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These studies generally are retrospective and do not to assess the influence of number of tumours or their volume on risk of symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p><jats:italic>Right from the Start<\/jats:italic> is a prospective cohort that enrolled pregnant women from the southeastern <jats:styled-content style=\"fixed-case\">USA<\/jats:styled-content> 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>) 1.16, 95% confidence interval (CI) 1.00, 1.33] and both symptoms [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.25, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 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 [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.79, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.17, 2.72].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Very large tumours are not requisite for experiencing symptoms, as small fibroids and increasing number of tumours are associated with pain and both symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12256","type":"journal-article","created":{"date-parts":[[2015,11,3]],"date-time":"2015-11-03T09:32:42Z","timestamp":1446543162000},"page":"115-123","source":"Crossref","is-referenced-by-count":4,"title":["The Relationship between Total Fibroid Burden and First Trimester Bleeding and Pain"],"prefix":"10.1111","volume":"30","author":[{"given":"Kara A","family":"Michels","sequence":"first","affiliation":[{"name":"Vanderbilt Epidemiology Center Institute for Medicine and Public Health Vanderbilt University  Nashville TN"},{"name":"Epidemiology Branch Division of Intramural Population Health Research <i>Eunice Kennedy Shriver<\/i> National Institute of Child Health and Human Development National Institutes of Health  Rockville MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine E","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Vanderbilt Epidemiology Center Institute for Medicine and Public Health Vanderbilt University  Nashville TN"},{"name":"Department of Obstetrics and Gynecology Vanderbilt University School of Medicine  Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin R","family":"Archer","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Vanderbilt University School of Medicine  Nashville TN"},{"name":"Department of Physical Medicine and Rehabilitation Vanderbilt University School of Medicine  Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Ye","sequence":"additional","affiliation":[{"name":"Division of Cancer Statistics, Department of Biostatistics Vanderbilt University School of Medicine  Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Digna R","family":"Velez Edwards","sequence":"additional","affiliation":[{"name":"Vanderbilt Epidemiology Center Institute for Medicine and Public Health Vanderbilt University  Nashville TN"},{"name":"Vanderbilt Genetics Institute Vanderbilt University  Nashville TN"},{"name":"Department of Obstetrics and Gynecology Vanderbilt University School of Medicine  Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,11,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2010.02.006"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(89)90194-4"},{"key":"e_1_2_6_4_1","first-page":"985","article-title":"First trimester bleeding","volume":"79","author":"Deutchman M","year":"2009","journal-title":"American Family Physician"},{"key":"e_1_2_6_5_1","first-page":"97","article-title":"Ultrasound diagnosis of uterine myomas and complications in pregnancy","volume":"82","author":"Exacoustos C","year":"1993","journal-title":"Obstetrics and Gynecology"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.1999.tb01168.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200005000-00025"},{"key":"e_1_2_6_8_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.56021\/9780801887000","volume-title":"Uterine Fibroids","author":"Stewart EA","year":"2007"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318197bbaf"},{"key":"e_1_2_6_10_1","first-page":"483","article-title":"Uterine leiomyomas. 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