Fibroids are more common in Black women, tend to appear at a younger age, and are more likely to cause heavy bleeding, anemia and a larger uterus by the time they are found. That does not mean you have to live with symptoms, and it does not mean a hysterectomy is your only answer. Most women with symptomatic fibroids have several treatment options, including ones that keep the uterus, and recent research suggests that results of fibroid procedures are similar across racial groups.
How much more common are fibroids in Black women?
The clearest numbers come from a 2003 study by Baird and colleagues. Researchers used ultrasound to screen 1,364 randomly selected women aged 35 to 49 in an urban health plan, including women who had never been told they had fibroids. They estimated that by age 50, more than 80% of Black women and nearly 70% of white women had developed fibroids. Black women had about 2.9 times the odds of having them.
Later work agrees. A 2017 systematic review of 60 publications by Stewart and colleagues found that Black race raises fibroid risk two- to threefold, and the American College of Obstetricians and Gynecologists (ACOG) states in its 2021 practice bulletin that fibroids are 2 to 3 times more common among Black women than white women.
Keep in mind that "having fibroids" on a scan and "needing treatment" are not the same thing. Many fibroids are small and cause no problems. What matters is how they affect your life.
Earlier, larger and more symptoms
The difference is not only in how often fibroids occur. ACOG's 2021 bulletin notes that Black women develop fibroids at an earlier age, are more likely to be anemic, and have larger uteri at the time of diagnosis. A 2014 review by Eltoukhi and colleagues described fibroids as "more common and more severe" among African American women and called them a public health issue.
A large US registry called COMPARE-UF shows what this looks like in real patients. In a 2021 analysis of 1,196 Black women and 1,141 white women about to have a fibroid procedure, the Black women were slightly younger (median age 41 vs 42) and reported worse symptoms, pain and day-to-day function on every scale the researchers used. They were also more likely to have already had a fibroid treatment (22.8% vs 14.6%).
Anemia is a particular concern. In a 2024 study of US insurance claims for women with fibroids and heavy bleeding, anemia was coded for 5.9% of Black women vs 3.6% of white women with commercial insurance. The authors note that claims data likely undercount anemia. If you feel tired, short of breath on stairs, or dizzy, read more in our article on fibroids and anemia.
Why does this happen?
Nobody knows the full answer, and it is important to say clearly what the evidence does and does not show.
- It is not something you did. Fibroids grow from the muscle of the uterus under the influence of hormones and genetic changes inside the fibroid tissue.
- Social factors likely play a role. ACOG's patient guidance says the differences "may be due to racism and inequities in society, which can increase the risk of health problems."
- Vitamin D is being studied. In a 2013 study, women with sufficient vitamin D levels had about 32% lower odds of fibroids. Only 10% of the Black participants and 50% of the white participants had sufficient levels. This was an observational study, so it shows a link, not proof that vitamin D prevents fibroids.
- Family history matters for women of every background.
Our article on what causes fibroids walks through each risk factor and how strong the evidence is.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
Treatment patterns: what the research shows
Older studies raised real concerns. A 2024 review of surgical trends summarized research from 2009 to 2011 showing that Black women with fibroids had lower odds of keeping the uterus and lower odds of minimally invasive surgery. A 2022 study of 732 Veterans found that, even among women whose uterus was small enough to be a good fit for minimally invasive hysterectomy, Black Veterans were about 12 percentage points less likely to receive it. The authors concluded that factors beyond uterine size were involved.
More recent data look different. In the COMPARE-UF registry, Black women were more likely than white women to choose a uterus-sparing procedure. After adjusting for other factors, their odds of having uterine artery embolization rather than hysterectomy were about 4 times higher, and their odds of myomectomy rather than hysterectomy were about 2.4 times higher. In national surgical data from 2015 to 2019, Black women were also more likely to have a myomectomy. The COMPARE-UF researchers reported that results for all procedures were similar across racial and ethnic groups.
These registries were based mostly at larger medical centers, and the authors caution that the findings may not hold for women without access to that kind of care. The practical lesson is simple: ask about every option, not just the first one offered.
Your treatment options, including keeping your uterus
Treatment depends on your symptoms, the size and location of your fibroids, and whether you hope to become pregnant. ACOG's 2021 bulletin supports several approaches:
| Option | Keeps the uterus? | Points to know |
|---|---|---|
| Watchful waiting | Yes | Reasonable if fibroids cause no symptoms or you do not want treatment now |
| Medication or hormonal IUD | Yes | Mainly reduces heavy bleeding; effects last while you use it |
| Uterine fibroid embolization (UFE) | Yes | No abdominal incision; shorter recovery than surgery; higher chance of a later procedure than surgery |
| Myomectomy | Yes | Removes fibroids surgically; recommended by ACOG if you want a future pregnancy; fibroids can return |
| Hysterectomy | No | Definitive; ends periods and pregnancy; longer recovery |
UFE blocks the blood supply that feeds fibroids so they shrink. It has trade-offs worth knowing. In the UK FEMME trial of 254 women, myomectomy gave somewhat better quality-of-life scores at 2 years, although the difference was no longer significant at 4 years. Re-treatment is more common after UFE than after surgery, and data on pregnancy after UFE are limited. Learn more about uterine fibroid embolization (UFE), compare UFE vs myomectomy, or browse every option in our fibroid treatment guide.
Making sure you are heard
Heavy, painful periods are common, but they are not something you should be told to simply accept. Some ways to get the most out of a visit:
- Describe how symptoms affect your life: missed work, changing protection overnight, avoiding activities.
- Ask for a blood count. UK national guidance (NICE NG88) advises a full blood count for every woman with heavy menstrual bleeding.
- Ask which type and location your fibroids are, and which options fit them.
- Say whether you want to keep your uterus or try for pregnancy. This changes the advice.
- If hysterectomy is the only option you are given, it is reasonable to ask why and to get a second opinion.
When to get care promptly
Seek urgent care if bleeding is so heavy that you feel faint, short of breath or have a racing heartbeat, or if you have sudden severe pelvic pain or fever. Book a prompt visit for any bleeding after menopause, a fibroid that is growing after menopause, or new bleeding between periods. These are not usually signs of anything serious, but they should be checked.
Frequently Asked Questions
Why do Black women get fibroids more often?
The exact reasons are not known. Researchers are studying hormones, genetics, vitamin D and other factors, and ACOG notes that racism and inequities in society may contribute. Having fibroids is not caused by anything you did.
Are fibroids more severe in Black women?
On average, yes. ACOG reports that Black women develop fibroids earlier, are more likely to be anemic, and have larger uteri at diagnosis. In a 2021 US registry study, Black women reported worse symptoms and pain before treatment.
Do fibroid treatments work as well for Black women?
In the COMPARE-UF registry of 3,116 women, results for all fibroid procedures were similar across racial and ethnic groups. Your own result depends on your fibroids and the treatment you choose.
Can I keep my uterus if I have fibroids?
Often, yes. Medication, a hormonal IUD, uterine fibroid embolization and myomectomy all keep the uterus. Which one fits depends on your symptoms, fibroid type and size, and pregnancy plans.
Should I take vitamin D to prevent fibroids?
A 2013 study linked sufficient vitamin D with lower odds of fibroids, but it was observational and does not prove that supplements prevent them. Ask your doctor whether checking your vitamin D level makes sense for you.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- What Causes Fibroids? Genes, Hormones and Risk Factors
- Fibroids and Anemia: Why Heavy Periods Drain Your Iron
- UFE vs Myomectomy: Results, Recovery and Fertility Compared
- Told You Need a Hysterectomy for Fibroids? Get a Second Opinion
- Pregnancy After UFE: Honest Numbers and What They Mean
- Fibroid Treatment Guide: every option, compared
Sources
- Baird et al., Am J Obstet Gynecol, 2003 — high cumulative incidence of fibroids in Black and white women (1,364 women)
- Stewart et al., BJOG, 2017 — epidemiology of uterine fibroids: a systematic review
- Eltoukhi et al., Am J Obstet Gynecol, 2014 — the health disparities of uterine fibroid tumors for African American women
- ACOG Practice Bulletin No. 228, Obstet Gynecol, 2021 — management of symptomatic uterine leiomyomas
- ACOG patient FAQ — Uterine Fibroids (last reviewed December 2025)
- Wegienka et al., J Womens Health, 2021 — Black women more likely to schedule uterine-sparing fibroid treatment (COMPARE-UF, 2,337 women)
- Myers et al., PCORI final report, 2023 — the COMPARE-UF study (3,116 women)
- Yu et al., J Womens Health, 2024 — surgical management of fibroids: a changing landscape
- Carey et al., Health Equity, 2022 — uterine weight and racial disparities in minimally invasive hysterectomy (732 Veterans)
- Baird et al., Epidemiology, 2013 — vitamin D and the risk of uterine fibroids
- Agarwal et al., AJOG Glob Rep, 2024 — anemia and bulk symptoms in US claims for women with fibroids and heavy bleeding
- Manyonda et al., N Engl J Med, 2020 — FEMME trial: UAE vs myomectomy (254 women)
- NICE guideline NG88 — heavy menstrual bleeding: assessment and management
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.
