Fibroids and Black women’s health: A silent crisis

July marked Uterine Fibroids Awareness Month. Uterine fibroids, although common, are seldom talked about, especially their disproportionate impact on Black women. According to experts, nearly 50% of Black women experience fibroids by age 35. By age 50, this number rises to 80%, compared to 70% of white women. Additionally, Black women tend to have larger fibroids than women from other racial groups. While most fibroids do not need treatment, they can sometimes lead to symptoms such as weight gain, heavy menstrual bleeding, frequent urination, or pelvic pain, which might necessitate surgical intervention. Although all women are at risk for developing uterine fibroids, Black women are disproportionately affected. One study indicates that Black women are three times more likely to develop fibroids compared to white women and are more likely to require surgical treatment. 

The burden of uterine fibroids (UF) is significantly greater for Black women compared to other racial or ethnic groups. On average Black women develop uterine fibroids approximately 5.3 years earlier than white women. Black women also experience larger and more numerous uterine fibroids than white women and are more likely to report severe disease, even when accounting for similar socioeconomic status. This contributes to a higher risk of complications during surgical treatment. Additionally, studies on women aged 45 and older have shown that tumors in older white women grew much more slowly than those in older Black women, with respective growth rates of 2% and 15%. The growth rate of uterine fibroids in white women, unlike in Black women, also significantly declined with age.

The lack of scientific consensus on the reasons behind the high rate of fibroids in Black women has led some to suggest “weathering” as a potential cause. Weathering refers to the gradual deterioration of health due to the chronic stress of racial discrimination. However, research on weathering is still emerging and our understanding of the various explanations for the racial disparity in fibroid incidence remains incomplete.

Limited federal funding for high-quality fibroid research, combined with a shortage of Black biomedical researchers and clinicians, has left many women without clear answers. The consequences are significant. According to the National Institutes of Health, 25 to 50 per cent of women with fibroids experience symptoms such as anemia, heavy bleeding and pain. Additionally, they may face higher rates of infertility and pregnancy complications. Fibroids are a particularly heavy burden for Black women, who are two to three times more likely to undergo a hysterectomy for treatment compared to other groups of women.

Dr. Erica Marsh, chief of reproductive endocrinology and infertility at the University of Michigan’s Center for Reproductive Medicine, noted that her patients have suggested various causes for their fibroids, including red meat, hair relaxers, and even “too many yams.” However, responding to these suspicions is challenging because, as she states, “We don’t know.”

Marsh co-authored a review of studies on the racial disparities in fibroids, which found no single factor responsible for the higher rates in Black women. The review concluded that due to the social, structural, and political context in Northern America, Black women disproportionately experience a range of exposures throughout their lives that may contribute to their increased incidence, prevalence and severity of uterine fibroids. These exposures include excessive ambient pollution, hormone-disrupting chemicals, elevated stress and nutritional deficiencies.

As noted in the review, the disparity in fibroid incidence is also linked to limited access to skilled gynecological care and racial bias in healthcare. Black patients reported having their concerns dismissed, leading to delays in diagnosis and suboptimal treatment. Much of the research on factors associated with fibroids does not confirm causation or indicate that these factors prompt fibroid growth. Experts suggest that understanding fibroid development at the cellular level would help women better manage risk factors and lead to improved treatments. More research can help shift the focus away from blaming fibroids on Black women’s behavior and towards sustainable solutions.

Addressing these issues requires increased federal funding for high-quality fibroid research and greater representation of Black biomedical researchers and clinicians. By advancing our understanding of fibroid development and focusing on sustainable solutions, we can move beyond attributing fibroids to Black women’s behavior and work towards equitable healthcare outcomes for all women.

Leisha Toory is the founder of the Human Rights Award-nominated Period Priority Project, the Sexual and Reproductive Health and Rights Director with the Young Canadians Roundtable on Health, and a BA in Political Science undergraduate at the Memorial University of Newfoundland and the University of Ottawa.