Black women scheduling a uterine-sparing treatment for leiomyomas

“Racial differences are at the forefront of nearly every issue in our region – from health to education to the economy,” said principal investigator Ganesa Wegienka, PhD, a senior staff scientist in the Department of Public Health Sciences at Henry Ford Health System in Detroit, Michigan. “Thus, unlike many other researchers, we have the ability to examine racial differences in care and disease occurrence to better understand ways to make care more equitable and patient-centered, as well as better understand racial differences in disease risk factors and progression.”

Prior research indicated that Black women with fibroids prefer uterine- sparing treatments. “However, whether Black women actually planned these uterine-sparing treatments for their care was largely unknown,” Wegienka told Contemporary OB/GYN.

The study comprised 1,141 White women and 1,198 Black women who were enrolled in the Comparing Options for Management: Patient-Centered Results for UFs (COMPARE-UF) treatment registry at any of the 10 participating clinical sites in the United States between November 2015 and March 2019.

Black women were younger (median 41.0 vs. 42.0 years) and reported significantly worse symptoms, pain and function on every scale compared with White women.

Black women were also more likely to have had a prior UF treatment than White women: 22.8% vs. 14.6%. Among current treatment options, White women chose a hysterectomy more often than Black women: 43.6% vs. 32.2%. But the rate of myomectomies was comparable: 50.9% vs. 50.2%, respectively.

However, Black women had a significantly higher incidence of uterine artery embolization (UAE): 15.1% vs. 4.7% for White women.

After adjusting for the specific clinical site, age and other important clinical variables including uterine size, Black women were more than twice as likely as White women to select a myomectomy and more than four times as likely to have a UAE.

“I was not surprised by the results,” Wegienka said. “We see racial differences in all aspects of care and disease occurrence.”

Wegienka said the clinical course of subsequent fibroid treatments in women after uterine-sparing fibroid therapy is somewhat unknown compared with hysterectomy patients in which there is no recurrence of fibroids or symptoms.

Additionally, uterine-sparing treatments are the only option to try to preserve fertility, according to Wegienka. “However, evidence about fertility after uterine-sparing treatments is weak,” she said. “This can create great conflict for a woman and her doctor who, hopefully jointly, need to decide what to do about her fibroids and symptoms so that she can go on managing everything in her life, while also thinking about how each treatment may impact her fertility in an unknown way.”

Because Black women overall tend to develop UFs at a younger age and have more and larger fibroids than their White counterparts, “Black women tend to be younger and earlier in their childbearing years when they have to make a decision about treating their UFs, yet they have incomplete information about subsequent fertility and the probability of needing additional fibroid treatments,” Wegienka said.

The authors advocate ensuring that all women have equal access to the same care options that will best meet their personal health goals. “We also need to understand the long-term effects of UF treatments,” Wegienka said. “Meanwhile, women cannot be advised on the likelihood they will require additional fibroid treatments prior to menopause if they select a uterine-sparing treatment.”

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Wegienka reports no relevant financial disclosures.

Wegienka G, Stewart EA, Nicholson WK, et al. Black women are more likely than White women to schedule a uterine-sparing treatment for leiomyomas. Published online February 1, 2021. J Womens Health. doi:10.1089/jwh.2020.8634