Uterine Fibroids
Also known as: Uterine leiomyoma, uterine myoma, fibroid tumors
Up to 80%
Of Black women develop fibroids by age 50
Overview
Uterine fibroids (leiomyomas) are noncancerous smooth-muscle growths of the uterine wall that range from pea-sized seedlings to grapefruit-sized masses. They are the most common uterine tumors and the leading indication for hysterectomy in the United States. Many fibroids cause no symptoms; others produce heavy or prolonged menstrual bleeding, pelvic pain, urinary frequency, and complications during pregnancy. Estrogen and progesterone appear to fuel fibroid growth, which is why fibroids typically shrink after menopause. Genetics, environment, and race are all significant risk factors — Black women are disproportionately affected at every level of disease severity.
How Uterine Fibroids affects Black patients
Black women develop fibroids at two to three times the rate of white women, begin developing them earlier (often in their 20s and 30s), and experience larger, more numerous, and more symptomatic tumors. By age 50, up to 80 percent of Black women have fibroids, compared to roughly 70 percent of white women. Critically, Black women are approximately twice as likely to undergo hysterectomy for fibroids — often because uterus-preserving alternatives (myomectomy, uterine artery embolization, focused ultrasound) are less frequently offered to them. ACOG's 2021 Practice Bulletin on uterine fibroids (Bulletin 228) explicitly acknowledges these racial disparities and urges clinicians to counsel all patients about the full range of treatment options before recommending hysterectomy.
Symptoms
- Heavy or prolonged menstrual bleeding, sometimes passing large clots
- Pelvic pressure, fullness, or pain
- Painful intercourse
- Frequent urination or difficulty fully emptying the bladder
- Constipation or rectal pressure
- Low back or leg pain
- Iron-deficiency anemia from chronic blood loss
- Difficulty conceiving or recurrent pregnancy loss
When to see a doctor
Schedule an evaluation for heavy bleeding requiring more than one pad or tampon per hour for several consecutive hours, bleeding between periods, pelvic pressure or pain interfering with daily activities, unexplained iron-deficiency anemia, or difficulty becoming pregnant.
Seek emergency care for sudden, severe pelvic pain, which may indicate fibroid degeneration (loss of blood supply) or torsion of a pedunculated fibroid.
Screening
No population-wide fibroid screening program is currently recommended. Annual well-woman pelvic exams may detect an enlarged or irregular uterus. If fibroids are suspected, transvaginal or pelvic ultrasound is the first-line imaging test. MRI may be used for detailed mapping before surgery or embolization.
Treatment overview
Options range from watchful waiting (for asymptomatic or perimenopausal women) to medications and surgery. GnRH agonists (leuprolide/Lupron) and antagonists (elagolix/Oriahnn, relugolix/Myfembree) shrink fibroids and reduce bleeding preoperatively or as short-term management. Tranexamic acid and hormonal contraceptives address bleeding. Uterus-preserving interventions include myomectomy (surgical removal of fibroids), uterine artery embolization (UAE), radiofrequency ablation (Acessa), and MRI-guided focused ultrasound (MRgFUS). Hysterectomy is curative but eliminates fertility. Black women who wish to preserve fertility or the uterus should ask specifically about myomectomy and embolization before accepting hysterectomy as the first treatment option.
Questions to ask your doctor
Bring this list to your next appointment.
- How many fibroids do I have, what are their sizes, and where are they located?
- What are my non-surgical options given my symptoms and fertility goals?
- Am I a candidate for myomectomy (uterus-preserving surgery) or uterine artery embolization?
- What are the recovery times and fertility implications of each option?
- What is your hysterectomy rate for patients with fibroids like mine?
- Can you refer me for a second opinion before we proceed with any major intervention?
- Is focused ultrasound (MRgFUS) available at your center or nearby?
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This content is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you are experiencing a medical emergency, call 911 or your local emergency number immediately.