Explanation of Chronic Stressors in Older Women with Uterine Fibroids -- A Qualitative Study

Yanzi GUO^1,2Xinyue Xie^1,2Lishi Huang^1,2Fan Kechen^1,2Congcong Yu^1,2Dongjian Yang^1,2*Nan Tuo^1,2*

• ¹Shanghai Jiao Tong University, Shanghai, China
• ²Shanghai Jiao Tong University School of Medicine Affiliated International Peace Maternal and Child Health Hospital, Shanghai, China

Abstract: Introduction: Older women with uterine fibroids experience complex challenges that extend beyond physical symptoms to include emotional stressors and other stressors. This study aimed to explain the chronic stressors faced by older women with uterine fibroids, with a focus on their effects on physical health, emotional well-being and daily functioning. Methods: This qualitative study employed semi-structured, in-depth interviews with 28 women aged 60 years or older diagnosed with uterine fibroids, conducted between 2023 and 2024 in China. Participants were purposively sampled to ensure diversity in education, marital status, and economic background. Each interview lasted approximately 30-40 minutes, was audio recorded with consent, and transcribed verbatim. Data were analyzed using conventional content analysis with NVivo 14 used for data management. To ensure rigor, Four-Dimensions Criteria (credibility, dependability, confirmability, and transferability) were applied. Results: The study sample consisted of 28 older women with uterine fibroids, with a mean age of 66.18 ± 4.997 years. The data were categorized into four main stressor categories: "health stressor" (with three subcategories), "family stressor" (with three subcategories), "financial stressor" (with two subcategories), and "social stressor" (with four subcategories). Continued uncertainty about symptom progression exacerbated anxiety, while cultural expectations around family roles deepened feelings of guilt and isolation. Financial limitations further restricted access to care, heightening both physical and emotional distress. The lack of social support exacerbates patients' sense of insecurity. Moreover, the four categories of stressors were interrelated, with challenges in one domain often compounding or intensifying stress in the others. Conclusion: This study revealed the multidimensional chronic stressors experienced by older women with uterine fibroids, including challenges in health management, family support, financial stability, and social inclusion. These domains interacted to form a reinforcing network that intensified both physical and psychological burdens. Addressing these interconnected stressors through integrated medical, psychosocial, and policy strategies is essential to improving the well-being of this population.