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FIBROIDS: A BLACK MATERNAL HEALTH CRISIS By Dr. Mercedes Giles, MD
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lack Maternal Health is complicated and involves many factors. One major cause of Black women’s health issues is uterine fibroids. These noncancerous tumors can grow in all layers of the uterus. In theory, they are benign, but in reality they can complicate Black maternal health and pregnancy. Symptoms include lower abdominal and pelvic pain, heavy periods, constipation, bloating, gas, and abdominal distension. The tumors can prevent embryo implantation and may grow during pregnancy competing with fetal blood flow. Uterine fibroids are a major cause for abnormal uterine bleeding and hysterectomy in the US. Studies show an alarming 80% of Black women will develop fibroids by age 50, compared to 70% of White women. Evidence also shows that Black women grow more and larger fibroids on average compared to White women. Additionally, Black women get pregnant at older ages compared to White women. These facts may explain why Black women suffer from more fibroid related pregnancy complications, however the disparity is not well understood. While 20% to 50% of all women with fibroids report having symptoms, there is no standard screening for uterine fibroids. To complicate matters even more, some Black women are misdiagnosed and do not recognize the signs of fibroids early on. One such example is a young Black woman who experienced several episodes of severe pelvic pain. She visited the ER 3 times along with multiple outpatient doctors before obtaining an accurate diagnosis. She was initially diagnosed with ovarian cysts, but an ultrasound showed normal ovaries and uterine fibroids. Although she was relieved to finally have the correct diagnosis, the work up was stressful. She recalls that none of her doctors were Black, and only one of them took the time to complete a full examination. Black women of childbearing age and who desire pregnancy need to understand their risks of developing fibroids and how to care for their bodies. In my primary care practice, I advise Black women to get yearly pelvic exams. In contrast to the pap smear test that is now recommended every 3 to 5 years, and only screens for cervical cancer. During the annual pelvic exam, I complete a bimanual exam where I palpate the patient’s uterus and ovaries. I can detect uterine or ovarian masses, and other abnormal findings not identified with a speculum exam. Positive findings are evaluated with an ultrasound.
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While society at large may not be moving fast enough to solve Black Maternal Health problems, there are steps that you can take to improve your personal outcomes. 1. Get your yearly well woman exam. A full pelvic exam includes a speculum exam, pap smear test, and bimanual exam. Knowing whether you have anatomical abnormalities is important prior to attempting pregnancy. 2. Know your numbers. Understand your blood pressure, BMI, and blood sugar as these do play a role in pregnancy. I advise that you bring these within goal before you embark on pregnancy. 3. Talk with your doctor. Have a conversation with your Ob/Gyn about how your current health may affect your future pregnancy. Discuss steps you can take to improve your chances of a smooth experience and what to do if complications arise. 4. Get your support system involved. Talk with your spouse, partner, and loved ones about your desires for pregnancy and how you would like them to be involved. 5. Be your own advocate. Just like the woman in the example, you may have to speak up for yourself when the diagnosis does not match your symptoms. It is appropriate to get a second opinion, and to ask your doctor questions. It is unlikely that the Black Maternal Health crisis will end soon. Understanding your health and risk factors will give you a place to start on making sure that you have the best experience possible.u WWW.THEBLACKINHR.COM
