Racial disparities in uterine fibroids and endometriosis: a systematic review and application of social, structural, and political context

Importance: Uterine fibroids and endometriosis are 2 of the leading causes of morbidity among reproductive-aged women. There are significant racial disparities in disease prevalence, incidence, age of onset, and treatment profile in fibroids. The data on endometriosis are less clear.Objective: To conduct a systematic review of racial disparities in prevalence of uterine fibroids and endometriosis in the United States and summarize the literature on these 2 highly prevalent benign gynecologic conditions using a framework that explicitly incorporates and acknowledges the social, structural, and political contexts as a root cause of racial disparities between Black and White women.Evidence Review: A systematic review regarding racial disparities in prevalence of fibroids and endometriosis was conducted sepa-rately. Two separate searches were conducted in PubMed to identify relevant original research manuscripts and prior systematic reviews regarding racial disparities in uterine fibroids and endometriosis using standardized search terms. In addition, we conducted a struc-tured literature search to provide social, structural, and political context of the disparities.Findings: A systematic review of the literature indicated that the prevalence of uterine fibroids was consistently higher in Black than in White women with the magnitude of the difference varying depending on population and case definition. Prevalence of endometriosis varied considerably depending on the base population and case definition, but was the same or lower among Black vs. White women. As a result of the social, structural, and political context in the United States, Black women disproportionately experience a range of ex-posures across the life course that may contribute to their increased uterine fibroid incidence, prevalence, and severity of uterine fi- broids. However, data suggest no racial difference in the incidence of endometriosis. Nevertheless, Black women with fibroids or endometriosis experience worse clinical and surgical outcomes than their White counterparts.Conclusion and relevance: Racial disparities in uterine fibroids and endometriosis can be linked with differential exposures to sus-pected etiologic agents, lack of adequate access to health care, including highly skilled gynecologic surgeons, and bias and discrimi-nation within the health care system. Eliminating these racial disparities will require solutions that address root causes of health disparities through policy, education and programs to ensure that all patients receive culturally-and structurally-competent care. (Fertil Steril (R) 2023;119:355-63.(c) 2023 by American Society for Reproductive Medicine.)

Automated summary

Uterine fibroids and endometriosis are two common gynecologic conditions in reproductive-aged women. There are significant racial disparities, with higher prevalence of fibroids among Black women and similar or lower prevalence of endometriosis compared to White women. These disparities may be attributed to social, structural, and political factors, as Black women experience greater exposure to risk factors and worse clinical outcomes.