Ok – so you read the title of this blog and probably thought one of two things: You’re a Black woman with fibroids who wants to understand if and WHY your fibroids and ethnicity are connected. Or, you read the title and thought, “Black women are more likely to have WHAT!?” The fact is uterine fibroids are the most common benign gynecologic condition and can affect any woman of reproductive age. Unfortunately, Black women are more likely to develop them, and often experience more severe symptoms.1 In this blog we are going to take a deeper dive into what we know about the link between fibroids and ethnicity.
How are symptoms different for Black women?
While the majority of women with fibroids will not experience symptoms, and others are only mildly affected, Black women experience more uterine fibroids and with greater severity of symptoms.2 Here are some statistics to put it into perspective:
- Black women are 3x more likely to develop fibroids.1
- Black women tend to develop uterine fibroids at a younger age. Clinical research estimated Black women, on average, are 3 years younger than white women when they develop. 2
- Black women generally suffer more severe symptoms – likely a result of larger and more rapidly-growing fibroids.1 These symptoms can include heavy bleeding, cramping, bulk or bloating, leg and back pain, and more.
- Unfortunately, the disparities don’t stop with the symptoms. When Black women seek treatment for fibroids, they generally experience a higher rate of complications with standard UF Treatment options.3,4
- When receiving a hysterectomy, the most commonly offered treatment option for uterine fibroids7, Black women are 40% more likely to develop complications and 3x more likely to have a longer hospital stay.*
- When receiving a myomectomy, Black women are 6x more likely to have a major complication and 2.3x more likely to undergo a blood transfusion.†
What is the link between fibroids and ethnicity?
More research is needed to understand why Black women see a substantially higher incidence of uterine fibroids but research suggests the following elements could be linked.
- A National survey suggested that Black women who had a lower intake of fruits, vegetable, and fiber were at higher risk for fibroids. The survey also found they were less likely to take vitamin and mineral supplements.5 The study suggested that fruit – specifically citrus – correlated with a lower risk for developing fibroids.5
- Some research has found that childhood height and weight were associated with early onset of fibroids in Black women.1 As we know, obesity is directly tied to diet. And although the connection between diet and fibroid growth is not completely clear, we do know that eating a balanced diet is better for overall health.
- There is a relationship between stress and fibroids. While any stress (vs. no stress at all) can have an impact, research has shown it is the particularly high levels of stress that have been found to be associated with fibroids in Black women.10
- Vitamin D deficiency
- Studies have shown that Vitamin D deficiency can be a risk factor for uterine fibroids. Vitamin D deficiency is estimated to be 10x more common in Black women compared to white women. Unfortunately, the reason for this high prevalence of vitamin deficiency is unkown.1
What are my treatment options?
Despite having minimally invasive options available, like the Acessa procedure or MyoSure, Black women are still 2x as likely to undergo hysterectomy than white women.6 For some women a hysterectomy may be the best option but if is not what you want, it is important to explore the many treatment options out there.
Black women are more likely to experience uterine fibroids, and often suffer not only from the symptoms, but also during treatment. As allies to Black women, we are working to help decrease the link between fibroid suffering and ethnicity by increasing cultural competency and reducing anti-Black biases to help women learn about their options. We can help reduce disparities in treatment. The most effective way to address racial disparities in the treatment of uterine fibroids includes increasing healthcare professionals’ awareness of how bias and discrimination contributes to disparities, representation in clinical trials, early screening, and access to minimally invasive treatment options. If history has taught us anything, it is that if you are not included, then you are not represented.
- Catherino, W., Eltoukhi, H., & Al-Hendy, A. (2013). Racial and Ethnic Differences in the Pathogenesis and Clinical Manifestations of Uterine Leiomyoma. Seminars in Reproductive Medicine, 31(05), 370-379. doi:10.1055/s-0033-1348896
- Al-Hendy, A., Myers, E. R., & Stewart, E. (2017). Uterine Fibroids: Burden and Unmet Medical Need. Seminars in reproductive medicine, 35(6), 473–480. https://doi.org/10.1055/s-0037-1607264
- Kim T, et al. Fertil Steril. 2020;114(1):175-184.
- Hakim RB, et al. Am J Public Health. 2004;94(8):1399-1405.
- Kant AK, Graubard BI. Ethnicity is an independent correlate of biomarkers of micronutrient intake and status in American adults. J Nutr. 2007;137(11):2456–2463.
- Weiss, G., Noorhasan, D., Schott, L. L., Powell, L., Randolph, J. F., Jr, & Johnston, J. M. (2009). Racial differences in women who have a hysterectomy for benign conditions. Women’s health issues : official publication of the Jacobs Institute of Women’s Health, 19(3), 202–210. https://doi.org/10.1016/j.whi.2009.03.001
- Clarke-Pearson, D.L & Geller, E.J. (2013). Complications of Hysterectomy: Obstetrics & Gynecology. Retrieved from http://journals.lww.com/greenjournal/abstract/2013/03000/complications_of_hysterectomy.23.aspx
- Wise, L. A., Palmer, J. r., Yvette, C. C., Hunt, M. O., et. al (2007). Perceived Racial Discrimination and Risk of Uterine Leiomyomata. Epidemiology, 18(6), 747-757. doi: 1097/EDE.0b013e3181567e92
- FitzGerald, C., Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics, 18, 19. https://doi.org/10.1186/s12910-017-0179-8
- Vines, A. I., Ta, M., & Esserman, D. A. (2010). The Association between Self-Reported Major Life Events and the Presence of Uterine Fibroids. Womens Health Issues, 20(4), 294-298. doi: 1016/j.whi.2010.03.009
*In comparison to White women, based on a retrospective cohort of women, of which 1,185 were Medicaid-insured and 1,240 were commercially-insured, evaluating medical decisions, inpatient decisions, and outcomes.
†In comparison to White women, based on a retrospective cohort study of women who underwent myomectomies as identified by CPT and ICD-9 and 10 codes, using the American College of Surgeons’ National Surgical Quality Improvement program database. Multivariable logistic regression was used to assess independent association of post-operative blood transfusion with major complications after adjusting for race and other patient demographics.
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IMPORTANT SAFETY INFORMATION The Acessa ProVu system is indicated for use in percutaneous, laparoscopic coagulation and ablation of soft tissue, including treatment of symptomatic uterine fibroids under laparoscopic ultrasound guidance. The Acessa ProVu system is contraindicated for patients who are not candidates for laparoscopic surgery and/or patients with a uterus adherent to pelvic tissue or viscera. The Acessa ProVu system’s guidance system is not intended for diagnostic use. Please read all instructions for use of the Acessa ProVu system prior to its use. Safe and effective electrosurgery is dependent not only on equipment design but also on factors under control of the operator. Rare but serious risks include, but are not limited to, skin burns, mild inter-operative bleeding, post-procedural discomfort (cramping, pelvic pain), infection, vaginal bleeding, blood loss and complications related to laparoscopy and or general anesthesia. If you or someone you know has possibly experienced a side effect when using our product please contact your physician. Insufficient data exists on which to evaluate the safety and effectiveness of the Acessa ProVu system in women who plan future pregnancy, therefore the Acessa ProVu system is not recommended for women who are planning future pregnancy.
We encourage patients to seek medical attention for typical and atypical symptoms associated with fibroids to help achieve and maintain good health with as high a quality of life as possible. Although many patients may benefit from the Acessa procedure, this treatment is not for everyone and results may vary. You should talk to your doctor about the potential benefits and risks and whether this treatment is right for you. Information contained on this site is not to be used as a substitute for talking to your doctor. You should always talk to your doctor about diagnosis and treatment information.