Uterine Health

Uterine Health: A Nutrition and Natural-Health Reference

1. Definition and Scope

Uterine health is a broad clinical concept encompassing the structural integrity and functional capacity of the uterus and its relationship to the broader female reproductive system. In the nutrition and natural-health literature, the term most commonly organizes research around a cluster of common benign and chronic uterine conditions: uterine fibroids (leiomyomas), endometriosis, and adenomyosis — conditions that share hormonal dependence on estrogen and a tendency to co-occur.

The term "gynecological diseases" in the clinical and regulatory literature refers to estrogen-dependent conditions that include uterine fibroid, endometriosis, adenomyosis, excessive uterine bleeding, abnormal uterine bleeding, and dysfunctional uterine bleeding. Uterine fibroids are benign non-cancerous tumors that originate from the smooth muscle layer, the myometrium, and the accompanying connective tissue of the uterus.

Adenomyosis is a benign uterine disorder in which endometrial glands and stroma are pathologically demonstrated in the myometrium. Women affected by adenomyosis may present with abnormal uterine bleeding, dysmenorrhea, dyspareunia, or infertility, but one third of them are asymptomatic.

Endometriosis is a chronic, estrogen-dependent disease affecting 5–10% of women of reproductive age, rising to nearly 30% among women with infertility.

2. Prevalence and Epidemiology

Uterine fibroids occur in 20% to 80% of women by the age of 50 years. African-American women, women who are overweight, and women with a family history of fibroids have a higher risk of developing them.

Among uterine diseases, uterine fibroids (also known as leiomyomas) are the most prevalent benign uterine tumors, affecting up to 25% of women and representing a major contributor to gynecological morbidity.

Uterine fibroids are benign tumors that arise from the smooth muscle tissue of the uterus and are the most common tumors in women. Due to their high prevalence, costs for the health care system, and the substantial impact on women's quality of life, they are a significant public health concern.

Fibroids are more common and more severe among African American women. Although this disease disproportionately affects the African American population, the causes of this disparity remain poorly understood. The cumulative lifetime incidence of fibroids is 70% and 80% in white and African American women, respectively.

Endometriosis is a chronic gynecological condition characterized by ectopic endometrial tissue, estrogen dependence, and persistent inflammation. It affects approximately 10% of women of reproductive age and is associated with pelvic pain, infertility, and reduced quality of life.

The prevalence of adenomyosis in women undergoing hysterectomy is 30.8% (range, 25.6%–37.7%).

3. Clinical Presentation and Symptoms

Uterine fibroids are benign tumors that affect a large proportion of women of reproductive age, especially between 30 and 40 years. These lesions may cause significant symptoms, including pelvic pain, heavy menstrual bleeding, and infertility.

Most uterine fibroids are asymptomatic, but approximately 25% of women with uterine fibroids develop symptoms requiring treatment.

During the menstrual cycle, endometriotic lesions grow, differentiate, and shed into the abdomen, thereby inducing a cascade of inflammatory events that may lead to nonmenstrual pelvic pain, pain during menstruation, painful intercourse, and, in some cases, infertility.

Uterine comorbidities are associated with menstrual symptoms and changes in menstrual patterns, often leading to heavy menstrual bleeding. According to the International Federation of Gynecology and Obstetrics (FIGO) classification, structural causes of abnormal uterine bleeding, summarized by the PALM acronym, include polyps, adenomyosis, and fibroids.

Women with uterine fibroids may also have concomitant gynecological conditions, such as endometriosis. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data.

4. Body Systems Involved

Uterine health conditions involve a complex interplay of multiple body systems:

• Endocrine system: Hormone-sensitive diseases of the reproductive system, such as uterine fibroids, endometriosis, and adenomyosis, can have a significant effect on quality of life. In these conditions, hormones such as estrogens and progesterone can have an impact on the severity and/or frequency of symptoms.
• Immune and inflammatory systems: Endometriosis is characterized by ectopic endometrial tissue, estrogen dependence, and persistent inflammation. Research has revealed that endometriosis is associated with elevated reactive oxygen species and oxidation products, decreased antioxidants and detoxification enzymes, and dysregulated iron metabolism. High levels of oxidative stress contribute to inflammation, extracellular matrix degradation, angiogenesis, and cell proliferation.
• Metabolic and adipose systems: Several studies have found obesity as a significant risk factor for uterine fibroid development, which has been attributed to the metabolic functions of adipose tissues. Adipose tissues produce and release various cytokines and growth factors involved in regulating diverse physiological and pathological processes, including immunity and inflammation. Adrenal androgens are mostly metabolized by aromatase in adipose tissues to estrogens.
• Gastrointestinal and microbiome system: A growing body of evidence underscores the significance of gut microbiota in the progression of endometriosis. In endometriosis, microecological imbalances within the gut microbiome trigger intestinal inflammation, leading to dysregulation of the immune response and the establishment of an immunosuppressive environment.
• Genetic system: Pathogenic exon 2 mutations in MED12 promote uterine fibroid formation and disrupt CDK8/19 kinase activity.

5. Contributing and Associated Factors

5.1 Hormonal Factors

In addition to an individual's genetic predisposition, estrogens, progesterone, and human growth hormone may all play important roles in the regulation of fibroid growth. Factors that increase exposure to oestrogen appear to increase the incidence of uterine fibroids. Fibroids are not seen before puberty, occur most commonly in women of reproductive age, and are commonly said to regress after the menopause. The reduction in size or resolution of fibroids in postmenopausal women is thought to be due to the lower average levels of endogenous ovarian hormones after the menopause.

5.2 Obesity and Body Weight

Robust epidemiological evidence identifies obesity as a significant risk factor for the development and growth of uterine fibroids. Adipose tissue contributes to increased peripheral estrogen production via aromatase activity, creating a hyperestrogenic environment conducive to fibroid growth.

The risk of uterine fibroid development is 3 times greater for women who weigh 70 kg or more compared with women who weigh 50 kg or less, suggesting that hyperestrogenic states in obesity may enhance fibroid growth.

Insulin resistance manifests through diminished insulin efficacy in facilitating glucose absorption and utilization within peripheral tissues. Research suggests that IR may amplify sex hormone-driven mitogenic signaling in uterine tissue. Furthermore, IR-associated hyperinsulinemia potentiates the activity of insulin-like growth factor-I (IGF-I), a mitogen implicated in uterine fibroid cell proliferation.

5.3 Vitamin D Deficiency

External and internal factors, such as endocrine-disrupting chemical (EDC) exposure, hyper-responsiveness to sex steroid hormones, obesity, vitamin D deficiency, and altered reproductive tract microbiome, contribute to chronic systemic inflammation. The inflammatory environment, EDC exposure, and vitamin D deficiency promote DNA damage and the accumulation of mutations.

5.4 Genetic and Racial Disparities

Disparities in fibroid prevalence may also be shaped by socioeconomic and environmental determinants, including unequal access to nutrient-rich foods, higher rates of obesity, vitamin D deficiency, and greater exposure to environmental pollutants. These factors may partly explain ethnic and geographical differences in incidence and severity.

5.5 Endocrine-Disrupting Chemicals (EDCs)

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, polluted drinking water, and endocrine-disrupting chemicals (EDCs).

5.6 Dietary Patterns

A diet high in saturated fat and low in fibre has been associated with increased levels of circulating estrogen, due to both increased endogenous synthesis and decreased intestinal excretion of steroid hormones. This hyperestrogenic state may promote fibroid growth and exacerbate heavy menstrual bleeding, thereby increasing the risk of iron-deficiency anemia.

Consumption of alcohol, red and processed meats, foods high in saturated and trans fats, and excessive caffeine has been correlated with increased systemic inflammation and hormonal dysregulation — key mechanisms implicated in endometriosis pathogenesis.

5.7 Lifestyle Factors

Lifestyle factors such as obesity, dietary choices, sedentary living, and smoking have been linked to fibroid occurrence, possibly due to their influence on estrogen production. Stress may also be a contributing risk factor for fibroids, as it is associated with a higher body mass index.

6. Dietary Factors Studied in Relation to Uterine Health

6.1 Fruits and Vegetables

Preliminary research has shown a beneficial effect of vegetable and fruit consumption on the occurrence of fibroids. Most studies on nutrition and uterine fibroids concentrate on dietary components such as vegetables, fruits, carotenoids, soy-derived products, or vitamin D and their impact on the prevalence of uterine fibroids.

Fruits and vegetables contain various nutrients that may decrease fibroid risk through inhibition of proliferation, apoptosis, or hormone-dependent pathways. This evidence is largely derived from observational and epidemiological studies and should be characterized as preliminary; randomized controlled trial confirmation is lacking.

6.2 Red Meat and Processed Foods

Uterine myomas or fibroids are the most common benign female tumors of the reproductive organs, associated with significant morbidity and quality of life impairment. Several epidemiological risk factors for their occurrence have been identified so far, including nutrition and dietary habits. Multiple observational studies included in narrative reviews have associated higher red meat intake with increased fibroid risk and greater vegetable intake with reduced risk, though confounding factors limit causal conclusions.

6.3 Dietary Fiber

Data indicate that a diet based on the Mediterranean and anti-inflammatory diet pattern, rich in dietary fiber, omega-3 fatty acids, plant-based protein, and vitamins and minerals, has a positive influence on endometriosis, yielding a promising improvement in patient symptoms. Dietary fiber is proposed to support estrogen excretion via the gut, though direct interventional trials specific to fiber in uterine health are limited.

6.4 The Mediterranean Diet

The most solid evidence is available for the effects of the Mediterranean diet (MD), which has a beneficial effect on endometriosis activity through several biological pathways. The MD is characterised by high consumption of vegetables, fruits, legumes, whole grains, and olive oil, as well as moderate fish intake, while red meat and refined carbohydrates are low. This diet is rich in antioxidants, omega-3 fatty acids, and polyphenols, which inhibit cyclooxygenase (COX) enzymes, reduce proinflammatory cytokine levels, and moderate oestrogen levels through increased SHBG.

The Mediterranean diet — rich in anti-inflammatory nutrients, fiber, and antioxidants — has been associated with decreased pain and improved quality of life. A prospective study enrolled 35 women with imaging- or surgically confirmed endometriosis, 26 of whom completed a 6-month Mediterranean diet intervention. Evidence remains at the preliminary stage; large RCTs are needed.

7. Nutrients Studied in Relation to Uterine Health

7.1 Vitamin D

Traditional Use: Vitamin D is not a traditional botanical or herbal remedy; its relevance to uterine health emerged from modern epidemiological and laboratory research rather than from any historical healing tradition.

Scientific Evidence: Epidemiological studies have reported a vitamin D deficiency in patients with uterine fibroids, raising interest in the potential biological effects of vitamin D supplementation. In vitro studies proved vitamin D efficacy in inhibiting uterine fibroid growth by targeting pathways involved in the regulation of various biological processes, including proliferation, extracellular matrix remodeling, DNA repair, signaling, and apoptosis.

Preclinical studies (in vitro and in vivo) demonstrate consistent inhibition of fibroid cell proliferation and a reduction in tumor volume with vitamin D supplementation. Clinical observations consistently associate low vitamin D levels with an increased frequency and larger size of fibroids.

Several small randomized controlled trials have specifically tested vitamin D supplementation: Hajhashemi et al. performed a randomized clinical trial involving women with fibroids greater than 2 cm in diameter and vitamin D levels below 20 ng/mL, administering 50,000 IU every 2 weeks for 10 weeks, and reported significant reductions in fibroid diameter in the treatment group. Arjeh et al. noted significant decreases in fibroid volume in a randomized clinical trial where women received 50,000 IU vitamin D weekly for 12 weeks.

However, clinical studies supported only in part the beneficial effects of vitamin D supplementation in reducing uterine fibroid growth and tumor volume. Randomized controlled trials and large population studies are mandatory, as the potential clinical benefits are likely to be substantial. The limited clinical evidence base is due to the small number of studies, short follow-up periods, and lack of standardized dosages. Overall evidence strength: preclinical evidence is consistent; human clinical evidence is promising but preliminary, limited by small sample sizes and short durations.

For endometriosis, vitamin D supplementation has shown beneficial effects on pain in some studies, while antioxidant vitamins C and E may reduce pain, inflammation, and oxidative stress.

7.2 Omega-3 Polyunsaturated Fatty Acids

Traditional Use: Consumption of fatty fish has longstanding cultural roles in many traditional diets (Scandinavian, Japanese, Mediterranean), though not specifically as a uterine remedy. Traditional use as a targeted gynecological intervention is not documented in established herbal traditions.

Scientific Evidence: Studies indicate that fish oil may have a positive effect on reducing endometriosis-related pain due to the effects of pro-inflammatory prostaglandins derived from omega-3 fatty acids. Findings suggest that omega-3 PUFA supplementation may be considered as a pragmatic adjunct to conventional management in symptomatic endometriosis, particularly for patients with persistent pelvic pain.

Supplementation with omega-3 fatty acids, N-acetylcysteine, resveratrol, vitamins C and E, and probiotics has demonstrated promising anti-inflammatory and antioxidative effects in both preclinical and clinical studies. Although compounds such as omega-3 fatty acids, curcumin, and quercetin show promise, recent evidence underscores the need for further high-quality trials before recommending these supplements in clinical practice. Further evidence is needed to establish the effective role of nutraceutical supplementation in combination with specific, targeted dietary interventions. An important limitation of the available RCTs is the lack of standardization in supplement dosing and the variable bioavailability of these compounds. Evidence strength: preliminary to moderate; mechanistic plausibility is strong but larger RCTs are required.

7.3 Vitamins C and E (Antioxidants)

Traditional Use: Vitamin C-rich foods (citrus, rose hips) and vitamin E-rich foods (wheat germ, nuts) have traditional roles in general health and wound healing in various cultures, but not specifically as uterine remedies in any major established herbal monograph.

Scientific Evidence: Nutrients such as antioxidants, B-complex vitamins, vitamin D, calcium, polyunsaturated fatty acids (PUFAs, particularly omega-3 and omega-6), and dietary fiber have shown promise in exerting anti-inflammatory and protective effects against endometriosis. The same pain-reducing effect seen with fish oil was also observed with the introduction of antioxidant vitamins C, D, and E. Evidence is largely from small trials and should be considered preliminary.

7.4 Magnesium and B Vitamins

Micronutrients and selected supplements, including vitamins C, E, and D, magnesium, zinc, folate, omega-3 fatty acids, N-acetylcysteine, curcumin, probiotics, and green tea polyphenols, show promising but variable evidence for symptom relief. Additional lifestyle factors, such as avoiding endocrine-disrupting chemicals, moderating alcohol intake, ensuring adequate sleep, and managing psychological stress, may further modulate inflammatory and hormonal pathways relevant to the disorder. Evidence for magnesium and B vitamins specifically within uterine health research is largely associational and has not yet been confirmed in dedicated large-scale clinical trials.

8. Herbs and Natural Ingredients

8.1 Green Tea Extract / Epigallocatechin Gallate (EGCG)

Traditional Use: Green tea (Camellia sinensis) has been consumed for millennia in East Asian traditions (Chinese, Japanese, Korean). Its use was associated broadly with health promotion, longevity, and digestive wellness. There is no historical record of specific traditional use of green tea for uterine fibroids or endometriosis in classic botanical texts; this application emerged from modern laboratory research.

Scientific Evidence: EGCG, a major polyphenol in green tea, inhibits cell proliferation and fibrosis while inducing apoptosis. Both in vitro and in vivo studies reveal the potential of EGCG in fibroid treatment, with clinical trials corroborating these findings.

Studies on epigallocatechin gallate showed its apoptosis-promoting and antifibrinolytic effect in fibroid cells. Initial results are promising, but further randomized trials are needed to draw firm conclusions about the effects of diet and nutrients on uterine fibroids.

The most-cited clinical study is the pilot RCT by Roshdy et al.: all consenting participants (n = 39) were confirmed by transvaginal ultrasonography to have uterine fibroids and were randomized to treatment groups: 22 received green tea extract (EGCG, oral dose, 800 mg/day) and 17 received placebo capsules. Women in the treatment group experienced a 32.6% reduction in fibroid volume, a 32.6% decrease in fibroid-specific symptom severity, and an 18.53% improvement in health-related quality of life. Additionally, the average blood loss in the treatment group decreased significantly from 71 mL/month to 45 mL/month. In contrast, the placebo group showed a 24.3% increase in fibroid volume, suggesting the potential efficacy of GTE in reducing fibroid size and improving symptoms.

A separate study showed mixed results: in a study by Biro et al., 25 women with uterine fibroids were administered GTE capsules daily for 6 months. There were no significant changes observed in myoma size or other objective parameters over the study period. Despite this, no relevant adverse side effects were reported, indicating the safety of GTE capsule ingestion. Together, these studies suggest that GTE may offer symptomatic relief and improve quality of life in women with uterine fibroids, though its effects on fibroid size may vary.

Epigallocatechin gallate, a green tea catechin, has demonstrated its ability to shrink uterine fibroids in prior preclinical and clinical studies. The NICHD funded the FRIEND trial to evaluate the use of EGCG for treating women with fibroids and unexplained infertility. Further randomized controlled trials with larger sample sizes and longer follow-up periods are warranted to validate these findings. Evidence strength: promising but preliminary; results from the single well-controlled RCT are positive but the study was small and conducted at a single center; a larger NICHD-funded multicenter trial is ongoing.

8.2 Curcumin

Traditional Use: Curcumin is the principal bioactive compound of turmeric (Curcuma longa), a spice used for thousands of years in Ayurvedic and traditional Chinese medicine. In Ayurveda, turmeric preparations were employed for inflammatory conditions, liver health, and as an emmenagogue to promote menstrual flow. Its specific use for uterine fibroids or endometriosis as a defined therapeutic indication is not described in classical Ayurvedic texts.

Scientific Evidence: In a study of curcumin and its impact on endometriosis, the authors found that this spice might have potential benefits for the prevention and treatment of endometriosis. Curcumin, omega-3, NAC, vitamin C, and EGCG supplementation decreased endometriotic lesion size in animal and human studies. Curcumin, omega-3, and NAC were found to prevent disease pathogenesis or recurrence in animal studies.

However, human clinical evidence is mixed. Gudarzi et al. found that 500 mg curcumin for 8 weeks failed to significantly improve pain or quality of life in endometriosis patients compared with the placebo group. Although extensive preclinical studies have demonstrated the potential of natural products such as curcumin and resveratrol to treat endometriosis by regulating programmed cell death, validation of their clinical efficacy remains crucial for translation into practice. Current clinical studies, though limited in scale, reveal their possibilities as adjuvant or alternative therapies. Evidence strength: strong preclinical basis; human evidence is mixed and limited; not yet sufficient to support routine clinical recommendations.

8.3 Resveratrol

Traditional Use: Resveratrol is a stilbene polyphenol found in grapes, red wine, and certain berries. Its consumption via red wine has cultural associations in Mediterranean traditions with longevity and cardiovascular health, but no classical herbal tradition specifically prescribed resveratrol-containing preparations for uterine disease.

Scientific Evidence: Many studies have been conducted on the effect of resveratrol on endometriosis, which is known to have antioxidant, anti-inflammatory, and antiangiogenic effects in patients with endometriosis. In an in vitro study, resveratrol has been shown to induce apoptosis by increasing TNF-α-related apoptosis-inducing ligand (TRAIL) in endometriotic stromal cells. In animal models, resveratrol has been shown to reduce matrix metalloproteinase (MMP)-2 and MMP-9 in endometriosis, and in another study it demonstrated anti-inflammatory and antiangiogenic activity, decreasing vascular endothelial growth factor (VEGF) levels. In an experimental endometriosis model, the anti-angiogenic and anti-inflammatory effect of resveratrol was reported by showing decreased serum VEGF and MCP-1 levels.

Resveratrol may be beneficial for women with impaired ovarian function, PCOS, endometriosis, and uterine fibroids. Evidence strength: primarily preclinical (in vitro and animal models); limited and heterogeneous human data; direct RCT evidence in humans is sparse and requires confirmation.

8.4 N-Acetylcysteine (NAC)

Traditional Use: NAC is a semi-synthetic derivative of the amino acid L-cysteine and has no traditional botanical use. It is a modern pharmaceutical and nutraceutical compound used clinically as a mucolytic agent and antioxidant.

Scientific Evidence: Endometriosis is a chronic, estrogen-dependent, inflammatory disease whose pivotal symptoms are dysmenorrhea, dyspareunia, and chronic pelvic pain. Recent evidence suggests potential benefits of oral N-acetylcysteine (NAC) on endometriotic lesions and pain. A prospective single-cohort study aimed to confirm the effectiveness of NAC in reducing endometriosis-related pain and the size of ovarian endometriomas. All patients received quarterly oral NAC 600 mg, 3 tablets/day for 3 consecutive days of the week for 3 months. Evidence strength: preliminary; small single-cohort studies show signal; larger RCTs needed.

8.5 Chasteberry (Vitex agnus-castus)

Traditional Use: Vitex agnus-castus (VAC), the fruit of the sacred Vitex, also called chasteberry, chaste berry, or monk's pepper, has a long tradition in the treatment of menstrual cycle disorders. Chaste tree was used traditionally as a "women's herb" in Europe and in the Mediterranean, with the most common use being for treating insufficient lactation. An extract of chaste tree berry has been used in Germany since the 1950s for breast pain, ovarian insufficiency, and uterine bleeding. The American Eclectic doctors of the 19th century used it as an emmenagogue (agent that promotes menstrual flow) and a stimulant for lactation.

Scientific Evidence: The clinical pharmacological effects of VAC extract are not entirely clear, but are supposed to be due to a dopaminergic activity in the hypothalamic-pituitary-gonadal axis, leading to reduced prolactin secretion and potentially alleviating symptoms of PMS and associated mastalgia/mastodynia.

Data from 1,700 women with a mean age of 30.2 years were analyzed in a real-world cohort study. The most common menstrual cycle disorders were dysmenorrhea (43.8%) and mastodynia/mastalgia (21.1%). Three-month treatment with VAC extract substantially decreased the percentage of patients with irregular cycle (from 9.1% to 0.1%) and breast tenderness (from 39.9% to 0.8%).

Vitex agnus-castus is effective in reducing symptoms of many gynecological problems. It is clinically used in abnormal uterine bleeding disorders and mastodynia. This plant is useful in mild hyperprolactinemia and luteal phase defect. It is also described as helpful in alleviating menstrual disorders and has been explored in relation to uterine fibroids and polycystic ovarian syndrome.

Evidence strength: moderate for PMS/dysmenorrhea and mastalgia based on multiple RCTs; botanical dietary supplements for premenstrual syndrome are less commonly used, and rigorous clinical trials have not been done for all indications. No adequately powered, well-controlled RCTs specifically addressing uterine fibroid volume or endometriosis lesions have been completed for VAC alone.

8.6 Additional Botanicals Referenced in Tradition

Some examples of botanicals used for premenstrual syndrome and menstrual disorders include Vitex agnus-castus (chasteberry), Angelica sinensis (dong quai), Viburnum opulus/prunifolium (cramp bark and black haw), and Zingiber officinale (ginger). These plants carry traditional use for menstrual discomfort, but peer-reviewed clinical evidence specifically addressing uterine fibroid burden or endometriosis lesions for these herbs individually remains very limited and cannot be characterized as established.

9. Dietary Patterns and Lifestyle Factors

9.1 Physical Activity and Exercise

Appropriate physical activity and exercise can help manage both physical and psychological symptoms of chronic conditions. A systematic review and meta-analysis was designed to assess the effectiveness and safety of physical activity and exercise in women with endometriosis. This systematic review and meta-analysis evaluated the effectiveness and safety of physical activity and exercise as adjunctive therapies for women with endometriosis, synthesizing data from six randomized controlled trials comprising 251 participants to determine whether structured exercise interventions could alleviate symptoms such as pain, poor quality of life, pelvic floor dysfunction, and bone loss. Evidence strength: growing and encouraging; methodological heterogeneity across trials limits pooled estimates.

9.2 Gut Microbiome and Probiotics

Endometriosis, a complex gynecological disorder, has been increasingly linked to gut microbiota dysbiosis, suggesting its potential role in disease pathogenesis. Treatment strategies for endometriosis include the use of probiotics and prebiotics, fecal bacterial transplantation, gut microbiota metabolite supplementation, and dietary modification. Attention is being directed toward the gut microbiota and its interaction with the immune and endocrine systems in women with endometriosis. This is an active and emerging area; causal relationships and optimal interventions have not yet been established in human clinical trials.

9.3 Anti-Inflammatory Dietary Patterns and Reducing Proinflammatory Foods

Consumption of alcohol, red meat, processed foods, and excessive caffeine may increase inflammation and hormonal imbalance, which may worsen endometriosis symptoms. On the other hand, nutrition such as antioxidants, B vitamins, vitamin D, calcium, omega-3 and omega-6 fatty acids, and fiber may help suppress inflammation and protect against the disease.

9.4 Body Weight Management

A higher incidence of surgically treated fibroids has been found in women who gained more than 20 kg compared with women who gained less than 10 kg, and a reduced risk has been found in those who lost weight. Body weight management is thus considered among the modifiable lifestyle approaches with the most epidemiological support in relation to uterine fibroid risk.

9.5 Reducing Exposure to Endocrine-Disrupting Chemicals

Lifestyle factors such as avoiding endocrine-disrupting chemicals, moderating alcohol intake, ensuring adequate sleep, and managing psychological stress may further modulate inflammatory and hormonal pathways relevant to the disorder.

10. Evidence Gaps and Overall Evidence Characterization

In most cases, the impact of diet and nutrition on the risk and progression of uterine fibroids remains unclear, with existing data being insufficient to draw firm conclusions.

High-level evidence and well-designed randomized studies are lacking when it comes to studying the effect of these modifiable risk factors on endometriosis.

Overall, current evidence indicates that integrating lifestyle interventions alongside conventional treatments offers clinically relevant benefits, although larger, well-designed clinical studies are needed to clarify the magnitude of these effects and to explore further promising lifestyle-based therapeutic approaches.

In younger women, the onset of fibroids is often associated with familial and genetic predisposition, whereas in adulthood, hormonal influences linked to environmental factors and states of exogenous or endogenous hyperestrogenism are more frequently observed. In both contexts, supportive management through an appropriate diet may provide clinical benefit.

References

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• PMC: Vitamin D: Mechanism of Action and Biological Effects in Uterine Fibroids
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• Johns Hopkins: A Systematic Review of Vitamin D and Fibroids: Pathophysiology, Prevention, and Treatment
• PMC: Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study
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• PMC: FRIEND Trial Protocol — EGCG to improve fertility in women with uterine fibroids
• PMC: The Health Disparities of Uterine Fibroids for African American Women: A Public Health Issue
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