For many Black women, uterine fibroids are not a rare diagnosis; they are a predictable feature of adulthood rather than an exception. Researchers have shown that Black women develop fibroids at younger ages, experience more numerous and larger tumors, and report more severe symptoms than white women (e.g., Jones, 2019; Stewart et al., 2013). Heavy menstrual bleeding, pelvic pain, anemia, and fatigue become part of an imposed “normal” that is rooted less in biology and more in how systems respond to Black women’s pain (Michigan Medicine, 2020). When a condition is this common and this disruptive, treating it as a minor gynecologic issue rather than a public health priority reflects a failure of governance, not a lack of evidence (Stewart et al., 2013).
Fibroids also shape the broader trajectory of a person’s life. Studies link fibroids to school absenteeism, work disruptions, and higher rates of surgical treatment, including hysterectomy, among Black women (Stewart et al., 2013; Wilcox et al., 2024). When a group already facing disproportionate maternal morbidity and mortality is also more likely to lose their uterus as a “solution” to an undertreated condition, that pattern cannot be separated from histories of reproductive control and neglect (American Medical Women’s Association [AMWA], 2025; The Century Foundation, 2022). Calling fibroids “just a women’s health problem” erases how deeply race, power, and policy are embedded in who is diagnosed, how they are treated, and what options they are given.
The Education and Screening Gap
The story begins long before the first ultrasound or specialist appointment. Black girls are often socialized to believe that painful, heavy periods are simply part of becoming a woman, rather than potential warning signs of an underlying condition (Resilient Sisterhood Project, 2024). School-based health education typically offers limited, biological overviews of menstruation and reproduction, with almost no attention to chronic gynecologic conditions such as fibroids or endometriosis (Society for Women’s Health Research, 2024). Community conversations may center on avoiding pregnancy or sexually transmitted infections, leaving little space for honest dialogue about persistent pelvic pain, clotting, or bleeding through pads and clothing.
On the clinical side, detection is commonly reactive instead of proactive. National guidance describes how fibroids can be identified through pelvic examination and imaging, yet, in everyday practice, many people are diagnosed only when symptoms escalate to acute bleeding, emergency visits, or fertility evaluations (American College of Obstetricians and Gynecologists [ACOG], 2022; National Institute of Child Health and Human Development, 2018). Qualitative work suggests that Black women frequently spend years seeking answers while being told to “wait and see,” offered iron for anemia without further investigation, or reassured that their symptoms fall within the range of normal (Michigan Medicine, 2020; Institute for Healthcare Policy and Innovation, 2023). In this context, delayed diagnosis is not a random occurrence; it is a foreseeable outcome of thin education, time-limited visits, and a health system that routinely doubts Black women’s accounts of their own bodies.
Clinical Encounters and Surgical Endings
By the time many Black women reach specialty care, their fibroids are large, numerous, and symptomatic enough that treatment conversations often revolve around major surgery. Review articles document racial differences in fibroid care, including higher rates of hysterectomy and open procedures among Black women compared to white women, even when controlling for factors such as insurance status (Samadi et al., 2025; Velez Edwards et al., 2024). Less invasive options—such as uterine fibroid embolization or laparoscopic myomectomy—and nonsurgical treatments are not consistently presented as viable alternatives, which limits the scope of informed consent (ACOG, 2022; Scientific Archives, 2025).
These patterns emerge within a broader historical and social context. Scholars of reproductive justice have traced how the bodies of Black women and people with uteruses have been sites of experimentation, coercive sterilization, and systematic neglect (AMWA, 2025; Stewart et al., 2024). Against that backdrop, a landscape in which hysterectomy becomes the presumed endpoint for a condition that disproportionately affects Black women raises questions about whose fertility is considered expendable. The gap between what medicine can offer and what Black women are routinely offered is one of the clearest ways governance shows up in the exam room.
Fibroids, Fertility, and the Price of Preservation
Fibroids also quietly shape fertility trajectories. They can distort the uterine cavity, interfere with implantation, and increase the risk of miscarriage and obstetric complications, intersecting with the already elevated risks Black women face during pregnancy and childbirth (National Women’s Law Center, 2025; Stewart et al., 2013). For a Black woman in her twenties or early thirties, an early and aggressive fibroid course should prompt transparent discussions about reproductive timelines, treatment choices, and the possibility of fertility preservation. However, many report that such conversations occur late, if at all, often only when family building has already become more difficult (Cofertility, 2023; Racial Disparities in Fertility Care Review Group, 2024).
Egg freezing is routinely marketed as a lifestyle benefit for highearning professionals, yet for people living with rapidly progressing fibroids, it can function as a critical tool to preserve the possibility of future pregnancy (CUNY Graduate Center, 2023; Cofertility, 2023). Access, however, is stratified by race, income, and employment sector. Fertility services, including egg retrieval, storage, and medications, are expensive, and insurance coverage remains inconsistent across states and plans (National Women’s Law Center, 2025; Racial Disparities in Fertility Care Review Group, 2024). Employers that offer generous fertility benefits tend to be clustered in certain industries where Black women are underrepresented, effectively tying reproductive options to labor market segregation (Kindbody, 2025). When a condition that disproportionately affects Black women drives a need for fertility preservation, but the tools to address that need are locked behind financial and occupational barriers, the line between health care and economic exclusion becomes blurred.
What Equity Would Require
If season 1 of Badly Governed is about tracing how policy shapes who is allowed to live well, then fibroids among Black women offer a clear, embodied case study. Moving toward equity demands aligned changes in policy, clinical standards, education, and financial structures.
At the policy level, advocates have argued that fibroids must be treated as part of the Black maternal health agenda, rather than as a tangential concern (The Century Foundation, 2022; Black Women’s Health Imperative, 2021). This includes investing in communitydriven research, funding public education campaigns, and mandating coverage for comprehensive fibroid care—diagnostics, medications, procedures, and postoperative support—across private and public insurance plans. It also means recognizing fertility preservation as medically necessary when conditions such as fibroids threaten reproductive capacity and ensuring that egg freezing and related services are covered accordingly (National Women’s Law Center, 2025; Racial Disparities in Fertility Care Review Group, 2024).
Clinically, professional societies can strengthen standards of care by naming racial disparities explicitly and incorporating early counseling about fertility, shared decisionmaking, and equitable access to less invasive interventions into guidelines (ACOG, 2022; Stewart et al., 2024). Health systems can implement equityfocused quality metrics, tracking which patients receive hysterectomy, myomectomy, uterine fibroid embolization, or medical management, stratified by race, age, and insurance type, with accountability mechanisms tied to closing unjust gaps (Samadi et al., 2025; Wilcox et al., 2024).
Education and screening are equally crucial. Public health agencies, school districts, and community organizations can collaborate with Black communities to cocreate reproductive health curricula that teach young people how to recognize abnormal bleeding and pain and how to navigate health care safely (Society for Women’s Health Research, 2024; Resilient Sisterhood Project, 2024). Primary care and obstetricsgynecology practices can implement symptom checklists and riskbased screening pathways that prioritize early evaluation for those at higher risk, rather than waiting until anemia, emergency visits, or infertility bring people into care (National Institute of Child Health and Human Development, 2018; Right as Rain, 2024).
Finally, equity in fertility and egg freezing requires both systemlevel and financial support. Employers, universities, and health systems that recruit Black women into demanding roles can commit to comprehensive, transparent fertility benefits that include medically indicated egg freezing, with navigation support to reduce administrative barriers (Kindbody, 2025). Communitybased organizations and advocacy groups can partner with fertility clinics to develop slidingscale programs, grants, or pooled funds that help lower the financial threshold for Black women living with fibroids to access preservation options (National Women’s Law Center, 2025; Racial Disparities in Fertility Care Review Group, 2024).
Across the season, Badly Governed has shown that governance is not abstract; it lives in budgets, benefit designs, clinical algorithms, and the curricula that tell young people what pain deserves attention. In the case of fibroids and Black women, better governance would mean believing Black girls when they say something is wrong, building systems that detect and treat conditions early, and designing policies that make preserving fertility a right rather than a privilege.
References
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American Medical Women’s Association. (2025). Fibroids and inequity: How racism shapes the care Black women receive.
Black Women’s Health Imperative. (2021). Black women’s health advocates applaud legislation to address the uterine fibroid crisis.
Cofertility. (2023). What Black women should know about egg freezing.
CUNY Graduate Center. (2023). A quilt of stories: Visualizing Black women’s egg-freezing journeys.
Institute for Healthcare Policy and Innovation. (2023). Uncovering drivers of racial disparities in uterine fibroids and endometriosis.
Jones, A. (2019). The health disparities of uterine fibroids for African American women.
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Michigan Medicine. (2020). Understanding racial disparities for women with uterine fibroids.
National Institute of Child Health and Human Development. (2018). How are uterine fibroids diagnosed?
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Right as Rain. (2024). Why are Black women at higher risk for fibroids?
Samadi, S., et al. (2025). Racial disparities in surgical outcomes for uterine fibroids: A systematic review.
Scientific Archives. (2025). Racial disparities in uterine fibroids and endometriosis: A systematic review.
Society for Women’s Health Research. (2024). Uterine fibroids toolkit: A patient empowerment guide.
Stewart, E. A., et al. (2013). The health disparities of uterine fibroids for African American women.
Stewart, E. A., et al. (2024). Uterine fibroids and Black people of African descent globally.
The Century Foundation. (2022). New fibroids policy must be part of the Black maternal health agenda.
Wilcox, C., et al. (2024). Uterine fibroid diagnosis by race and ethnicity in an integrated health system.
