Ask an Expert: What Are the Challenges to Getting Fibroid Care?

Ask an expert: Dr. Shepherd

Xiaoyu Liu / Verywell

Many people with uterine fibroids struggle to access treatment, but getting care is particularly difficult for Black people and people of color.

The inequalities in accessing care are even starker when you consider that uterine fibroids are more common in Black people with a uterus and people of color with a uterus. More than 84% of African American women have fibroids by the age of 49 compared to 70% of white women.

These disparities extend to treatment, too: Black women are more likely to have surgery to remove the fibroids (or the uterus) than they are to receive nonsurgical treatments like medications or noninvasive procedures.

More than 84% of African American women have fibroids by the age of 49 compared to 70% of white women.

Access to care can be a major issue with fibroids. The pain and other symptoms that fibroids can cause will only get worse if left untreated. If a person has barriers to accessing adequate healthcare—such as cost or the lack of transportation—their fibroids may grow to the point where noninvasive or smaller surgical procedures would not be helpful and a hysterectomy might be needed to treat them.

Jessica Shepherd, MD, Chief Medical Officer of Verywell Health and a board-certified obstetrician-gynecologist, discusses the biggest barriers to fibroid care and highlights the fibroid-specific resources that are available to people who need them.

Verywell Health: What are the biggest obstacles to getting the proper care for fibroids?

Dr. Shepherd: There is a healthcare disparity with fibroids—more African American women and women of color have them. There are so many issues and symptoms from fibroids that impact daily lives, yet there are women who say they can't get to someone who can help them.

If you look at literature, there have been many studies that show that open hysterectomies are performed more often in the South and more often on Black women. That can pose an issue because the recovery time ranges anywhere from 8 to 12 weeks for these women, who may not have that kind of time to take off from work. Access to and resources about more minimally-invasive procedures would be beneficial.

Fibroids also have a financial cost—both for the individuals who have them and for society. According to a 2017 report, the direct annual healthcare costs for fibroids are over $9.4 billion. The cost of lost wages and sort-term disability is more than $5 billion.

In general, the topic of fibroids needs to be discussed more. We need to get to a point where women feel that they have enough education and information. This is where we need to do a better job.

Verywell Health: Why are there more hysterectomies for fibroids in Black patients than in white patients?

Dr. Shepherd: I think that there is a serious racial disparity in health care overall. As far as the management of fibroids and hysterectomy, I think that many times, other options are not offered. Fibroids can be so debilitating. But patients who don’t have time to take off work to see a doctor might not do so until it's really severe.

Fibroids may progress to a state where urgent, serious care is needed. By that point, a patient may have fewer options because it needs to be taken care of right away.

I also think there is a mistrust of going to the doctor among Black women. There is a lack of representation in medicine and people feel that the information they are getting may not be the information that is best for them. There is a gap in communication between a community and how they get information. These are all barriers that might be seen between a community and healthcare providers.

Verywell Health: What can healthcare providers do differently?

Dr. Shepherd: We need to do a better job with the information and content that we provide to patients, and then by allowing them to process the information. You can communicate all day with someone, but if you're not asking them how they take in information and how information resonates with them, then they may not get the information you're sending out. It can fall flat.

Verywell Health: What kind of healthcare professional should a person see if they are experiencing symptoms that might be related to fibroids?

Dr. Shepherd: Pap smears are the hallmark of a well-woman visit and the most important step to getting a a definitive fibroid diagnosis. During this appointment, patients can share any changes in their cycle, discus fertility issues, or make note of pressure felt during the pelvic exam. But there are a lot of patients who don't have an established OBGYN. They can definitely take it up with their primary healthcare provider. Family practitioners are wonderful at being able to guide patients along. They can start the process by getting imaging done, as well as the lab tests that would then allow them to then send the patients to an OBGYN if needed. This can also be done by other providers such as nurse practitioners, physician assistants, and certified nurse-midwives.

Verywell Health: Are there any dedicated fibroid specialists or fibroid treatment centers?

Dr. Shepherd: There are definitely centers that focus on fibroid treatment and some doctors specialize in the medical and surgical management of fibroid. But any gynecologist can diagnose and treat fibroids. Some are just more focused on this in their practice than others, and therefore, can offer a wealth of treatment options.

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  1. Hartmann KE et al. Management of Uterine Fibroids [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Dec. (Comparative Effectiveness Review, No. 195.) Evidence Summary.