While fibroids might be a common affliction for most people with a uterus, the risk is much higher for Black women. In fact, some studies show that over 80 percent of Black women over the age of 50 will have uterine fibroids, and their fibroids can be larger in size, which can cause greater physical discomfort and more intense symptoms. Many Black women also have a more difficult time getting treated for fibroids, which is sad yet unsurprising given the history of how Black women’s sexuality and reproductive health has been exploited in the name of medicine in America for centuries.
Additionally, research shows that overweight or obese people, and those over the age of 65 are more at risk for uterine fibroids than others. On average, Black people also develop fibroids at an earlier age than their white counterparts and have higher rates of hospitalization from complications.
Despite how many folks deal with fibroids, there are still a lot of misconceptions floating around about what they actually are. While they should be taken seriously, they are not always a reason for fear. With swift treatment and the right information, a uterine fibroid diagnosis can be addressed and treated with relative ease — which is why it’s so important to know if you might be more at risk and to talk to a healthcare professional.
What are uterine fibroids?
According to the Office on Women’s Health, uterine fibroids (also known as “leiomyomas”) are characterized as muscular tumors that grow in the wall of the uterus, which are almost always benign, or not cancerous. Not all people with fibroids have symptoms, and the size and shape of the fibroid can vary greatly, ranging from tiny growths that are undetectable to the human eye to large masses that can distort the uterus’ shape.
According to an article written for Hopkins Medicine by gynecologist Mindy Christianson, between 20 to 70 percent of people with uteruses will develop uterine fibroids during their reproductive years, though they’re usually harmless. Despite the fact that they are only cancerous for less than one in a thousand people, your OB/GYN will still most likely suggest treating them, as they can be inconvenient, and sometimes cause physical pain.
No one is entirely sure what causes fibroids, but researchers have two main hypotheses: Some doctors point to hormone levels as a cause, suggesting that fibroid growth is caused by an increase in levels of estrogen and progesterone. Others, however, suggest fibroids are caused by genetics, so if someone in your family has been affected by uterine fibroids, you may be more likely to have them as well.
Why are Black women more at risk for uterine fibroids?
While almost everyone with a uterus can get them, some groups are more likely to get fibroids than others. Older women, overweight or obese people, and Black women are more likely to get uterine fibroids than other groups. While all of these groups are affected by uterine fibroids, Black women are by far the most affected. Katherine Brown, a Black OB/GYN and fellow with Physicians for Reproductive Health, a collective of physicians fighting for reproductive rights in San Francisco, explained some reasons why to Allure. “Research understanding these racial differences is ongoing and is looking at racial disparities in care for fibroids, environmental reasons, genetic causes, molecular mechanisms of fibroids, and medical and surgical treatments for fibroids,” explains Brown.
She continues, “The Black Women’s Health Study has helped to characterize the burden of many medical problems, including fibroids, among Black women. I use the word ‘women’ here but recognize that all people with a uterus can experience symptoms of uterine fibroids and may need to seek treatment for uterine fibroids.”
The group has conducted studies into Black women’s increased risk for illnesses such as diabetes and breast cancer. Specifically, the Black Women’s Health Study’s research has suggested possible links between Black women’s greater risk of uterine fibroids and several causes including childhood trauma.
Aren Gottlieb, an OB/GYN based in New York City, offers another reason. “Fibroids are believed to be estrogen-responsive, and since obese patients make a lot of exogenous estrogen, they tend to have more fibroids,” Gottlieb says. And as Black women in the United States are disproportionately affected by obesity, this could be one reason why they are more at risk for developing uterine fibroids.
How would I know that I have uterine fibroids?
People with uterine fibroids usually present with a few key symptoms, most commonly including heavy menstrual bleeding, periods that last longer than a week, and pressure or pain in the pelvic area. Depending on where the fibroids develop, they could also cause pressure against the rectum or block the urethra, causing constipation or making urination more difficult.
While these symptoms may be some of the most common, others include anemia caused by extreme blood loss, swelling of the uterus caused by large fibroids, and increased urination, writes Christianson for Johns Hopkins.
Brown tells Allure that Black women should be especially cautious when determining if they are presenting with uterine fibroid symptoms. “Because fibroids are so common among Black women, many Black women may experience heavy menstrual bleeding throughout their lives,” she explains. “However, fibroids should not cause postmenopausal bleeding. If you’ve already stopped getting your period, you should seek evaluation for the cause of bleeding even if you know you have fibroids.” Brown tells Allure that while there is no recommended screening for fibroids, it’s advised that you schedule a visit with an OB/GYN or a specialist as soon as possible if you suspect that you have them.
While fibroids are almost always noncancerous, left untreated they can still cause a lot of damage such as extreme blood loss, anemia, or even changes in reproductive health, such as the potential for decreased fertility or blockage of the fallopian tubes in the case of larger fibroids, according to Gottlieb.
How can I get treated or talk to my doctor about fibroids?
Again, if you even suspect you may have uterine fibroids, it’s important that you speak to your doctor as soon as possible. While some smaller and asymptomatic fibroids might not need to be removed, only your doctor can assess this.
If you do need to have your fibroids removed, there are several options available. Treatments range in scope from hormonal treatments which shrink the size of the fibroid by blocking the production of estrogen and progesterone to a Uterine Fibroid Embolization (UFE). UFE is a minimally invasive procedure that uses a fluoroscope, a type of X-ray imaging, to guide small particles through a catheter into the uterus and fibroids. The aim of the procedure is to shrink the fibroids and therefore ease any discomfort they may have caused.
An abdominal myomectomy, which is an open abdominal surgical procedure to remove the fibroids, is also an option for many people who have multiple fibroids, very large fibroids, or very deep fibroids. And, though extreme, a full hysterectomy, which is a removal of the uterus, is the only procedure that acts as a proven permanent solution for uterine fibroids. “The only way to one hundred percent assure that uterine fibroids will not come back is to remove the uterus,” says Brown. according to research from the Mayo Clinic. Your doctor can help you determine what procedure is right for you based on your age, previous medical conditions, and the stage and size of your fibroids.
While all people deserve equal access to treatment, it’s important to note the financial and structural barriers that frequently prevent many Black women from getting the medical help that they need. Too often, doctors ignore or disregard Black women’s physical pain, do not believe their symptoms, or misdiagnose out of indifference. Brown offers Black women some words of encouragement despite the many ways the US healthcare system has failed them.
“Through history — and into the present — Black women have been experimented on, abused, exploited, degraded, neglected, and ignored by the health care system and in the field of obstetrics and gynecology,” she says. “Thanks to the activism of Black women, we are actively working to undo the work of structural racism. Hold your doctor accountable. You have the right to dignified care, to ask questions of your doctor, to have medical recommendations and treatments explained to you, to seek second opinions. If you feel you are not being listened to by your doctor, you have the right to seek care with another doctor.”
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