By age 50, up to 80% of women will develop uterine fibroids. Among Black women, the prevalence is even higher — fibroids appear earlier, grow larger, and cause more severe symptoms. Fibroids are the leading cause of hysterectomy in the United States. They account for billions of dollars in health care costs annually. They cause significant pain, heavy bleeding, fertility complications, and reduced quality of life for millions of women.
And yet, for most of modern medicine’s history, they have been treated as an inconvenience rather than a disease.
The Treatment Gap
Until recently, the primary treatment options for fibroids were hysterectomy (the surgical removal of the uterus) or myomectomy (surgical removal of individual fibroids). Both are invasive. Both carry risks. And both have been administered at dramatically higher rates in Black women — not because Black women’s fibroids are more severe on average, but because they have been less likely to be offered or informed about less invasive alternatives.
Minimally invasive options, including uterine fibroid embolization (UFE) and focused ultrasound ablation, have existed for years. Black women are referred for these procedures at lower rates than white women with comparable fibroid burden. The reasons involve a combination of physician referral bias, patient awareness gaps, and insurance coverage inconsistencies.
The Research Deficit
NIH funding for uterine fibroid research has historically been disproportionately low relative to prevalence. A 2016 analysis found that fibroids received roughly $17 million in annual NIH funding while affecting one of the largest patient populations in the country. By comparison, conditions with far lower prevalence received substantially more research investment.
This is not simply a budgetary quirk. Research determines what treatments get developed, what guidelines get written, and what clinical training covers. When a condition is underfunded, the entire downstream infrastructure of care suffers.
Black Women Carry a Disproportionate Burden
Black women are two to three times more likely than white women to have symptomatic fibroids, more likely to require surgery, and more likely to experience surgical complications. The SWHR Fibroid Working Group has called for increased NIH investment in fibroid research with explicit attention to racial disparities in prevalence, treatment, and outcomes.
The fibroid burden is concentrated in the population least well served by the current system. That is not a coincidence. It is an equity crisis with a research solution and a policy solution — and neither has been pursued with the urgency the numbers demand.
