How Racial Disparities, Personal Stigma Persist in Uterine Fibroid Care


Erica Marsh, MD, MSCI, discusses the need for improved patient involvement and open discussion in the highly prevalent, potentially psychologically impactful condition.

The most common form of benign pelvic tumors in women, uterine fibroids are estimated to persist in upwards of two-thirds of all people with a uterus. Their impact can vary; many patients are capable of living without treatment resolution of the growths, while some need to address burdensome symptoms or the effect fibroids can have on infertility or failed pregnancy treatment.

The prevalence and care strategies for uterine fibroids are indeed robust, but trends in who is most impacted and how are apparent to experts—and need to be better understood by the public.

In the first segment of an interview with HCPLive, Erica Marsh, MD, MSCI, professor of Obstetrics and Gynecology at University of Michigan Medical School, discussed the need for improved clinical information, treatment option literacy, and shared decision-making for patients with uterine fibroids.

“I think, as a field, we need to put ourselves in a position to provide all those things,” Marsh said.

Marsh explained that approximately 65-70% of all people with a uterus from European and African descent report having a fibroid by age 50. Specifically among people of African descent, that rate can be closer to 90%. And yet, there may be a multitude of complex factors driving that significant disparity.

“We know that individuals of African ancestry have higher estrogen levels on average, and we know that fibroid growth is facilitated by estrogen and progesterone, so that could contribute at some level,” Marsh said. “There’s epidemiological and some basic science studies that suggest that vitamin D levels are protective against fibroid and fibroid growth, and we know that individuals of African ancestry—because of how vitamin D is processed and metabolized—have lower levels than people of European ancestry. We know that obesity, in most studies, is associated with a higher risk of fibroids, and we know that obesity is more prevalent amongst folks of African descent in the US.”

Marsh also discussed other “societal and structural determinants” that may impact racial disparities in uterine fibroid treatment options and referral—matters which point more so to issues around health care-associated racism than it does patient race-related health.

“The data we do have suggest there are delays in diagnosis and differential counseling, in terms of what treatments patients are preferentially offered—or according to patients, what treatments are pushed in their direction,” she said.

Additionally, Marsh considered the role of stigma surrounding uterine fibroids and their most impactful symptoms, and how perception of such issues as taboo clinical discussion may perpetuate issues for patients.

“The term many of (qualitative trial) participants used was ‘closeted’ about having fibroids and the associated symptoms of bloating, heavy menstrual bleeding, having to take off work during a menstrual period,” Marsh said. “While we’re certainly working societally and globally to take away that stigma of talking about menstruation and acknowledging it as a normal physiological process…we have a lot of work to do.”

A key message from Marsh and her colleagues to patients: there’s no need to suffer in silence.

“That’s not okay,” Marsh said. “It shouldn’t be, “Well this is what it means to have a period.” It doesn’t have to be that way.”

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