New research from the COEQUaL initiative is examining how clinical counseling, insurance design, and referral patterns shape disparities in uterine fibroid care.
Efforts to address longstanding racial disparities in uterine fibroid care are increasingly focusing on how clinical counseling, health system structures, and access to treatment options shape patient outcomes. Investigators with the COllaboration for EQuity in Uterine Leiomyomas (COEQUaL), a National Institutes of Health–funded Specialized Center for Health Disparities Research, aim to identify modifiable barriers to equitable fibroid care while promoting treatment approaches aligned with patient preferences and values.1
Uterine fibroids affect a large proportion of individuals with a uterus and are associated with particularly high disease burden among Black patients. Historical inequities in gynecologic practice—including forced sterilizations and hysterectomies performed without consent in some regions—have contributed to persistent mistrust and disparities in treatment patterns. COEQUaL’s work is guided by the research framework of the National Institute on Minority Health and Health Disparities and is designed to reduce or eliminate disparities in fibroid outcomes, particularly among Black individuals.
A central issue in fibroid care is the historically high reliance on hysterectomy. According to Ebbie A. Stewart, MD, one of the COEQUaL investigators and a professor in the Department of Obstetrics and Gynecology with joint appointments in Department of Physiology and Biomedical Engineering, Division of Endocrinology, Department of Medicine and Department of Surgery at Mayo Clinic, Rochester, Minnesota, investigators are increasingly questioning whether surgical counseling fully reflects the spectrum of available options.
“When I was trained and for many years of my practice, the teaching was hysterectomy was the solution for fibroids,” Stewart said.
She noted that this perspective is evolving. “I think that’s an outdated concept,” Stewart said. “For a woman who chooses hysterectomy, there are still good reasons to choose it, but many women don’t want a hysterectomy.”
Even among patients who do not plan future pregnancies, uterine preservation may remain an important priority. “There are women who have no intention of having a pregnancy but want uterine preservation for other reasons,” she said. “We need to respect women’s choices, and we also need to represent the full range of treatment options.”
COEQUaL investigators are also examining structural barriers that may limit access to alternatives such as uterine artery embolization or newer medical therapies. One component of the research analyzes how insurance design affects real-world treatment availability.
“For example, my health plan may say they cover a uterine artery embolization or a medication that uses a GnRH antagonist combination,” Stewart said. “But if the copay for the procedure is $5000 and the copay for the medication is $1000 a month, maybe in reality I don’t have access to those treatments.”
Another study component compares outcomes between contiguous states that did and did not expand Medicaid under the Affordable Care Act, with the goal of determining whether insurance expansion improves earlier diagnosis or treatment.
The project is also surveying clinicians across specialties—including family medicine, pediatrics, internal medicine, and advanced practice providers—to better understand referral patterns and knowledge gaps. “Is it a lack of knowledge? Do we need more CME courses on fibroid treatments for non-OB/GYN clinicians?” Stewart said. “Or is it system barriers like spending many hours doing preauthorization every time you want to offer a treatment?”
Although it remains unclear how treatment utilization might shift with fully equitable access, Stewart said earlier engagement in care will likely be a key indicator of progress.
“The best thing we would hopefully see short term is women coming in to see knowledgeable providers sooner and following up,” she said. “I think we’d like to see that shortening of time from symptoms to diagnosis, from diagnosis to effective treatment.”
Such changes could signal meaningful progress toward equity in fibroid care and help ensure treatment decisions align more closely with patient priorities.
Reference:
Stewart EA, Venable S, Borah BJ, et al. Fibroids and Health Disparities: The COllaboration for EQuity in Uterine Leiomyomas (COEQUaL) Specialized Center. Am J Obstet Gynecol. 2026 Jan 12:S0002-9378(26)00009-8. doi:10.1016/j.ajog.2025.12.068
