Among insured patients in one large health system, Black women reached a first fibroid treatment less often and about two months later, and more often received options that preserve the uterus.
By EEW Magazine Online Health & Wellness Editors
Black women are diagnosed with uterine fibroids at three times the rate of white women in Kaiser Permanente Northern California, and a new study finds they were less likely to receive long-term treatment. (Getty Images)
Black women in Kaiser Permanente Northern California are diagnosed with uterine fibroids at three times the rate of white women. A new study of more than 84,000 of the system’s patients finds that after diagnosis, Black women were less likely than white women to receive one of six long-term treatments.
Those who were treated reached their first procedure or device about two months later. The differences emerged among patients who all had insurance through the same health system.
Fibroids are noncancerous growths in the muscular wall of the uterus. Some women never have symptoms. Others live with heavy or prolonged periods, pelvic pain, frequent urination and anemia that can leave them exhausted and disrupt work and daily life. According to the NICHD, Black women tend to develop fibroids at younger ages and have more severe symptoms than other groups.
The study, published in the June issue of the Journal of Women’s Health, followed 84,206 patients ages 18 to 54 for up to five years after a first fibroid diagnosis between 2009 and 2022. Kaiser Permanente researchers tracked six long-term treatments: hormone-releasing intrauterine devices, two forms of myomectomy, uterine artery embolization, endometrial ablation and hysterectomy.
A Kaiser Permanente medical office building in San Francisco on Feb. 19. Researchers analyzed the health records of 84,206 Kaiser Permanente Northern California patients to track fibroid treatment after diagnosis. (Photo by Smith Collection/Gado/Getty Images)
Over the study period, 37 percent of patients received at least one of them, and hysterectomy accounted for 45 percent of all treatments given.
Black patients’ rate of receiving a tracked treatment was 12 percent lower than that of white patients. Among women who were treated, the median time from diagnosis to first treatment was 149 days for Black patients and 87 days for white patients. That interval measures time to a first procedure or device, not time to any medical care. Women may have been seen, tested or given medication in the meantime.
In neighborhoods ranked most disadvantaged on a measure of neighborhood deprivation, Black patients’ treatment rate was 17 percent lower than that of white patients in similar areas.
Asian and Hispanic patients were also less likely than white patients to receive treatment. The trend largely held across age, body weight, symptoms and neighborhood conditions, with exceptions in some groups, including younger patients.
The kind of care differed as well. When Black women received a first treatment, they were more likely than white women to have uterine artery embolization, which cuts off blood flow so fibroids shrink, or myomectomy, which removes the fibroids and leaves the uterus in place. White patients were more likely to start with an IUD, endometrial ablation or hysterectomy.
A 2021 study of 2,337 women scheduled for fibroid procedures at 10 U.S. clinical sites found a similar pattern. Black women had more than twice the odds of white women of undergoing myomectomy rather than hysterectomy, and four times the odds of undergoing embolization. Neither study determined what drove those differences.
Asking which treatments fit her fibroids, and how soon each could begin, can help a woman weigh her options with her doctor. (Courtney Hale/Getty Images)
Preserving the uterus is also distinct from preserving fertility. Myomectomy is the option generally considered for women who hope to become pregnant, and embolization’s effect on future pregnancy calls for careful discussion with a doctor.
The new study’s authors wrote that identifying the causes is a step toward equitable access to fibroid care. Treatment choices can reflect a woman’s priorities, her doctor’s recommendations and the size, number and location of her fibroids. Researchers lacked complete records of fibroid characteristics and of conversations between patients and doctors. They could not always tell whether a hormonal IUD was placed for fibroid symptoms or for birth control.
The study drew on one health system and counted only six treatments, so women managing symptoms with oral medication or monitoring were not counted as treated. Those limits mean a lower treatment rate does not by itself show that care fell short. They also leave the disparities unexplained.
Treatment options have expanded in recent years. The FDA approved two oral medications for fibroid-related heavy bleeding, Oriahnn in 2020 and Myfembree in 2021. Both carry boxed warnings for blood clots and vascular risks, are not right for every patient and are limited to 24 months of use because of bone loss.
Myomectomy, embolization and MRI-guided focused ultrasound shrink or remove fibroids while preserving the uterus, according to the NIH’s guide to treatment options. Hysterectomy remains the only permanent cure.
MedlinePlus, the NIH’s consumer health service, advises women with fibroids to contact a provider about heavy bleeding, increased cramping, bleeding between periods, or fullness in the lower belly. When symptoms persist, a gynecologist who specializes in fibroids can offer a second opinion.
The findings suggest two questions worth bringing to the appointment: which treatments fit her fibroids, and how soon each could begin.
