I want to open this article with a number that I find genuinely shocking: studies suggest that by the age of 50, up to 80% of Black women will have developed uterine fibroids, compared to around 70% of women overall. That is not a small difference. And yet fibroids remain dramatically under-discussed, frequently dismissed, and — in my clinical experience — often endured in silence for years before a woman receives a proper diagnosis and treatment plan.
I have sat with patients who have been bleeding heavily every month for a decade, taking iron tablets for the resulting anaemia, missing work during their periods, and managing debilitating pelvic pain — all without anyone properly investigating why. When I ask how long this has been going on, the answer is sometimes: "Since I was in my twenties. I thought it was normal."
It is not normal. And you do not have to live with it.
Why Black and African women are disproportionately affected
The disparity is real, well-documented, and still not fully understood. What we do know:
Genetic factors play a significant role. First-degree relatives of women with fibroids have a significantly higher risk. Specific genetic variants associated with fibroid development appear more commonly in women of African ancestry.
Hormonal sensitivity — fibroids grow in response to oestrogen and progesterone. There is evidence that women of African origin may have higher circulating oestrogen levels and different patterns of hormone receptor expression in fibroid tissue.
Vitamin D deficiency — Black women are significantly more likely to be vitamin D deficient, particularly in northern countries like the UK. Vitamin D appears to have an inhibitory effect on fibroid growth. This is an area of active research.
Later and less aggressive treatment — studies consistently show that Black women wait longer to receive treatment for fibroids and are more likely to be offered hysterectomy (removal of the uterus) as a first-line surgical option, rather than myomectomy (removal of fibroids while preserving the uterus). This is a documented healthcare disparity.
Symptoms — what fibroids actually feel like
Not all fibroids cause symptoms. Small fibroids in the outer wall of the uterus may be entirely silent. But when symptoms do occur, they can be significantly disruptive:
Heavy menstrual bleeding: The most common symptom. "Heavy" means soaking through a pad or tampon every hour or two, passing clots, or bleeding for longer than 7 days. This level of bleeding causes iron deficiency anaemia — fatigue, breathlessness, pallor — in many women.
Pelvic pain and pressure: A dull ache or feeling of heaviness in the lower abdomen, particularly around periods. Larger fibroids can cause a constant sensation of pressure.
Painful periods (dysmenorrhoea): Cramping significantly worse than what you experienced before fibroids developed.
Frequent urination: Fibroids pressing on the bladder.
Constipation or bloating: Fibroids pressing on the bowel.
Pain during sex: Particularly with certain positions, if fibroids are pressing on specific areas.
Fertility problems: Depending on size and location, fibroids can interfere with implantation or block the fallopian tubes. They are a significant cause of recurrent miscarriage and subfertility.
Enlarged abdomen: Large fibroids can cause visible abdominal swelling — women are sometimes asked when they are due.
Case study: Nkechi's ten-year wait
Nkechi, 38, a finance director from Lagos now based in London, came to see me after being referred by her GP for what was documented as "menorrhagia" — heavy periods. She had been on tranexamic acid (a medication to reduce bleeding) for six years.
When I took a full history, the picture that emerged was striking: periods lasting 10–12 days, changing pads every 45 minutes on her heaviest days, missing at least one day of work per month, and a persistent sense of pelvic heaviness. Her haemoglobin was 9.2 — significantly anaemic.
She had never had an ultrasound.
I arranged one immediately. It showed multiple fibroids — the largest measuring 8cm. She was referred to a gynaecologist who offered her options. She chose a myomectomy, had the surgery, and eight months later described her periods as "unrecognisable — like a normal person's."
"Ten years," she said. "I spent ten years thinking this was just how my body was."
How fibroids are diagnosed
Pelvic ultrasound is the standard first investigation — quick, painless, widely available. It shows the number, size, and location of fibroids clearly in most cases.
MRI gives more detailed information, particularly useful when multiple fibroids are present or when planning surgery.
Hysteroscopy — a camera inserted through the cervix — directly visualises fibroids inside the uterine cavity.
If you have any of the symptoms above, ask your GP specifically for a pelvic ultrasound. Do not accept "heavy periods are normal" without investigation if they are significantly impacting your quality of life.
Treatment options — you have more choices than you may have been offered
Watchful waiting: Fibroids that are small and causing minimal symptoms may simply be monitored. They often shrink after menopause when oestrogen levels fall.
Medication:
- Tranexamic acid: Reduces bleeding. Does not shrink fibroids.
- Combined oral contraceptive pill or progesterone: Manages bleeding and pain. Does not shrink fibroids.
- GnRH agonists (e.g. Zoladex): Creates a temporary menopause-like state, shrinking fibroids significantly. Used short-term before surgery or as a bridge to menopause. Side effects include hot flushes and bone density loss.
- Ulipristal acetate (Esmya): Was widely used but is currently suspended in Europe due to liver concerns — check current guidance.
- Relugolix (Ryeqo): A newer GnRH antagonist approved for fibroid treatment with add-back hormone therapy to reduce menopausal side effects. Increasingly available in the UK.
Surgical options:
- Myomectomy: Removal of fibroids while preserving the uterus. Can be done laparoscopically, hysteroscopically, or via open surgery depending on fibroid size and location. The procedure of choice for women who wish to preserve fertility.
- Hysterectomy: Removal of the uterus. Definitive cure for fibroids — they cannot recur. Appropriate for women who have completed their families and have severe symptoms. Should not be the automatic first surgical offer.
- Uterine Fibroid Embolisation (UFE): A radiological procedure that cuts off blood supply to fibroids, causing them to shrink. Less invasive than surgery. Increasingly available and evidence strongly supports its effectiveness. Ask your gynaecologist about this option.
- Radiofrequency ablation (Acessa procedure): Newer minimally invasive technique. Growing evidence base.
Fibroids and fertility
Fibroids do not automatically cause infertility — many women conceive and carry pregnancies without difficulty. However, depending on location and size, fibroids can:
- Distort the uterine cavity, interfering with implantation
- Block the fallopian tubes
- Cause recurrent miscarriage
- Increase risk of preterm labour, placenta praevia, and caesarean section
If you are trying to conceive and have known fibroids, a fertility specialist review is appropriate. Myomectomy improves fertility outcomes in carefully selected patients.
Vitamin D — worth checking
Given the evidence linking vitamin D deficiency to fibroid growth, and the high prevalence of deficiency in Black women living in northern latitudes, it is reasonable to have your vitamin D level checked and to supplement if deficient. The NHS recommends 10 micrograms (400 IU) daily for the general population — those with deficiency may need higher doses under medical supervision.
This is not a cure for fibroids, but it is a low-risk intervention with other health benefits too.
Sources: Stewart EA et al, Nature Reviews Disease Primers 2016; Marsh EE et al, Seminars in Reproductive Medicine 2019; NICE Clinical Guideline NG88 — Heavy Menstrual Bleeding (2018, updated 2021); Bulun SE, NEJM 2013; Wise LA et al, American Journal of Epidemiology 2011.