Disclaimer: This article is written by Chris Craft of Nao Media. He is not a trained physician and does not give medical advice in this article. Please consult a qualified medical professional with any questions.
Fibroids and the symptoms they cause have historically given black women more problems than women of other ethnic groups. This article will help black women and their loved ones learn what fibroids are, their symptoms, and solutions for treating them.
Why Do Fibroids Affect Black Women?
Uterine fibroids (also called leiomyomas or myomas) are noncancerous growths of the uterus. These benign tumors can be as small as a pea or as large as a cantaloupe. While they can occasionally occur individually, the vast majority of women have multiple fibroids. They often appear during a woman’s childbearing years when her estrogen levels are higher.
According to the Office on Women’s Health, upwards of 80 percent of women develop uterine fibroids during their lifetime. Fibroids are most commonly diagnosed in women aged 30 to 50 years old, however women of color tend to get fibroids earlier in life. They also tend to have bigger and more numerous fibroids.
In asymptomatic women, they may be detected on routine well-woman exams. Other times fibroids may be noted on ultrasounds of the abdomen or pelvis.
The chance of developing uterine fibroids increases as women grow older, but they are usually not an issue once a woman is in menopause. However, for some postmenopausal women they will continue to cause symptoms (i.e. increased urinary frequency, nocturia) which may require treatment.
One out of three women with uterine fibroids experience symptoms during their lifetime.
While fibroids can go undetected, sometimes they cause symptoms that make life very difficult.
Fibroids typically cause the following symptoms:
- Heavy and lengthy bleeding during periods, passing clots
- Pain or pressure in the pelvic region which can involve the lower back, buttock, and legs
- Increased urinary frequency and waking up at night to urinate
Depending on the location of the fibroid, symptoms can also include:
- Pain during intercourse
Black Women and Fibroids
Black women and fibroids have an unfortunate link. Black women aged 25-45 years old are more likely to experience fibroids and their symptoms than other racial groups. Studies have shown fibroids to be at least three times more likely among black women.
While in general, 20 percent of women older than 35 have fibroids, this is statistically much higher with black women.
One study showed a peak in fibroids between ages 40 and 44 years while other studies suggest black women experience fibroids at an even earlier age. In addition, black women can experience faster fibroid growth. They are also less likely to have their fibroids regress after pregnancy and delivery. All of this can impact a woman’s general quality of life.
According to another study, black women were 77 percent more likely to miss work due to fibroid symptoms.
Because of these facts, black women are more likely symptomatic, and more likely to undergo surgery for their fibroids.
Important Points for Black Women
Science and medicine have yet to explain why black women are more prone to fibroids. However, realizing the greater occurrence of fibroids in black women, they should be aware of common symptoms, general facts, and possible preventive measures.
If you have a close family member (your mother in particular) with fibroids, you are at an increased risk of developing them. Be alert for fibroid symptoms at a younger age, and understand your fibroids might grow more quickly. If you are considering starting a family, or struggling to conceive, know that fibroids have been linked to infertility.
While you might be more prone to fibroids, a healthy diet and lifestyle can help prevent fibroids from developing more quickly.
- Obesity has been linked to fibroids; obese women are 2-3 times more likely to develop fibroids. This is because estrogen is stored in fat.
- Hormone rich foods like red meat, ham, non-organic chicken, and dairy have been linked to fibroids.
- Flavonoids are part of a diverse group of phytonutrients and are responsible for the vibrant color of fresh fruits and vegetables. Flavonoids block an important enzyme in estrogen production and therefore can help prevent fibroids and their growth.
Lastly, an NIH study in 2012 suggested a link between hair relaxer use and fibroids in black women. The main ingredient in hair relaxers is biochemically almost identical to estrogen.
If you do find yourself with uterine fibroids and experiencing symptoms, you will discover that there are many treatment options, including both surgical and nonsurgical options. These numerous options can be very confusing and frustrating for women to really know what their best option is.
It is often helpful to get an opinion from different medical specialists.
For example, Uterine Fibroid Embolization (UFE) is an excellent, nonsurgical outpatient treatment option that is performed by Interventional Radiologists who are physicians specifically trained in minimally invasive nonsurgical procedures.
What Happens If Fibroids Are Left Untreated?
Women who have fibroids without symptoms typically leave them untreated. However, there are over 1 million women in the United States who are currently suffering with symptoms from uterine fibroids. These women are untreated because they were only offered a surgical option by their Gynecologist (most often hysterectomy) and they do not want to undergo surgery.
These women suffer in silence unnecessarily as they only know of surgical options that just don’t work for them. Many studies have shown that most women suffering with uterine fibroids do not hear about a nonsurgical option (like UFE) from their Gynecologist who typically give them the surgical treatment options.
A study in the Journal of Women’s Health from several years ago looked at ~1,000 women suffering with fibroids. The average time from diagnosis to treatment was over 3 ½ years and ~25 percent of them waited five years! The main reason for this delay was because the women did not want surgery and were not told about nonsurgical options like UFE.
Fibroid Surgery and Risks
There are two main types of fibroid surgery: removing some of the fibroids surgically (myomectomy) or removing the uterus (hysterectomy). Both of these procedures are performed in the hospital under general anesthesia, and both have a number of risks associated with them.
Before agreeing to any of the surgical options, make sure you not only know about the surgical risks, but also what happens after the uterus is removed.
Simply put, a myomectomy is the surgical removal of one, or more commonly, a number of uterine fibroids. The complexity of the surgery depends on the location and size of the fibroid(s). Usually there are many more fibroids in the uterus than can be safely removed surgically.
This means that typically when the woman wakes up from her myomectomy surgery, she will still have living fibroids in her uterus. Consequently, it is often necessary for women to undergo multiple procedures after the myomectomy. Studies have shown that most women that undergo myomectomy will need another procedure within five years and one-third of women will need another procedure within three years.
While a myomectomy, unlike a hysterectomy, still preserves the uterus, side effects can include:
- Heavy bleeding requiring transfusion. This can be especially problematic if the patient is already anemic due to heavy menstrual cycles.
- Injury to critical organs in the pelvis (i.e. bowel requiring drainage and colostomy bag, bladder or ureter requiring drainage and urinary diversion through tubes and bags).
- Need for c-section delivery. Due to the fear of uterine rupture, the vast majority of surgical myomectomy patients will require a cesarean delivery if they become pregnant.
- Scar tissue: Surgery causes keloids and scar tissue in the pelvis which can cause future complications (i.e. bowel obstructions, fallopian tubal blockages and infertility).
Hysterectomy is the 2nd most common surgery performed in the United States. This is rather surprising as half of the population (i.e. men) don’t even have a uterus. The most common reason hysterectomy is performed is not for uterine cancer–which would be appropriate. It is done for benign uterine fibroids.
For many women, a hysterectomy is the only treatment option given; particularly if she is not interested in future fertility. While some fibroids can be removed with a vaginal hysterectomy or robotic, laparoscopic hysterectomy, most fibroid sufferers have larger fibroids that will require an abdominal incision (i.e. open hysterectomy).
Although a hysterectomy is a common surgery, any abdominal surgery carries risks and a total hysterectomy can have potential long-term effects which include:
- Immediate or early menopause
- Scar tissue causing bowel obstruction, infertility
- Weakened pelvic muscles and ligaments; leading to loss of control of bladder and/or bowel
- Sexual dysfunction (i.e. loss of libido, loss of orgasm)
In addition, research has linked hysterectomies in women under the age of 50 with an increased risk of cardiovascular disease (i.e. increased risk for high blood pressure, heart attack, stroke).
One other very important question to ask your Gynecologist is besides the surgical options being offered, are there any nonsurgical treatment options that would effectively treat the symptoms without surgery?
A Nonsurgical Solution: What Is UFE?
UFE (Uterine Fibroid Embolization) is a minimally invasive, outpatient, non-surgical procedure for the treatment of uterine fibroids. UFE has a high success rate (90 percent) and treats all of the fibroids in the uterus. Because it is non-surgical, it is much safer than the surgical counterparts.
It also has a drastically lower chance of a complication, and the complications post-UFE are much less in severity than those associated with surgery.
Because UFE treats all of the fibroids in the uterus (not just some of them like surgical myomectomy), most women who undergo UFE once will not need another procedure to treat fibroids or their symptoms.
In addition, UFE patients go home the same day as the procedure with just a simple band aid covering the entry site at the top of the right leg (or left wrist). As a result, UFE patients return to work much faster than those women that undergo surgery – typically in one week, compared to two months for surgery!
Importantly, UFE preserves the patient’s fully-functioning uterus–leaving her with the ability to conceive and have a healthy pregnancy and delivery. Births following UFE are typically full-term and vaginal, whereas after most myomectomies they must have a c-section.
How does UFE work?
A specially-trained physician called an Interventional Radiologist uses x-ray to guide a tiny catheter the size of a spaghetti noodle into the specific arteries feeding the fibroids. Particles that are sized for these small vessels are mixed with contrast that can be seen under x-ray and injected until the fibroid branches are completely blocked.
The larger uterine vessels remain open; and therefore, the uterus is completely alive, but the fibroids die. They will then soften and begin to shrink in size. As this occurs, a woman’s symptoms start to disappear.
“As a black female physician who frequently sees black women with atrocious fibroids and insurmountable fears of surgery, I believe it is critically important for us to know about minimally invasive options which can preserve both the uterus and fertility. As a woman, I would prefer an option such as UFE whenever feasible.” – Wanda Guy-Craft, MD
Atlanta Fibroid Center Is Here for You
If you have any questions, contact Dr. John Lipman and his team at Atlanta Fibroid Center.
Dr. Lipman is one of the world’s leading experts in the non-surgical treatment of uterine fibroids. His exemplary training at Georgetown, Harvard, and Yale provided the perfect foundation for his vast experience in Uterine Fibroid Embolization (UFE). He has performed more UFE procedures than any other physician, and patients from around the globe have sought his expertise.