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Uterine Fibroids: Risk Factors & Lifestyle-Based Treatments
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Uterine leiomyomata, or fibroids, are common benign tumors that affect many women at some point in their lives. Globally, prevalence of uterine fibroids has increased an estimated 78.82% in the past few decades, from 126.41 million to 226.05 million cases.1 However, prevalence may be dramatically higher due to asymptomatic cases that go undiagnosed.1 Studies have shown a notable difference in the prevalence and presentation of fibroids based on race, with Black women experiencing fibroids more often and with more severe symptoms than some other racial populations.2
Women with uterine fibroids often report a decreased quality of life,3 as the condition can cause severe and chronic symptoms such as the following:4
- Heavy or prolonged menstrual bleeding
- Abnormal uterine bleeding
- Anemia
- Pelvic pain
- Infertility
- Recurrent pregnancy loss
Uterine fibroids are one of the most common reasons for a hysterectomy, yet even when the ovaries are conserved, hysterectomies can greatly increase risks for other health issues.5 What risk factors may play a role in the development of uterine fibroids, and what options other than hysterectomy are available for patients?
In the following video, IFM educator Joel Evans, MD, IFMCP, describes a functional medicine approach to fibroids as well as endometriosis that includes foundational lifestyle interventions that address gut health, detoxification, insulin levels, and personalized exercise and nutritional prescriptions.
Risk Factors
The underlying cause of uterine fibroids and the mechanisms of their growth are not fully known, and the factors that predispose women to fibroid development continue to be studied. Age, race, genetic predisposition, and family history are a few of the noted risk factors that are not modifiable; however, certain modifiable lifestyle factors such as physical activity, diet, stress, and smoking status may play a role in fibroid development.6 In addition, obesity, high serum lipids, and metabolic syndrome may increase the risk of fibroids, suggesting a cardiometabolic connection.7,8 Low vitamin D levels as well as chronic inflammation may also play a role in fibroid formation.9-11 Research studies suggest that chronic exposures to environmental toxicants likely play a role in the development of fibroids, including exposures to cosmetic or beauty-product-related chemicals,12 polluted drinking water,13 and endocrine-disrupting chemicals (EDCs).14
Treatment Considerations
Healthy lifestyle factors may not only play a preventative role in fibroid risk but may also be part of an effective treatment plan. As part of a personalized therapeutic strategy to decrease uterine fibroids, the following are all components of a foundational functional medicine approach:
- Addressing hormonal imbalances that may include estrogen dominance.
- Supporting gut health and decreasing overall inflammation.
- Improving detoxification and waste elimination to help remove excess estrogen.
- Stabilizing blood sugar and insulin.
- Reducing exposure to endocrine-disrupting chemicals.
- Implementing the most effective exercise strategy for an individual patient.
- Addressing micronutrient deficiencies and prescribing a personalized nutrition intervention.
One of the emerging non-surgical treatments for fibroids is modulating progesterone.15 Uterine fibroid cells themselves have been shown to alter the expression of ovarian hormone receptors.15 For that reason, it’s important to help patients restore hormonal balance even after their fibroids and the resulting symptoms are adequately treated.
Conclusion
While some risk factors may not be modifiable, the development of uterine fibroids may be influenced by some modifiable lifestyle factors. Further, from a functional medicine perspective, interventions that prioritize hormonal balance and reduce systemic inflammation, improve modifiable lifestyle factors, and reduce exposure to environmental toxicants are treatment approaches that should be considered for uterine fibroids. For the many women who suffer from fibroids but wish to avoid hysterectomy, these low-harm therapies may provide the relief they seek.
Learn more about uterine fibroids and hormonal health from functional medicine experts at IFM’s upcoming Hormone Advanced Practice Module (APM).
Related Articles
Common Endocrine-Disrupting Chemicals and Women’s Health
Nutrition and Impacts on Hormone Signaling
Chronic Stress and Hormone Disruption
References
- Lou Z, Huang Y, Li S, et al. Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study. BMC Public Health. 2023;23(1):916. doi:1186/s12889-023-15765-x
- Katon JG, Plowden TC, Marsh EE. Racial disparities in uterine fibroids and endometriosis: a systematic review and application of social, structural, and political context. Fertil Steril. 2023;119(3):355-363. doi:1016/j.fertnstert.2023.01.022
- Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, prevalence, and treatment of uterine fibroids: a survey of U.S. women. J Womens Health (Larchmt). 2018;27(11):1359-1367. doi:1089/jwh.2018.7076
- Sohn GS, Cho S, Kim YM, et al. Current medical treatment of uterine fibroids. Obstet Gynecol Sci. 2018;61(2):192-201. doi:5468/ogs.2018.61.2.192
- Madueke-Laveaux OS, Elsharoud A, Al-Hendy A. What we know about the long-term risks of hysterectomy for benign indication-a systematic review. J Clin Med. 2021;10(22):5335. doi:3390/jcm10225335
- Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2018;46:3-11. doi:1016/j.bpobgyn.2017.09.004
- Qin H, Lin Z, Vásquez E, Luan X, Guo F, Xu L. Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis. J Epidemiol Community Health. 2021;75(2):197-204. doi:1136/jech-2019-213364
- Brewster LM, Haan Y, van Montfrans GA. Cardiometabolic risk and cardiovascular disease in young women with uterine fibroids. Cureus. 2022;14(10):e30740. doi:7759/cureus.30740
- Vahdat M, Allahqoli L, Mirzaei H, et al. The effect of vitamin D on recurrence of uterine fibroids: a randomized, double-blind, placebo-controlled pilot study. Complement Ther Clin Pract. 2022;46:101536. doi:1016/j.ctcp.2022.101536
- Mohammadi R, Tabrizi R, Hessami K, et al. Correlation of low serum vitamin-D with uterine leiomyoma: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2020;18(1):85. doi:1186/s12958-020-00644-6
- AlAshqar A, Reschke L, Kirschen GW, Borahay MA. Role of inflammation in benign gynecologic disorders: from pathogenesis to novel therapies. Biol Reprod. 2021;105(1):7-31. doi:1093/biolre/ioab054
- Gaston SA, James-Todd T, Harmon Q, Taylor KW, Baird D, Jackson CL. Chemical/straightening and other hair product usage during childhood, adolescence, and adulthood among African-American women: potential implications for health. J Expo Sci Environ Epidemiol. 2020;30(1):86-96. doi:1038/s41370-019-0186-6
- Hammarstrand S, Jakobsson K, Andersson E, et al. Perfluoroalkyl substances (PFAS) in drinking water and risk for polycystic ovarian syndrome, uterine leiomyoma, and endometriosis: a Swedish cohort study. Environ Int. 2021;157:106819. doi:1016/j.envint.2021.106819
- Bariani MV, Rangaswamy R, Siblini H, Yang Q, Al-Hendy A, Zota AR. The role of endocrine-disrupting chemicals in uterine fibroid pathogenesis. Curr Opin Endocrinol Diabetes Obes. 2020;27(6):380-387. doi:1097/MED.0000000000000578
- MacLean JA 2nd, Hayashi K. Progesterone actions and resistance in gynecological disorders. Cells. 2022;11(4):647. doi:10.3390/cells11040647
