The Health Disparities of Uterine Fibroids for African American Women

Some women’s pelvic health conditions are more common than others.

Urinary incontinence, for instance, and pelvic organ prolapse, are among the most prevalent pelvic floor issues. But there are pelvic conditions that don’t involve a weakening of the pelvic floor, such as uterine fibroids and endometriosis. When it comes to fibroids specifically, racial disparities have been found.

Uterine fibroids—also known as leiomyomas—are the most common benign pelvic tumors in women. They are also more common and more severe among African American women.¹

Let’s explore the health disparities of uterine fibroids for African American women, which has been described as a public health issue. 

Understanding Uterine Fibroids

If you have uterine fibroids, you’re not alone. These common growths of the uterus often appear during your “pregnancy years,” when you are able to conceive. They aren’t cancer, almost never turn into cancer, and aren’t linked with a higher risk of other types of cancer in the uterus. 

Fibroids can vary in number and size, ranging from one fibroid to many, and from some that are too small to see, to those that can be as big as a grapefruit—or larger. In fact, in some cases fibroids can grow large enough to distort your uterus or abdomen. 

Fibroids are often grouped by their location in the pelvis: intramural fibroids grow within the muscular wall of the uterus; submucosal fibroids bulge into the uterine cavity; and, subserosal fibroids form on the outside of the uterus.²

There are various treatments available, depending on the location, number and size of fibroids, as well as your symptoms. That includes medical therapies, and minimally invasive surgery. However, a hysterectomy—or surgical removal of the uterus—remains the most common intervention. In the United States, fibroids are the top reason for hysterectomies.¹

What are the Symptoms of Uterine Fibroids?

Many women have uterine fibroids sometime during their lives, and may not even realize they have them, because they do not always create side effects. In fact, it’s estimated that only 20-50% of all women with fibroids experience symptoms, and since screening for fibroids is not routinely performed, the true number of women with fibroids is difficult to know for certain.¹ 

Here are some of the common symptoms of uterine fibroids:²

• Heavy menstrual bleeding, painful periods, longer periods or more frequent periods.
• Pelvic pressure or pain.
• Frequent urination or trouble urinating.
• Growing stomach area.
• Constipation.
• Pain in the stomach area or lower back.
• Pain during sex.

Who is at Risk of Uterine Fibroids?

There seem to be several factors that impact a woman’s risk for having uterine fibroids, including age, as older women seem to be at higher risk than younger women. Fibroids usually grow in women when they are of childbearing age, and research suggests that they may shrink after menopause. 

Other risk factors include:³

• being obese
• having a family history of uterine fibroids
• suffering from high blood pressure
• having no history of pregnancy
• a deficiency in Vitamin D
• consumption of food additives
• use of soybean milk

There’s another big risk factor—the reasons for which are not well understood— impacting African American women. 

Fibroids disproportionately affect the African American population.

Here’s what we do know:

1. Fibroids are more common and more severe among African American women, and researchers understand little about what causes this disparity.¹

2. For African American women, fibroids typically develop at a younger age, grow larger, and cause more severe symptoms.³

3. The size and growth rates of fibroids are greater in African American women.¹

4. African American women are likely to have different responses to medical treatment than white women.¹

5. African American women are more likely to undergo surgical intervention than other racial groups.¹ 

6. Research also shows that fibroids are more likely to shrink in postmenopausal white women than in postmenopausal black women.³ 

Health Disparities of Uterine Fibroids for African American Women

African ancestry is considered a key risk factor for the development of fibroids. When it comes to overall pelvic health, the Society for Women’s Health Research reports that African American women with uterine diseases tend to experience worse clinical outcomes than their white counterparts.⁴ 

The issue is complex, as there are disparities in uterine health that may extend beyond genetic, racial, and ethnic factors, to social determinants of health like economic stability, and disparity in diagnosis and treatment.⁴ 

Here’s what the Society reports:

• About 70% of white women and 80-90% of black women will have uterine fibroids by the age of 50.^4,5 
• Black women tend to develop fibroids at a younger age, have larger fibroids, and have fewer days between periods.⁴
• 42 out of every 1,000 women are hospitalized annually because of fibroids, but African American women have higher rates of hospitalization, surgical removal of fibroids, and hysterectomies compared to white women.⁴
• African American women are twice as likely to have hysterectomies for benign conditions despite the available options for minimally invasive treatments.⁴

Other Impacts of Fibroids

Fibroids may also adversely affect reproductive health, fertility, success with assisted reproductive technology, and birth rates. Since fibroids are more common in African Americans compared with women of other races, they can present major health problems among African American women.

Another factor is how socioeconomic status and race influence access to appropriate health care. In the United States, access to some therapies may be directly affected by insurance status, as well as cost of the procedure.

Here is an example:

• When hysterectomies are performed, white women and women of other racial groups with private insurance are more likely to undergo laparoscopic procedures.
• African Americans, Hispanics, and women with Medicare coverage are more likely to undergo abdominal procedures, even for the same type of problems.

There’s also a financial impact. The annual cost of uterine fibroids in the United States, which includes direct medical costs as well as lost work-hour costs, is estimated to be  approximately $34.4 billion. The annual cost of fibroid-related care, which includes surgery, hospital admissions, outpatient visits, and medication, is estimated to be $4.1 to 9.4 billion.¹ 

It’s also estimated that patients suffering from fibroids may spend up to $25,000 out of pocket per year after diagnosis and surgery, but these costs may be underestimated, and they do not encompass all uterine health conditions.⁴

Moving Forward on Fibroids Treatment 

Information on the genetic basis of fibroids in African American women has been sparse, but there is hope. In 2024, a National Institutes of Health award was provided to support a new center at the Mayo Clinic to deal with health disparities in uterine fibroid treatment.

The goals of this center are to conduct further study to understand the health disparities in diagnosis and treatment of fibroids, and improve care for all women, especially African American women. 

Led by a Mayo Clinic gynecologist and researcher, doctors at the center want to better understand the barriers to wider use of conservative nonsurgical treatment options. They also wish to diagnose patients with fibroids earlier, identify barriers that make it difficult for patients to receive care, and increase communication between patients and healthcare providers.

The center will collaborate with researchers at the Fibroid Foundation as well as two other medical centers.⁵

See A Doctor

Whether or not you suspect you have fibroids, it’s important to see a doctor if you have pelvic pain that doesn’t go away, heavy or painful periods that limit what you can do, or spotting or bleeding between periods. Seek medical attention immediately if you have severe bleeding from the vagina or sharp pelvic pain that comes on fast.²

Use our Physician Finder to find a doctor near you with expertise in women’s health who can answer your questions about uterine fibroids. You can also seek guidance on other women’s pelvic health issues, like pelvic floor muscles exercises, a positive addition to your daily regimen at any age. You can use a tool like the Gynesis pelvic floor trainer shorts, which use exclusive Multipath Technology to deliver targeted muscle stimulation to strengthen your pelvic floor. It’s a solution that has been cleared by the FDA and is designed to be comfortable for everyday use. Research has proven that pelvic floor exercises help keep pelvic floor muscles “fit,” and are a positive benefit for all women.