Racial Injustices in Medicine and Uterine Fibroids
Did you know that uterine fibroids — noncancerous growths of the uterus — occur in over 70% of people with uteruses by the onset of menopause? According to a study published in 2011 (Stewart, et. al), Black women in the U.S. are three times more likely than white women to be affected. Black women are also reported to have an earlier onset and 2.4 times more likely to undergo hysterectomy.
What Are Uterine Fibroids?
Uterine fibroids (UF) are the most commonly occurring non-cancerous tumors. They are clinically detectable in 25% women, which means sometimes women have them but do not have any symptoms. Their pathogenesis is unknown. Common symptoms include heavy bleeding that can lead to anemia, painful periods, feeling fullness, physical bloating of the abdomen, frequent urination, pain during sex, lower back pain, infertility and complications during birth.
Not only are Black women disproportionately affected by UF, but people of color are also less likely to seek treatment or delay seeking treatment due to a mistrust of the U.S. healthcare system, (Corbie-Smith 2002) which has a history of medical racism and eugenics. (scroll below to see side bars on Medical Racism with a content warning: violence against women of color) With this backdrop, less invasive and more natural treatment options are needed. Enter Chinese Medicine, which offers more natural treatments options like acupuncture and herbal formulas.
Acupuncture Can Help
Acupuncture is commonly used in China to treat fibroids. Though it is not as widely accepted in the Western world due to bias, there is a significant amount of evidence based research to show that it is a safe and viable treatment option. Acupuncture causes the body to release endorphins that regulate the endocrine and nervous system. UF are known to be regulated by the relationship between sex steroid hormones and growth factors. Acupuncture does not add anything into the system the way that contraception and other hormone therapies do. A recent study in 2017 suggests that acupuncture reduced symptoms of UF such as emotional imbalance, spotting, abdominal pain, pelvic pain, low back pain, nausea, frequent urination and difficulty with bowels. Some participants even reported that some of their symptoms were completely eliminated.
How Is Someone Diagnosed with Uterine Fibroids?
If you present with associated symptoms further investigation by your gynecologist can include a transabdominal or transvaginal ultrasound. If you experience heavy or abnormal bleeding, a CBC (complete blood count) test is done to determine if your blood loss is causing anemia and the first step in ruling out other conditions. In some cases, an MRI can be done for more details on location and size of the fibroids. In asymptomatic people, they are sometimes detected during a routine pelvic exam. (mayo clinic).
How Black Women Experience Fibroids (according to the cited studies)
In a 2013 survey comparing the experience of UF between Black and White women in the US found that Black women experience more symptoms as well as an increase in symptom severity versus White women. (2013 Steward, et. al) Black women also tend to have an earlier onset of UF and increased size of fibroids. The experiences of bloating, pressure abdominal protrusion was 2x higher and anemia 3x higher. Additionally, it was reported that Black women were more significantly impacted by heavy or prolonged periods, which also showed that it was more likely that UF would interfere with their daily activities and caused more functional impairment.
*I know this can be a sensitive topic for many people which is why I did not ask people in my community to share their personal stories/quotes with me for this post. If you have a personal story that you would like to share with others about your journey in healing with fibroids please feel free to contact me .
Solutions in Western Medicine for Fibroids
Western Med treatment of UF varies on the severity and impairment of the patient. Medications such as gonadotropin-releasing hormone agonists help to shrink fibroids by blocking the production of hormones but can cause hot flashes and cannot be taken for long term as it can cause bone loss. An IUD is also a common treatment that does not affect the fibroids but can alleviate symptoms. Fibroids can also be surgically removed if they are smaller and less fibroids are present. A hysterectomy is the surgical removal of the uterus and sometimes the cervix and is considered the only proven solution to fibroids that will insure they do not return. It is invasive, requires a hospital stay, ends the ability to bear children and will bring on menopause. Black women are 2.4 times more likely to undergo a hysterectomy for fibroids. (Wechter 2011)
What Traditional Chinese Medicine Can Do For Fibroids
As a clinician, I have worked with a lot of people who found success with what Chinese Medicine offers. Some have had a significant reduction of their unwanted symptoms. Many have seen their fibroids shrink in their ultrasound follow ups and some have gone on to conceive and give birth when they were told their fibroids might not allow it. Though these stories are anecdotal, it is worth noting that there are natural options for those with fibroids who might not have known about Chinese Medicine and the research that supports UF treatments.
Guizhi Fuling Wan (GZFLW) is a traditional Chinese herbal formula that is commonly used in the treatment of fibroids and many different gynecological conditions. This formula contains Cortex Moutan, Radix Paeoniae, Ramulus Cinnamomi, Poria Cocos, and Semen Persica and dates back almost 2000 years when it is first mentioned in the Jin Gui Yao Lue by the Chinese Doctor Zhang Zhongjing. A systemic review of randomized clinical trials in 2014 (Chen et al.) showed that the herbal formula could be helpful in reducing the size of fibroids and could notably reduce painful periods. A 2016 study (Shen et al.) further studied GZFLW to find that it inhibits the formation of UF and can bring about apoptosis (cell death) of UF. *Please be advised that this formula should not be taken without the consultation and direction of a trained and experienced herbalist. Holistic and herbal treatments should based on the individual and each person should be individually evaluated for the condition, health history, medications and unique constitution.
Gender, race and socio-economic status impacts the type of care one receives in the US. Black Americans have a higher mortality rate than White Americans. Black mothers are 2-3 times more likely to die from childbirth than their white counterparts. Bias in medicine and research led some people to believe that these healthcare disparities were because of genetic predispositions. More recently, it is being recognized that these beliefs are outdated and that biological factors play a much smaller role. It is more likely that environmental and social factors are contributing to these healthcare disparities.
Black women are disproportionately affected by UF. The impact of medical racism can cause Black women to prolong seeking healthcare in certain situations. Acupuncturists can provide a safer place for people to seek less-invasive and more natural options when it comes to their reproductive health.
Chinese Medicine suffers under its own bias in the US, a country that has history of anti-Chinese violence. This is just one example of how racism in our society can create barriers to access and care. Healthcare costs, ability to obtain health insurance and financial privilege can determine the type of care one can receive. This system of healthcare often teaches us as a society to wait before seeking treatment when we notice symptoms. I hope this article helps to bring awareness to more people about the options that Chinese Medicine offers. Additionally, I hope it encourages people to seek acupuncture and Chinese Medicine at an earlier stage in order to prevent or possibly decrease their suffering from UF.
Additional statistics
• Uterine fibroids are the most common non-cancerous uterine tumors.
• Estimated incidence is 20-40% in women during their reproductive years
• Incidence of UF by the age of 35 is 60% among black women and increasing to more than 80% by the age of 50.
• Caucasian women show an incidence of 40% by age 35 and almost 70% by age 50.
• Black women are 2.4 times more likely to undergo hysterectomy for UF
• Black women have 6.8 fold increase of undergoing a myomectomy for UF
• 8% of hysterectomies in the US are performed for cancer
• 49% of hysterectomies in the US are performed for UF and abnormal uterine bleeding
(Statistics are taken from Khan 2014 and Stewart 2013)
CONTENT WARNING: Medical racism and the practice of eugenics on Women of Color
• Dr. J. Marion Sims, known to some as the “father of modern gynecology” used Black women who were reported to be his slaves, for experimental surgery. He performed numerous surgeries on these women without anesthesia. It is not known how many women he murdered this way but when his surgeries were perfected, he performed them on white women using anesthesia.
• “Mississippi appendectomy” refers to unnecessary hysterectomies performed on Black women in teaching hospitals in the South in the 1960-70’s.
• Federally funded coerced sterilizations occurred in 32 states as a way to control “undesirable” populations. Black, Puerto Rican and Chicano women were heavily targeted in this practice.
• In 2020, reports surfaced that women in ICE detention centers were being given involuntary hysterectomies.
By Dr. Emily Grace Siy, DACM, L.Ac. on February 21, 2022
Sources:
Chen, N.-N., Han, M., Yang, H., Yang, G.-Y., Wang, Y.-Y., Wu, X.-K., Liu, J.-P. (2014) Chinese herbal medicine Guizhi Fuling Formula for treatment of uterine fibroids: a systematic review of randomised clinical trials BMC Complementary and Alternative Medicine vol. 14, article 2
Corbie-Smith, G., Thomas, S.B., St.George, D.M.M. (2002) Distrust, Race, and Research ARCH INTERN MED Vol 162 2459-2463
Khan, A.T., Shehmar, M., Gupta, J.K., (2014) Uterine fibroids: current perspectives International Journal of Women’s Health 2014:6 95-114
Mayo Clinic Diagnosis and Treatment of Uterine Fibroid, retrieved online Oct 24, 2020 https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/diagnosis-treatment/drc-20354294
Shen, Q., Ye, W.J., Hu, X.L., Zhao, C.C., Zhou, L., Zhu, X.Q. (2016) The Effects of Guizhi Fuling Capsule Drug Serum on Uterine Leiomyoma Cells and Its Mechanism Evidence-Based Complementary and Alternative Medicine Vol2016 Article ID 2393640
Stewart, E.A., Nicholson, W.K., Bradly, L., Borah, B.J. (2013) The Burden of Uterine Fibroids for African-American Women: Results of a National Survey JOURNAL OF WOMEN’S HEALTH Volume 22, Number 10
Wechter, M.E, Stewart, E.A., Myers, E.R., Kho, R.M., Wu, J.M. (2008) Leiomyoma-related hospitalization and surgery: Prevalence and predicted growth based on population trends. Am J Obstet Gynecol. 205:492 e491-495
Williams, David R. (2002) Racial/Ethnic Variations in Women's Health: The Social Embeddedness of Health American Journal of Public Health April; 92(4): 588–597.
Treisman, Rachel (2020) Whistleblower Alleges' ‘Medical Neglect’, Questional Hysterectomies of ICE Detainees September 16 NPR.org