# The Fibroid Conversation We Need to Have
Your grandmother probably had them, your mother might have them, and the statistics say there's a real chance you will too — but nobody's talking about why, or what that actually means for your life.
There's a particular silence in Black women's health conversations when it comes to fibroids. We'll talk about everything else — the obstetric violence, the maternal mortality rates, the way our pain gets dismissed — but somehow the fibroid conversation stays quiet, relegated to whispered exchanges with aunties or hushed comments after a disappointing ultrasound. The thing is, silence is a choice someone else is making for us. It's time we choose differently.
If you're Black, the probability that you'll develop uterine fibroids in your lifetime sits at roughly 80% compared to about 70% for white women. And if you develop them at all, you're likely to develop more of them, and earlier. Three times more likely to need intervention, in fact. That's not a coincidence. That's not just biology. That's a combination of biology we still don't fully understand, healthcare access disparities that are well-documented, and a medical system that's historically moved slower to innovate when the primary beneficiaries would be women of color.
What makes this particularly hard is that fibroids exist in this strange middle space of the medical world — they're benign, so there's less research urgency. They're not immediately life-threatening, so they get deprioritized. And they fall squarely into reproductive healthcare, an area where Black women's voices have historically been least centered. The result? You're left to navigate them often alone, with limited options presented to you, and a lot of misinformation floating around.
Why this matters for us
When we talk about fibroids and Black women, we have to name what's actually happening. The higher prevalence isn't because our uteruses are fundamentally different or weaker. The disparity exists because of the interplay between genetic predispositions that exist in Black populations (particularly related to vitamin D, estrogen metabolism, and growth factor sensitivity) and systemic barriers that delay diagnosis and treatment.
Black women tend to seek care later in the fibroid journey, not because we're negligent about our health, but because we navigate healthcare with good reason being skeptical. A fibroid gets discovered during a routine ultrasound for something else entirely. You mention heavy bleeding during your period, and your doctor says "let's monitor it." Years pass. The symptoms worsen. You finally get imaging again, and now the fibroid has grown significantly — and suddenly the options feel more limited, more invasive, more urgent.
There's also an economic piece here that's not abstract. If you work a job without paid time off — and Black women are overrepresented in service and care work — you can't afford to take time for a myomectomy recovery, even if that procedure would be ideal for you. You can't afford to miss work for multiple specialist appointments. You can't afford the out-of-pocket costs for the newer, less invasive procedures. So you manage the symptoms. You change your life around heavy periods. You schedule your life around pain. And you call it normal.
It's not normal. It's what's available to you within systemic constraints.
What the research says
Here's what we know: A landmark study from the Journal of Women's Health found that Black women have significantly higher odds of having multiple fibroids (rather than a single fibroid) and are more likely to experience severe symptoms from those fibroids. The same research indicated that Black women were less likely to be informed about all available treatment options — a difference that wasn't explained by symptom severity or insurance status alone.
The biological piece matters too. Research published in Reproductive Sciences has identified that certain polymorphisms in genes related to estrogen receptor signaling and angiogenesis (blood vessel formation) are more prevalent in people of African descent. This means fibroids may grow faster and respond differently to treatment. Additionally, vitamin D deficiency — which is more common in Black women due to melanin's effect on vitamin D synthesis and systemic barriers to supplementation — appears to correlate with higher fibroid risk and severity. Women with vitamin D levels below 20 ng/mL showed significantly higher fibroid burden in multiple studies.
The treatment gap is real too. Black women are less likely to be offered minimally invasive options like uterine artery embolization or myomectomy, and more likely to be counseled toward hysterectomy as a first-line solution. That matters, especially if you want to preserve fertility or simply want to keep your uterus.
What to actually do
Start with documentation. Keep a symptom diary for two menstrual cycles before your appointment. Track bleeding (how many days, how heavy — do you soak through protection?), pain level, and how it impacts your life. This isn't vanity. This is evidence you're bringing to your doctor so they can't minimize what you're experiencing.
Get imaging if you haven't already. A pelvic ultrasound (transvaginal is more detailed) is the first-line imaging. If fibroids are found, ask about MRI. Yes, it's more expensive, but it gives a complete picture of fibroid size, location, and number — which matters for treatment decisions. Many hospitals have financial assistance programs. Ask.
Seek out a gynecologist who specializes in fibroids or reproductive endocrinology. Not all OB/GYNs keep up with the newer fibroid treatment landscape. A specialist will present you with options rather than one solution. Telehealth has made this more accessible — you can see someone outside your immediate area.
Understand your actual options. You have more than you might think. Conservative management (waiting and monitoring) is legitimate if symptoms are mild. Medication — like GnRH agonists or the newer GnRH antagonists — can shrink fibroids or control bleeding without surgery. Myomectomy (surgical removal of the fibroid while preserving the uterus) is appropriate for many women. Uterine artery embolization blocks blood flow to fibroids, shrinking them. Hysterectomy is an option, but it should be your choice for your reasons, not the default.
Invest in vitamin D. Get your level checked (ask for serum 25-hydroxyvitamin D). If it's low, supplement. Most Black women need somewhere between 2,000-4,000 IU daily, though some need more. This isn't a cure, but emerging evidence suggests it supports overall reproductive health.
Consider working with a functional or naturopathic practitioner alongside your conventional care. Anti-inflammatory practices matter — reducing processed foods, increasing omega-3s, managing stress. These won't dissolve fibroids, but they can reduce symptoms and support your body's baseline health.
Labs to ask for
- Pelvic ultrasound (transvaginal preferred for accuracy) - Pelvic MRI (if fibroids are confirmed and you need detailed mapping for treatment planning) - Complete blood count (CBC) — fibroids cause heavy bleeding, which can lead to anemia - Serum ferritin and iron studies — especially if you're bleeding heavily - Vitamin D (25-hydroxyvitamin D) — baseline and periodic monitoring - Thyroid panel (TSH, Free T4) — thyroid issues can worsen fibroid symptoms and fertility impacts
The conversation we deserve
Sister, you deserve to know what's happening in your body without shame, without dismissal, and without pressure to choose options that don't align with what you actually want. You deserve a healthcare provider who sees you as the expert on your own experience and who presents you with real choices, not ultimatums. You deserve to know that what you're experiencing is real, that the statistics exist for reasons that have nothing to do with your body being "wrong," and that you have agency here.
Fibroids are common in your community for reasons that are part biology and part systemic. The path forward isn't to accept limited options or to suffer quietly. It's to get informed, to advocate clearly for yourself, and to find providers who actually see you. You're worthy of that. 🤎