I'm William Brangham and this is "Horizons."

For millions of women, uterine fibroids not only cause painful symptoms, but the diagnosis can bring more questions than answers.

First of all, I felt shame, you know, what did I do to cause them?

And then I felt very alone and quite scared for my reproductive health.

Brangham: Even though most women will develop them, misconceptions remain about who gets them and how they should be treated.

Fibroids and women's health coming up next.

♪ Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

From the David M. Rubenstein Studio at WETA in Washington, here is William Brangham.

Welcome to "Horizons."

Today, we are talking about a condition that most women will endure in their lifetimes.

That's fibroids.

They're tumors that grow on or in the wall of the uterus, and about 70 to 80 percent of women will have them in their lifetime.

Black women suffer the most.

While fibroids start off small, they can grow to be very large, as big as a grapefruit or even a watermelon.

Fibroids are not cancerous, but as one of our guests today remind us, they can wreak as much havoc on your life as cancer can, causing severe bleeding, anemia and a lot of pain.

They can also complicate a woman's ability to have children.

Fibroids cost the American health care system an estimated 40-plus billion dollars a year.

And given that so many women experience them, it's alarming that they are so widely misunderstood and poorly researched.

Federal research about fibroids receives far less money when compared to other conditions like prostate or breast cancer.

So, to help us understand this landscape, we are joined by two women who know this topic intimately.

Dr.

Soyini Hawkins is a gynecologist and surgeon who started the Fibroid and Pelvic Wellness Center of Georgia.

And Sateria Venable is the founder of the Fibroid Foundation, which advocates for women suffering with fibroids and campaigns for greater awareness and research.

Thank you both so much for being here.

Such a pleasure to have you.

Dr.

Hawkins, I'd love to start with you first.

You heard what I said about fibroids.

Educate us a little bit more.

What else would you add to that about what they are and how they develop?

Absolutely.

So, fibroids, in their simplest definition, are tumors that grow from the uterus.

So, altogether, that tells you that everyone that's born female has the potential to grow fibroids in their lifetime.

We usually see it during the reproductive age, and it can grow from the cells of the uterus and get as big as, you said, like a watermelon.

Depending on where they're located is how fibroids can wreak that havoc.

Fibroids that are close to the lining of the uterus, we call those submucosal, usually cause the most problems with patients that have extremely heavy bleeding.

That's the number one symptom patients will present and complain of.

But those symptoms can vary all the way to symptoms of daily living, how much they have to go to the restroom because the fibroids are pressing on their bladder, back pain, pains with intimacy.

And one of the silent symptoms of fibroids that I think sometimes we don't necessarily talk a lot about is infertility.

Sometimes that's the only symptoms that patients have and will discover fibroids on that evaluation.

So, they definitely can span, and 70 percent of women can have fibroids.

That is two to three times more in African American population.

Sateria, those statistics are just so shocking, 70 percent, 80 percent of women.

What else would you add to this about what we need to know about this condition?

Well, the reason I became an advocate is because I didn't want women to continue to suffer.

So, there are so many women and menstruators who go to work every day, have very demanding jobs, are taking care of families, and they're smiling and suffering through these debilitating symptoms.

And to help people take a walk in the shoes of someone who has uterine fibroids, I'd like to give some examples, like, for instance, going to work with half the blood in my body.

So, your hemoglobin is supposed to be... Brangham: Half the blood?

- Half, half.

My hemoglobin was 5.6.

At its lowest point, I was seeing stars.

Brangham: What is your hemoglobin normally supposed to be?

Venable: About 12.

Brangham: Wow.

Venable: Yeah.

So, and when I was very symptomatic, I could lose two points in one day from the hemorrhaging.

So, that lets you know that, you know, I was experiencing shortness of breath, I was managing a construction team of 300 people doing a six-floor construction project in Chicago, and I caught a cab to work because I couldn't walk the four blocks from the bus stop to get to work.

And I was just, you know, you want to keep your job.

I was much younger at that point, had just started a new job.

Another instance I'd like to share is that I prepped to go on a vacation, not knowing that the altitude of an airplane could trigger bleeding again.

So, one hour into my flight, I started hemorrhaging and had to turn around and come right back home.

And there have been many instances of me on planes where you experience a gush, which is where the blood leaves your body at 200 percent the normal rate because of the impact of the air pressure in a plane.

So, there are circumstances like that, where women and menstruators are just pushing through their daily lives in a manner that they shouldn't be expected to.

I mean, Dr.

Hawkins, to listen to Sateria here describe this, I mean, it just... it's still such a striking statistic how many women will eventually have to deal with these.

How does one...?

I mean, obviously, if you went to the doctor and described the symptoms that Sateria is describing, a doctor would know to look deeply into what was going on there.

But how are they diagnosed normally?

Sure.

So, the thing about it is, us as clinicians, we're detectives, so there are some patients that will present with the exact same symptoms and not get to the actual diagnosis of fibroids.

So, the intentionality of going to your doctor is explaining what has changed in what was normal at one time to now the abnormal that has been described is extremely important.

Most doctors from that will do their anemia testing and look at things like that hemoglobin to see if something is off-putting there.

A lot of times, primary care doctors will say, "Oh, your hemoglobin is low.

"It must be... you need a colonoscopy."

And for menstruating women, sometimes it's simply the heaviness of our cycle.

The way we diagnose fibroids is through imaging.

So, a simple ultrasound that is noninvasive, very cheap, easy to do, and well-tolerated, a lot of times will hint us into the actual cause of that heavy bleeding, or, at the very least, rule it out.

Ultrasounds are the golden standard for diagnosing fibroids.

Brangham: Sateria, when you were a younger woman, did your doctor talk to you about this?

I mean, how long did it take you to figure out what was really causing all this distress?

So, like many women, I come from a family of women who suffered through really bad periods.

So, it got really bad.

And I was 26, and I went to the doctor and found out that I had fibroids.

I had never heard the word fibroids.

And I think that's a common theme.

Brangham: You think having a heavy period in your family meant it might have just been explained away.

"That's what that is.

Don't worry."

Exactly.

I just thought it was normal.

That was life.

And if you think about it, for a young girl who starts her period, like I did at 11, by the time I'm 26, you become very acclimated to incredibly heavy periods.

And you just think this is your plight.

But even for me, it became too much.

And so I went to the doctor and was diagnosed with fibroids and had never heard that word.

And I was just shocked that it was not explained to me whether or not it was cancerous, which was scary to me.

Uterine fibroids are non-cancerous.

Brangham: But just that word tumor.

Exactly.

And so I started on a journey of surgery number one, which would become four surgeries over the course of my reproductive experience with uterine fibroids.

And it was just horrendous.

Dr.

Hawkins, is there anything that can be done to prevent fibroids from growing?

Yeah, that's a really good question and probably one of the most questions, most common questions I'm asked.

Before treatment, after treatment, how can I prevent this from coming back?

Because we do know that just the prevalence of fibroids is very high, that recurrence rate of fibroids are very high.

Fibroids can return at a rate of up to 40 to 60 percent, depending on the source that you're reading, even within three years of intervention.

So we usually will talk to patients about that holistic approach of doing what you can with the things that you can make a difference.

You cannot change the fact that you are genetically female, that you have a uterus and that you have hormones that are going to feed it.

That is the base of where fibroids come from.

But we do talk to patients about their nutritional intake, not adding to their diet things that have a lot of hormones in it, such as red meats, not adding things that have a lot of additives in it or synthetic products to even what they put on their skin and their hair makes a difference.

And then stress.

I can't overstress how much stress has to do with the way that fibroids grow.

I tell my patients all the time, during COVID is when I saw the largest symptomatic worsening of symptoms or, excuse me, worsening of symptoms for my patients because it was a point where we were at a standstill of being able to do a lot for them.

We kind of embraced medications during that time and their fibroids grew rapidly.

And then the last thing is we do have some holistic and more natural approaches that has been well-researched and well-studied to speak at how important research and studies are.

We now know that vitamin D, as well as green tea extract, actually does make a difference in the way that fibroids grow over time and may even be able to keep small fibroids small or shrink them to a degree.

It's hard to shrink very large fibroids, but in the beginning, when you find out that you have small ones, sometimes there's a lot that you can do to try to hold them at bay.

Brangham: Dr.

Hawkins, just staying with you for a second, you mentioned interventions.

If someone does have a fibroid that you believe and that your patient agrees needs intervention, what does that actually mean?

How do you... Is it a surgical removal?

How do you address them?

There are lots of different interventions for fibroids, anywhere from observation, which I wouldn't say is an intervention, but is plausible at some points.

Fibroids are not always symptomatic.

Fibroids, although they affect 70% of the general population of women, it's about 60% that actually will be symptomatic and probably about 40% that will actually present to their doctor or complain to someone that this is bothersome to them.

With that, their intervention or observation might be practical, but the part that's important with observation is actually keeping an eye on the fibroid, maybe getting that image that we spoke of earlier once or twice a year just to see how it grows in progressive.

Most of the time, when the symptom is debilitating or before it gets debilitating, I beg you, women, before it gets debilitating, we're giving interventions.

Even medications can help with the heaviness of the bleeding.

To actually do something about the fibroid, though, usually looks like some type of procedure to either shrink them with either uterine fibroid embolization or a procedure that I do, which is the newest technology in the treatment of fibroids, radiofrequency ablation that can shrink it with heat in a painless way and patients get back to life very quickly.

I'm a minimally invasive surgeon, so I'm always trying to do the least to get the most for my patients.

Then, of course, we can remove fibroids and that's called a myomectomy, which I think is the one most people know about and most people had.

That's the surgery that I had for my fibroids and that's when we actually cut them out and try to restore as much as possible in the normal anatomy of the uterus.

That also, depending on the size, can be done laparoscopically or robotically or sometimes, if it's very large, needs to be open.

Then, of course, the definitive surgery for fibroids is removing the fibroid and the uterus, a hysterectomy, but it is not usually the only or the first option that patients have.

Brangham: Sateria, obviously, anything to do with the uterus will make a lot of women wonder, does having fibroids complicate my ability to have a child?

What does the research tell us about that?

Do getting fibroids mean you're going to have complications or unable to have a child?

Well, first of all, I want to dispel fears.

Women have fibroids and have healthy babies every day.

However, it's also true that estrogen feeds fibroids.

When women are pregnant, sometimes the fibroid can grow at the same rate or faster than the uterus.

We have community members who have had children with birth defects due to a fibroid crowding out the baby in utero.

It's something that really needs to be tracked very carefully, which is why oftentimes, because so many women have a goal of becoming a mom, we refer our community members to reproductive endocrinologists or fibroid specialists like Dr.

Hawkins so that they can have that care while they are going through their motherhood journey.

Brangham: I want to ask you both about this question that I mentioned at the beginning, which is the gap between what we know fibroids cost our society, let alone the pain and anguish that they cause women, which is impossible to put a monetary figure on, but the fact that we do not spend nearly as much on fibroid research as we do on these other conditions.

Dr.

Hawkins, to you first.

What is it that that research could help us understand?

What are the questions we don't know the answers to that we need to know?

Oh, the questions are rampant.

A lot of patients have questions like where do fibroids come from?

Why do they affect Black women so drastically?

What is it that is in our environment that might feed it different than our neighbors across the pond?

And things as such.

The only way that we get answers to that is through research.

How we come up with new technology like the radiofrequency ablation is through research.

How we know where to spend our dollars and understand the economic impact of fibroids is through research, is through data sourcing, is through things like surveys that some of my patients have participated in to get a better understanding of it.

It really, honestly, is disheartening to know that there's such a wide gap.

But the great thing about conversations like this is it sheds light on the true impact of fibroids and how devastating it can be to sometimes women that are taking care of a whole household and cannot slow down to worry about this heavy menstrual cycle.

They don't want to lose that promotion at work.

They don't want to lose productivity or miss another baseball game.

The research helps us get closer to closing the gap of care and also knowing where to put our economic power to help these women that are suffering.

Brangham: Or you don't want to stop doing that six-story construction job in Chicago like you were doing.

Exactly.

Brangham: Why do you think this research gap exists, Sateria?

Well, I know that there are disparities in care.

I know that women in the Southeast portions of the country, Southeast states of the United States, are recommended hysterectomy more frequently, which is a huge issue.

Brangham: Much more invasive and life-changing experience.

Venable: Absolutely, and can carry cardiovascular complications as they age.

And one of the reasons we're always talking about women of European descent versus women of African descent is because that's the only data we have.

We don't have data to truly reflect how many ethnicities, which is all, all ethnicities are impacted by uterine fibroids.

Just last year there was a study that 47 percent of Asian women had uterine fibroids.

That's new data that we got just in 2025.

So, you know, as Dr.

Hawkins said, we don't really know the full impact because we don't have the data to support it.

We don't have nutritional studies, which would be very helpful.

We don't have enough studies really exploring how we can minimally invasively treat these, so you know, these uterine fibroids the way that we need to.

And very importantly, you know, the education in medical schools does not really provide the minimally invasive gynecologic surgery training that we need, a fellowship is required.

And so, therefore, there are providers who don't really, you know, have the surgical skills or the knowledge of uterine fibroids to treat them minimally invasively the way that most patients would like them to.

Brangham: And, Sateria, just staying with you for a moment, I know your foundation is campaigning for a lot of things.

One of them is for increased funding.

You come to Washington, D.C., a lot.

You get on Capitol Hill, and you're trying to badge your lawmakers into doing this.

What do they tell you as far as why these disparities in funding exist?

Do you ever get a satisfactory answer to that question?

Behind the scenes in one-on-one meetings, we hear that, "My mother has fibroids," because I always invite even our legislators to go home and ask their family members who has fibroids.

And if I encounter them again, they invariably come back and say, "I had no idea my mother had a hysterectomy due to fibroids."

"I didn't know that my sister had birthing complications."

But then, when we try to pass it on the floor, there's often pushback that's bipartisan.

We did receive bipartisan support of the fibroid bill a few years ago in the Senate, but, sadly, not in the House.

And there's just absolutely no reason for that to occur, because it impacts every woman's family, every family, every walk of life.

No one's excluded from this touching their lives.

And the rate of hysterectomy due to fibroids is about 300,000 hysterectomies in the United States per year, which is about half of the hysterectomies annually in the United States are due to fibroids.

And just think about those numbers and how many women's lives could be enhanced by not having to undergo that surgery and potentially complications following it.

I want to ask you both about something.

I want to read this quote.

As you both know, the actress Lupita Nyong'o has been very public about her own struggle with fibroids.

She is the star, for people who don't recognize her, "12 Years a Slave," "Black Panther."

She's in "The Odyssey" right now.

She was diagnosed in her 30s.

She's talked about the pain she went through, the surgery she went through.

She mentioned in a statement that she put out a while ago, going to her doctor after one of her surgeries and saying to the doctor, "OK, I have gone "through this surgery now.

"What can I do to prevent this?"

And the doctor said, "Well, "there's really nothing you can do.

"They're just going to come back again."

And she said this, quote, "This moment crystallized something profound for me.

"I realized that, as women, "we are conditioned from an early age "to expect suffering and to endure it in silence."

Dr.

Hawkins, does that ring true to you?

It does.

Unfortunately, that is what a lot of my women that I take care of come in the door with.

They are already devastated by how it impacts them daily.

They're devastated again when they go to their doctors and they feel like none of the options that they've been given actually gel with the life that they're willing to live or compromises that they're willing to have with their general health or their future family planning.

Because if you offer a 30-year-old a hysterectomy, that is unconscionable to them because they had bigger plans for that uterus.

And so, you know, a lot of women come in already on the defense, which is reasonable.

And so you're doing more than just taking care of their wound.

You're taking care of their mental health.

You're taking care of their planning for their future.

And that's because the impact can be so wide.

So her statement is eye opening in a sense for the rest of the world.

But for these women that are suffering with fibroids, it hits the nail on the head.

Brangham: Does that ring true to you as well?

Absolutely.

Because it's so disheartening.

I've had four fibroid surgeries and between surgeries three and four, I became a pescatarian to reduce the hormone load.

And it did lengthen the time between surgeries three and four.

But I still had to have surgery number four.

And I think you know, you feel so invaded, I guess, is the word that comes to mind when you have one of these surgeries, because you're tender for so long.

You could be in so much pain.

I remember going back to work after eight weeks off from my open myomectomy, and I felt like I was tiptoeing on the concrete like every step.

I felt it all the way up through my abdomen.

And I've been in meetings before where I've shared with physicians who did not have a uterus, how the pain really transfers through the body.

It's not just the uterus.

It's up and down your legs, through your back.

It can impact your breathing if you're anemic.

And so it's, you know, when you... I've met women out in social settings that have told me that they can't bend over and stand up because their bodies have to adjust to their low hemoglobin level.

And I remember waking up in the morning and having to slowly sit up out of bed because, if I sat up too quickly, I could pass out because you have so little blood, your body has to adjust.

And these are adjustments that women are adapting to taking care of families, and they shouldn't have to.

Brangham: Really unbelievable stories.

Dr.

Hawkins, we have about 30 seconds left.

Imagine a young woman listening to this conversation thinking, "Oh, my gosh, what do I do?"

What would you counsel her?

How to approach her doctor?

How to be thinking about her body?

How to be monitoring her body?

What would you tell her?

I would tell her, "Understand that, if your cycle is an event, "if it is not something that you feel "like you can just continue on with your normal life, "then something might be wrong, something might be going on.

"Understand that you're not alone in this journey.

"There are communities out there "that can help you kind of navigate, again, "what's normal, abnormal, "but also what are resources that can help me?

"There's chat these days "and other things that you can look up on the Internet.

"But go to your doctor.

"Go to your doctor.

"Go to a provider that you feel "like is taking your concerns seriously.

"If you're not receiving that where you are, "get a second opinion, "and then make sure you're understood "and heard and you have options."

Brangham: Dr.

Soyini Hawkins, Sateria Venable, thank you both so much for this conversation.

Really appreciate it.

Venable: Thank you.

And that is it for this episode of "Horizons."

Thank you so much for watching.

We'll see you next week.

Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

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