Understanding Uterine Fibroids

Uterine fibroids (also called leiomyomas) are smooth muscle tumors of the uterus. They are benign (non-cancerous) 99% of the time. Although the exact cause remains unclear, multiple genetic, hormonal, and environmental factors contribute to their formation and growth.

Potential Causes of Uterine Fibroids

According to updated summaries from the Mayo Clinic (2023) and UCLA Reproductive Health (2025):

• Genetic predisposition: Many fibroids contain changes in genes different from those of normal uterine muscle cells. Family history markedly increases risk.

• Hormonal influences: Estrogen and progesterone promote growth by binding to more receptors in fibroid tissue than in normal uterine tissue. Fibroids tend to grow during reproductive years and shrink after menopause.

• Ethnicity: African American women have a higher risk and more severe fibroid burden, likely due to genetic and hormonal differences.

• Lifestyle and metabolic factors: Obesity, vitamin D deficiency, and diets low in fruits and vegetables or high in red meat increase risk.

• Growth factors and extracellular matrix: Substances like insulin-like growth factor and increased ECM support tissue proliferation and fibroid fibrosity.

Symptoms of Uterine Fibroids

Uterine fibroids can cause a variety of symptoms, and some women remain asymptomatic. The symptoms often depend on the number, size, and location of the fibroid in relation to the uterus.

• Heavy menstrual bleeding or prolonged periods — Often the most frequent symptom, especially with fibroids growing toward the uterine cavity (submucosal fibroids), causing heavy bleeding, large clots, and anemia risk.​

• Pelvic pressure and pain — Fibroids can cause a persistent feeling of fullness or pressure in the lower abdomen or pelvis. This can be accompanied by pain in the pelvic region or lower back.​

• Frequent urination or difficulty emptying the bladder — Due to pressure on the bladder by fibroids, leading to increased urgency or urinary frequency.​

• Pain during intercourse (dyspareunia) — Especially if fibroids are near the cervix or uterus lining.​

• Enlarged abdomen or growing belly — Large fibroids can cause the uterus to enlarge, visibly increasing abdominal size, sometimes mistaken for pregnancy.​

• Constipation or difficulty with bowel movements — Fibroids pressing on the rectum can cause bowel symptoms

  
  

Management and Shrinking Uterine Fibroids

Management depends on a patient's age, symptoms, size and location of fibroids, and fertility goals. Many fibroids shrink naturally after menopause.

Diet, Lifestyle, and Preventive Care for Uterine Fibroids

• Foods to Emphasize

  • High-Fiber Foods (vegetables, fruits, legumes, whole grains): Fiber binds and helps eliminate excess estrogen through the stool, lowering reabsorption from the intestines.​

  • Cruciferous Vegetables (broccoli, cauliflower, kale, Brussels sprouts): Contain indole-3-carbinol (I3C) and DIM, which support estrogen metabolism toward less proliferative forms.​

  • Omega-3-Rich Foods (flaxseed, chia, walnuts, wild salmon): Help reduce prostaglandin-driven inflammation that worsens fibroid pain and bleeding.​

  • Antioxidant Fruits (berries, pomegranate, citrus): Combat oxidative stress, which plays a role in fibroid growth.​

  • Vitamin D Sources (fortified dairy, eggs, mushrooms, or supplements): Low vitamin D levels have been linked to increased fibroid risk; adequate intake may slow fibroid growth

• Foods to Limit or Avoid

  • Red Meat and Processed Meats: Contain saturated fats and exogenous hormones that amplify estrogen dominance and inflammation.​

  • Refined Sugars and Flours: Increase insulin, which stimulates ovarian androgen and estrogen production.

  • Alcohol and Caffeine: Impair liver detoxification of estrogen metabolites, contributing to hormonal buildup.​

  • Dairy with Added Hormones: Choose organic or hormone-free alternatives to avoid xenohormone exposure.

    
    

• Supplements Supporting Fibroid and Hormone Balance

Supplement	Mechanism	Typical Dose Range	Guidelines and Notes
Vitamin D3	Regulates estrogen synthesis and smooth muscle growth inhibition	2000–4000 IU daily (individualize to serum 40–60 ng/mL)	Low levels correlate with higher fibroid incidence
DIM / Indole-3-Carbinol (I3C)	Enhances hepatic estrogen metabolism, shifting estrogen balance toward benign forms	DIM: 100–200 mg/day; I3C: 200–400 mg/day	Useful for estrogen-dominant states
Green Tea Extract (EGCG)	Antiproliferative and antioxidant; may modestly shrink small fibroids	400–800 mg EGCG daily	2024 meta-analyses show volume reduction in small trials
Curcumin (Turmeric)	Blocks fibroid cell proliferation pathways (e.g., NF-κB, MAPK)	500–1000 mg daily with black pepper or liposomal for absorption	Reduces pain, inflammation
Omega-3 Fish Oil / Algal Oil	Reduces inflammatory mediators linked to fibroid pain	1–2 g EPA/DHA daily	Balances prostaglandins, supports uterine tone
Magnesium and B-Complex	Supports detoxification and stress adaptation	As daily multi-nutrient	Aids cortisol rhythm in estrogen metabolism balance

Medical (Non-surgical) Treatments for Uterine Fibroids

Pharmacological therapies are most effective for symptomatic management, especially for heavy menstrual bleeding, not for large or numerous fibroids. There is no strict upper limit to the size of the fibroid, but limited efficacy if fibroid-related symptoms are from very large (>8–10 cm) or multiple fibroids distorting the uterine cavity.​ Uterine size should be less than 12×10×8 cm, volume ≈500–600 cc. Ultrasound is typically performed to measure size.

Treatment Type	Mechanism	Shrinks fibroids	Common Indication	Guidelines
NSAIDs	Symptom relief for pain	No	Mild, symptomatic fibroids	Considered first line for pain
Hormonal contraceptives (pill, IUD)	Regulate estrogen and progesterone	Slightly	Control bleeding, not for size reduction	Used for symptom control
GnRH agonist/antagonist	Suppress estrogen to induce temporary menopause	Yes (30-60%)	Pre-surgical shrinkage, heavy bleeding	short term use (<=6 months) due to bone loss
Selective progeterone receptor modulators (SPRMs) like ulipristal	Block progesterone effects	Yes	Symptomatic with desire to avoid surgery	for 3-6 month cycles under liver safety monitoring
Tranexamic acid	Prevents blood loss	No	Heavy menstrual bleeding	Short-term management option

Minimally Invasive Procedures for Uterine Fibroids

Minimally invasive procedures are a nice alternative to surgery, but they do have specific guidleines associated with them. If you have an ultrasound performed periodically to measure your fibroids, keep these guidelines in mind. The number of fibroids and size can limit your options.

Procedure	Indication (Main Criteria)	Fibroid No./Size	Uterine Volume Limit	Fertility Preservation	Guideline Details
Uterine Artery/Fibroid Embolization (UAE / UFE)	Symptomatic multiple fibroids (bleeding or bulk)	Any number; ≤10 cm each	≤20–24 weeks size (≈1200 cc)	Possible but pregnancy discouraged within 6 months	First-line uterus-preserving interventional therapy; recurrence 10–25%
Radiofrequency Ablation (Lap-RFA, Sonata)	≤10 intramural or submucosal fibroids	1–10 <7 cm	≤16-week size (≤1000 cc)	Yes	FDA 2025 updated criteria: safe up to 6.5–7 cm; uterus <16 weeks ​
MRI-Focused Ultrasound (HIFU)	≤4 fibroids with symptoms	Each ≤10 cm; ≤3–4 total	≤20 weeks	Yes	Requires clear sonographic window; favored for women avoiding surgery

Surgical Treatments for Uterine Fibroids

Type	Indication	Fibroid/ Uterus Size Criteria	No. Fibroids	Fertility	Guideline Position
Hysteroscopic Myomectomy	Submucosal types 0–2, cavity-distorting	≤4–5 cm	≤3 fibroids	Yes	Preferred for cavity restoration and improved fertility
Laparoscopic Myomectomy	Intramural or subserosal; uterus <16 weeks	≤10 cm per fibroid	≤4–5 fibroids	Yes	technically feasible up to 4–5 fibroids; beyond that → abdominal approach
Abdominal Myomectomy	Numerous (>5) or large (>10 cm) fibroids; uterus 16–20 weeks+	>10 cm, >5 fibroids	Often ≥5	Yes	Used when minimally invasive options not feasible
Hysterectomy	Symptomatic fibroids unresponsive to other therapy or no fertility desire	Any	Any	No	Definitive cure; vaginal route preferred if uterine size permits (<14–16 weeks)