WASHINGTON, DC (June 10, 2021)—Black women are disproportionately affected by uterine fibroids, and a new study published in Women’s Health Issues reveals some of the factors that influence their decisions about fibroid management. The authors found that Black women’s decisions about fibroid surgery were influenced by social and historical conditions as well as by concerns about fertility and cancer and by interactions with clinicians and social networks.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based in the Department of Health Policy and Management at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.
Brianna VanNoy, first author of the study, completed her MPH and previously worked at Milken Institute SPH with Dr. Ami Zota, Associate Professor at Milken Institute SPH and senior author of the study. They analyzed interviews of 37 Black women who enrolled in a larger study about environmental exposures and uterine fibroids among women in the Washington, DC area. All of the interviewed women had decided to undergo either a myomectomy (surgical removal of fibroids while preserving the uterus) or hysterectomy (removal of the uterus), and they described their experiences of seeking treatment and deciding on those procedures.
Study participants expressed frustration at receiving less information about their diagnoses from their providers than they expected; some responded by finding other doctors or seeking treatment information from online sources or their social networks. Some wondered why their providers immediately recommended hysterectomy without suggesting less invasive options first, or questioned if providers’ recommendations were different for Black patients. “These views may be rooted in the historical legacy (e.g., forced sterilizations) and contemporary reality (e.g., Black maternal mortality) of inequity against Black women, and may influence how Black women navigate health care settings,” VanNoy and her co-authors explain.
Participants noted that fibroids are particularly common among Black women, and some had expected the diagnosis given their race or family history. When deciding how to manage their fibroids, participants appreciated advice and support from members of their social networks, though one woman reported encountering stigma: “like ‘you’re half a woman, what’s wrong with you?’” The authors note that in addition to fertility concerns, which many participants expressed, a few feared that fibroids could become cancerous—despite the fact that fewer than one percent of fibroids are malignant.
“Because social networks and community norms may influence how women conceptualize fibroids and approach treatment, it is important that clinicians and institutions partner with communities to disseminate culturally relevant information on fibroids care and management,” VanNoy and her colleagues recommend.
“As health care providers and their organizations work to address structural and interpersonal racism, it is essential that they hear from patients about their experiences,” said Amita Vyas, Editor-in-Chief of Women's Health Issues and associate professor of prevention and community health at Milken Institute SPH. “We hope that providers who treat patients with fibroids will consider these findings and use them to improve the quality of the care they give.”
“Black Women's Psychosocial Experiences with Seeking Surgical Treatment for Uterine Fibroids: Implications for Clinical Practice” has been published in the May/June issue of Women’s Health Issues.
