What Are Uterine Fibroids?

An overview, with insights into the effect on Black women

Uterine fibroids—also known as leiomyomas—are fairly common. These growths are benign (they are not cancerous) and they may be asymptomatic (without symptoms), or they can cause symptoms ranging from pelvic/abdominal discomfort to irregular bleeding to pregnancy issues.

No group is hit harder by uterine fibroids than Black women. Not only are Black women three times more likely than women of other races to develop fibroids, but they are more likely to get them earlier in life and develop symptoms.

As a result, symptomatic fibroids lower the quality of life for many Black women by causing pain, compromising the ability to get pregnant, and increasing the likelihood of serious medical complications like anemia.

In addition, Black women are two times more likely to undergo hysterectomy and nearly seven times more likely to undergo uterine-sparing myomectomy.

Learn more about the types, symptoms, and causes of uterine fibroids, along with the effect on Black women and access to care.

uterine fibroid pain

Catherine McQueen / Getty Images

Other Names for Uterine Fibroids

Uterine fibroids may also be referred to as myoma, leiomyoma, leiomyomata, and fibromyoma. 

Types of Uterine Fibroids

There are four types of uterine fibroids based on where they develop in the uterus or along the uterine lining. A woman may have one or all of these types, especially if she has multiple fibroid tumors. Fibroids can range in size from that of a pea to that of a football.

Intramural Fibroids

The Most Common Type of Fibroid

Intramural fibroids are the most common type of fibroid tumor. They typically grow and expand within the muscular walls of the uterus.

Signs and symptoms of intramural fibroids include:

  • Prolonged menstrual cycles
  • Passage of blood clots
  • Pelvic pain
  • Frequent urination

Intramural fibroids are sometimes mistaken for pregnancy, weight gain, or may cause bloated sensation because the uterus may feel larger than normal as the intramural fibroid tumor expands.

  • Intramural fibroids can also cause excessive menstrual bleeding along with abdominal fullness if additional pressure is placed on surrounding organs by the growth of the fibroid. 

Subserosal Fibroids

Subserosal fibroids typically develop outside of the uterus along the outer uterine wall. As a result, subserosal fibroid tumors rarely cause abnormal uterine bleeding or interfere with a woman’s typical menstrual flow.

The most common symptoms of subserosal fibroids are pelvic pain and pressure. 

Pedunculated Fibroids

Some subserosal fibroids can grow so large in size that they attach to the uterus via a stalk. These special types of subserosal fibroids are called pedunculated fibroids.

Pedunculated fibroids can grow into the uterus cavity or outside of the uterus into the pelvis. These are called pedunculated submucosal fibroids and pedunculated subserosal fibroids, respectively.

Symptoms associated with pedunculated fibroid tumors include pelvic pressure and pain, especially if the stalk becomes twisted, blocking blood flow to the fibroid. 

Submucosal Fibroids

The Least Common Type of Fibroid

Submucosal fibroids are the least common type of uterine fibroid and typically develop just under the lining of the uterine cavity.

If submucosal fibroid tumors become large enough, they can block the entrance to the fallopian tubes which can cause complications with fertility.

While submucosal fibroids may enlarge the uterine cavity, they are not always symptomatic. Still, these fibroids are especially troublesome for their impact on women’s fertility. 

When symptoms do appear, they can be severe, with women often citing heavier and more prolonged menstrual bleeding as the most common symptoms.

If left untreated, complications such as anemia and fatigue may ensue, which could potentially lead to a future need for blood transfusions.

Uterine Fibroid Symptoms

The location of a fibroid plays a large role in whether or not you will develop symptoms. Some women may experience one or more symptoms, while others may have no symptoms at all.

Some common uterine fibroid symptoms include:

  • Abnormal uterine bleeding in the form of periods that are longer, heavier, or more frequent than usual
  • Significant menstrual pain
  • Bleeding between periods
  • Difficulty getting pregnant
  • Pain during intercourse
  • Pelvic, abdominal, or back pain or pressure 
  • Protruding abdominal or belly area
  • Increased menstrual cramping
  • Frequent urination
  • Urinary retention
  • Pain on urination or dyspareunia
  • Constipation
  • Fatigue from anemia
  • Pregnancy complications, such as needing a cesarean section to deliver a baby

Uterine Fibroid Symptoms Common in Black Women

The first sign of uterine fibroids is often excessive vaginal bleeding. Many Black women also experience sharp, stabbing pain in the abdomen, along with swelling, signaling uterine degeneration.

Uterine fibroid degeneration occurs when a fibroid outgrows its limited blood supply.

Causes

The cause of uterine fibroids is unknown, although some research supports a hereditary or genetic component. Some studies have demonstrated racial differences in fibroids at the molecular level, with differential expression of genes, proteins, and micro-RNAs, which may shed light on the potential differences in how Black women respond to medical therapy.

Other studies have linked vitamin D deficiency with increased fibroid risk in Black women, underscoring a possible preventable factor that may be a target of treatment. No matter the case, it is likely that the genesis of fibroids is multifactorial in nature.

What we know is that Black women are four times more likely to have fibroids between the ages of 18 and 30, compared to White women, and over a woman’s entire life, it is estimated that 80% of Black women will go on to develop some form of benign pelvic tumor condition vs. 70% in White women.

The reasons for the disparities are unclear, although research offers some clues. Fibroids have been associated with the following risk factors:

  • African ancestry
  • Age (development of fibroids increases with age, but symptoms tend to diminish since tumors regress after menopause)
  • Obesity
  • Family history of uterine fibroids
  • High blood pressure
  • No history of pregnancy
  • Vitamin D deficiency

Definitively, there are factors that have been shown to lower the risk of fibroids such as:

  • Pregnancy (the risk decreases with an increasing number of pregnancies)
  • Long-term use of oral or injectable contraceptives

Effect on Black Women

Uterine fibroids have long plagued Black communities.

Likelihood of Black Women Getting Uterine Fibroids

Black women are three times more likely to develop the condition at an early age, develop symptoms, and respond differently to standard medical treatment, compared to White women.

Studies show that by age 50, nearly two-thirds of women will develop uterine fibroids, with the majority being Black women. However, the true number of affected Black American women is unknown due to a lack of representation in studies.

Black women and uterine fibroids

Julie Bang / Verywell

A review of 106 studies cited in the Agency for Healthcare Research and Quality (AHRQ) report on uterine leiomyomas found that nearly one in four studies on uterine fibroids did not include data on a patients’ ethnicity or race. Despite numerous studies reporting that up to half of uterine fibroid patients are Black, Black women only make up 15% of study participants.

Black Women Are Underrepresented in Studies

Despite numerous studies reporting that up to half of uterine fibroid patients are Black, Black women only make up 15% of study participants.

Underrepresentation in research studies is particularly troubling given that Black women are more likely to experience this condition during their reproductive years, increasing the risk of infertility and the development of pregnancy complications. 

Diagnosis

Unless a woman has symptoms, it is likely she does not know she has uterine fibroids. Fibroids are sometimes found on a physical examination when a healthcare provider feels a firm, irregular, and often painless lump during an abdominal or pelvic exam. You may be asked to undergo imaging soon after to help diagnose the condition.

Some common types of imaging technology are:

  • Ultrasound, which uses sound waves to form the picture
  • Saline infusion sonography, which uses an injection of salt solution into the uterus to help create the ultrasound image
  • Magnetic resonance imaging (MRI), which uses magnets and radio waves to create the picture
  • X-rays, which use a form of electromagnetic radiation to “see” into the body
  • Computed tomography (CT) or computer-assisted tomography (also called a CAT scan), which scans the body with X-rays from many angles to create a more complete picture

Because fibroid tumors can be multiple and can be spread out in the uterus, there are usually more fibroids present than can be detected because of their small size. Even a woman who has only one visible fibroid needs to consider that there may be multiple uterine fibroids present when discussing therapy.

Additionally, research has not found that fibroid size is associated with symptom severity, so even small fibroids should be diligently monitored.

Treatment

Treatment for fibroids can range from no treatment at all to surgery. A wait-and-see approach should be taken for most women with asymptomatic uterine fibroids because most fibroids spontaneously decrease in size, especially during menopause. Additionally, fibroids are benign, non-cancerous growths and rarely develop into cancer.

Management should be tailored to the individual based on the following factors:

  • Symptoms
  • Size and location of the fibroid
  • Age
  • Desire to maintain fertility
  • Access to treatment

As previously mentioned, it is common for a woman to have multiple fibroid tumors, therefore it may be difficult to understand which fibroid or fibroids are causing your symptoms. 

Birth control pills and intrauterine devices (IUDs) may be used to control symptoms of heavy bleeding, while surgery is sometimes used to remove painful fibroids. 

Medications

Contraceptive pills and progestin agents are most commonly used to reduce bleeding and regulate the menstrual cycle. Tranexamic acid may also be used to reduce heavy menstrual bleeding. If your symptoms do not improve, you may want to follow up with your healthcare provider. 

Of note, these medications do not shrink tumors, and women more than 35 years old who smoke should not take certain oral contraceptive therapies.

Intrauterine Devices (IUDs)

IUDs are particularly effective at reducing heavy bleeding, but they do not affect the size or nature of uterine fibroids. 

GnRH Agonists (Lupron)

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 menopause such as hot flashes and the long-term symptom of bone loss. 

Uterine Artery Embolization (UAE)

In uterine artery embolization, polyvinyl alcohol is injected into fibroids via a catheter to cut off the fibroid blood supply, which causes them to shrink and die. This procedure is usually performed in an outpatient setting.

Surgery

Surgery for uterine fibroids includes:

  • 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 child-bearing age, although it is likely to be a temporary fix as the fibroids are capable of growing back.
  • Hysterectomy: Surgical removal of the uterus via a hysterectomy provides the most effective treatment against fibroids and eliminates any chance that they will return, but it wipes out your chance of getting pregnant. Fibroids are the leading reason for hysterectomies, accounting for nearly 40% of all hysterectomies performed annually in the United States.

Black Women and Hysterectomy

Black women are two times more likely to undergo hysterectomy and are nearly seven more times likely to undergo uterine-sparing myomectomy, compared to White women.

Access to Care

Lack of insurance coverage, mistrust in the medical system, and lack of support from some healthcare professionals are barriers that stand in the way of Black women getting the help they desperately need.

Still, research has shown that even when unequal access to care among Black and White women is eliminated, health disparities remain. This underscores the need to understand the race-based differences in the outcome and response to fibroid treatment.

Special consideration should also be given to differences in socioeconomic status and pain management. Black women are more likely than White women to have low socioeconomic status as a result of structural racism and the gender pay gap. Research shows that those who are of low socioeconomic status are more likely to access care later, if at all.

Additionally, racial bias in pain management—a critical healthcare domain with well-documented racial disparities—reveals that a substantial number of White healthcare professionals hold false beliefs about biological differences between Black and White people.

These false beliefs lessen treatment recommendation accuracy and contribute to the normalization of pain in Black women, which delays treatment and prolongs suffering.

Coping

Heavy periods can be very taxing, and severe symptoms can make you feel down, irritable, or grumpy. In fact, a study shows that many women lack support to help them deal with these issues, and very few seek help from a mental health professional.

Resources

If you have uterine fibroids and are looking for guidance and support, The White Dress Project—a nonprofit organization that is primarily made up of women with impactful fibroid journeys—is a great place to turn to. Other helpful resources include:

Frequently Asked Questions

How painful are uterine fibroids?

The pelvic discomfort experienced by some people can range from sharp, shooting pain to a vague discomfort in the abdomen or pelvis. If your fibroids are large, you may even experience difficulty lying down, bending over, or exercising.

Over-the-counter medications like ibuprofen and acetaminophen are commonly used to help alleviate this pain, although they play no role in ameliorating the growth or accompanying symptoms of your fibroids. 

Why are Black women more likely to develop uterine fibroids?

Research has shown that Black women are more likely to experience early periods, higher levels of stress, obesity, and Vitamin D insufficiency in their life, all of which are associated with a higher risk of fibroid development. Still, more research needs to be done to provide more conclusive reasons as to why this is the case. 

Of note, some Black women may normalize the experience of fibroid symptoms. As a result, the aforementioned symptoms may actually be underreported.

Many girls are raised to believe painful, heavy periods are just a part of life. By asking detailed questions about period symptoms, healthcare professionals can help avoid needless suffering and delayed treatment.

Do uterine fibroids go away? 

Uterine fibroids can spontaneously regress when estrogen levels are low, as is the case post-pregnancy and during menopause. Maintaining a healthy weight, exercising, and avoiding foods high in sugar, sodium, or calories can also help stop the growth of current and new fibroids.

Limiting red meat intake and processed foods have also been shown to decrease fibroid symptoms. Uterine fibroid embolization can also be used to disrupt the tumor’s blood supply, stunting its growth.

Fibroids may also regress during a process called uterine fibroid degeneration, which occurs when a fibroid outgrows its limited blood supply. Without blood, the cells of the fibroid may die and the fibroid may decrease in size, but unlike spontaneous regression of fibroids, uterine fibroid degeneration may be accompanied by symptoms including:

  • Acute abdominal pain lasting a few days to a few weeks
  • Swelling of the abdomen
  • Fever in addition to other symptoms
  • Bleeding during pregnancy, resulting from a type of degeneration called necrobiosis

A Word From Verywell

Living with fibroids may not be life threatening, but it can still severely impact your life on both a mental and physical level. Fibroid symptoms like heavy periods, intense cramps, and frequent urination can impact your career, relationships, self-esteem, and ability to perform your daily tasks.

Fortunately, treatment is available so you do not have to suffer from your fibroid symptoms indefinitely. With advances in medical and surgical therapies, there are ways to alleviate your symptoms so you can live a happy, healthy, and pain-free life.

Eating a healthy diet, reducing stress, and addressing your fibroid condition early on can help reduce your risk of developing fibroid symptoms. This message is important for Black women to hear since they are disproportionately impacted by stigma, pain, and lack of access to care.

Fibroids don’t have to be a nightmare scenario. Instead, you can view your fibroid diagnosis as a chance to take back control of your body.

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