How Uterine Fibroids Are Treated

With insights into the effect on Black women

This article is part of Uterine Fibroids and Black Women, a destination in our Health Divide series.

There is no one best approach to treating uterine fibroids.

Treatment for uterine fibroids can vary depending on the size, number, and location of the fibroids. The desire to get pregnant and symptoms are also factors when deciding on treatment options.

Since fibroids are benign, noncancerous tumors that rarely become malignant, watchful waiting is the preferred management of fibroids in women who are asymptomatic.

Studies have shown that Black women are not only more likely than White women to have a diagnosis of uterine fibroids but are also more likely to have complications, longer hospitalization stays, and invasive procedures performed. Doctors haven’t quite figured out why that is, but some studies have suggested that lack of access to care, gaps in socioeconomic status, and differences in treatment efficacy all play major roles.

No matter the case, the goal of uterine fibroid treatment is simple:

  • Symptom relief
  • Sustained reduction of the size of fibroids
  • Maintenance of fertility if desired
  • Avoiding harm

This article discusses the treatment options for uterine fibroids, along with insights into the effect on Black women.

speaking with healthcare provider

FatCamera / Getty Images

Home Remedies and Lifestyle

Although most fibroids go unnoticed and disappear without treatment, home remedies and lifestyle changes to fight uterine fibroids have been around for quite some time.

This section chronicles the lifestyle factors that play the biggest role in fibroid growth and development, as well as changes you can make to feel healthier and happier.

Reduce Stress

Some preliminary research has linked high stress levels with fibroid symptoms.

High levels of stress upset your hormonal balance, throwing off estrogen and progesterone levels, which triggers excessive output of adrenal stress hormones, like cortisol.

Uterine fibroids thrive in chaotic hormonal environments, so it's not surprising that growth in the size of uterine fibroids is seen during more stressful periods in your life.

Relaxation techniques—like yoga, massage, tai chi, and acupuncture—have been reported as effective means of not only managing stress but relieving pain as well. 

Maintain a Healthy Weight

A large meta-analysis found that women who are obese were 17% to 26% more likely to have uterine fibroids, although the cause-and-effect link between the two is unknown. Other studies have found that the risk of women who are obese developing fibroids is two to three times greater than that of women of average weight.

Maintaining a healthy weight, exercising, and avoiding foods high in sugar, sodium, or calories have been shown to halt the growth of current fibroids and stop the development of new ones.

Lower Blood Pressure

Studies suggest that the presence of uterine fibroids is associated with increased blood pressure levels, and the prevalence of hypertension in women with uterine fibroids has been shown to be as high as 40%.

Lowering your blood pressure will not only help your fibroids but also your overall health.

Limit Red Meat Intake

High red meat intake has been associated with higher fibroid prevalence, but the causal link between the two is unknown.

Still, health professionals suggest limiting red meat consumption for its overall health benefits.

Avoid Processed Foods

Processed foods have lots of additives that make even potentially healthy foods unhealthy, especially if they are high in sugar, sodium, or calories.

Eliminating most processed foods from your diet has been shown to help stop the growth of current and new fibroids. Some doctors even encourage eating a special fibroid diet high in natural fruits and vegetables.

Stay Away From Soybeans

High soybean consumption is associated with a high risk of uterine fibroids because soybeans contain phytoestrogen, which can raise estrogen levels.

Over-the-Counter (OTC) Therapies

Vitamins and OTC pain medications—such as ibuprofen—are the most common nonprescription medications used to combat symptoms of uterine fibroids. 

Nonsteroidal Anti-Inflammatory Drugs (NSAID) 

The first line of defense against fibroid pain are nonsteroidal anti-inflammatory drugs (NSAID)—such as ibuprofen or naproxen—to help relieve mild pain.

Regular NSAID use has also been shown to reduce heavy menstrual bleeding caused by fibroids, although more frequent use should be discussed with your doctor, as studies have shown that the use of NSAIDs for more than 90 consecutive days can lead to gastrointestinal ulcers in some women.

NSAIDs are not as effective as oral birth control pills at limiting heavy menstrual bleeding in three months.

Vitamin A

A recent study of nearly 23,000 postmenopausal women actually found that women who ate higher levels of vitamin A in dairy products, fish, and meat were less likely to get uterine fibroids.

Foods high in vitamin A that are integral to a fibroid diet that may help mitigate fibroid growth and symptoms include:

  • Oily fish, such as salmon, mackerel, and tuna
  • Foods rich in flavonoids, including berries
  • Green vegetables, such as broccoli, spinach, and lettuce
  • Citrus fruits, such as lemons and limes

Vitamin D

Women with darker-pigmented skin tones are more likely to experience vitamin D deficiency, which some studies have associated with an increased risk of uterine fibroid development.

A 2019 study found that taking oral vitamin D supplements resulted in a significant reduction in the size of uterine fibroids in premenopausal women.

Prescription Medications

The goal of prescription medications is to relieve pain, reduce menstrual blood flow, and, in some cases, shrink the growth of fibroids.

Birth Control Methods

Birth control pills are the most commonly prescribed medication to help control symptoms of heavy menstrual bleeding, especially for women who do not plan to get pregnant anytime soon.

Contraceptive pills and progestin agents also regulate the menstrual cycle. Tranexamic acid may also be added to a treatment regimen to further reduce heavy menstrual bleeding. If your symptoms do not improve, you may want to consult a healthcare provider.  

The Mirena, an intrauterine device (IUD) that releases levonorgestrel, has been shown to significantly reduce menstrual blood loss at 12 months in comparison with oral birth control pills.

Of note, IUDs and oral contraceptive pills do not shrink tumors. Women over 35 years old who smoke should not take certain oral contraceptive therapies. 

GnRH Agonists (Lupron)

The GnRH agonists—the most well known being Lupron—are a class of hormone-stimulating medications that temporarily shrink fibroids and stop heavy bleeding by blocking the production of the female hormone estrogen.

Lupron is not always well tolerated—possibly causing short-term symptoms of hot flashes and long-term symptoms of bone loss.

It is commonly used as a preoperative treatment to decrease the size of tumors before surgery or in women approaching menopause.

Iron Supplements

If you have symptoms of severe heavy menstrual bleeding, you may become anemic and require the use of iron supplements to restore your depleted iron levels.

In severe cases, a blood transfusion may also be needed. In most cases, this quickly corrects your anemia.

Surgeries and Specialist-Driven Procedures

A study of women ages 18 to 54 years old who were enrolled from 10 clinical sites in the United States found that Black women were more likely to schedule a uterine-sparing uterine fibroid treatment and a nonsurgical uterine fibroid treatment than their White counterparts.

With so many options out there, knowing which one is best for you can be daunting.

Finding a specialized OB-GYN who is proficient in performing these procedures can also be a challenge. This section will explain what's out there for you, because knowing the options is half the battle.

Myomectomy

If you desire to have kids in the future, you may choose to have a myomectomy, a uterus-sparing operation to remove fibroids.

This is often a preferred choice for women of childbearing age, although it is likely to be a temporary fix as the fibroids are capable of growing back.

Black Women and Myomectomy

Black women receive myomectomy more than any other group. They are nearly seven times more likely to undergo this procedure.

A myomectomy is often performed through a large abdominal incision, although a new surgical technique that uses small incisions, called laparoscopy, is becoming more common.

Laparoscopic myomectomy assesses and removes fibroids using long-handled instruments and a tiny camera—also known as a laparoscope—through a one-quarter-inch incision made in or near the belly button. This is also called a minimally invasive approach. 

Hysterectomy

Surgical removal of the uterus via a hysterectomy provides the most effective treatment against fibroids and eliminates any chance they will return, but it also eliminates your chance of getting pregnant.

An open hysterectomy means that a large abdominal incision is made to access the uterus. As with a myomectomy, a minimally invasive approach can sometimes be used, which decreases surgical scarring and recovery time.  

Hysterectomy is usually the best course of action for symptomatic women who want curative treatment and do not desire to have children in the future.

Fibroids are the leading reason for hysterectomies, accounting for nearly 40% of all hysterectomies performed annually in the United States.

black women and hysterectomy

Julie Bang / Verywell

Uterine Fibroid Embolization (UFE)

In uterine fibroid embolization (UFE), small particles of polyvinyl alcohol are injected into the uterine arteries via a catheter, blocking blood flow to the fibroids and causing them to shrink and sometimes die. This procedure is usually performed in an outpatient setting by an interventional radiologist.

UFE is a very effective, minimally invasive, nonsurgical procedure that is used by women who want to preserve their uterus.

Black Women and Uterine Fibroid Embolization

Shockingly, almost half of Black women diagnosed with uterine fibroids report that they were not presented with less invasive treatment options than hysterectomy. In fact:

  • 73% of Black women report that they have never heard of UFE from their OB-GYN or primary care physician.
  • One in five Black women believes hysterectomy is the only solution for fibroid symptoms, underscoring the lack of information that hinders Black health.

Misinformation or inadequate information about treatment for uterine fibroids illustrates how important it is to raise awareness about women’s health topics.

UFE is associated with clinically significant symptom relief in Black women and is considered a safe alternative for women looking for a less invasive, uterine-sparing treatment option. Efforts are needed to widen access to this nonsurgical treatment.

Magnetic Resonance-Guided Focused Ultrasound

Magnetic resonance-guided focused ultrasound (MRgFUS)—also known as myolysis—uses MRIs to monitor troublesome fibroids and uses focused ultrasound waves to remove them.

MRgFUS is usually performed in an outpatient setting and is the only nonsurgical technique suitable for women wishing to preserve or enhance fertility.

Overall, this procedure has minimal side effects, and people are allowed to go home the same day. Localized pain and some short-term heavy bleeding may occur.

Effect on Black Women

Why Black women experience a disproportionate fibroid burden is a complicated question with a lot of potential answers.

What we know is that many Black women suffer in silence, and that needs to change. More inclusive research is one way to accomplish that.

The scientific community has also made it known that there are multiple factors at play when it comes to the development, growth, and treatment of uterine fibroids. While research is limited, we know that risk factors like low vitamin D, obesity, genetic factors, higher rates of exposure to endocrine-disrupting chemicals like phthalates and BPA, stress, and racial discrimination all play a role in uterine fibroids.

And while there is a wide array of treatments available for fibroids, unfortunately not all women have the same options and access to care.

When you go to a healthcare provider, you expect to get all the information as a whole so you can make an informed decision for yourself and your future, but sometimes that is not the case.

A small study of 37 single, college-educated, and insured Black women found that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions.

Some noted that they left their appointments with more questions than answers, citing that their knowledge and perceptions of fibroids were also influenced by community norms, while others made choices based on their financial status and what they could afford.

While it is impossible to generalize the results of a small study to an entire group of women, it highlights some potential targets that we may want to emphasize in clinical practice so that Black women are provided the equitable and effective treatment they need. 

Access to Care

Lack of insurance, the normalization of pain, poor doctor-patient interactions, and non-inclusive research studies are obstacles to care that are not highlighted enough. 

The propagation of Black pain myths in the U.S. healthcare system is especially troubling. Fibroid symptoms are likely underreported because some Black women may normalize their painful experiences. Even if they discuss their symptoms with their healthcare provider, it may be discounted or not addressed appropriately. Many women are raised to believe painful, heavy periods are just a part of life. By asking detailed questions about period symptoms, healthcare professionals can delegitimize pain myths and help avoid needless suffering and delayed treatment.

Also, access to care is largely dependent on where you live. Your insurance coverage varies based on geography, and rural areas tend to have fewer specialists than urban areas.

Black Health Coverage

Some insurance companies cover more specialized procedures, while others do not. The areas in which these procedures are not covered by certain companies are places like the Delta states—Missouri, Louisiana, Kentucky, Mississippi, Arkansas, and Tennessee—where there are more Black women and therefore a higher demand for fibroid treatment. 

Specialized care tends to be clustered around major cities. Certain areas are more rural in nature and may be devoid of specialty-trained OB-GYNs who feel comfortable performing certain procedures. If your OB-GYN has not been trained in certain minimally invasive or highly specialized techniques, those options may not be offered to you.

A Word From Verywell

Uterine fibroids are a common condition that many will experience during their life.

Word of mouth is a powerful tool to learn about new ideas from friends, family, or coworkers, but it is important to do your own research and consult healthcare professionals to get the most accurate and up-to-date information about the latest technologies and research.

Lack of proper health education has led many women to believe all the fibroid treatment myths they hear or see. Even more, deep-seated medical mistrust and pain stigmatization have resulted in some Black women normalizing their pain and forgoing seeking treatment.

Increasing access to health insurance, and ultimately to treatment options, is just one of many solutions to this fibroid puzzle. No matter your situation, know that there are lifestyle changes or affordable treatment options out there for you; no woman should have to live in pain.

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