By Eboni Brandon
Uterine fibroids affect millions of women worldwide, with Black women facing the greatest burden. In this feature, we look at the science, treatment options, and systemic gaps surrounding fibroid care—while also amplifying the voices of women in St. Kitts and Nevis whose lived experiences bring the issue into sharper focus.
For many women, the first signs of a uterine fibroid are subtle—a heavier period than usual, unexpected fatigue, or persistent pelvic discomfort that seems to have no explanation. Yet beneath these seemingly minor symptoms, a condition is quietly shaping lives, affecting physical health, emotional wellbeing, and even fertility.
Fibroids—benign growths in or around the uterus—are often dismissed as a “normal” part of womanhood, but for Black women, the stakes are far higher. By age 50, as many as eight in ten Black women will have experienced fibroids, a prevalence more than double that of white women.
In St. Kitts and Nevis, the burden is visible. The Ministry of Health reported that 78 women underwent surgery for fibroids in 2018. That same year, Chief Medical Officer Dr. Hazel Laws noted that more than 60% of women aged 35–50 are thought to have fibroids, with around 30% experiencing symptoms severe enough to affect quality of life. Behind these numbers lie countless women navigating pain, heavy bleeding, and fertility challenges—often without timely diagnosis or access to the full spectrum of care.
The reasons for this disparity are layered. Genetics increase risk, but other factors push the odds higher: early menstruation, higher rates of obesity, diets rich in red meat and processed foods, and chronic exposure to environmental toxins such as endocrine-disrupting chemicals. Hormonal imbalances, particularly estrogen dominance, further fuel growth. Taken together, these influences reflect broader social, economic, and environmental pressures that shape women’s health.
Despite their prevalence, fibroids remain under-discussed and under-treated. Many women only seek medical attention once symptoms become debilitating—anaemia from relentless bleeding, pain that disrupts daily routines, or complications during pregnancy. By then, treatment options often feel limited. Too frequently, women are offered hysterectomy or myomectomy without a meaningful discussion of less invasive choices.
For Marcia N., a 29-year-old store clerk from Nevis, fibroids reshaped her work and self-confidence. “My periods last almost two weeks, and the bleeding is so heavy I have to change every hour. I don’t wear light-coloured clothes anymore because I’m terrified of an accident at work. Every month I end up calling in sick at least one day, and I know my boss doesn’t understand. It’s embarrassing, but people don’t realise how much [fibroids] affect your life.”
Latoya J., a Kittitian banker, now 35, underwent a myomectomy at the JNF Hospital in 2023 after being diagnosed at age 27. “When they told me I had fibroids, I thought it meant I couldn’t have children. I was devastated. After my surgery, the doctor said my chances are much better. Recovery wasn’t easy—it took weeks before I felt like myself again—but at least I still have my uterus. I just wish I had known earlier what my options were.”
Latoya now has a 16 month old daughter.
Medical research confirms there are proven alternatives. Uterine fibroid embolization (UFE) and radiofrequency ablation have been shown to shrink fibroids and dramatically improve symptoms. In one study of 65 women treated with UFE, uterine size decreased by more than half, while heavy bleeding, pelvic pain, and urinary symptoms improved in more than 80–90% of patients. These are not experimental—they are safe, evidence-based procedures. Yet many women, particularly Black women, are never told about them.
This silence reflects deeper problems within healthcare systems. Implicit bias, limited training in newer procedures, and medical paternalism contribute to treatment gaps. As a result, Black women are more likely to undergo invasive surgery, face longer recovery, and lose reproductive choices.
The toll is not only physical. Chronic pain, fatigue, and heavy bleeding erode mental health, trigger anxiety and depression, and strain intimate relationships. For women hoping to conceive, fibroids can transform dreams of motherhood into a source of stress and uncertainty.
Keisha M., a 33-year-old waitress from St. Kitts who had a total hysterectomy in 2024, still feels the emotional weight of her diagnosis. “I wanted children in the future but my doctors told me the only option was hysterectomy. I wasn’t ready to give up hope, but I didn’t feel like I had a choice. I didn’t know about embolization or other treatments until I saw a video online. By then it was too late. Every time I think about never having children, I feel depressed.”
Stories like hers highlight a painful truth: too many women are making life-altering decisions without full information.
Not every woman who undergoes surgery feels despair or regret. For many, the relief from years of bleeding, pain, and fatigue far outweighs the loss of the uterus, bringing a renewed sense of freedom and improved quality of life. Yet, this is not the full picture. Some women remain conflicted about their decisions, especially if fertility was still a hope, while others face difficult outcomes. A minority experience serious post-surgical complications such as early menopause requiring lifelong hormone replacement therapy and urinary incontinence that alter daily living.
The conversation surrounding this hidden burden requires a shift in both personal and systemic approaches. Women must be empowered to advocate for themselves—asking about all available treatments, seeking second opinions, and openly voicing fertility goals. Healthcare providers must, in turn, prioritise comprehensive counselling that considers both surgical and minimally invasive options, while recognising the emotional as well as physical impact of fibroids.
Prevention and lifestyle adjustments matter too. Maintaining a healthy weight, exercising regularly, eating a diet rich in fruits, vegetables, and whole grains, and limiting exposure to endocrine-disrupting chemicals may help lower the risk of developing fibroids or slow their progression. At the community level, public health systems must ensure awareness campaigns reach women, that minimally invasive procedures are available locally, and that cost barriers do not prevent access.
Fibroids are not simply a medical condition—they are a lens into the inequities of women’s health. For Black women, who carry the heaviest burden, the conversation must move beyond surgery to include honest discussions of risk, fertility, emotional wellbeing, and treatment choice. Only then can women move from silent suffering to informed action, reclaiming control over their health and their futures.
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