Black Women’s Psychosocial Experiences with Seeking Surgical Treatment for Uterine Fibroids: Implications for Clinical Practice

Abstract Background Black women are disproportionately impacted by uterine fibroids and are more likely to undergo surgical treatment for fibroids compared with non-Black women. However, few studies have characterized the psychosocial experiences of Black women seeking treatment for fibroids. This study aimed to identify factors that shape Black women’s fibroid management decisions; explore how discrimination based on race, class, and gender feature in treatment-seeking experiences; and compare experiences by age and socioeconomic status (SES). Methods We conducted semi-structured interviews with 37 Black premenopausal women, undergoing either a hysterectomy or myomectomy for fibroids at an academic medical center. We used a thematic analysis to code transcripts and identify themes. Results Participants were predominately single, highly educated, and privately insured. Respondents reported that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions. Their knowledge and perceptions of fibroids were also influenced by social and community norms and differed by SES; women of higher SES had greater fibroid awareness than women of lower SES. Discrimination was discussed in the context of historical inequity against Black women, with one participant questioning whether Black women were valued less in clinical settings compared with non-Black women. While several women discussed positive experiences seeking fibroids care, others expressed medical mistrust or said that alternative management options were not offered by clinicians. Conclusions Fibroid management decisions were influenced not only by individual-level interactions with clinicians and social networks, and concerns about fertility and fibroid malignancy, but also by broader social and historical conditions. These findings suggest that clinicians should deliver culturally-competent gynecologic care that centers the voices of Black women and acknowledges the diverse perspectives and perceptions that Black women may have when seeking fibroid treatment.