Black women and fibroids

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2015 National Women's Conference
8 October 2014

Conference, fibroids are small benign tumours that grow on the walls of the womb, inside and out, and can range from a single growth to multiple. For most women they give no cause for concern and grow unnoticed. But, for others, the genetic disorder can mean heavy and painful periods and lead to fatigue and anaemia. In the worst cases, it can make conceiving more complicated, cause infertility and increase the risk of miscarriage. Common indications are pain, heavy menstrual bleeding, pressure on or adjacent organs such as the bladder.

Medical treatment available:

1) Tablets or injections to manipulate hormones that effect fibroid growth, however discontinuation of treatment will result in re-growth

2) Myomectomy – surgical procedure- that removes just the fibroid, not the entire uterus

3) Hysterectomy – removal of the uterus

4) Microwave Endometrial Ablation – gynaecologists remove fibroids via a probe

5) Uterine Artery Embolisation (UAE) – the arteries feeding the fibroids are blocked off under local anaesthetic, this procedure does not remove them, but will cause it to shrink.

Conference, Black women suffer disproportionately from fibroids and are three to five times more likely to develop them than White women. Black women also tend to have larger, more numerous fibroids at diagnosis. Fibroids seem to occur at a younger age and grow more quickly in Black women as well. Fibroids are the reason behind 30 percent of hysterectomies in white women and over 50 percent of hysterectomies in Black women.

Those who are overweight, started puberty early, or have not had children, are also more likely to have fibroids. Dr On said: “Fibroids are non-fatal. They do not kill you so the medical community doesn’t care much about them. They think hysterectomies can cure it so their job is done, but there are psychological side effects and many other side effects’

“Common sense will tell you that unless you start collecting data and continuously revising your statistics, how do you know what the situation is? Does it make sense not to have research on a condition that is so poorly understood you don’t even know the exact causes of it?

As Dr On pointed out, the most common form of treatment for fibroids is a hysterectomy, the removal of the womb. For women still hoping to conceive, they can undergo a myomectomy which removes the fibroids, but leaves the womb untouched. However, myomectomies have a high recurrence rate of about 75 percent meaning a life spent in and out of hospital.

Health disparities are not a new phenomenon, especially when it comes to level of health care and access to services that Black women receive. Why don’t medical institutions seem to care about Black women’s high rates of unnecessary hysterectomy?

Conference, fibroid embolisations – an alternative treatment, involves injecting grain-sized particles into the womb using small needles that cause the fibroids to dry up and shrink by 60 percent.

The recovery period is two weeks and does have a few side effects, including abdominal pain and passing big blood clots, but it is a “small price to pay” for a treatment that has almost permanent results without going under the knife.

What is “really bad news from a cosmetic point of view” for Black women, said Dr Walker, is that the cutting open of the body can lead to unsightly scarring because Black skin is likely to develop keloids. The procedure is available on the NHS so why don’t more GPs recommend embolisations or, at least, brief patients on all the options? “There is a problem in this country and that problem is lack of information. GPs claim not to know anything about embolisations, even though the knowledge is readily available and has been published in all the medical journals,” said Dr Walker who has been carrying out the procedure since 1996.

Conference therefore call on the National Women’s Committee to work with

a) The National Black Member’s Committee to produce information leaflets on fibroids that highlight the alternative treatment options.

b) Community based and health organisations to raise the issue of fibroids amongst Black women, develop treatment initiatives and highlight the alternatives to hysterectomies

c) Work with the health service group on seeking to influence Clinical Commissioning Groups and Public Health England on this issue.