Sterilized by Omission
A Personal Essay on Fibroids, Black Womanhood, and Medical Neglect
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Through my personal experience, I hope what I’ve learned can help someone on their journey. I am creating what I wish existed when I needed it most. Take what you need, leave what doesn’t fit. Spread the word. You’re not alone.
The pain was excruciating even though I exceeded the maximum dose of ibuprofen allowed for one day. I was riding the metro north commuter rail back from Union Square (New York City) heading up to Yonkers after a long and very uncomfortable day of work. My insides felt like they were going to drop out. I felt throbbing and stabbing pains in my lower abdomen and pressure on my bladder. I tried using the bathroom on the train hoping for relief, to no avail. And worse, I feared having my pad leak through on the train, even though I doubled up with a pair of period panties (special panties with a lining that absorbs monthly flow in lieu of or in addition to other protection). Not even 3 stops out from the city, I made the costly decision –$100–to exit the train several stops early and call an Uber so I could be dropped directly at my door. I couldn’t contemplate making it through the rest of the ride and then having to walk from the station to my apartment.
This was my life at 43 years old with Uterine Fibroids. I was wasting away before my very eyes. Struggling more and more with each passing year and each monthly period. More pain, more bleeding, and more impact on my social and personal life. Dating was a challenge as the thought of being intimate with someone conjured up a reminder of the once inexplicable pain I felt during intercourse. Then there was pretending to be sick to avoid dates or social gatherings, something many women who didn't have my condition, had a hard time understanding. It wasn’t until I finally found compassionate care at NYU Langone Medical Center, that I began to understand what was happening and what it was costing me, costs I had never considered.
Fibroids operate like a slow and insidious undercurrent that you know is there but you can’t quite identify what it’s doing to you…
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Sterilized by Omission (Cont’d)…
Rewind to age 25, nearly two decades earlier when I first received the diagnosis of having fibroids. I presented with abdominal pain and pressure and was tested for a UTI and sent to see a urologist which yielded no results. My gynecologist at the time decided to do an ultrasound and surprise-surprise she told me I had two small growths called fibroids on my uterus. Her exact words were, "it's nothing to be concerned about right now." I was young and just starting to understand my own medical agency but I had no idea what to ask other than whether there was a treatment. She listed symptoms I didn’t have and told me birth control was the standard treatment. I wondered why I would take this approach if I didn’t have the typical symptoms, and was relatively unbothered aside from the random pains which brought me into her office in the first place. She attributed my pain to the fibroids likely because additional testing showed no other possible causes. I asked my doctor to explain what birth control would do for me and didn’t receive much explanation. I mentioned surgically removing the fibroids and she said "if they aren't bothering you we don't bother them." I took birth control for roughly a month before the misery of the side effects like crazy acne and bloating, prompted me to stop.
We never discussed the fibroids after that initial conversation. There was no information provided on what they were, that if removed they grow back with a vengeance, that they could negatively impact my fertility and ability to carry a child, and no real monitoring or mention of family planning, no lifestyle recommendations, no discussion of hormones, or periods or anything that could have better prepared me for what was to come. And at 25, before we became as tech savvy and knowledge overloaded as we are now thanks to Web MD and Chat GPT, I happily went along with the rest of my life until my 40s side-swiped me.
I went through a lapse in my health insurance and I missed an exam or two, but I resumed the practice of good health by finding a new gynecologist. By age 30 I had switched doctors a few times, and each time I had an annual exam, none of the doctors ever asked me about my history with fibroids, and honestly, at that time they weren’t bothering me so I didn’t bother them. With the stress and overwhelm of working to hard, proving myself, and building a career, I kept going to appointments, checking in, asking about my blood count and being told to take an iron supplement. The fibroids had disappeared from my radar but the anemia was trying to tell me otherwise.
By my late 30s I noticed my periods suddenly becoming heavier and incredibly painful, so painful that I was taking nearly double the dose of ibuprofen allowed in a day (fun fact, Tylenol doesn’t help menstrual cramps because it doesn’t work on prostaglandins, the hormones that cause uterine contractions and inflammation). My body would swell and cause my toe nails to hurt from excessive water retention. I was extremely tired with brain fog and basically couch ridden, finding it challenging to get to work on time or to concentrate even when working from home. I assumed however, this was just a a normal progression of my cycle as I entered peri-menopause. I was getting old, I told myself, and that meant suffering.
That day on the metro north was the worst it had gotten, but leading up to that I started playing detective and trying to figure out why my periods were heavier and more disruptive than ever before. I revisited the fibroids with a new gynecologist. After my annual well-woman exam, my doctor sent me to do an intra-vaginal ultrasound, having felt a large fibroid during my pelvic exam. When I came in for the results I was mortified. There were 20 Fibroids, maybe more, varying sizes, one the size of a grapefruit sitting on top of my bladder. It was such an invasion of my body that all I could compare it to was the movie Alien. I was scared and sad that I had no idea this was where those two little acorns were headed. I asked about treatment options and the only option offered was to get a hysterectomy, a surgery which the doctor explained really "wasn't a big a deal." “I go in laparoscopically,” she said, “and I pull out the uterus,” and there was something else about my ovaries staying put and continuing to make hormones, but by that point I was numb and my ears were ringing. When she said, “it’s not a big deal to have a hysterectomy,” I was shocked. How could removing any organ, let alone my womb, not be a deal? Maybe it’s not a big deal to the surgeon who removes too many uteruses to remember, but it might be a big deal to the patient who only has one uterus to spare.
Questions about whether I wanted to be a mother were also presented to me during that conversation, but for a host of reasons, I was unprepared to answer. I was never dead set on having children, but not totally against it if I were married and it was in the cards for me. And then there was the stigma of age and childlessness, even if by choice, none of which I was prepared to negotiate with myself at that moment. What I knew for sure was that I always wanted to keep my body intact–keep the organs I was born with short of something life threatening. Fibroids were terrible but they weren’t going to kill me from what the doctor explained (there isn’t enough research to show long term impact of fibroids on the body systems which are incredibly interconnected). I left that doctor teary eyed and in shock. I blamed myself for not being more vigilant when I was younger, but I know now that the derelict “wait and see approach,” without any understanding or information on care and treatment was a failure of the medical system.
I made it a point to find better care and came across a private facility that treated me with some dignity. The new doctors did not dismiss my desire to keep my uterus, and even though I was 43 and uncertain about children, they explained egg retrieval and IVF as options still available to me. It was the first experience I had where I felt seen and heard but I couldn’t afford the out-of-network expenses. However, they gave me my power back so I went on the hunt for more doctors, coming across a specialist at NYU who offered the option of Uterine Fibroid Embolization (UFE). I'm not advocating for any particular procedure, but rather to say that options were available if doctors were willing to explain them. I learned that what a doctor could offer was often tied to what the doctor’s specialty and knowledge base was. If the doctor didn't know how to do the procedure or had never heard of it (which is more common than you think), it's likely it would not be offered. Why would I offer something I can't charge you for, that doesn’t advance my skill or practice, or that I care not to learn about? This unspoken reality of the medical sector means that patients, often sick and in distress, have to shop around online for information and options, and then find doctors who are willing to explore those options with them.
The UFE is a minimally invasive procedure that allowed me to deal with the fibroids and keep my organs. A small catheter is placed through a vein in either your wrist or your thigh, travels to the uterus, and injects tiny particles that cut off blood supply to the fibroids. The particles are made of a substance that is not toxic to the body. The trajectory for childbirth after having this procedure is disputed as some say it’s not possible though successful pregnancies have been documented. I made a personal and nuanced decision for myself regarding motherhood and I was grateful to find something that felt right for my needs. I was also grateful for a doctor who took the time to listen and validate what I was going through and the impact it was having on my life. At NYU I was given a survey that not only asked me questions about my symptoms, but also lifestyle and quality of life challenges, and that was when I understood the magnitude of the disruption fibroids caused unbeknownst to me. It was easy to articulate the heavy bleeding and pain, but not so much the social aspects. The survey let me know that what I was feeling emotionally and experiencing in my personal life, as a result, was also real.
It was this doctor working in concert with another surgeon colleague, who also sent me to be tested for uterine cancer based on family history, and a hematologist due to the excessive blood loss which developed into anemia and resulted in me needing intravenous iron infusions for several weeks before surgery. For years prior, my bloodwork would always have some numbers that were off, some more than others, one set of numbers one month and another set of numbers the next, yet no one sent me to see a hematologist or questioned a possible connection to the existing fibroids. Every time I would have blood drawn I would ask about the levels to no avail. “It was nothing to be worried about,” because the numbers were mildly off and I could simply take an iron pill. When I saw the hematologist I was immediately scheduled for the iron infusions and after the first infusion my energy levels improved. The hematologist also discovered that I was a carrier for sickle cell trait and Alpha Thalassemia trait both of which were never previously mentioned to me or even tested for. I share this only to say that much of what impacts us is interconnected but our care is often fragmented. It took me over 40 years and finding the right doctors and my own voice to put these puzzle pieces together. Knowing about the traits has become useful in other medical contexts.
My UFE was a success and life is much better now with normal periods, at 45, and so far no other symptoms returning, including the cramping that from the age of 16 I thought was par for the course. But why did it take 2 decades and a descent into agony to receive a baseline of information and a modicum of care? For all women our bodies are seen as vessels of reproduction and legacy, yet we do not prioritize the health and longevity of women's bodies. We focus on whether a woman wants to abort a life, but not the value of that woman's experience as a woman in her body. As a black woman, I am used to medical gaslighting and dismissal, experiences that lead to hypervigilance and distrust when engaging the healthcare system. If women’s health is still a questionable priority, then black women’s health is the most questionable of all. Doctors can be impatient when too many questions are asked, but gone are our grandmother's days when you took your diagnosis and your pills no questions asked. As patients we have more information at our disposal now, and a right to better partnership regarding our care.
Let us recall the historical trauma we endured at the hands of a system that once put a price tag on the black woman’s womb. Black women's bodies were made to breed slaves for profit. When slavery ended, our bodies were subjected to forced sterilizations. One such push for sterilization was in the south where upwards of 700,000 (that's almost 1 million black women) cases were reported during what was known as the "Mississippi Appendectomy's" which activist Fannie Lou Hammer brought attention to after going in for a tumor removal and instead being sterilized. These and other transgressions were heavily explored by Dorothy Roberts in "Killing the Black Body: Race, Reproduction, and the Meaning of Liberty."
The system no longer confers value but instead prefers to erase our wombs. Whether we choose to see it or not, the medical neglect of black women's reproductive health is sterilization by omission. Fibroids can lead to infertility, miscarriages, years of suffering, lost quality of life, lost wages from missed work, stigma, and social isolation. Black women are often told to just not worry about it (as we recently saw Venus Williams share about her experience with fibroids) until they plan to have children and at that point, the situation could be too far advanced.
Black women are not counseled on how to care for themselves or to monitor the progression of fibroids. For example, an intra-vaginal ultrasound with each annual exam would have allowed my doctors to know the rate at which my fibroids were growing and to some degree where they were located and which ones were of most concern. It could have helped me track symptoms that might indicate an intervention was needed sooner than I actually received it, perhaps allowing me more time to make critical decisions about motherhood later in life, like whether to do egg retrieval and IVF, questions asked of me when I was under incredible duress and just wanting the misery to be over. I opted to forgo this process but I might have chosen differently with time, planning and support or early education in my 20s and 30s.
Nearly 2 decades after my diagnosis there is still a dearth of research and understanding about what causes fibroids, why black women are so impacted (the generational womb trauma is not lost on me) and how fibroids could be prevented or treated without sacrificing reproductive freedom. More funding is needed for research, identifying holistic and non-surgical treatments, early detection, monitoring and prevention, and overall women's health education and understanding of our reproductive journeys from periods to menopause and the in between like peri-menopause and fibroids. These efforts would be greatly served if our healthcare system treated the whole person and the interconnectedness of our body’s systems, rather than the current fractured approach that says we treat your heart disease but we don’t investigate the gum disease you have which is a contributor to your heart disease (yes, your gums impact your heart). Whole people need whole solutions but to do that would mean turning a rigid and oppressive healthcare system built on race and class divides, on its head, and depriving pharmaceutical companies of the profits they would lose if people were actually healthy—black people and women in particular.
Lupita Nyongo's recent sharing of her journey with fibroids inspired me to reflect back on my own journey and to speak up in support of her voice and the initiatives she’s advancing through legislation with members of Congress, supporting fibroid research. Lupita has specifically endorsed the Stephanie Tubbs Jones Uterine Fibroid Research and Education Act of 2025 (H.R. 4395), which allocates $30 million annually for research, education and training, and the complimentary U-FIGHT Act which emphasizes early detection and patient navigation for fibroid care. Other bills have previously been introduced but have not passed.
We must use this moment to become a movement, to end the suffering of so many black women at the hands of medical disregard and to remember the suffering of black women's bodies throughout history as a reminder that our bodies still endure. But now we are ready and we deserve to move from endurance and suffering to thriving, joy, and healing.
Recognition is not enough. Reparation begins with care. This is how we heal. This is how we truly lean in. To Venus Williams and countless others who continue to share their stories, thank you for your bravery. To Lupita, thank you for your advocacy, inspiration and push for change. To Senator Kamala Harris and Assemblywoman Yvette Clarke, thank you for leading the way.