Factors Predisposing Women to Fibroids

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Uterine leiomyomata, or fibroids, are very common, affecting up to 70% or even 80% of women at some point in their lives.1,2 Despite this lifetime prevalence, many cases go undiagnosed, increasing the probable incidence,1 while clinical guidelines appear to lack consensus on optimal evidence-based treatment strategies.3

In general, uterine fibroids are known to be estrogen responsive,4 and both genetics and ovarian hormone exposure are likely antecedents for the development of fibroids.2 Studies have shown a notable difference in the prevalence and presentation of fibroids based on race, with Black women experiencing larger fibroids more often and at a younger age than some other racial populations.1,2,5 The heavy bleeding associated with fibroids can cause anemia, fatigue, and pain.1 Women with uterine fibroids report a decreased quality of life, difficulty getting diagnosed, and concerns about available treatment options.6,7

Often, women with fibroids want to avoid hysterectomy.6,7 However, in the United States, uterine fibroids are one of the most common reasons for a hysterectomy,8 yet it is well known that even when the ovaries are conserved, hysterectomies can greatly increase risks for other health issues like cardiovascular and metabolic conditions, including congestive heart failure.9 What risk factors may play a role in the development of uterine fibroids, and what options other than hysterectomy are available for patients?

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 may also play a role in fibroid development.5,10-12 Increased blood pressure correlates with the increased risk of fibroids.2,5 Obesity, high serum lipids, and metabolic syndrome also increase the risk of fibroids, suggesting a cardiometabolic connection.13-15 Low vitamin D levels may also increase risk for fibroids.16,17 In addition, chronic inflammation may also play a role in fibroid formation.18

As mentioned, Black women are much more likely to develop fibroids, and they are also more likely to report more severe symptoms.5,19 Adding to this connection, central centrifugal cicatricial alopecia (which primarily affects Black women) is highly correlated with uterine fibroids, suggesting a similar underlying pathophysiological mechanism.20


Either as part of an inflammatory milieu or otherwise, environmental toxicants also likely play a role in the development of fibroids, including exposures to cosmetic or beauty-product-related chemicals,21,22 polluted drinking water,23 and air pollution. One large-scale, longitudinal study demonstrated that exposure to high amounts of air pollution [particulate matter (PM) 2.5] correlated with an increased risk of fibroids.24 Heavy metals25 and endocrine-disrupting chemicals26 such as persistent organic pollutants (POPs)25,27 and polychlorinated biphenyls (PCBs)27 have also been correlated with uterine fibroid development. Critical windows of exposure may affect long-term hormonal patterns, especially pre-menarche exposures.28

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 and nutritional plan for an individual patient.

In addition, one of the emerging non-surgical treatments for fibroids is modulating progesterone.11 In one study, perioperative treatment with the progesterone receptor modulator ulipristal acetate (or UPA) resulted in 61% of women electing not to continue with surgery, as their symptoms were adequately managed.29 Fibroids themselves alter the expression patterns of estrogen and androgen receptors.30 For that reason, it’s important to help patients restore hormonal balance even after their fibroids and the resulting symptoms are adequately treated.

Best practices for treating fibroids have not yet been established;31 however, from a functional medicine perspective, interventions that prioritize hormonal balance and reduced systemic inflammation, improve modifiable lifestyle factors, and reduce exposure to environmental toxicants are treatment approaches that should be considered. For the many women who suffer from fibroids but wish to avoid hysterectomy, these low-harm therapies may provide the relief they seek.


Related Articles

A Functional Medicine Approach to Uterine Fibroids

Common Endocrine-Disrupting Chemicals and Women’s Health


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