This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
I sport an afro or natural hair, but I use to have a perm. About a year ago, I shared my hair journey with Afrobella at Essence. com: Natural Hair Diary: Danielle N. Lee, Scientist. When I was younger, I sat between my mother/older cousin/aunt/grandmother's legs with jar of grease, cup of water, and tin of barrettes at the ready. Each morning I braced myself for the rough brushing, parting, plaiting, and smoothing down of edges with blue or green grease. By junior high school I was a big girl and I could wear my hair down. Each week I got my hair washed and then I held on tightly to my ears and held my head down obediently as my 'kitchen 'was attended to - a press and curl. For the rest of the week I was in charge of rolling, combing, and oiling my scalp each day. By high school and college, I was getting chemical relaxers or perms. As we - Black females - transition from elementary to junior high or middle school and then to high school, our hair styles change, as does the hair rituals and regiments. Relaxers seem to be a rite of passage for Black females. It was something that mature, often professional women did. The box recommends touch-ups every 6-8 weeks. I hated getting relaxers so much that I would stretch it out 3-4 months. Finally, one day 13 years ago instead of getting a touch up, I had my beautician cut all of the chemically processed hair off. I was left with 2-3 inches of new growth or virgin hair.
I was eleven when I got my very first relaxer. That was also the age I was when I got my first period. But little more than a year before either of these landmarks I was having my first traumatic 'lady problems' episode. I had spent two days bending over, clutching my right side, and crying in pain. It was when I starting vomiting that my mother took me to the pediatrician. I tried my best to stretch out on the table as Dr. Dancy pressed on my lower abdomen. I screamed in pain. Since I hadn't had my first cycle yet, and I wasn't wearing a training bra, they all feared appendicitis. My mother nearly died when she was 12 years from a ruptured appendix. I saw the fear in her eyes when the doctor said, take her to the hospital, now!
I spent 4 days in the hospital. I was ultra-sounded, X-rayed, and palpated in every imaginable matter. They quickly eliminated appendicitis, but they were still uncertain as to my ailment. I was hooked to an IV, had my blood drawn daily and put on a restricted diet. What I remembered most was being SO Hungry.
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In the end, they determined I had ovarian cysts. Cysts?! That sounded a whole lot like cancer to me and I was afraid. They assured me that cysts were not cancerous. I had to be careful and that they would keep on eye on them as I grew up and started having my periods. Other than monthly cramping (Midol or Pamprin took care of all that PMS stuff) my lady issues seemed uneventful.
Until one day, completely out of the blue, I started bleeding and wouldn't stop. At first I had no cramps. I was driving in the work car and felt warmness and then it felt like something passing through me. A few minutes later, sudden and severe pain kicked. I realized what was happening. I'm bleeding! Am I having a miscarriage? I didn't know. Thankfully I was with female co-workers and they calmly handled the manner and rushed me to the Emergency Room.
There I was being poked and prodded and this time with speculums and transvaginal ultra sound wands, and stuck with IV and blood collection needles. It was pretty traumatic. It was there that I heard the radiologist whisper to herself - Fibroid. I was stabilized and sent home to recuperate. Two weeks later I went to my OBGYN who looked over the hospital charts and did another exam. Nothing spectacular. What about fibroids? I asked. I heard the radiologist say she thought she saw fibroids. He looked a the MRI results and the less-than conclusive ultra sound (I was in a lot of pain and was swelling, the ultra sounds couldn't get clear images), and looked over my history. His response: Nah, I don't think that's it. Maybe just an adverse reaction to Depo-Provera. It can do that?! I asked. Yes, he said. Until that moment I had none of the symptoms typical of uterine fibroids. And after that incident I never did.
Uterine Fibroids are tumors, usually benign - not cancerous, that grow from the uterus. Most women diagnosed with fibroids complain of very heavy periods, lots of PMS cramps, lower back pain and painful intercourse. Other than a growing bloated feeling, I felt fine - and I chalked that up to my weight gain. But more than a year after the incident, I went in for my annual exam and my nurse practitioner remarked, "Uh oh" as she was palpating me on the right side. "Uh oh, what?" I asked. She said my womb felt "full", like a fibroid was present. She authorized diagnostic tests and 2 weeks later it was confirmed. I had uterine fibroids.
I was the latest among my girlfriends who had discovered she had fibroids. Among 30-something African-American women, uterine fibroids are common. Very common. But no one knows exactly why uterine fibroids develop or why Black women seem to get them more than women from other racial/ethnic backgrounds. Some studies suggest it could hormonal - since it affects women of child-bearing age but who have no children most often. It also seems to happen to over-weight women more. Check, check, check, and check.
Because of the disparity, there have been some studies trying to understand why and how uterine fibroids disproportionally affects Black women. Since it is a reproductive tract related problem, studies focus on physiological explanations. Hormones seem to be at play, though it is not certain what the mechanisms are. We do know that after menopause fibroids shrink and the complications associated with them disappear. If, the tumors are hormone-sensitive, which I believe they may be, then diet and weight make since. Body fat is metabolically important to gonadal hormones, especially estrogen-family hormones. Estrogen is very sensitive to body fat and circulating fat levels in the blood stream. In fact, the switch that signals the female body to start puberty is fat-sensitive. Once the female body reaches a certain weight and body fat composition, her hypothalamus and pituitary gland send signals to the ovaries (and the rest of the body) that this little girl is ready to be a woman. Primary or vertical growth begins to halt and now that energy is directed to secondary sexual characteristics like growing breasts, and hips, and preparing for monthly menses. Fat is so important to female menses that under-weight women and also some athletic women fail to have periods sometimes.
So when this came across my Twitter feed from The Root
Study: Perms Linked to Fibroids
it was like a record scratch. What the heck?
Just the sound of the connection between hair chemicals and reproductive issues sounded sketchy to me. I followed the links first to BET New Study Links Relaxers To Fibroids
then to the original research articles referenced.
1. Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women by LA Wise, JR Plamer, D Reich, YC Cozier, & L Rosenberg.
American Journal of Epidemiology (2012) doi:10.1093/aje/kwr351
2. Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study by T James-Todd, MB Terry, J Rich-Edwards, A Deierlein, & R Senie
Annals of Epidemiology (June 2011) Volume 21, Issue 6 , Pages 461-465 doi:10.1016/j.annepidem.2011.01.009
which led me to
3. Racial/Ethnic Differences in Hormonally-Active Hair Product Use: A Plausible Risk Factor for Health Disparities by T James-Todd, RSenie and MB Terry
Journal of Immigrant and Minority Health (2011) doi: 10.1007/s10903-011-9482-5
Superficially, it makes no sense - biologically/physiologically - to hypothesize that perms or hair products (as opposed to another 'environmental' contributor like hormones) would be responsible for uterine fibroids. It just struck me as far-fetched. I mean seriously, it makes me wonder what was the scientific narrative. It just sounds so weak. So I read the papers, starting with the oldest study first, (3, next 2, then 1).
Papers 3 & 2 by James-Todd et. al were not impressive at all. And I say that as a researcher who really hates to disparage another Black female scientist. It's not that the science was weak, but the line of logic was just too, too iffy. The hypothetical proposal that there are hormonally-active ingredients in hair products commonly used by Black women and that these products could be responsible for the higher incidence of uterine fibroids....the exact connection between these occurrences was never fully detailed.
They noted if products like hair oil, hair lotion, leave-in conditioners, and relaxers/perms had label ingredients such as hormones, placenta, estrogen, estradiol, estriol, estrone, methylparaben, butyl-paraben, and proplyparaben. The study found that Black women of African-American and Caribbean descent had higher usage of some products like hair oil and hair lotions compared to Latino or white women. Black women also used hair products more frequently and for longer duration than Latino or white women. However, the researchers did not assess the total estrogenic activity of the hair products. I think doing that would have been a very necessary piece of work to do before drawing conclusions that:
Frequent chronic exposure to hormonally active chemicals in hair products could increase the risk of conditions associated with EDC (endocrine-disrupting chemicals) exposure.
The other paper by this team examined the association between childhood product use and age at first menses. They proposed that high use of EDC hair products among Black girls and women might explain earlier onset of puberty, which is linked to greater risk of developing fibroids. Again, the researchers did not collect any data on specific EDC content of hair products subjects said to have used over their lifetimes. That alone is major gap in this line of logic that hair products would be responsible for early onset of menarche. The study simply confirms behavioral differences in hair product preferences and use among different racial/ethnic populations of females. They use that data, combined with suspected differences in hormone concentrations in those products to conclude that:
Exposure to EDCs from hair products may explain some of these variations in age at menarche.
By their own admission, they did not collect any data on prepubertal body size and actually refer to that as only a
potential mediator of the association between hair product use and earlier age at menarche....Given our broad range age range, the chemical composition of hair products may have changed over time. As such a prospective study would provide more definitive confirmation of our findings. Nevertheless, these results suggest that the use of certain types of hair products could impact age at menarche.
My mind was literally blown reading this. Body mass index is a well-known and studied mediator of onset of menarche and they refer to it as possible mediating variable! What? By the end I was screaming at the paper, These results don't suggest a damn thing! Has any one on that team had an endocrinology class? Seriously!
I had to take a walk and chill before reading the last paper by Wise et. al, the one that the news items were actually referring to. I was pleased with this paper. The authors did not overstate the significance of the research or the causal connections connections of chemical hair relaxers and uterine fibroid development among African-Americans. They make NO Causal connections between relaxers and uterine fibroids. What they found was that among a very large survey sample of primarily African-American women who had reported being diagnosed with uterine fibroids that a majority of them also admitting to having had chemical relaxer treatments at some time. The researchers were cautious, stating that such hair products may contain hormonally active compounds and connecting known negative effects of chemicals like parabens and phthalates on cell models and animals. These chemicals can be absorbed into the skin. They propose that they could enter the skin via lesions from chemical burns. But like the other studies, they have no data on the ingredients or the potential hormone disruptive activity of the ingredients in the chemical relaxers used by the study subjects.
Parabens and phthalates can do some funky things. (I don't trust these chemicals.) They are problematic and should be evaluated for safety, especially by the US Food and Drug Administration. Parabens can be an estrogen mimic - but only slightly it seems. But it's everywhere - not just in Black hair care products like shampoos and perms. Parabens are preservatives in cosmetics and pharmaceuticals, so it's in lotions, shaving gel, KY Jelly, makeup, even in food. Phthlates are what make plastics flexible, transparent, durable and strong. Exposure to these chemicals is coming from who-knows-how-many-sources: those dissolving plastic pill caplets, adhesives in bandages, toys, food packaging, even textiles, and paint.
My problem with this study is that it doesn't eliminate all of these confounding and possibly conflicting variables. Again, what was the reason for hypothesizing hair care products for the disparity. It's a leap - a huge leap and the data just doesn't convince me. In my opinion, finding strong correlations of relaxer use among African-American women who happen to have fibroids is an artifact. Culturally, getting relaxers is a very typical hair-care regime among adult black women today. It's a cultural phenomenon. So is being ashy and using lotion -- which potentially has the same possible EDC risks as hair care products. These studies fall far short in making a connection between high occurrence of uterine fibroids and hair care rituals of Black women.
Furthermore, I found the headlines misleading and alarming. The studies do not address any questions women like me have.
- How would relaxers or hair products cause uterine fibroids?
- I went natural many years before I had any fibroid issues. Is it duration and accumulation of hormone-disrupting chemicals that are to blame or just any exposure to the chemicals/hormones?
- Would going natural make any difference?
It disappointed me more because not only could these studies provide no answers, they provided no insight, either. They just threw some random guesses out at a statistical machine. These weren't even good or reasonable or plausible guesses that they postulated. The whole line of inquiry just left me frustrated.