For years, Angela Landon has had unbearable cramps during her menstrual cycle. She figured it was normal, but when she started gaining weight in her midsection – despite her extensive workout regimen – she knew it was time for a doctor’s visit.
“I looked like I was eight months pregnant,” she said. “It was embarrassing when people would ask me when my baby was due.”
An MRI revealed that Landon had multiple uterine fibroids — noncancerous growths in the uterus — the size of cantaloupes.
“I didn’t know much about fibroids, but any type of growth is cause for concern, so I was scared,” she said.
Despite being a common condition, particularly for Black women, uterine fibroids are rarely discussed. According to the Black Women’s Health Initiative, by age 35, about half of Black women have had them, and by age 50, 80% of Black women have them, compared to 70% of white women.
Most cases require no treatment, but they can cause weight gain, heavy periods, frequent urination or pelvic pain, and they may require surgery.
What causes fibroids?
No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be hormonal (affected by estrogen and progesterone levels) or genetic (runs in families).
“It’s mostly genetic,” said Anitra Beasley, associate professor at Baylor College of Medicine. “So, there’s nothing that you can do with respect to diet, exercise, things like that. You can’t change whether you have fibroids by lifestyle or medication, the same way you can’t change your risk for heart disease or diabetes. They’re either there or they’re not.”
Most doctors do imaging tests to confirm that a woman has fibroids. These are tests that create a “picture” of the inside of your body without surgery. Some doctors may find that you have fibroids when conducting a routine pelvic exam to check your uterus, ovaries and vagina. The fibroid might be compared to fruits, nuts or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or a volleyball.
While all women are at risk for developing uterine fibroids, Black women are disproportionately affected, with one study showing that Black women are three times more likely to develop them than white women and that Black women are more likely to need surgical treatment. Fibroids can cause disabling problems for Black women. They are more likely to have severe pelvic pain and anemia (a low red blood cell count) due to heavy bleeding.
And it’s an even bigger problem for Black women with Sickle Cell Disease (SCD.) HoustonFibroids.com reported that a recent study in Academic Radiology found that 61.2% of Black women with SCD had fibroids while SCD-free Black women have a lower 52.1% rate. Moreover, a recent study in Environmental Health Perspectives suggests larger fibroids may be related to early formula feeding for babies. The study showed that Black women who were fed with soy-based formula as babies saw a 32% increase in fibroid diameter, and a 127% increase in the total fibroid problem.
According to the American Psychological Association, obesity is more common among Black people in the U.S. than other groups, which could also explain the higher prevalence of fibroids in Black females since researchers believe there may be a link between nutrition, body weight, and fibroids. According to www.HealthyWomen.org, “Eighty percent, or four out of five Black women are considered overweight or obese according to the U.S. Department of Health and Human Services Office of Minority Health. Black women also have the highest rates of obesity or being overweight compared to other groups in the United States, with 56.9% classified as obese.”
Suffering in silence
When Landon finally decided to get vocal, she learned that the majority of the women in her life dealt with fibroids, too.
“I was stunned to learn that every one of my mother’s sisters had issues with fibroids. Then when I talked to the women in my church and sorority, more than half of them dealt with fibroids. I couldn’t help but wonder why we were all walking around here enduring all of this in silence. I wish that we were open about this. It probably could’ve saved me a lot of worry and grief,” she said.
Because most Black women have fibroids at some point during their lives, the symptoms they experience might seem “normal” for them. Many girls are raised to believe painful, heavy periods are just a part of life.
“Too many Black women do not have an accurate idea of what normal really is. Women suffer needlessly before seeking treatment for their fibroids,” said Tammy Boyd, JD, MPH, chief policy officer and counsel for the Black Women’s Health Initiative. “Disparities in diagnosis and care of uterine fibroids result in Black women waiting longer than white women before seeking treatment: normally four years of more. By any measure, these statistics and outcomes are dire and indicative of a pressing public health crisis.”
There’s no way to prevent uterine fibroids, so health experts say the best thing for women to do is to get regular checkups and know about the symptoms should they arise. Only 35 to 40% of women with fibroids will have symptoms. Aside from surgery to remove fibroids, doctors may prescribe oral contraceptives or ibuprofen to ease symptoms.
Black women are at least twice as likely as white women to remove their uterus through a hysterectomy. When symptoms are severe, fibroids are the leading reason for hysterectomy in the United States. Black women have higher rates of hospitalization for fibroids compared with white women. They are two to three times more likely to undergo hysterectomy (removal of the uterus by surgery) for fibroids and seven times more likely to have a myomectomy (surgical removal of one or more fibroids).
Doctors say a decision to have a hysterectomy is one that should not be taken lightly. For schoolteacher Dionne Blacknell, it was one that has changed her life.
“After bleeding three months straight because of my fibroids, an ablasion surgical procedure that only worked for about a month, I decided to have a complete hysterectomy. It’s the best decision I ever made,” said Dionne Blacknell.
Beasley said she urges her patients to seek a hysterectomy as a last resort, unless you’re past the childbearing years.
“Nothing bad happens if the fibroids are non-cancerous,” said Beasley. “It’s not like a fibroid is going to change into something that’s cancerous. But if you are having symptoms from your fibroids, those symptoms could get worse and may make it harder to treat. I tell my patients if your fibroids aren’t bothering you, they’re not bothering me. I think that it’s really important that people realize that fibroids aren’t something that is in itself, just dangerous by themselves. But if you are having symptoms than it’s really important to advocate for yourself so that you know you can get the treatment that’s most appropriate for you early on.”
While a hysterectomy may be the proper treatment for certain patients, the Food and Drug Administration recently approved a new medication to treat heavy bleeding related to fibroids. And there are other advances in the field making it possible to shrink the growths. Newer methods known as “minimally invasive surgery” use small surgical incisions and small surgical instruments to remove fibroids while preserving a woman’s ability to have children. Even hysterectomies can be done using a less invasive technique, call laparoscopic hysterectomy! (A laparoscope is a thin tube with a very small camera that is inserted through a small incision into the abdomen that allows the doctor to see pelvic organs.) These minimally invasive techniques reduce the risk of life-threatening complications and shorten the time needed for recovery after surgery.
“No one ever or rarely needs a hysterectomy. It’s whether you want a hysterectomy to manage your symptoms. It’s very different if you’re having a hysterectomy at 50 and you’re having a hysterectomy at 21,” Beasley said.
Just the facts
- Fibroids account for about 39% of all annual hysterectomies.
- About 60% of Black women develop fibroids by age 35. That number increases to more than 80% by age 50.
- About 25% of all Black women have fibroids between ages 18 and 30. Only about 6% of white women have fibroids in this age group.
- Black women are 2 to 3 times more likely to experience recurrent fibroids and associated health issues.
- Only about 1 in 1,000 fibroids (that’s 0.1%) are cancerous.
*Source: American Journal of Obstetrics and Gynecology, U.S. Department of Health & Human Services’ Office on Women’s Health.
Factors that can increase a woman’s risk of developing fibroids.
Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
Family history. Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
Ethnic origin. African-American women are more likely to develop fibroids than white women.
Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
Some of the ways doctors treat fibroids.
Radiofrequency ablation uses heat to destroy fibroid tissue without harming surrounding normal uterine tissue. The fibroids remain inside the uterus but shrink in size. Most women go home the same day and can return to normal activities within a few days.
Anti-hormonal drugs may provide symptom relief without bone-thinning side effects.
Hysterectomy is the total removal of the uterus.