the pain.
Unfortunately, by the time I had a hysterectomy, my uterus had enlarged to the point that I couldn't get the vaginal hysterectomy or the horizontal bikini-line incision. I had to get the vertical incision, but it had to be extended above the navel because of complications. After my hysterectomy, there was a very brief grieving period, but that was quickly replaced with relief. I truly wondered why I had waited so long.
I am not sure if I would have made different choices had I known my family history with fibroids and PCOS, which affects fertility. I only recently learned that I am not the only one in my family who has it. Maybe I would have focused on starting a family after college. Maybe not. But it would have been great to have been armed with more information — much, much sooner.
My experience has taught me to be open about my medical history, especially with family and friends. It also taught me to ask my family questions, because everyone should know his or her family's medical history. That's because certain conditions tend to run in families, such as heart disease, diabetes, obesity, certain cancers and other genetic disorders, and even male pattern baldness. But when it comes to women's gynecologic health, mothers, daughters and even aunts and grandmothers shouldn't shy away from talking to one another about their gynecologic conditions.
Patients also need to share what they learn with their doctors — which is why they ask about family history on medical questionnaire forms.
"It's important to provide your doctor with any information about your family medical history, whether you believe it to be relevant or not," advises Dr. Waverly Peakes, a gynecologist at Houston Methodist. "Once your doctor knows your family history, it will steer future conversations around these conditions. We want to know your history up front, so we can look for things that may affect your gynecologic health, as well as future pregnancy and expectations for labor and delivery."
Dr. Peakes helped me through my uterine fibroid journey and she has some advice about a few conditions that genetics can influence that other women can benefit from.
What if I have a family history of breast or ovarian cancer?
"If a woman has a significant family history of breast cancer or ovarian cancer, then I may refer her to a preventive oncologist. We can test her for the BRCA1 or BRCA2 gene mutation, which significantly increases a woman's risk of developing breast cancer and ovarian cancer. If this gene mutation exists, then we may recommend risk-reducing surgery, such as prophylactic mastectomy or removal of her fallopian tubes and ovaries," says Dr. Peakes.
This condition is known as hereditary breast and ovarian cancer (HBOC) syndrome, and by age 70, the risk for ovarian cancer in women with the BRCA1 mutation is increased risk by 39 to 46% and, by 10 to 27%, for women with a BRCA2 mutation, according to the American College of Obstetricians and Gynecologists.
Patients with a family history of Lynch syndrome, the common cause of hereditary colorectal cancer, are also more like to develop endometrial (uterine) cancer.
Does it matter when my mom first started her menstrual period?
"Many women think that if their mothers started their periods or menopause early, that they will too, but there is only anecdotal evidence that suggests genetics is a factor. There are too many other lifestyle and environmental factors that play into the timing of menarche and menopause," explains Dr. Peakes. "What is more likely to be inherited that affects a woman's period are conditions, such as polycystic ovary syndrome, uterine fibroids and autoimmune conditions that affect the lifespan of the ovary."
Do my uterine fibroids run in the family?
They do. Fibroids are benign muscular tumors in the wall of the uterus that can cause heavy periods, pain, pregnancy and labor complications, and even infertility — although some women experience no symptoms at all. According to the National Institutes of Health, 70% of white women and 80% of African-American women develop fibroids by the time they reach age 50. A woman's symptoms determine how they are treated.
If I have polycystic ovary syndrome (PCOS), does it mean my daughter will, too?
PCOS is characterized by multiple ovarian cysts and is caused by an imbalance in reproductive hormones that can lead to infertility. It affects 5-10% of women ages 15 to 44, during their prime childbearing years. The syndrome causes irregular periods, excess facial and body hair, weight gain, acanthosis nigricans (darkening and thickening of the skin around the neck, groin, armpits and other body folds), and skin tags. It also drastically increases a woman's risk for insulin resistance and type 2 diabetes, high blood pressure, high cholesterol and cardiovascular disease, as well as endometrial cancer.
"If a woman has polycystic ovary syndrome or has a family history of it, I would recommend that she bring her teenage daughter in to have her evaluated so that we can start addressing any issues as soon as possible, since PCOS can start any time after puberty," says Dr. Peakes. "There are multiple ways to treat teenagers with PCOS symptoms — most teens do not know to come in for these symptoms unless their mom has experienced these same problems."
Do my height and pelvis size matter?
Although a woman's height and the size of her pelvis, which she inherits from her family, are not conditions to be treated, a woman with short stature or small pelvis may more likely require a c-section to safely deliver her baby.
Do fraternal twins run in the family?
Having identical twins isn't a trait that you can inherit, but having fraternal twins can run in the family. Fraternal twins result when a woman releases two eggs, instead of one, during the same menstrual cycle and both eggs are fertilized. The propensity to release more than one egg during the same cycle, known as hyperovulation, can be inherited.