Uterine Fibroids

What it is

Fibroids are growths of muscle and fibrous tissue in the wall of the uterus. They are not cancer, and many people have them without ever knowing, but they can cause heavy bleeding, pain and pressure [2].

Why this guide is written for Black patients

African American women are more likely to develop fibroids than white women [2]. More than 80 percent of African American women and about 70 percent of white women will have uterine fibroids by age 50 [3].

The difference is not only in how many. For African American women, fibroids typically develop at a younger age, grow larger, and cause more severe symptoms [1]. Research also shows that fibroids are more likely to shrink after menopause in white women than in Black women [1].

What happens next is where the disparity becomes surgical. African American women are 2 to 3 times more likely to undergo hysterectomy for fibroids than other racial groups, and carry almost a 7-fold increased relative risk of myomectomy [3]. Compared with white women, the relative risks reported for hospitalizations, myomectomies and hysterectomies were 3.5, 6.8 and 2.4 [3]. African American women are also more likely to be symptomatic and to respond differently to medical treatment than white women [3].

Being offered a hysterectomy is not the same as needing one. Knowing that the offer arrives earlier and more often for Black patients is the reason to ask what else is on the list.

What to ask a clinician

• How many fibroids do I have, how large, and where are they sitting in the uterine wall?
• Which of my symptoms are you treating, the bleeding, the pressure, or both?
• What are my options that keep the uterus, and am I a candidate for each one?
• Do I want a future pregnancy, and how does that change the recommendation?
• Am I anemic, and what is the plan for that separately from the plan for the fibroids?

What good care looks like

Good care starts with the symptom you actually came in with. Common symptoms are heavy bleeding, which can be heavy enough to cause anemia, painful periods, a feeling of fullness in the pelvis, an enlarged abdomen, frequent urination, pain during sex and lower back pain [2]. Many women have no symptoms at all [2].

The treatment list is longer than most people are told. Non-surgical options include over-the-counter pain relief, iron supplements for anemia, and hormonal medicines such as birth control pills or GnRH agonists [2]. Surgical options that keep the uterus include myomectomy, which removes fibroids without taking out healthy uterine tissue, uterine fibroid embolization, which blocks the blood supply through a catheter, endometrial ablation for heavy bleeding, and myolysis, which destroys fibroids with electric current or freezing [2]. Hysterectomy is the only sure way to cure uterine fibroids, and it is a major operation [2].

A good appointment names which of those you qualify for and why the others are ruled out. If the answer to every option is no, ask what would have to change for it to be yes, and ask whether a second opinion would be reasonable. It usually is.

When it is urgent

Go the same day for bleeding that soaks through a pad or tampon every hour for two hours or more, for dizziness or fainting with heavy bleeding, or for sudden severe pelvic pain. Heavy bleeding is the route to anemia, and anemia is the reason many women describe years of exhaustion they had put down to something else [2].

Book soon rather than later for periods that have changed and stayed changed, for pain during sex, or for pressure that is affecting how often you have to pass urine.

What to do next

Bring numbers, not adjectives. How many days you bleed, how many pads or tampons, whether you flood at night, and whether you pass clots.

Then take it to an OB-GYN. Start with Black OB-GYNs, ask for a recent hemoglobin or ferritin result, and ask which uterus-sparing option you are a candidate for before any date for surgery is discussed.