We need to talk about Fibroids and Black Women
The topic of uterine fibroids comes and goes within sister circles and friendship groups in hushed whispers, but when are we going to have an open conversation about this often debilitating condition that on average affects Black women twice as much as women from other ethnic groups?
A number of celebrities such as Lupita Nyong’o, Venus Williams and FKA Twigs have spoken up about their experiences in recent years.
This is helpful because it demystifies the condition and encourages others to speak up and seek medical help. In the spirit of doing our bit on Black Skin Directory, we spoke to GP and leading Women’s Health advocate Dr Aziza Sesay for all the facts.
Fibroids 101
Black women are 2-3 times more likely to be diagnosed with fibroids. Around 60% of Black women have fibroids by age 35, and up to 80% by age 50.
Fibroids tend to develop at an earlier age in women of African descent, often in their 20s and 30s, compared to women of other racial backgrounds.
We tend to have multiple and larger fibroids and worse symptoms - therefore, the impact of fibroids is worse overall due to the severity of symptoms
We tend to have delayed diagnosis and often face a higher risk of recurrent fibroids and complications (2-3 times more likely)
We are affected by fertility issues more commonly attributed by these fibroids
We are likely to have radical surgical interventions like hysterectomies.
Dr Aziza Sesay
Common fibroids symptoms amongst Black women
Heavy and longer periods (Heavy periods are those where bleeding through clothes or bed sheet occur, needing to change period products every hour, passing clots bigger than the size of a 10p or quarter coin etc and longer periods are those that last more than 7 days) - these are NOT normal but quite common amongst Black women who sadly perpetuate this narrative as normal, endure and persevering with these symptoms and sadly do not seek help early.
Anaemia symptoms due to the heavy periods - tiredness, fatigue, chest pain, shortness of breath, dizziness, fainting, pica, cold hands and feet, brittle nails and hair, paler skin and more.
Severe pelvic pain and period cramps. Sometimes the pain is felt even outside of periods eg due to pressure symptoms felt from larger fibroids or where they are located and where they are pushing into.
Abdominal swelling and bloating due to the size of the fibroid protruding outwards - some even look as though they are pregnant due to the size.
Urinary symptoms like needing to urinate more even if only a small amount comes out at a time and unable to empty bladder fully often due to the fibroid pushing against the bladder or pushing against the urethra (tube that carries urine to the outside from the bladder).
Constipation or bowel symptoms - similarly if the fibroid is pushing against the bowel they may cause these symptoms as well as some digestive issues.
Painful sex especially if fibroid is near the cervix or vagina.
Infertility - if the fibroids distorts the shape of the womb making implantation unlikely or increasing the risk of miscarriage. If the fibroid pushing against and blocks the fallopian tube then sperm cannot meet the egg to be fertilised.
Pregnancy complications such as early labour, C-sections and breech presentation of the baby.
BSD: Why are there disparities between Black women and other ethnic groups for fibroids?
AS: The short answer is we don’t know for sure. We need more research for this. The fact is that women’s health research funding only accounts to 1-2% excluding cancer. When intersectionality such as ethnicity is added, this number decreases further. However, there are some factors that are believed to contribute including:
Genetics - they tend to run in families
Chronic Inflammation and stress such as that experienced from racism and societal pressures overall increases inflammatory markers in the body which may contribute to fibroid growth.
Hormonal factors - Fibroids are hormone dependent specifically oestrogen but also progesterone. Their growth is influenced by these hormones, the higher they are, the more they tend to grow. Research suggests that African-American women tend to have higher levels of estradiol (a type of estrogen) and progesterone compared to white women. Also, Black women tend to start their periods younger and research has also shown that earlier periods are associated with an increased risk of fibroid development and greater fibroid burden. Some of this is thought to be due to the longer exposure to reproductive hormones from a younger age. There is also some research that say Black women are more sensitive to oestrogen based on how we process the hormone and our receptor sensitivity, though more research is needed.
Exposure to chemicals: There is some research which has shown an association with chemical relaxers/straighteners and fibroids. It is said that women who used hair relaxers at least seven times a year had a 1.4 times higher risk of developing fibroids than those who did not use these products. Also the use of daily products such as plastics, personal care products and cosmetics which contain endocrine disrupting chemicals (EDC) - BPA and phthalates - cause hormonal disturbances which are linked to fibroid growth.
Dietary factors such as having more processed and red meat, low fibre diet, low vitamin D are thought to increase fibroid risk. Obesity too - Black women have a higher rate of obesity compared to other racial groups, and obesity is strongly associated with an increased risk of fibroids.
Delayed diagnosis and dismissal - Black women have said that their symptoms are often dismissed by healthcare professionals and this can lead to delays in diagnosis so treatment is late and require extensive intervention. It means they endure symptoms for longer, deal with complications and are diagnosed at later stages where fibroid growth would have progressed. But there is also the lack of health literacy within these communities as well as cultural nuances and beliefs - some who believe and are taught that heavy painful periods are normal, especially if they run in families. Therefore, they do not seek help early enough and again endure symptoms of fibroids which progress and cause further symptoms attributing to the disproportionate experience Black women face. They are then diagnosed with fibroids at a later stage. This is precisely why education is so key.
There is also evidence that socioeconomic factors, medical bias and systemic racism also play a role in the higher rates of fibroids development and management in Black women
BSD: In terms of lifestyle and diet, what advice would you give to women living with fibroids?
AS: Lifestyle and dietary changes can help in managing fibroids in terms of symptoms, reducing their growth and improving overall well-being. However, they do not ‘cure’ fibroids as is sometimes claimed online. Simple advice include:
Taking vitamin D supplements daily - as Black women we tend to have lower vitamin D levels. One of the reasons include our skin tone, we do not absorb vitamin D as well from the sun. Some people find magnesium helpful too but it's worth discussing with your healthcare professional first.
Consider anti-inflammatory diets such as fruits and vegetables, healthy fats like avocado and olives and some herbal teas like ginger, turmeric or green tea; chamomile tea may help with cramps. Avoid alcohol, processed foods, red meat, excess dairy, refined sugar (eg. cakes, fizzy drinks), and caffeine. Ensure good hydration so drinking at least 2 litres of water daily and increase fibre intake in diet.
Maintain a healthy weight
Don’t smoke or vape!
Exercise - at least 150 minutes of moderate exercise a week according to the NHS
Relieve stress - exercise, yoga, meditation, journaling, good sleep hygiene and counselling where appropriate as having fibroids can really have an effect on an individual’s mental health
BSD: How do fibroids affect a woman’s reproductive health, particularly if she wants to have children but hasn't yet?
AS: Fibroids can have an effect on fertility depending on their size, location, how many there are and the type. It is said they can cause hormonal disruptions which can have an effect on fertility and pregnancy as well.
If they are large or block the fallopian tube or cervix it means the sperm cannot meet the egg so fertilisation does not occur.
If they distort the shape of the womb, they can affect implantation from occurring at all or adequately which can lead to miscarriages.
If they are big and take up space then they will not allow for the pregnancy to grow appropriately which can lead to miscarriages and pregnancy complications too.
They can interfere with the blood flow to the womb for example by blocking the blood vessels. This can have an effect on the placenta and its development and subsequently the developing fetus too.
They may cause pregnancy complications like miscarriages, preterm and breech births. They can affect the quality of uterine contractions during labour but also induce early labour by causing contractions. They can grow and put pressure on the cervix which may cause something called cervical insufficiency, a condition where the cervix begins to dilate and open prematurely which could lead to miscarriage or preterm birth
Having said all of this, women can still go on to conceive naturally and have successful pregnancies despite being diagnosed with fibroids. It is important for women who want to have children but have fibroids to seek support from their doctors early to monitor fibroid growth and consider treatment options such as having a myomectomy (surgical removal of fibroids) to improve their chances of conceiving and having a healthy pregnancy if warranted.
BSD: What do you think is the greatest misunderstanding people have about fibroids?
AS: There are many myths and misconceptions but the biggest misunderstanding is that fibroids always cause symptoms. They don’t! Many women who have fibroids don’t even know they have it and some are incidentally found during routine pregnancy ultrasound scan! In fact, it is said that up to 50% with fibroids don’t experience any noticeable symptoms.
So yes, fibroids are very common (around 80% of women of reproductive age will develop fibroids at some point in their lives), but they do not always cause symptoms or complications. This is why it is important to remember that every woman is different - it is not one size fits all and managing fibroids should be personalised based on their individual symptoms, concerns, needs and health goals.
Bonus myth - surgery is the only treatment option for fibroids. It is NOT! There are many other options. It is not usually the first option that should be given either so please be sure to seek a second or third or fourth opinion if you are concerned or given only one option. You are in control and should be able to make an informed decision. Always advocate for yourself. :)
BSD: Women with fibroids often feel very alone and it can help to know about the experiences of others. Do you have any personal experiences?
AS: I found out I had a fibroid incidentally. I did not have symptoms and it was a routine scan which was done for something else which led to me finding out. I panicked because fibroids are common in my family, as is infertility due to them, sadly. Fortunately, I was able to conceive naturally twice (I am blessed with 2 children). However, I did have some pregnancy complications due to the location of the fibroid which meant that I needed more regular serial scans to ensure the baby was growing well. There was also a concern about the need for a C-section with my second baby but I did end up delivering vaginally with the use of forceps.
I have family members and friends with fibroids who have conceived through IVF, some who after having myomectomies conceived and others who have also conceived naturally without any interventions - all of whom have successfully given birth. I am saying this to give reassurance to those trying to conceive that there is hope. Having fibroids does not automatically mean you will not ever conceive naturally or through assisted conception. It is very important to stay informed, familiarise ourselves with our options, advocate for ourselves and lead a healthy life to improve our chances. Knowledge is power!
Interview compiled by: Crystal Angelee