Black Women and Fibroids
Most women will have uterine fibroids in their lifetime. By the time they get to 50 years, 80 percent of black women and 70 percent of white women will develop fibroids. Black women are three times more likely than white women to develop fibroids. And relative to white women, black women are 2-3 times more likely to develop fibroids at a younger age, to have larger and more numerous fibroids, to have recurring fibroids, and to have more severe symptoms.
Furthermore, the rate of hospitalization for fibroids is three times higher for black women than white women. One study concluded that black women who have fibroids also face a 40 percent increased risk of endometrial cancer. A number of social and biological factors come into play, but the reasons for the disparities are unclear.
Fibroids have been associated with potential risk factors, including stress, obesity, starting periods younger, alcohol consumption, poor diet and lower Vitamin D levels. Although some evidence also points to history of abuse as a risk factor.
Fibroids, also called leiomyomata or myomas, are mostly noncancerous tumors that grow in a woman’s uterus (womb). The size of fibroids range from pea to football sized and even larger — making non-pregnant women look pregnant. Some women do not experience symptoms, and many will never know they have or had them. They are usually a problem for women during their reproductive years, then shrink after menopause.
However, others have significant pain, bleeding, increased urinary frequency, painful intercourse, anemia, passage of blood clots during their period, fertility problems and pregnancy complications.
For some women with uterine fibroids, they not only have to contend with the physical burden, but also with significant distress that negatively affects quality of life, including depression, anxiety and body image issues. Not to mention the social awkwardness as they try to hide their condition.
Notwithstanding the cost implications for both individuals and the healthcare system, ethnic minorities and women in lower income brackets are particularly affected by the psychological impact. The disparities have real-world consequences and should set the agenda for extensive research on uterine fibroids. Research on the cost of both missed work days and limitations on productivity and career advancement need to be studied to understand the true costs of uterine fibroids.
Black women face a double jeopardy, as provider beliefs and biases about them are linked to racial disparities in health and healthcare. Though, often unconscious, these biases affect the care provided by the physician and subsequently the trust the woman has in the recommended treatment. Moreover, the historical injustices of limiting reproductive freedom of black women through practices such as compulsory sterilization underlie the concerns black women of all ages have about uterine fibroids. Particularly their impact on fertility and childbearing.
Some of these disturbing biases include that black women have a high threshold for pain. Thus women’s complaints of discomfort and pain are downplayed or unheard. Physicians need training to recognize their own biases and develop new strategies to prevent them from negatively influencing the care they deliver.
An altered perception of ‘normal’ is a big reason many women delay treatment and suffer longer. Many girls are raised up to believe painful, heavy periods are normal and need not cause alarm. Too many black women, especially, do not have an accurate idea of what normal is. These misconceptions of ‘normal’ are the reasons 42 percent of Black women wait four or more years before pursuing treatment for fibroid symptoms. This is in comparison to 29 percent of white women who wait longer than four years to seek care.
Hysterectomy (removal of the uterus by surgery) provides for the most effective treatment of fibroids, eliminating any chance of recurrence. But it is rarely an option for reproductive age women, as it eliminates a woman’s ability to get pregnant and comes with substantial risks for complications.
Despite the risks black women are 2 to 3 times more likely to undergo hysterectomy. And seven times more likely to have a myomectomy (surgical removal of one or more fibroids). Several nonsurgical treatments are available and work for some women. These include some birth control methods, oral contraceptives and intrauterine devices, which can be effective at reducing heavy bleeding. Tranexamic acid also reduces heavy menstrual bleeding, but does not interfere with getting pregnant.
Other medications shrink the fibroids’ size and are usually administered for 3-6 months in preparation for fibroid surgery or when menopause is close, as they can menopausal symptoms.
Newer technologies include noninvasive treatment options that requires no incision and is done on an outpatient basis. This procedure is performed under an MRI scanner. Minimally invasive procedures destroy uterine fibroids without removing them through surgery and thus preserves a woman’s ability to have children. They also reduce the risk of life threatening complications and shorten the time needed for recovery after surgery.
Unfortunately, black women needing surgery for their fibroids are less likely to have minimally invasive procedures than white women. And this is true even for upper-income black women.
For equal access to healthcare, research needs to be inclusive and reflective of everyone affected by the disease.