Many Black women are proactive about their health, especially when it comes to asking questions during doctor’s appointments. But when it comes to uterine fibroids, getting answers isn’t always easy.
For many Black women, they don’t often get a fibroid diagnosis initially. Instead, their journey can begin with years of unanswered questions. Heavy periods become something they’re told to “push through.” Pelvic pain is dismissed as normal menstrual cramps. Frequent urination, bloating, fatigue, painful sex, and even fertility challenges are often explained away as stress, aging, or simply part of being a woman.
By the time many Black women finally receive a fibroid diagnosis, the condition has significantly worsened, and treatment options may be more limited than if the condition had been identified earlier.
Black women are more likely to develop uterine fibroids, and by age 50, up to 90 percent will develop them. Despite how common fibroids are, many women still spend years searching for answers before receiving a diagnosis.
BlackDoctor Pro spoke with Stephanie Marshall Thompson, MD, reproductive endocrinologist at CCRM Fertility of New Jersey, about why these delays happen and what providers can do.
One of the biggest reasons fibroids go undiagnosed is because many women have been conditioned to believe that painful or heavy periods are simply part of being a woman.
Heavy menstrual bleeding, severe cramping, pelvic pressure, and fatigue can gradually become part of everyday life, causing women to adjust their schedules around their symptoms instead of seeking medical care. Because these symptoms often worsen over time, many don’t realize something more serious may be happening.
Dr. Thompson said there is an important difference between typical menstrual discomfort and symptoms that require medical attention.
“Pain that is debilitating and preventing you from going to work or school is never ‘normal,’” she explained. “Any typical menstrual pain can be relieved by over-the-counter medications and should resolve within a day or two. If you are soaking more than two menstrual pads per hour for more than three hours, that is considered abnormal bleeding. Heavy bleeding can also make you anemic, leading to fatigue, shortness of breath, and inability to function normally. You should seek urgent medical care for any of these symptoms.”
It’s easy for women to mistake their menstrual cycle or hormonal changes for uterine fibroids, as the symptoms overlap. However, it’s important to know that fibroids don’t always present the same way, which can make the diagnosis more challenging.
Depending on their size and location, fibroids may cause symptoms that resemble endometriosis, adenomyosis, ovarian cysts, gastrointestinal disorders, urinary problems, or hormonal changes. Some women primarily experience bloating or abdominal fullness, leading them to believe they’ve gained weight. Others notice frequent urination and assume they have a bladder issue. Others experience infertility before ever realizing fibroids may be contributing.
Because symptoms overlap with several health conditions, reaching the correct diagnosis often requires imaging, such as an ultrasound, in addition to a physical exam.
Dr. Thompson said that once women receive an appropriate evaluation, diagnosing fibroids is usually straightforward. “A fibroid diagnosis is generally clear once a patient has an appropriate workup, such as a thorough physical exam and ultrasound.”
For many Black women, the delay isn’t always about recognizing symptoms — it’s about being able to access care and feeling comfortable seeking it.
Dr. Thompson said historical experiences within the healthcare system contributed to mistrust that may cause some women to postpone medical care. “Black women often have less access to care, as well as a fear of the medical system, secondary to historic experiences by Black patients.”
Financial barriers can also prevent women from seeking care or receiving timely evaluations. “For women without insurance, there is always a concern of a large medical bill later, as well as the fact that it may take longer to get to an appointment with a healthcare provider,” she explained.
These barriers can delay diagnosis, allowing fibroids to continue growing and symptoms to become more severe before treatment begins.
Receiving a fibroid diagnosis is only the beginning of the journey. Dr. Thompson said she frequently sees women whose symptoms were either minimized or whose treatment options didn’t fully consider their future goals.
“I often see patients whose concerns were minimized, but more regularly, I see patients who were offered inappropriate procedures for management of their fibroids without regard to their future desires for fertility and childbearing,” she said.
To improve earlier detection and timely referral to specialty care, primary care providers must step up. During initial visits, having conversations about fertility goals, symptom severity, and available treatment options can help women make more informed decisions about their care and ensure they receive treatment that aligns with their needs.
While some menstrual discomfort is common, certain symptoms should never be ignored. For clinicians, early evaluation can lead to earlier diagnosis, giving women more treatment options before fibroids significantly affect their health, fertility, or quality of life. As awareness grows and barriers to care continue to be addressed, more Black women may receive earlier diagnoses, expanded treatment options, and better health outcomes.
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