Black women and fibroids

Fibroids have been making the news recently because Black women are more prone to them than white women. Black women also have more difficulty getting the problem recognised. This is clearly a concerning problem and all women should be aware of the symptoms and issues they can cause.

What are fibroids?

Fibroids are non-cancerous growths that develop in or around the womb. The growths are made up of muscle and fibrous tissue and vary greatly in size. They can be as small as a coin or as large as a melon! Fibroids are present in about 6% of white women and nearly 25% of Black women by age 30. This increases to 60% by age 35, although many women are unaware of them because they do not have any symptoms.

Around 1 in 3 women may experience the symptoms of:

  • Heavy or painful periods
  • Abdominal pain
  • Lower back pain
  • Frequent need to urinate
  • Constipation
  • Pain/discomfort during sex.

In rare cases, further complications caused by fibroids can affect pregnancy or cause infertility. In fact, fibroids are present in 5-10% of infertile patients and may be the sole cause of infertility in 1-2.4%.

Problems with diagnosis

Research in the US shows that Black women report significant delays in fibroid diagnosis. They find it harder to get valid information on treatment and are more likely to experience symptoms longer before seeking treatment. Dr. Deborah Lee, Sexual and Reproductive Healthcare Specialist and medical author said, “Ethnicity is an important factor for consideration diagnosing fibroids. In Black women, fibroids tend to cause troublesome symptoms at an earlier age, be larger in size, be more numerous and grow more rapidly.”

Vitamin D may play a role

Dr. Lee continued, “Fibroids are also sensitive to oestrogen. Black women more commonly possess a specific oestrogen receptor known as the oestrogen receptor-α PP variant, which has also been linked to the presence of fibroids. Some research suggests fibroids may be linked to vitamin D deficiency. Black women are more likely to vitamin D deficient than white women. Vitamin D is an essential vitamin for bone health, but it also plays a vital role in regulating the immune system.”

However, the difficulties with diagnosis and getting treatment points to some degree of structural racism. Black women report that they didn’t go to the doctor for years because they didn’t think their worries would be met. Dr. Lee observed, “History tells us that Black women have suffered from bias and stigma dating back many generations.”

Racial disparity in pain management

Dr. Lee, pointing out that this is not a new phenomenon. As evidence she pointed to a 2018 US study, which looked at racial disparities in the management of pain. That stated that Black patients were 40% less likely to receive pain relief than white women. 36% were less likely to be prescribed strong analgesics such as opiates (morphine). Dr. Lee firmly believes that women shouldn’t have to wait until pain is taking over their lives to be taken seriously by a doctor.  Their concerns should be dealt with appropriately. With that in mind, she had some advice for those who are concerned about seeing their doctor about fibroids:

  • If you are nervous, take someone with you to the clinic, perhaps your partner, a friend or a relative that can support you
  • Remember: you can ask for a doctor of the sex of your choice
  • Write a list of questions before you go to the surgery and don’t be afraid to get this out to go through one by one
  • If you don’t understand anything you are told, ask for clarification
  • Don’t be worried about telling the doctor about your concerns about fibroids. The doctor has a duty of care and must listen to your ideas, concerns and expectations.

It’s clear that when it comes to the health and fertility of women, and especially Black women, it would be useful to focus research on fibroids that are currently an understated problem.