A Functional Medicine Approach to Uterine Fibroids

Uterine fibroids (leiomyomas or myomas) are the most common benign tumors in women, affecting an estimated 60% of reproductive-aged women, with 80% of women developing the disease during their lifetime.1 Some studies have also suggested that the incidence rate of uterine fibroids is very high in perimenopausal women aged 40-54 years due to hormone imbalance.2

Issues including heavy or prolonged menstrual bleeding, abnormal uterine bleeding, resultant anemia, pelvic pain, infertility, and/or recurrent pregnancy loss are generally associated with uterine fibroids.1 However, there are typically no obvious subjective symptoms in the early stages of uterine fibroids, and they are often not detected in physical examination.2 Risk factors like obesity may provide a theoretical basis for the prevention and control of uterine fibroids.2 Although surgical and radiologic therapies are often used to treat these tumors, some research suggests that lifestyle interventions to reduce the risk of obesity may be considered as first-line treatments.1

Between gut health, improved detoxification, normalizing insulin, the right exercise, and the right diet, these are the foundational interventions for lifestyle ways to decrease fibroids.

– IFM educator Joel Evans, MD.

A small, case-controlled study for premenopausal women found that vegetable and fruit intakes significantly decreased the risk of fibroids; conversely, a high BMI significantly increased the risk.3 The relationship between visceral fat and the development of uterine fibroids was further investigated in a 2019 case-control study, suggesting that increased body fat (especially abdominal visceral fat) may enhance the risk of uterine fibroids and may be used as an indicator for screening high-risk groups.2 At the same time, write the authors, providing nutrition guidance and changing diet and exercise habits are important measures to prevent the development of uterine fibroids.2

In the following video, Joel Evans , MD, a hormone expert and educator at IFM’s Hormone Advanced Practice Module, describes the lifestyle interventions he personalizes for his patients suffering from fibroids.

Dr. Evans is a board certified OB/GYN and an IFM Certified Practitioner. He serves as UN Representative and chief medical advisor for OMAEP – World Organization for Prenatal Education Associations.

Video Transcript:

As a Functional Medicine practitioner, we always talk about lifestyle interventions first.

When we’re talking about lifestyle interventions for fibroids, we go back to the basics of the imbalances that are leading to the fibroid to grow. We’re talking about increased visceral adipose tissue [VAT], increased insulin, and increased inflammation.

Then we can also talk about ways that the body clears estrogen from the body. And that is through the detoxification pathways of phase 1 and phase 2 detoxification. The other thing that the body does is gets rid of estrogen through the digestive tract. We’ll talk about ways to do that as well.

Let’s start with increased body weight, or increased visceral adipose tissue. It is so important to tell patients, yes, all about the importance of having an appropriate body weight and how it affects almost every system in the body. But specifically, for now, we are talking about what to do for fibroids. It’s getting rid of that visceral adipose tissue. The best way to do that is through a combination of healthy eating and appropriate exercise.

There are lots of ways that the Functional Medicine Toolkit can help you with advertising patients how to eat.

We’re talking about now either intermittent fasting [or] ketogenic diets. This is all very good for fibroids. We’re talking about high intensity interval training in terms of the best method of exercise for the body.

This will lead to a decrease in the amount of estrogen in the body.

In terms of normalizing insulin, it’s the same thing, the diet. But this time, it’s more keto or a cardiometabolic diet and looking at the appropriate types of fat and making sure that we’re eating low glycemic index foods. It’s critical to add that low glycemic index filter to the foods that we’re telling patients to eat…

Then we have nutraceuticals, which are so important. Things like alpha lipoic acid [ALA], cinnamon, chromium, vanadium. Of course, also berberine; those are ways we can normalize insulin levels. There’s acacia, there’s certain hops derivatives as well. Those are the nutraceuticals that are important for normalizing insulin.

Then when we talk about the way that the body releases estrogen, we have to make sure the detoxification pathways are working properly. We have to make sure, first of all, that we’re not taking in too much exogenous estrogen into our body through foods…for example, dairy. It’s been shown that milk has bovine growth hormone that can have estrogenic effects. So just going through a list of those xenoestrogens and making sure that we avoid them is so important.

Then we need to be able to detoxify. Taking supplements that help the liver in phase 1 and phase 2. We have to methylate well to get rid of our estrogen. We need to think about things like cruciferous vegetables, cauliflower, kale, cabbage, and so on that are so important to help eliminate our estrogens.

And then our intestinal tract, we have to make sure there is no constipation. Because when we’re constipated, we reabsorb estrogen through an enzyme called beta glucuronidase and the glucuronidation process. With the glucuronidase process, we attach a glucuronide molecule to estrogen in order to dump it into the gut where it can’t be reabsorbed again. If we have a microbiome that’s not healthy, then we’re going to have too much of the beta glucuronidase enzyme, which cleaves that estrogen-glucuronide combination. Once it’s separated, the estrogen can be reabsorbed and go back to that fibroid.

You have to make sure you’ve got a good microbiome with a good probiotic, and you eliminate constipation.

Between gut health, improved detoxification, normalizing insulin, the right exercise, and the right diet, those are the foundational interventions for lifestyle ways to decrease fibroids.

End transcript.


Factors Predisposing Women to Fibroids 

Nutrition and Impacts on Hormone Signaling 

Chronic Stress and Hormone Disruption

  1. Sohn GS, Cho S, Kim YM, Cho CH, Kim MR, Lee SR. Current medical treatment of uterine fibroids. Obstet Gynecol Sci. 2018;61(2):192-201. doi:5468/ogs.2018.61.2.192
  2. Sun K, Xie Y, Zhao N, Li Z. A case-control study of the relationship between visceral fat and the development of uterine fibroids. Exp Ther Med. 2019;18(1):404-410. doi:3892/etm.2019.7575
  3. He Y, Zeng Q, Dong S, Qin L, Li G, Wang P. Associations between uterine fibroids and lifestyles including diet, physical activity and stress: a case-control study in China. Asia Pac J Clin Nutr. 2013;22(1):109-117. doi:6133/apjcn.2013.22.1.07

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