Endometriosis and uterine fibroids disproportionately affect women of color in terms of diagnosis, treatment, and health outcomes. These conditions, which are common reproductive health issues, cause severe pain, infertility, and other significant health complications, but women of color—particularly Black and Latina women—often face barriers that lead to worse outcomes compared to white women. The disparities are rooted in a combination of social, economic, and healthcare factors, including delayed diagnosis, limited access to care, systemic racism, and cultural stigmas. Below, we will explore the ways in which endometriosis and uterine fibroids affect women of color disproportionately, focusing on diagnosis, treatment disparities, access to care, and health outcomes.

1. Delayed Diagnosis

Women of color, especially Black and Latina women, experience delays in diagnosis for both endometriosis and uterine fibroids, which can lead to more severe symptoms and complications. These delays stem from several factors, including medical bias, lack of awareness, and healthcare disparities.

For endometriosis, the delay in diagnosis is a well-documented issue across all racial and ethnic groups, with an average delay of 7 to 10 years. However, research suggests that this delay is even longer for women of color. One reason for this is that endometriosis has long been considered a condition primarily affecting white, affluent women. As a result, healthcare providers may not readily associate the symptoms of endometriosis—such as chronic pelvic pain, heavy menstruation, and infertility—with women of color. Consequently, women of color often endure their symptoms without receiving a proper diagnosis, and their concerns may be dismissed as normal menstrual pain or attributed to other conditions.

Similarly, for uterine fibroids, Black women are disproportionately affected by delayed diagnosis. Fibroids are benign tumors that grow in or around the uterus, and Black women are two to three times more likely to develop fibroids than white women. Despite this higher prevalence, Black women often experience delays in diagnosis because their symptoms may be downplayed by healthcare providers. Additionally, they may face dismissive attitudes regarding their pain or heavy menstrual bleeding, leading to delays in receiving proper medical attention. By the time fibroids are diagnosed, they are often larger and more numerous, making treatment more difficult and increasing the likelihood of complications such as hysterectomy.

2. Higher Prevalence of Uterine Fibroids

Uterine fibroids disproportionately affect Black women in terms of both prevalence and severity. Studies have shown that Black women are more likely to develop fibroids than women of other racial or ethnic backgrounds. By the age of 50, up to 80% of Black women will have fibroids, compared to about 70% of white women. Moreover, Black women tend to develop fibroids at younger ages, and their fibroids are often larger and more numerous.

The exact reason for the higher prevalence of fibroids among Black women is not fully understood, but several factors are believed to play a role, including genetic predisposition, environmental factors, and lifestyle influences. For example, studies have suggested that higher exposure to environmental toxins, such as endocrine-disrupting chemicals, may contribute to the increased risk of fibroids in Black women. Additionally, factors like diet, stress, and lack of access to preventive healthcare may exacerbate the development and growth of fibroids.

The early onset and aggressive nature of fibroids in Black women also contribute to more severe symptoms, such as heavy menstrual bleeding, chronic pelvic pain, and fertility issues. These symptoms can significantly impact a woman’s quality of life, leading to anemia, fatigue, and difficulties with work or daily activities. Unfortunately, the disproportionate impact of fibroids on Black women is often compounded by delayed treatment and limited access to effective care.

3. Barriers to Accessing Care

Women of color, particularly Black and Latina women, face significant barriers to accessing quality healthcare, which exacerbates the challenges of managing endometriosis and uterine fibroids. These barriers include lack of health insurance, limited access to specialists, financial constraints, and geographic disparities.

For many women of color, especially those in low-income communities, lack of insurance or underinsurance limits their ability to seek timely medical attention. Without insurance, women may delay or forgo visits to the doctor, leading to worsening symptoms and more advanced disease by the time they receive a diagnosis. Even for those with insurance, high out-of-pocket costs, such as copayments and deductibles, can deter women from seeking care or following through with recommended treatments.

In addition, geographic disparities in access to healthcare services disproportionately affect women of color. Many low-income and predominantly Black and Latino neighborhoods have fewer healthcare providers, particularly specialists like gynecologists, who are trained to diagnose and treat conditions like endometriosis and fibroids. Women living in these areas may have to travel long distances to see a specialist, further delaying diagnosis and treatment.

Cultural and linguistic barriers also affect Latina women in particular. For Spanish-speaking women or those who are not proficient in English, communication with healthcare providers may be challenging, leading to misunderstandings about symptoms, treatment options, or follow-up care. These barriers, combined with financial and logistical challenges, create a significant gap in healthcare access that worsens outcomes for women of color suffering from endometriosis and fibroids.

4. Medical Bias and Discrimination

Systemic racism and medical bias play a major role in how endometriosis and fibroids are treated in women of color. Studies have shown that Black women, in particular, are less likely to have their pain taken seriously by healthcare providers. This bias can lead to inadequate pain management, delayed diagnosis, and suboptimal treatment for reproductive health conditions.

For endometriosis, which is often associated with severe and chronic pain, racial bias in pain management can have devastating effects. Black and Latina women may be less likely to receive pain-relieving treatments or referrals to specialists, such as pain management clinics or gynecologists who specialize in endometriosis. Instead, their pain may be dismissed or inadequately treated, leading to prolonged suffering and reduced quality of life. The failure to recognize and adequately treat pain in women of color contributes to health disparities and worsens outcomes for those with endometriosis.

In the case of uterine fibroids, hysterectomy—the surgical removal of the uterus—is more commonly recommended to Black women than to white women, despite the availability of less invasive treatment options. This is partly due to implicit bias, where providers may assume that Black women are less likely to want or need fertility-preserving treatments. Studies have shown that Black women are more likely to undergo hysterectomy than white women, even though alternatives such as uterine artery embolization or myomectomy (surgical removal of fibroids) exist. The overuse of hysterectomy in Black women reflects broader disparities in healthcare access and decision-making, where women of color may not be offered or fully informed about less invasive options.

5. Mental Health Impacts

The emotional and psychological toll of living with conditions like endometriosis and fibroids can be significant, particularly for women of color who may face additional stressors related to systemic racism, discrimination, and economic hardship. Chronic pain, fertility issues, and the disruption of daily life caused by these conditions can lead to mental health challenges such as depression, anxiety, and stress.

For Black and Latina women, these mental health challenges are often compounded by cultural stigmas surrounding reproductive health. In some communities, discussions about menstruation, pain, or infertility may be taboo, preventing women from seeking support or discussing their symptoms openly. The isolation that comes with managing a chronic condition, combined with the stigma surrounding reproductive health, can lead to worsening mental health outcomes for women of color.

Furthermore, the healthcare system’s failure to adequately address the mental health needs of women with chronic reproductive conditions means that women of color are less likely to receive the psychological support they need. Mental health care may be inaccessible due to cost, lack of providers, or cultural barriers, leaving women to cope with the emotional and psychological burdens of endometriosis and fibroids on their own.

6. Disparities in Treatment and Health Outcomes

Ultimately, the disparities in diagnosis, treatment, and access to care result in worse health outcomes for women of color with endometriosis and fibroids. For endometriosis, delayed diagnosis and inadequate pain management can lead to infertility, debilitating pain, and a reduced quality of life. Similarly, untreated or poorly managed fibroids can lead to severe anemia, chronic pelvic pain, complications during pregnancy, and, in extreme cases, life-threatening bleeding.

Black women with fibroids are more likely to undergo hysterectomy at a younger age, which not only affects fertility but also has long-term health consequences, such as an increased risk of cardiovascular disease. The over-reliance on hysterectomy as a treatment option reflects broader disparities in healthcare, where women of color are often given fewer options and less agency in their healthcare decisions.

For women of color with endometriosis, the delay in diagnosis and inadequate treatment can result in years of untreated pain and potential fertility issues. Since endometriosis can only be definitively diagnosed through surgery, women of color may face additional barriers to accessing the surgical procedures necessary for diagnosis and treatment. The lack of specialized care for endometriosis among women of color exacerbates their suffering and limits their options for managing the condition.

Conclusion

Endometriosis and uterine fibroids disproportionately affect women of color due to a combination of medical bias, delayed diagnosis, limited access to care, and inadequate treatment options. Black and Latina women are particularly vulnerable to these disparities, facing higher rates of fibroids, more severe symptoms, and greater barriers to receiving appropriate care. Addressing these disparities requires a multifaceted approach, including improving access to specialized healthcare, increasing awareness of these conditions among