Uterine Fibroids in Black Women

Uterine fibroids, which are benign pelvic tumors, affect Black women harder than any other group. The reason for this trend is not understood. Given the magnitude of the problem—markedly altered quality of life, the effect on reproductive health, and the costs of health care for this disease—the high prevalence of uterine fibroids in Black women is considered a major public health issue.

Statistics

A study looking at over 1 million U.S. women from 2003 to 2014 found that Black women had the highest rate of diagnosed uterine fibroids, with most diagnoses made between the age of 30-54 years old. The rates of diagnosis increased with age, peaking at age 45 to 49 years old.

Here are some telling stats that shed light on the disparities that Black women face due to uterine fibroids:

• Black women carry the burden of uterine fibroids at a much higher rate than their racial counterparts. There are no reported statistics on the total number of Black women with uterine fibroids in the U.S. but studies show that Black women are 3 to 4 times more likely to develop uterine fibroids in their lifetime compared to non-Hispanic white women; and estimated 70-80% of Black women will develop fibroids over their lifetime.
• Black women are more likely to experience symptoms of uterine fibroids. Nearly 25% of Black women between 18 and 30 will experience symptoms from their fibroids compared to about 6% of white women, according to some national estimates, and by age 35, that number increases to 60%.
• Black women face an exhaustive list of barriers and challenges leading to delays in accessing care. Inadequate access to appropriate healthcare facilities, lack of available well-trained providers, poor quality of services when available, affordability issues and medical mistrust are just a few of the obstacles that Black women face when trying to access care. One study found that Black women with symptoms waited about 3.5 years until seeking treatment and about a third of women waited 5 years.
• Black women have higher healthcare expenses due to uterine fibroids. It is estimated that the annual financial impact of uterine fibroids on Black women in the United States is as high as 30 billion dollars; and this number may be an underestimation, as at least one-quarter of women reported losing work due to their disease.
• Black women are more likely to undergo surgery for uterine fibroids. Black women are 7 times more likely to undergo a myomectomy compared to non-hispanic white women.
• Uterine fibroids return at higher rates for Black women. Black women experience higher rates of recurrence than white women following surgical treatment; recurrence can be as high as 59% within 5 years. 
• Black women are more likely to have a hysterectomy because of lack of options. Black women are 2.4 times more likely to undergo hysterectomy than white women. Also, the reason for hysterectomy is to help manage uterine fibroids symptoms 66% of the time for Black women compared to 22% of the time for white women. 
• Uterine fibroids is a leading cause of Black women missing work. According to an online survey conducted by Harris Interactive between December 1, 2011 and January 16, 2012, Black women were 77% more likely to miss work due to uterine fibroids than White women.

The Impact of Fibroids on Black Women

Uterine fibroids have long plagued Black communities. 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, noncancerous tumors that develop within the muscle tissue of the uterus. The health effects of fibroids range from being asymptomatic to significant pain, anemia, bleeding, increased urinary frequency, fertility problems, and pregnancy complications. Unfortunately, many Black women experience the latter, especially during their reproductive years, increasing the risk of infertility and the development of pregnancy complications.  

Health Disparities

Women of color are disproportionately impacted by uterine fibroids. Black women are four times more likely to have fibroids between the ages of 18 and 30, compared to white women. Over a women’s entire life, it is estimated that 80% of Black women will go on to develop some form of benign pelvic tumor condition versus 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

Factors that may lower the risk of fibroids:

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

Symptoms

Fibroids can be particularly disabling for Black women. Not only are Black women two to three times more likely to have recurring fibroids or suffer from complications, but their symptoms are less likely to regress after menopause.

Black women also report more severe pelvic pain and are more likely to be anemic due to heavy bleeding.

Fibroid symptoms that are common to Black women include: 

• Heavy or prolonged periods
• Painful menstrual cramps
• Passage of blood clots during their period
• Painful intercourse

Fibroids may also interfere with physical and social activities, relationships, and work. 

Treatment

Treatment for fibroids can range from no treatment at all to surgery. Sometimes fibroids do not require treatment, but many Black women experience excessive bleeding, discomfort, or bladder problems, necessitating treatment.

Medical treatment can help limit uterine fibroid symptoms, but it does not make them go away. Birth control pills can help limit heavy bleeding. Large fibroids that put pressure on other structures are not helped by medical treatment and therefore, may require surgical removal.

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 consult a healthcare professional. 

Of note, these medications do not shrink tumors, and women over 35 years old who smoke should not take 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)

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. 

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

Hysterectomy

Fibroids are located in the uterus, so surgical removal of the uterus via a hysterectomy provides the most effective treatment and eliminates any chance that they will return. This surgery can be performed as an open surgery or laparoscopically.

A hysterectomy wipes out your chance of getting pregnant. A myomectomy may be a better option for those who wish to preserve the ability to bear children. 

Myomectomy

A myomectomy is an operation to remove fibroids while preserving the uterus. Minimally invasive or laparoscopic myomectomy can be used to remove fibroids, especially for those who desire to have kids. But this is often a temporary fix as the fibroids are likely to grow back.

The younger you are and the greater the number of fibroids, the more like they are to re-grow. Still, these surgeries are often preferred over hysterectomy due to the shortened time needed for recovery after surgery, preservation of a woman's ability to have children, and reduced risk of life-threatening complications. 

There are three types of myomectomies: 

• Abdominal myomectomy: Fibroids are removed through a bikini cut incision from the wall of the uterus. This procedure is usually performed in a hospital under general anesthesia and requires a one or two night hospital stay, plus a four to six-week recovery.
• Laparoscopic myomectomy: This minimally invasive procedure removes fibroids through four one-centimeter incisions in the lower abdomen. A small camera and long instruments are used to visualize and remove the fibroids. Acute post-surgical recovery is typically much shorter than abdominal myomectomy. 
• Hysteroscopic myomectomy: Women who have fibroids that expand into the uterine cavity may have to have a hysteroscopic myomectomy performed. During this procedure, telescope and cutting instruments are used to shave off submucosal fibroids. This is usually an outpatient procedure with one to four days of recovery time at home. 

Prevention

While there is no way to completely prevent fibroids, Black women can mitigate their risk by maintaining a healthy weight via healthy eating and routine exercise, monitoring vitamin D levels, and regularly getting physical examinations. Keeping your blood pressure at or below 130/80 and reducing unhealthy stress may also help limit fibroid symptoms.

Eliminating Health Disparities

Personalized treatment plans, greater access to quality care, and unpacking the normalization of pain that is associated with Black women are all needed to help eliminate health disparities among Black women with fibroids.

Research has shown that Black women are more likely to be diagnosed with fibroids later in their life and less likely to have removal through laparoscopy. This delay in diagnosis and quality care worsens the overall prognosis for Black women.

Low-socioeconomic status Black women and women without private health insurance are even less likely to receive a timely diagnosis and quality care, including laparoscopic surgery if needed. Strategies that ensure equal access to care are needed to stem the health disparities that exist in diagnosis and treatment.

More research also needs to be done to explain the genetic, social, and environmental factors that contribute to the high prevalence of uterine fibroid development in Black women.

Black women should also be made aware of the appropriate alternatives to hysterectomy via aids that are tailored to Black women. Facilitating meaningful discussions about fibroid treatment with plans that are developed with participation by Black women and their healthcare providers is key to managing fibroids and may serve as a path to greater trust and participation in fibroid research.

Frequently Asked Questions

Do Black women have worse periods?

Studies show that Black women experience heavy menstrual bleeding in disproportionate numbers compared to non-Hispanic white women, which may be largely attributable to higher rates of uterine fibroids and the potential of higher baseline estrogen levels in premenopausal Black women. Heavy menstrual bleeding is associated with lower quality of life, loss of productivity, and increased healthcare expenses.

Pinpointing the cause of these disparities has been elusive. The possibility of biological differences coupled with higher obesity rates, vitamin D deficiency, and delays in healthcare access due to differences in socioeconomic status have all been discussed as potential factors, but few resources provide a multifactorial approach towards addressing the problem. With frustratingly few answers to improve their symptoms many Black women have simply learned to live with heavy menstrual bleeding. More efforts need to be done to address this issue, as nearly one third of Black women suffer from heavy menstrual bleeding in their lifetime. 

Will my daughters have fibroids because of me? 

While studies consistently show a hereditary link between fibroids in mothers and daughters, developing fibroids is far from certainty even if your mother and grandmother have had it. With that said, if you have a family history of uterine fibroids you are at a higher risk of developing them and passing those genes to your daughter. The Office of Women’s Health says that the risk of experiencing uterine fibroids is three times higher in those with a family history of the condition.

How do I know if my period is normal?

If your uterine fibroids are causing symptoms they may throw off your period. Over time it may be difficult to differentiate between normal and abnormal periods. 

The heaviness of your flow is different for every woman. Subjectively, an abnormal period is any period that results in more blood flow and associated symptoms than you have experienced in the past. 

A normal menstrual cycle occurs every 21 to 35 days and lasts two to seven days. The clinical criteria for heavy menstrual bleeding is a total blood loss of at least 80 mL per menstrual cycle or a menstrual cycle lasting longer than 7 days. The clinical diagnosis of heavy menstrual bleeding is usually made after you have experienced heavy or prolonged bleed for two cycles.

Signs that you are losing more blood than normal include: 

• Feeling more fatigued than normal
• Passing blood clots
• Changing your sanitary protection more than normal
• Bleeding in between periods 

If you are extremely tired or feel as if you are going to faint you may be experiencing severe blood loss, and should contact a healthcare professional immediately. Extreme blood loss can cause anemia which is treated in the hospital with fluid replenishment and a blood transfusion.

A Word From Verywell

If you have fibroids, you may want to be evaluated periodically to monitor your fibroid and uterus size, even if you do not have symptoms. Remember that having fibroids doesn't necessarily mean that you need treatment, and many Black women live happy and healthy lives despite this condition. If you are experiencing disabling symptoms, consult a healthcare professional and seek support from trusted family or friends.