Am I Truly Invisible? How Treatment Limitations and Research Priorities Shaped Fibroid Care

Fibroids are among the most common conditions affecting women of reproductive age.

They are routinely diagnosed and widely recognized within gynecology.

Yet many women — particularly Black women, who bear a disproportionate burden — describe a persistent experience: their symptoms were acknowledged, but meaningful change often came only after disease became severe.

This experience reflects more than individual clinical encounters.

It reflects how fibroids have historically been understood within medicine.

A Condition Medicine Could See, But Rarely Modify

For decades, the clinical reality of fibroids was clear.

They could be detected through imaging and monitored over time, but effective early interventions were limited.

Management typically consisted of observation, symptom control, or surgery once symptoms became severe.

This therapeutic landscape shaped how fibroids were framed:

As benign.

As common.

As largely unavoidable.

The language reflected not only biology, but the limits of available treatment.

When “Benign” Does Not Mean Harmless

In medical terminology, benign simply means non-malignant.

But in practice, the label often implied something more — stability, low urgency, and limited need for early intervention.

For many women, this did not match lived reality.

Fibroids can grow unpredictably, disrupt fertility planning, cause chronic anemia, and significantly affect daily functioning.

For these women, the condition is neither static nor inconsequential.

The Role of System Incentives

As a gynecologist, it is clear that clinical practice is shaped not only by scientific knowledge, but by structural incentives.

For decades, the most definitive treatments for fibroids were procedural — surgery or interventional radiology — and healthcare reimbursement systems have historically rewarded these interventions far more than time-intensive medical management or preventive strategies.

There has been little practical incentive to pursue long-term disease-modifying approaches, particularly low-cost interventions such as Vitamin D supplementation, which offer no commercial return and require sustained patient engagement.

Similarly, referral patterns for non-surgical options, including uterine artery embolization or more recent ultrasound-guided ablation techniques, have often been influenced by training pathways, institutional workflows, and reimbursement structures.

The result has been a diffuse but persistent form of low-priority attention — a quiet normalization of fibroids as conditions to tolerate until they become severe enough to warrant definitive intervention.

A Changing Understanding

Recent research is beginning to challenge this longstanding framework.

Emerging evidence suggests that fibroids may be biologically dynamic, influenced by environmental exposures, and potentially responsive to earlier intervention.

These developments support a shift in thinking — from viewing fibroids as static anatomical findings to recognizing them as a potentially progressive and debilitating health condition in many women.

What Will It Take to Change Course?

Some of the most promising preventive strategies — including low-cost interventions such as Vitamin D supplementation — are unlikely to attract large randomized trials because they lack commercial incentives.

In medicine, paradigm shifts do not always begin with definitive trials.

They often begin with a change in how a condition is conceptualized.

As evidence accumulates, the question is no longer simply how fibroids are treated in crisis, but how they are understood before that point.

Revisiting an Old Question

Fibroids have never been invisible to medicine.

But the historical limits of treatment — combined with structural research and financial priorities — have shaped how the condition has been framed, and how many women have experienced care.

As scientific understanding evolves, the question that remains is not only how fibroids should be treated, but whether it is time to see them differently.

References 

Al-Hendy A et al., 2023 — International Journal of Women’s Health

Uimari O et al., 2022 — Frontiers in Reproductive Health

Li B et al., 2023 — Archives of Medical Science

Wilson LF et al., 2024 — BMC Women’s Health

Munro MG, 2024 — International Journal of Gynecology & Obstetrics