Hypothetical scenario for illustration only: Imagine you have had heavy periods for years. Your mother and aunts did too, and everyone told you this was “just how it is” for women in your family. When you finally see a specialist, you learn you have multiple large fibroids — and that earlier intervention might have preserved more options. This is not an uncommon story.
The Scale of the Disparity
Uterine fibroids — noncancerous growths of the uterine muscle — are extraordinarily common. By menopause, more than 80% of Black women in the United States will have had fibroids, compared with approximately 70% of white women, according to research cited by Henry Ford Health (2024). Those statistics alone understate the disparity.
What makes fibroids a particular health equity issue is not just prevalence, but burden: Black women develop fibroids at younger ages, sometimes in their 20s. Their fibroids tend to be more numerous, larger, and more painful. They are more likely to experience heavy menstrual bleeding that leads to anemia, pelvic pressure, urinary frequency, and fertility challenges. And they are significantly more likely to undergo hysterectomy — the most aggressive surgical option — compared with white women who receive minimally invasive alternatives.
Why Does This Disparity Exist?
Researchers do not fully understand the cause. Henry Ford Health’s ongoing PEACE project, funded by a $7.8 million NIH grant, is studying why Black patients receive different care than white patients with equivalent fibroid burden. Current hypotheses include vitamin D deficiency (lower levels are more common in Black women and have been linked to fibroid growth in some studies), genetic and ancestry-related factors, chronic stress and its hormonal effects, and decades of medical mistrust that delay care-seeking.
A 2024 systematic review found that Black women were more likely to receive hysterectomy and less likely to receive myomectomy compared with white women with similar fibroid burden. Racial disparities in medical management prior to surgery have also been documented: Black patients were less frequently offered hormonal therapies or newer medications like relugolix before surgery.
A 2024 qualitative study published in Reproductive Health found that Black and Latina women with fibroids commonly reported normalizing their pain within their communities — “In our community, we normalize pain.” This normalization delayed diagnosis and treatment-seeking. This is a systemic failure, not a personal one.
“Fibroids are the number-one reason women have hysterectomy in this country. For Black women, the question is whether they are being offered every option first.”
Your Full Range of Treatment Options
Fibroids exist on a spectrum of severity, and treatment should match your symptoms, fertility goals, and preferences. If you have only ever heard about hysterectomy, ask about all of the following:
Evidence-Based Options — Ask About All of These
- Watchful waiting: Appropriate for small fibroids that cause no symptoms. Fibroids often stop growing or shrink after menopause.
- Medication: Hormonal therapies including GnRH agonists and the newer combination therapy relugolix can reduce fibroid size and heavy bleeding, particularly before surgery. A 2024 clinical study found relugolix significantly reduced fibroid-associated bleeding in Black women.
- Myomectomy: Surgical removal of fibroids while preserving the uterus. Available laparoscopically, hysteroscopically, or via open surgery depending on fibroid size and location. The preferred option for women who want to preserve fertility.
- Uterine Fibroid Embolization (UFE): A minimally invasive, non-surgical procedure in which a radiologist blocks blood flow to the fibroids, causing them to shrink. Highly effective for many women; data on subsequent pregnancies is still developing.
- Endometrial ablation: For bleeding symptoms only; not suitable for women who want to become pregnant, and not a fibroid treatment by itself.
- Hysterectomy: Complete removal of the uterus. Definitive; appropriate for severe cases or when other treatments have failed or been declined. Should not be the first or only option presented.
Symptoms Not to Normalize
Seek Evaluation If You Have
- Periods lasting more than 7 days or soaking through a pad or tampon every hour for several consecutive hours
- Pelvic pressure or a feeling of fullness in the lower abdomen
- Frequent urination or difficulty fully emptying the bladder
- Constipation or a sense of rectal pressure
- Fatigue and shortness of breath (possible signs of anemia from blood loss)
- Pain during sex
- Difficulty getting or staying pregnant
Three Questions to Ask Your OB-GYN or Specialist
- “Given my fibroid size, location, and fertility goals, what is the least invasive option that would adequately treat my symptoms?”
- “Am I a candidate for UFE or myomectomy before we consider hysterectomy?”
- “Would I benefit from medication to shrink the fibroids before any procedure, and is relugolix an option for me?”
The Bottom Line
Fibroids are not “just a Black woman thing to deal with.” They are a real medical condition with a documented treatment disparity. If you have been told to live with heavy bleeding or that hysterectomy is your only option, you have the right to a second opinion and a full conversation about every available treatment. The research is clear: you deserve the same minimally invasive options as anyone else.
References
- Henry Ford Health. “Henry Ford Health Researchers Aim to Find Out Why Black Women Suffer More from Uterine Fibroids.” July 2024. henryford.com [Research institution press release]
- Scientific Archives. “Racial Disparities in Surgical Outcomes for Uterine Fibroids: A Systematic Review.” 2024. scientificarchives.com [Peer-reviewed systematic review]
- PubMed. “‘In our community, we normalize pain’: discussions around menstruation and uterine fibroids with Black women and Latinas.” Reproductive Health. 2024. pubmed.ncbi.nlm.nih.gov/38610011 [Peer-reviewed qualitative study]
- Healio. “Relugolix Combination Therapy Reduces Uterine Fibroid-Associated Bleeding for Black Women.” January 2024. cm.healio.com [Clinical news summary]
- OCRA Hope Research Exchange. “Racial Disparities in Medical Management of Uterine Fibroids Prior to Myomectomy or Hysterectomy.” 2024. researchexchange.ocrahope.org [Peer-reviewed study]
Black-Led Organizations & Resources
- The White Dress Project (thewhitedressproject.org) — A nonprofit founded by a Black woman with fibroids, focused on fibroid education, advocacy, and connecting women with minimally invasive specialists.
- FIBROID Foundation (fibroidfoundation.org) — Dedicated to eliminating fibroid health disparities in Black women. Offers a specialist directory and research updates.
- Black Women’s Health Imperative (bwhi.org) — Ongoing fibroid advocacy work and policy initiatives to improve treatment equity.
- National Medical Association (nma.net.org) — Find a Black OB-GYN or minimally invasive gynecologic surgeon near you.
These organizations are independently operated. iBlackBeauty.com is not affiliated with them and does not receive compensation for these links.
Expert Guidance Built for You
iBlackBeauty was created by a Board-Certified Acute Care NP for Black and Latina women who are done settling for generic health advice that was never designed for their bodies.
Nellie W.K. is a Board-Certified Adult-Gerontology Acute Care Nurse Practitioner with 10+ years of clinical experience specializing in metabolic health and preventive care for Black and Latina women. She is the founder of iBlackBeauty.com.
