Many women have suffered in silence with heavy periods, anemia, pelvic pain, back pain and discomfort, thinking these were routine symptoms of their monthly cycle. But, for some, those symptoms aren’t simply par for the course, they could be indicators that something more serious is happening. These are all markers of fibroids.

What are fibroids?

These tumors are the most frequent type women experience. In most cases, the tumors are benign. UCLA’s Obstetrics and Gynecology department describes fibroids as “compact tumors that are made of smooth muscle cells and fibrous connective tissue.” It’s estimated between 20 and 80 percent of women will develop fibroids by age 50 and many will not get a proper diagnosis.

What causes them?

Fibroids can be as small as a pea, as large as a grapefruit or even bigger. While it’s not totally clear what causes them, physicians believe the tumors begin as abnormal muscle cells. Some holistic health experts believe what you’re eating, or not eating, can be the cause. Celebrity Chef Ahki, a natural foods activist, maintains that a meat-free, low or no starch, non-hybrid diet –foods that are not genetically modified– can eliminate fibroids in just over a month. What’s clear is these tumors impact millions of women each month and their presence and size can even cause pregnancy complications.

Who’s at risk?

While fibroids do impact women during their child birthing years, women nearing menopause are at highest risk due to their years of estrogen exposure. Obese women are also at an increased risk of developing the tumors.

African American women are especially hard hit by fibroids. Black women are three times more likely to develop fibroids and many do so earlier in life than other racial and ethnic groups. It’s not exactly known why the tumors affect black women so often. Some have pointed to possible genetics while others have drawn links between fibroids and the chemical hair straighteners many black women use. What is clear is the symptoms for black women are more severe and many often delay treatment, which can impact their relationships and lead to missed days at work.

How to get rid of fibroids

Doctors can perform a surgical procedure called a myomectomy, removing the fibroids but keeping the uterus intact. This is the preferred procedure for women who still hope to get pregnant.

A noninvasive focused ultrasound procedure may also be performed to treat fibroids. It delivers sound waves to the fibroids to destroy them. The procedure is done from inside an MRI scanner.

Women may also opt for a hysterectomy if the uterus is overgrown and a myomectomy isn’t possible. Black women are disproportionately encouraged to choose this option. The National Institutes of Health (NIH) found black women are 2.4 times more likely to undergo hysterectomy and are nearly seven times more likely to undergo myomectomies than other groups researchers studied.

So, how can women prevent fibroids?

Fibroid prevention remains a gray area for many women and doctors. Certainly, a balanced diet and a healthy body weight are encouraged. But, there’s still a lot that we don’t know about the condition and the government doesn’t seem to be bringing us closer to learning more as it has reduced its research efforts surrounding fibroids. NBC News reports NIH was slated to spend about $10 million researching the tumors in 2016. That’s $4 million less than it spent in 2012.

Fortunately, there’s been an awakening among many women who are now beginning to talk about their heavy periods and struggles with fibroids to raise awareness. Campaigns like The White Dress Project and Change The Cycle are leading the way in sparking conversations among women –particularly African Americans– who have long been on the back burner of medical research.