Why Black Women Are Disproportionately Impacted By Uterine Fibroids

Forbes

4 days ago

Women at doctor's office.
Although uterine fibroids are not an uncommon topic, the potential for severity of the condition is rarely discussed. This is especially true for Black women who tend to develop fibroids at a younger age and experience more severe symptoms and complications than white women. But there are steps that women of color can take to ensure they are getting the proper care. Uterine fibroids are noncancerous growths in and around the uterus, are far more common than some women might think. A systematic review estimated that 70% to 80% of women will develop uterine fibroids in their lifetime — but Black women experience them at disproportionate rates to other races, according to past research.
Fibroids are almost always noncancerous, and many people do not ever develop symptoms or need treatment, according to a review published August 2022 in Endocrine Reviews. But for others, symptoms can be bothersome, painful, and even cause reproductive problems, such as infertility, multiple miscarriages, or early labor. Almost two-thirds of all women will develop uterine fibroids. Black women, however, are three times more likely to experience them than women of other races. Black women also have an increased chance of having larger and multiple tumors with more severe symptoms, and are more likely to develop them earlier in life compared with women of other races.
Research published in Clinical Obstetrics and Gynecology found that nearly 1 in 4 Black women between ages 18 and 30 have fibroids compared with roughly 6 percent of white women. These findings also showed that by age 35, 60 percent of Black women will have fibroids, compared with 40 percent of white women of the same age. Black women are also 2 to 3 times more likely to experience complications or recurrent fibroids. According to Hilda Hutcherson, MD, professor of obstetrics and gynecology and associate dean for diversity and minority affairs at Columbia University Medical Center in New York City, uterine fibroids in the majority of women are asymptomatic, and these tumors don't cause a serious health threat.
But for those who do get symptoms, they may experience things like:
Some women may also experience complications during pregnancy and labor — or in rare cases, infertility. 'Fibroids are not often associated with infertility — in fact, many women don't discover they have them until their first ultrasound after becoming pregnant,' says Dr. Hutcherson. Although it isn't entirely clear why Black women develop fibroids at a higher rate compared with other races, the 2022 research from Endocrine Reviews has uncovered a few factors that may contribute. Those include:
Higher Levels of Chronic Stress An accumulating body of research suggests that racism contributes to chronic stress, or allostatic load, which refers to the cumulative burden of chronic stress and life events. Chronic psychological stress was found to be associated with a risk of uterine fibroids, according to a meta-analysis of observational studies. A study that followed more than 22,000 Black women found that higher exposure to perceived racism was associated with a higher risk of fibroids among women who were born in the United States.
This added stress may directly increase the likelihood of fibroids by activating inflammatory and other biologic pathways, or indirectly contribute to risk by leading to behavioral coping mechanisms like overusing alcohol, poor diet, or lack of physical activity, according to the authors of the January 2023 Fertility and Sterility review.
Exposure to Harmful Chemicals Black women may also have an increased risk of fibroids because they disproportionately experience environmental and occupational exposures, including organic pollutants and air pollution. Per the Environmental Protection Agency, organic pollutants are chemicals that are used in agriculture and manufacturing that can have an adverse impact on human health. Black women are also more likely to use chemical hair straighteners, which contain endocrine-disrupting chemicals that past research has linked with fibroids.
In addition there are certain risk factors noted in the Endocrine Reviews paper that make it more likely for women of any race or ethnicity to have fibroids, such as being overweight or getting older, until menopause, when they usually decline, per research. What does this mean for women of color who are diagnosed with uterine fibroids? 'The question of what to do when confronted with fibroids is a tricky one,' says Hutcherson. 'Fibroids are benign, so if they aren't actively affecting a woman's health or threatening her fertility, I typically recommend that my patients just leave them alone.'
If a woman with the condition opts for treatment, Mayo Clinic notes there are medications that can shrink fibroids or relieve heavy menstrual bleeding, and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to help relieve pain. If medications aren't enough, minimally invasive surgery may be used to remove the fibroids or there are procedures that can destroy the fibroids without surgery.
In extreme cases, a hysterectomy can be recommended — but that should be the treatment of last resort. There are alternative treatments for severe fibroids that are less invasive and can preserve fertility. There is evidence that Black women may not always be offered the same treatment options compared with white women. A study published in the American Journal of Emergency Medicine that looked at management of acute pain in the ER found that Black patients were 40 percent less likely to be given medication for acute pain compared with white patients.
According to a study published in 2022 in the Journal of Minimally Invasive Gynecology, Black women are less likely to receive minimally invasive treatment for uterine fibroids: 81 percent of white women included in the review underwent a less invasive laparoscopic fibroid surgery compared with only 57 percent of Black women. Instead, Black women are at least twice as likely to have a hysterectomy due to fibroids compared with white women, per Michigan Medicine. What's more, about one-third of these hysterectomies are performed between ages 18 and 44 — significant childbearing years.
Although these disparities have existed throughout America's history, it's only recently that there has been more dialogue and research about the extent and effects of these injustices, according to BU School of Public Health. Black women–led health advocacy organizations are part of the effort to to educate and disseminate information about conditions that disproportionately impact women of color. The Resilient Sisterhood Project is dedicated to educating and empowering women of African descent through outreach efforts to build awareness about diseases of the reproductive system that disproportionately affect them. The U.S. government is also investing in improving these disparities. In March 2023, the White House detailed several initiatives, including $471 million to support implementation of the White House Blueprint for Addressing the Maternal Health Crisis to reduce maternal mortality and morbidity rates and address persistent disparities and implement implicit bias training for healthcare providers.
In most cases, uterine fibroids can be treated. However, it's important to find the right doctor who will help you better understand your options. That's the first step that women of color can take toward receiving quality medical care and experiencing a successful and healthy recovery. Start your search with these tips: