Uterine fibroids, or noncancerous growths of the uterus, often develop during someone’s childbearing years. While they’re not uncommon, Black women are more likely than white women to have uterine fibroids. Black women are also more likely to develop painful, more severe fibroids at younger ages (as young as age 20).
It’s largely unknown as to why Black women are more likely to develop uterine fibroids. But according to a recent Henry Ford Health study, Black women are less likely than white women to receive treatment for them.
“I think there is a historical—and current day—context that’s largely responsible for this, where Black women have not been taken seriously in medical settings,” says Andrew Bossick, Ph.D., MPH, an assistant scientist at Henry Ford Health. He collaborated with the U.S. Department of Veterans Affairs (VA) to understand racial disparities in uterine fibroid treatment among female veterans and found that Black veterans were less likely to receive treatment for uterine fibroids within the VA.
“Other studies have shown that symptoms Black women experience are oftentimes dismissed," he says. "This potentially leads to delayed diagnosis, resulting in greater severity and fewer treatment options. Also, generations of medical racism—including forced sterilization—has led to mistrust of the healthcare system. This has led Black women to delay seeking care. Barriers to access—like ability to pay—isn’t a factor, because the VA is an enhanced access system where many patients qualify for care without co-payments.”
Dr. Bossick also believes the reason why Black women are more likely to develop uterine fibroids is based in racism. Some people think it’s solely diet and some think there are biological factors—but no one has really been able to account for the observed racialized disparities in outcomes. “I believe it’s probably due to social determinants of health that are caused by racism,” he says. “We’re doing more research in this area to understand it better and hopefully reduce these racialized disparities.”
Symptoms & Complications Of Uterine Fibroids
Uterine fibroids can be so small that they’re practically undetectable or so big that they enlarge the uterus. Symptoms of uterine fibroids include heavy bleeding, constipation, frequent urination, pelvic pain and anemia from blood loss.
“Fibroids can grow up to the size of a grapefruit and they’re very noticeable and painful,” says Dr. Bossick. “They can disrupt fertility and cause the uterus to become misshapen and block the fallopian tubes, which can prevent implantation and make it difficult to conceive a child. Or sometimes—although rare—there’s so much scarring and tissue damage from previous treatment that the egg can’t implant in the uterine lining, or there's a uterine rupture during pregnancy.”
Treatments For Uterine Fibroids
The only definitive treatment for uterine fibroids is a hysterectomy (or removal of the uterus). But there are also fertility-sparing options that can help manage and minimize fibroids, such as birth control and a surgery called myomectomy, which removes the fibroids while leaving the uterus intact.
Uterine fibroids are not life threatening but they can be incredibly debilitating. “You may have to take time off work because of pain, which has implications for your financial stability,” says Dr. Bossick. “It’s about quality of life and, in general, listening to and respecting people who have a uterus. Clinical guidelines need to change: If someone comes in experiencing symptoms related to uterine fibroids, you get them in for a scan to see if they have uterine fibroids—you don’t dismiss them.”
Reviewed by Andrew Bossick, Ph.D., MPH, an assistant scientist at Henry Ford Health.
