Uterine Fibroids in Black Women

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Uterine fibroids, a benign condition that causes pelvic tumors, hit African American women harder than any other group, but no one understands why. 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, some medical professionals consider the high prevalence of uterine fibroids in Black women a major public health issue.

woman at doctor discussing uterine fibroids

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The Impact of Fibroids on African American Women

Uterine fibroids have long plagued Black communities. African American women are three times more likely to develop the condition, receive an early diagnosis, 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 American 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. 

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. 

Treatment

Treatment for fibroids can range from no treatment at all to surgery. Most cases of fibroids require no 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 and are often used prior to surgery. Large fibroids that put pressure on other structures are not helped by medical treatment and therefore, may require surgical removal.

The following are treatment options for 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 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 cutting off the blood supply causing them to shrink and die. This procedure is usually performed in an outpatient setting. It’s important to note that UAE is a relatively new procedure and success rates vary widely.  

Surgery

Hysterectomy

Fibroids are contained in the uterus so surgical removal of the uterus, via a procedure called a hysterectomy, provides the most effective treatment for fibroids and eliminates any chance that they will return. It also wipes out your chance of getting pregnant. This surgery can be performed as an open surgery or laparoscopically. 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 due to the shortened time needed for recovery after surgery, preservation of a woman's ability to have children, and the 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 to 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 eliminating 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 great trust and research participation in fibroid research.

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 isn't an indication that you need treatment and that many Black women live happy and healthy lives despite this condition. If you are experiencing disabling symptoms, tell a family member or friend and consult a healthcare professional if possible.

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  1. Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA. The health disparities of uterine fibroid tumors for African American women: a public health issue. Am J Obstet Gynecol. 2014;210(3):194-199. doi:10.1016/j.ajog.2013.08.008

  2. Stewart, E. A. (2015) Uterine fibroids. New England Journal of Medicine. 372:1646-1655. 23 April 2015. doi:10.1056/NEJMcp1411029

  3. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and risk factors of uterine fibroidsBest Practice & Research Clinical Obstetrics & Gynaecology. 2018;46:3-11. doi:10.1016/j.bpobgyn.2017.09.004

  4. Stewart E, Cookson C, Gandolfo R, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic reviewBJOG: Int J Obstet Gy. 2017;124(10):1501-1512. doi:10.1111/1471-0528.14640