This Q&A accompanies Fibroids: The Reality Behind the Diagnosis
Cover image: Depiction of a lady who has Uterine Fibroids MyUpchar CC BY-SA 4.0
What exactly are fibroids, where do they develop in the body, and how common are they among women? Are there misconceptions about fibroids that you would like to dispel?
Uterine fibroids (also called leiomyomas) are noncancerous (benign) tumors made of smooth muscle and connective tissue that grow in and around the uterus. More than 70% of women will develop uterine fibroids by the age of 50, making it one of the most common gynecologic conditions worldwide. For that same reason, the impact of fibroids on the health of women is too often dismissed and undertreated. Just because fibroids are common, does not mean that they are normal. Whenever the body experiences dysregulation and uncontrolled cellular growth, these changes should be monitored and treated appropriately.
What causes fibroids to develop and grow? We know that hormones such as oestrogen and progesterone play a role, but what do scientists currently understand about the biological processes behind their development?
The cause of fibroids is unknown, but studies have identified various factors that are associated with their development and growth. Mutations in certain genes (e.g., MED12 and HMGA2) have been associated with the transformation of the uterus’ myometrium cells into the fibroid tumors. And yes, estrogen and progesterone help to promote cell growth and thickening of uterine tissue in preparation for pregnancy. This function has also been linked to fibroid growth, which is why fibroids tend to shrink after menopause when these hormone levels decline throughout the body. Other growth factors and changes in the extracellular matrix have been attributed to the rigid fibrous structure of the tumors.
Fibroids present an added complexity in that a woman may have multiple fibroids comprising different genetic mutations, structures, growth rates, and/or triggers. While each of these factors are potential therapeutic targets, one can see how personalized medicine is important for treating the whole person.
Fibroids disproportionately affect Black women, who are more likely to develop them, often at a younger age and with more severe symptoms. What does the research tell us about why this disparity exists? How much of it can be explained by genetics and biology, and how much might be related to environmental, social or healthcare factors?
African ancestry is considered a key risk factor for developing fibroids and Black women have one of the highest lifetime incidences for this disease. Yet, there is a dearth of prospective, clinical, or basic research studies investigating the gaping disparities for this significant population of high-risk patients.
Many of the seminal genome-wide association studies on fibroids have been conducted in countries with few women of African descent or low inclusion when the population is present. However, a recent multi-ancestry GWAS study (J Kim, 2025: https://doi.org/10.1038/s41467-025-57483-5) identified novel risk genes specifically among women of African descent.
Vitamin D deficiency has emerged as a risk factor for uterine fibroids in recent years because of the anti-proliferative role its receptor plays in the uterine lining. Given that people with darker skin color have a higher prevalence of Vitamin D deficiency, this adds to Black women being among those at increased risk for fibroids.
Environmental risk factors are also a significant topic of interest concerning Black women and fibroids. Some studies indicate that exposure to environmental estrogens early in life can increase risk for developing fibroids. So if a woman has spent her life regularly exposed to such chemicals, starting as early as in utero, dysregulated hormone and epigenetic activity by the time a girl reaches puberty can only be expected.
Black women are documented to have increased exposure to endocrine-disrupting chemicals compared to other ethnic groups. While the extent to which these chemicals influence fibroid development is not fully understood, support for their suggested risk is steadily increasing. Phthalates are common in personal care products, and bisphenol A and parabens are used in plastic bottles and food can linings. The grand challenge enters with consumer marketing and socioeconomic drivers for marginalized groups affect access to safer or more expensive products that use fewer EDCs. This is just one example of how health disparities and care gaps can begin to widen exponentially for Black and many other women of color.
What symptoms should women be aware of, and which symptoms might be dismissed as having a “heavy” or “painful” period?
Menstrual bleeding that is heavy and/or irregular can be a sign of fibroids; and some women experience large or painful releasing of blood clots. Bleeding or pain between periods or during intercourse are symptoms of fibroids as well. Pelvic or back pain that hurts enough to disrupt your day is also a sign to consult with your gynecologist. Another challenge women with fibroids might experience is with conceiving and maintaining pregnancy. While fibroids is the primary cause of infertility in 2-3% of women, millions of women living with fibroids do become pregnant and carry their babies to term.
Why can it sometimes take so long for women to receive a diagnosis or treatment, particularly for Black women?
While majority of women will develop fibroids, not all women who have fibroids are notably symptomatic. Fibroids can be easily observed by ultrasound, but such an imaging test is only ordered when a patient complains of symptoms, and approximately 25% of women living with fibroids will experience symptoms bothersome enough to seek medical intervention.
Too often do women dismiss or normalize their menstrual pain, heavy bleeding, and irregular cycles. My mother always had heavy cycles. My sisters and I all have bad cramps. Ironically, it can sometimes become a badge of courage or honor to be able to press through and endure this lifelong monthly cycle of extreme discomfort and disruption.
Studies report this normalization especially among Black women, which is also compounded with stereotypes and biases that exist among both patients and health care professionals that Black women are stronger or have higher tolerances for pain, delaying the investigation of symptoms that warrant further medical attention.
What treatment options are currently available for fibroids? Could you explain the differences between medication, minimally invasive procedures and surgery, and how doctors decide which treatment may be appropriate for an individual woman?
There are actually a variety of treatment options to address symptoms like heavy bleeding and pain, as well as fibroid growth. Hormonal contraceptives and tranexamic acid are used to reduce bleeding, and the former can also address pain. Other therapeutics target gonadotrophin-releasing hormone (GnRH) receptors to reduce bleeding and/or the size of fibroids. Some work by regulating estrogen and progesterone levels, and others are administered with the hormones to optimize effect.
Current methods to directly remove fibroids require surgical procedures, many of which have minimally invasive developments that only utilize small incisions or access through the vagina. Uterine artery embolization is a procedure that cuts off blood flow to fibroid growths, promoting shrinkage and symptom relief. Ablation procedures (endometrial and radiofrequency) typically use heat or currents to destroy fibroids and surrounding tissue. Similarly, magnetic resonance-guided focused ultrasounds use soundwaves to heat and destroy tissue lesions. Myomectomy procedures (hysteroscopic, laparoscopic, or robotic) are designed to cut out fibroids while leaving the uterus intact. There are also minimally invasive hysterectomy options that can have reduced physical impact and recovery time for patients.
The decision as to which individual or combination of treatments depends on each patient’s specific situation, needs, and health goals. Factors include the patient’s age, lifestyle and family planning goals, the quantity, size, and location of the fibroids, symptoms and their severity, and other health risk factors, to name a few. Because there is no cure or perfect solution to fibroids, it is critically important that treatment plans are researched, discussed, and decided upon as a collaboration between the doctor and patient. Shared decision-making takes time, but it is invaluable to the relationship of trust and communication needed as women navigate their health journey with a chronic condition like fibroids.
Are there ways to prevent fibroids from developing or reduce their growth or symptoms through lifestyle, diet or other measures? What does the scientific evidence tell us, and are there any common myths about fibroid prevention that you would like to correct?
Because of the multi-layered factors that influence uterine tissue homeostasis, there is currently no defined way to prevent fibroids from developing – shy of a hysterectomy that removes the uterus altogether. However, that is an option many seek only as a last resort, and not as primary prevention.
Diet and lifestyle approaches can be extremely helpful to manage certain symptoms for many women; however, there is limited evidence that provides any definitive intervention. Certain recommendations that are tried and true for managing chronic conditions can also be applied to fibroids. For example, a balanced diet that includes antioxidants, fiber, vitamin D, and anti-inflammatory nutrients can support healthy weight management and reduce inflammation and accumulation of toxins in the body. Regular physical activity and stress management also promote healthy hormone balance throughout the body.
A dangerous myth is that you can implement a special diet or eat a particular food every day, based on what someone claims worked for them. If you identify a new approach that you would like to try, share it with your health care provider. This way, you can work together to take a scientific approach to incorporating that particular intervention with your overall treatment plan. You and your doctor can discuss benefits, risks, and expectations, as well as how to monitor your progress and when to revisit further modifications.
A bit of personal advice I would offer is to be gracious with yourself while you try different approaches along your personal journey to find one that works well for you, your health, your lifestyle, and your goals.
Looking at SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality) and SDG 10 (Reduced Inequalities), what needs to change to ensure that women—particularly Black women—have equitable access to timely diagnosis, appropriate treatment and high-quality care?
The health care community needs to recognize and improve the clinical and social education and care concerning the gynecologic health of women and young girls. We cannot address fibroids in a good health and wellbeing conversation without also addressing menarche, chronic pain, amenorrhea, fertility, endocrine disruptors, and other overlapping health topics.
As we then talk about equity and inequalities, social determinants of health will often be raised. This popular public health term is more than a buzz word – it is a concept rooted in intention. SDoH identify unique challenges to specific communities to enable actors (healthcare providers, policymakers, health organizations, etc.) to reach diverse and marginalized groups. Just as treatment plans are not one-size fits all, the approach to reach and engage diverse populations, such as Black women, in this fight against fibroids, interventions need to be developed (or existing ones adapted) to reflect the increased risk and disparity among Black women.
To say that there was limited research on environmental exposures, disparities, or epigenetics in fibroids research 15 years ago is one thing. To allow that to still be the excuse today is a consistent choice to deprioritize our investment in pursuing health care solutions for this majority population of women living with more fibroids, larger fibroids, more severe symptoms, and fewer answers, fewer intact uteruses, and fewer resources to improve their gynecologic and long-term health.
What are researchers currently investigating that could change the way fibroids are prevented, diagnosed or treated in the future? Are there promising developments that women and healthcare professionals should be aware of?
Deep dives into environmental exposures – estrogens and endocrine-disrupting chemicals – are positioning the field to develop prevention strategies that have particular advantages for Black women. Genetic studies are currently underway to identify additional signature mutations in fibroids as therapeutic targets. Studies that are taking the necessary steps to investigate different ancestry groups will not only help stratify risk among subpopulations of women, but also move towards personalized medical treatment options. Similarly, studies on extracellular matrix involvement in fibroid structure and growth are exploring the ECM as another potential therapeutic target. Minimally and non-invasive treatments seek to provide fertility friendly options for women, reduced recovery times, and decreased tissue damage, scarring, and sequelae from procedures that are able to remove or shrink fibroids instead of just address symptoms.
What would you most like women, healthcare professionals and policymakers to understand about fibroids? How can greater awareness and better research help address the health inequalities surrounding fibroids, particularly for Black women?
Uterine fibroids is a disease and should be monitored and treated as such. Because it has been overlooked and undertreated for so long, we have to ask different assessment questions in the clinic. Encourage women to think back years and not just months, reflecting on how long they have been experiencing severe pain or irregularities in their menstrual cycle. What has become their normal may have been abnormal from their early puberty years. For Black women, we have to encourage that one patient in the doctor’s office to explore her family history and increase awareness among other women in her family about fibroid symptoms and consequences of leaving them untreated. That one patient could very well unlock a solution for another woman in her family or friend circle, which can now reach more women, and healing the larger community of women can begin.