Why Are Uterine Fibroids in Black Women More Common?
Black women are more likely to suffer from fibroids, or muscular tumors that grow in the wall of the uterus (womb). We spoke to experts about the symptoms of fibroids, how uterine fibroids are treated and why women from certain ethnic backgrounds are more prone to this common health condition.
What are fibroids?
Uterine fibroids, or leiomyomas, are growths in the uterus and are typically noncancerous. These growths vary in size and don't always cause problems or symptoms.
Fibroids are classified as small, medium or large. Those sizes, according to the Midwest Institute for Non-Surgical Therapy (MINT), are defined as follows:
- Small fibroids are less than 1 centimeter up to 5 cm in length (size of a pea to a cherry).
- Medium fibroids are between 5 cm and 10 cm (size of a plum to a large orange).
- Large fibroids are 10 cm or more (size of a grapefruit and larger).
It's possible to have fibroids without symptoms. However, the symptoms of fibroids may present in a number of ways.
"Symptoms can be heavy bleeding, pain or pressure. Some will even feel a mass or growth in their lower abdomen. Fibroids can sometimes be felt but can almost always be seen on an ultrasound. Sometimes they are seen when looking for other things," said Wendy Goodall McDonald, M.D., a board-certified OB-GYN at Women's Health Consulting in Chicago. "When a person has heavy bleeding or a growing abdomen, or pressure on their bladder or bowels, fibroids should be suspected.
"Some may have challenges with achieving or maintaining a pregnancy. Fibroids can sometimes be the culprit."
Other symptoms of fibroids may include:
- Pain during sex
- Heavy menstrual bleeding
- Abdominal or pelvic discomfort
- Difficulty conceiving
Up to 25 percent of women experience symptoms, according to the Resilient Sisterhood Project. Yes, fibroids can cause weight gain due to the growth and weight of the tumors.
Fibroids tend to be more common in women who haven't reached menopause and have a family history of the condition. Other higher risk factors include being overweight and having a diet high in red meat.
Researchers don't yet know the cause of uterine fibroids, but they have been linked to the hormone estrogen, which is produced in the ovaries. This could be why fibroids tend to occur in women of reproductive age.
How are fibroids treated?
Fibroid treatment options depend on the person and the severity of the fibroids. Sometimes, physicians will keep an eye on the situation and only take further action when symptoms worsen as the tumor grows.
"Unless they cause symptoms, treatment is not needed," said Hana Patel, B.Sc., M.B.B.S., a general practitioner and mental health coach in London.
But some people do have uncomfortable or painful experiences with fibroids. For them, treatment in the form of oral contraceptives or an intrauterine device (IUD) can help.
"[Fibroids] can cause heavy, irregular periods in some people, leading to treatments being offered from your GP such as pain relief or hormonal therapies, including the Mirena coil. This can help to reduce heavy and painful periods," Patel said.
Hormonal treatments such as gonadotropin-releasing hormone (GnRH) agonists can shrink the uterus and the size of the tumors. After three months of GnRH treatment, uterine size shrank by up to 50 percent, Brigham and Women's Hospital noted.
GnRH treatment ends menstrual flow (amenorrhea) and enables women with bleeding-induced anemia to recover their iron loss, improving their symptoms, at least until the treatment stops.
Mirena, a progestin-releasing intrauterine device (IUD) can minimize fibroid growth and associated symptoms. Other contraceptives that can help treat fibroids include birth control pills, the birth control patch (Ortho Evra patch), injections (Depo-Provera) and the vaginal ring (NuvaRing), according to Harvard Health.
"If there are multiple fibroids or the initial treatments offered do not help, then surgery to remove fibroids or a hysterectomy for severe cases is offered," Patel said.
A hysterectomy is the only way to stop fibroids.
"If you do need surgery for your fibroids, this can take place in different forms. You may be offered a uterine artery embolization, which will shrink the fibroids by cutting off their blood supply," Patel noted.
It might seem daunting, but it isn't as bad as it sounds.
"This is a relatively simple procedure. The other surgical procedure commonly used to treat fibroids is ablation surgery, which involves destroying the tissue. Again, this is a fairly simple outpatient procedure," Patel said.
Why are fibroids more common in Black women?
It's clear fibroids are more common in Black women. But why?
"We don't know the complete answer to that question at the moment," Goodall McDonald said. "Studies do demonstrate a genetic predisposition, an association with higher lifetime stress, an association with lower vitamin D levels—which we can sometimes see in people with darker skin tones—and an association with eating excess refined carbohydrates and foods with added sugar may trigger or worsen fibroids."
A 2013 study suggests a couple of things. Fibroids are more common in African American women compared to women of other races. They also appear to present with major health problems, possibly due to the development of fibroids occurring at an earlier age.
Another study indicates Black women were more likely to experience impairments in their personal relationships due to their fibroid-related symptoms. These women reported greater concerns related to employment, job security and career opportunities due to missed work days.
The bottom line
Research surrounding racial disparities in healthcare, particularly in relation to Black women, has increased in recent years. However, more research is necessary to determine why fibroids appear to affect Black women more often and how to overcome the gap in treatment.
"More research needs to be done to understand why Black women, in particular, have such a hard time with fibroids and what can be done to change that trajectory," Goodall McDonald said.
Raising fibroid awareness could help Black women obtain an earlier diagnosis and better treatment options for uterine fibroids.