Video: My Approach to Fibroids

Fibroids affect approximately 70% of women at some point in their lives.1 In the following video, Joel Evans, MD, a hormone expert and an 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.


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 advising 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.

  1. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review.2017;124(10):1501-1512. doi:10.1111/1471-0528.14640

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