🍒 What Are Fibroids?

Fibroids, or uterine leiomyomas, are benign tumours that develop from the muscular tissue of the uterus (myometrium). The uterus comprises three layers:

Endometrium: the inner lining shed during menstruation
Myometrium: the muscular middle layer where fibroids originate
Serosa: the outermost layer covering the uterus

Fibroids can vary in size and number, ranging from small, undetectable growths to large masses that can distort the uterus. They are estrogen-responsive, meaning they tend to grow during reproductive years and often shrink after menopause.

🍎 Who’s Affected and Why?

Fibroids can affect anyone with a uterus, but Black women are three times more likely to develop them than white women. Despite this disparity, the medical literature offers limited clarity on the reasons, reflecting a broader neglect of Black bodies in research.

Potential contributing factors include genetics, environmental exposures, and hormonal imbalances. However, systemic racism, medical negelct, and the historical dismissal of Black women's pain play significant roles in delayed diagnoses and limited treatment options.

🍓 Symptoms and Impact

While some individuals with fibroids remain asymptomatic, others experience life-altering symptoms:

Heavy or prolonged menstrual bleeding, leading to anemia and fatigue
Pelvic or lower back pain
Frequent urination or difficulty emptying the bladder
Constipation
Pain during intercourse
Enlarged abdomen or bloating

These symptoms can significantly impact daily life, leading to missed work, social withdrawal, and emotional distress.

🍇 Fibroids and Pregnancy

Most people with fibroids will have an uncomplicated pregnancy and 80% can still have a vaginal birth. However, close monitoring is important:

First trimester: Fibroids may grow due to increased oestrogen levels
Second/third trimester: Growth often stabilizes or fibroids may shrink as hormones balance out
12- and 20-week scans: Fibroid size and location will be monitored to assess risks
If a fibroid obstructs the cervix, a C-section may be advised

After birth, fibroids can interfere with the uterus’s ability to contract, increasing the risk of:

Postpartum hemorrhage (PPH)
Retained placenta requiring manual or surgical removal

In severe cases of uncontrollable bleeding, a hysterectomy may be considered as a life-saving intervention.

It is often advised against removing fibroids (myomectomy) during a C-section primarily due to the risk of uncontrolled hemorrhage. While some studies suggest it can be a safe procedure in certain cases, the increased blood supply to the uterus during pregnancy can complicate myomectomy and potentially lead to excessive bleeding.

The good news? Oestrogen levels drop post-birth, and fibroids usually shrink naturally. After 6 weeks postpartum, your obstetrician can assess whether any further intervention is needed. If someone has safely gone through one fibroid-affected pregnancy, it’s likely they can go through another without issues.

🍋 Treatment Options

Treatment depends on symptom severity, fibroid size and location, and the patient's reproductive goals:

Medications: Hormonal therapies can regulate menstrual cycles and shrink fibroids.
Non-invasive procedures: Uterine artery embolization cuts off blood supply to fibroids, causing them to shrink.
Surgical options:
- Myomectomy: Surgical removal of fibroids, preserving the uterus. It can be performed via:
- Laparoscopic (keyhole) surgery: Minimally invasive, suitable for smaller fibroids.
- Open surgery: Required for larger or numerous fibroids.

It's important to note that fibroids can recur after treatment, necessitating ongoing monitoring.

🍌 The Systemic Challenge

Accessing timely diagnosis and treatment for fibroids can be challenging, especially for Black women. The NHS typically requires the presence of symptoms before approving diagnostic scans, which can delay detection, particularly in asymptomatic cases.

Moreover, Black women often face medical neglect, leading to their pain being dismissed or minimized. This systemic issue underscores the importance of self-advocacy and seeking second opinions when necessary.

🍍 Empowerment and Advocacy

If you're Black, have a uterus, and think something isn’t right, find an advocate to help you share your concerns with your obstetrician.

Track your cycle, pain levels, and any irregular symptoms
Bring a list of questions to appointments
Ask for a second opinion if you don’t feel heard
Connect with support communities and doulas who understand your lived experience

Remember, your pain is valid, and you deserve comprehensive, compassionate care.