Fibroids are common — really, really common. Still, I’m betting there are things about fibroids that you may not have considered, especially when it comes to race and ethnicity.
Fibroids are noncancerous growths of the uterine muscle. For some people, these growths don’t cause any issues. For others, the symptoms can be severe and require treatment. Unfortunately, these issues disproportionately affect Black people.
Compared with people in other racial groups, people of African descent are more likely to develop uterine fibroids. By age 50, up to 90% of Black people with a uterus have fibroids, which means that among every 10 people you know in this group, nine of them may have fibroids! Furthermore, Black people develop fibroids at younger ages and have larger, faster growing fibroids.
Not surprisingly, because they have more-severe fibroids, Black people have worse symptoms compared with those of white people — severe pain, anemia due to heavy periods, and symptoms that interfere with relationships, physical activity and the ability to go to work.
In fact, symptoms are so severe that Black people have more surgeries and have surgery at younger ages compared with people in other racial groups. Research has shown that compared with white people, Black people are:
- Three times more likely to be hospitalized for problems related to fibroids
- Seven times more likely to have surgical removal of fibroids (myomectomy)
- Two times more likely to have a hysterectomy to remove the uterus and fibroids
As a surgeon, one of the most concerning differences is that Black people have higher rates of open or large-incision surgery rather than minimally invasive surgery — such as vaginal, laparoscopic or robotic surgeries — for fibroids. Having minimally invasive surgery, when possible, is the best approach because it’s associated with less pain, fewer complications and a faster recovery compared with surgery with a large incision.
While the route of surgery can depend on the number, size and location of fibroids, race should not be a factor in determining which type of incision people receive. But unfortunately, that’s exactly what previous research has found. Studies show that Black people are not only more likely to have a more invasive surgery than are white people but they’re also more likely to have surgical complications, such as the need for a blood transfusion, after fibroid removal.
Where you have your care matters. Studies show that when people see fibroid specialists, their likelihood of having minimally invasive surgery that enables them to keep the uterus is significantly higher and their after-surgery outcomes are better.
Because Black people are diagnosed with uterine fibroids at younger ages, it’s especially important for them to consider whether they are done having children. Uterus- and fertility-preserving treatment options exist! Some untreated fibroids can also affect the ability to become pregnant or to have a successful, uncomplicated pregnancy, so treatment decisions in young people have many considerations.
Despite having more-severe symptoms, Black people have greater delays in receiving treatment compared with white people. Black people have been shown to wait a full year longer than white people do before receiving care. This may be due to lack of medical access or negative experiences with health care in the past.
If fibroids are not causing symptoms, they probably do not need treatment. But if you are having symptoms or considering pregnancy, you have many treatment options to discuss with your doctor. These include:
- Medications. These are a low-risk way to control period-related issues such as heavy bleeding. But most medications are hormone-based and therefore cannot be taken if you are trying to get pregnant.
- Uterine fibroid embolization. This is a minimally invasive procedure that blocks blood flow to fibroids, causing the fibroids to shrink and symptoms to improve. However, because of changes in the uterus as a result of this treatment, many studies have shown worse pregnancy outcomes after embolization, so many doctors do not recommend this treatment for women desiring future pregnancy.
- Radiofrequency fibroid ablation. This is the newest technology to shrink fibroids and treat related symptoms. Fibroid ablation is also minimally invasive and can be done through the vagina or through small incisions, depending on the fibroid location. Because radiofrequency fibroid ablation is a new technology, we don’t yet know if it’s safe to get pregnant after having the treatment.
- Myomectomy. This procedure removes fibroids surgically and can be done through the vagina or the abdomen — either laparoscopically with small incisions or through a cesarean section-type incision — depending on the fibroid type. Myomectomy is the traditional surgery for people who have symptoms but also want to preserve their ability to have a pregnancy in the future.
Many studies have tried to determine why Black people are more prone to developing fibroids, but there are no definitive answers yet. Certain genes have been correlated with fibroid growth, but studies of these genes have not included a representative sample of Black people. Vitamin D deficiency, which is more common in people with dark skin, has been correlated with fibroid growth, but there isn’t enough information to advise women about taking supplements.
Regardless of the causes for fibroid growth, many treatment options can address goals such as preserving the uterus or the ability to have children. All people can be empowered by knowing their options. Don’t be afraid to ask questions or ask for a referral to fibroid specialists such as those at Mayo Clinic.
Michelle Louie, M.D., MSCR, FACOG
Dr. Louie is a Minimally Invasive Gynecologic Surgeon in Phoenix, Arizona. Dr. Louie has dedicated her career to improving the quality of life for patients suffering from painful, heavy or irregular menstrual bleeding and engaging in shared decision-making with patients to determine their treatment plan.