The Silent Burden: Why Uterine Fibroids Are Common Among African Women and How to Treat Them

Uterine fibroids, also known as leiomyomas, are the most common benign tumors of the uterus, particularly among African women. Studies indicate that African women are disproportionately affected, with up to 80% developing fibroids by the age of 50. Despite being benign, these tumors can lead to severe symptoms painful menstruation (Dysmenorrhoea) and heavry menstrual bleeding (menorrhagia) that significantly impact daily life and reproductive health. The higher prevalence among African women has been linked to genetic, hormonal, and environmental factors. This essay explores why fibroids are so common in African women, their clinical presentation, and the various treatment options available.

Why Are Fibroids Common Among African Women?

Research suggests that genetic predisposition plays a crucial role in the high prevalence of fibroids among African women. Studies indicate that fibroids in Black women tend to develop earlier, grow larger, and are more numerous compared to other ethnic groups. Additionally, elevated levels of estrogen and progesterone, two hormones that stimulate fibroid growth, may contribute to the increased risk. Other risk factors include early onset of menstruation, obesity, and dietary habits rich in red meat but low in fruits and vegetables. Environmental factors, such as exposure to endocrine disrupting chemicals in hair relaxers and cosmetics, have also been hypothesized as contributing factors.

Clinical Presentation of Uterine Fibroids

The symptoms of fibroids vary depending on their size, location, and number. Many women remain asymptomatic, while others experience severe symptoms that interfere with their quality of life. The most common symptoms include heavy menstrual bleeding, pelvic pain, frequent urination, constipation, and pain during intercourse. In some cases, fibroids can lead to infertility or complications during pregnancy, such as miscarriage or preterm labor. The location of the fibroids also influences symptoms. Submucosal fibroids, which grow close to or inside the uterine lining, are associated with excessive bleeding, while intramural fibroids within the uterine wall may cause dysmenorrhoea, pelvic pressure and bloating.

Medical and Non-Surgical Approaches to Treatment

Treatment for fibroids depends on the severity of symptoms, the size and location of the fibroids, and the patient’s reproductive goals. Medications such as hormonal therapy (birth control pills, GnRH agonists) can help manage symptoms by shrinking fibroids and reducing bleeding. Non-hormonal options like tranexamic acid help control heavy periods without affecting fertility. Minimally invasive procedures such as uterine artery embolization (UAE) block blood flow to the fibroids, causing them to shrink. Another technique, MRI-guided focused ultrasound surgery (FUS), uses high-frequency sound waves to destroy fibroids while preserving the uterus.

Surgical Interventions: When Is Surgery Necessary?

For women with large or multiple fibroids that cause severe symptoms, surgery may be necessary. Myomectomy, a procedure that removes fibroids while preserving the uterus, is ideal for women who wish to conceive in the future. However, there is a risk of fibroid recurrence. In severe cases, hysterectomy—the complete removal of the uterus—may be recommended, particularly for women who have completed their childbearing years. Advances in laparoscopic and robotic-assisted surgeries have made these procedures less invasive, with shorter recovery times. However, access to these treatments remains a challenge in many African countries due to limited healthcare resources and high costs.

Uterine fibroids are a significant health concern for African women, with genetic, hormonal, and environmental factors contributing to their high prevalence. While many women experience mild or no symptoms, others suffer from debilitating complications that affect their fertility and overall well-being. Understanding the different treatment options, from medication and minimally invasive procedures to surgery, is essential for managing fibroids effectively. Increasing awareness, improving access to healthcare, and promoting early diagnosis can help women make informed choices about their reproductive health.

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