title: The Relationship between Total Fibroid Burden and First Trimester Bleeding and Pain.
abstract: BACKGROUND
  Few studies comment on the association between fibroids and symptoms among pregnant women. These studies generally are retrospective and do not to assess the influence of number of tumours or their volume on risk of symptoms.
  
  
  METHODS
  Right from the Start is a prospective cohort that enrolled pregnant women from the southeastern USA between 2000 and 2012. In the first trimester, all participants had standardised ultrasounds to determine the presence or absence of fibroids. Symptoms were queried in a telephone survey. We used polytomous logistic regression to model odds of bleeding, pain, or both symptoms in relation to increasing total fibroid number and volume among white and black women.
  
  
  RESULTS
  Among 4509 participants, the prevalence of fibroids was 11%. Among those reporting symptoms (70%), 11% reported only bleeding, 59% reported only pain, and 30% reported both symptoms. After adjusting for age, race, parity, hypertension, smoking, alcohol use, and study site, increasing number of fibroids was associated with pain [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.00, 1.33] and both symptoms [OR 1.25, 95% CI 1.08, 1.45] but not with bleeding among all women. Fibroid volume was not associated with symptoms among black women, but white women with the smallest fibroid volumes were more likely to report both symptoms than those without fibroids [OR 1.79, 95% CI 1.17, 2.72].
  
  
  CONCLUSIONS
  Very large tumours are not requisite for experiencing symptoms, as small fibroids and increasing number of tumours are associated with pain and both symptoms.
authors.affiliation: Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN.|Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD.
authors.forename: Kara A
authors.initials: KA
authors.lastname: Michels
authors.affiliation: Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN.|Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Hartmann
authors.affiliation: Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, TN.|Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.affiliation: Division of Cancer Statistics, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.affiliation: Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN.|Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN.|Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Digna R Velez
authors.initials: DR
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology; D005260:Female; D006801:Humans; D010146:Pain / Q000208:ethnology* / Q000209:etiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000208:ethnology* / Q000209:etiology; D011252:Pregnancy Complications, Neoplastic / Q000208:ethnology*; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000208:ethnology* / Q000209:etiology; D014594:Uterine Neoplasms / Q000150:complications / Q000208:ethnology*; D044465:White People / Q000208:ethnology; D055815:Young Adult
keywords: leiomyoma; pain; pregnancy; prospective studies; uterine haemorrhage