Allostatic load and uterine fibroids: role in pathogenesis and racial disparities

Uterine fibroids are the most common gynecologic tumors. Despite their non-cancerous nature, they pose significant symptoms that can impact women's quality of life and mental health. Black women have the highest incidence of uterine fibroids, with a lifetime risk of about 80%. Allostatic load reflects the cumulative biological consequences of chronic stress arising from environmental and social exposures, including low socioeconomic status, microaggression, and racial discrimination. Disproportionately prevalent among Black women, allostatic load is associated with adverse health outcomes across multiple organ systems, and emerging epidemiological evidence suggests a plausible association with uterine fibroids. This review examines how allostatic load is measured and its effects on the body's regulatory systems, including neuroendocrine, immune, and metabolic pathways. Importantly, allostatic load is presented here as a hypothesis-generating integrative framework rather than an established causal mechanism. This review also explores the epidemiological and biological evidence linking chronic stress to uterine fibroids, with particular attention to the potential role this framework plays in contributing to racial disparities in fibroid burden among Black women. A distinction is drawn between the biological embedding of chronic stress (allostatic load), structural determinants of health (socioeconomic status, healthcare access), and interpersonal factors (clinician bias, institutional mistrust)-each representing complementary but conceptually distinct contributors to observed disparities. In addition, this review discusses the potential impact of stress, lifestyle factors, and genetic predisposition on fibroid development, and recommends preventive strategies encompassing both public health and individual-level interventions.