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Uterine Fibroids

Benign smooth-muscle tumors of the uterus that affect 70 to 80% of women by age 50. Hormone-sensitive and very common; nutrition and lifestyle can help with symptoms such as iron loss, though they do not reliably shrink established fibroids.4

Hormonal & Women's Health Evidence-Based

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Definition

What Are Uterine Fibroids?

Uterine fibroids, also called leiomyomas or myomas, are benign tumors that arise from the smooth muscle and connective tissue of the uterus. They are estrogen- and progesterone-sensitive, range from millimeter-sized seedlings to grapefruit-sized masses, and are the most common pelvic tumor in women.

Estrogen and progesterone, along with growth factors like IGF-⁠1, drive their growth, which is why fibroids typically appear in the reproductive years, often expand in pregnancy and shrink after menopause6. The amount of trouble a fibroid causes depends overwhelmingly on its location, not just its size: a small submucosal1 fibroid pressing on the endometrium can cause far more bleeding than a large subserosal fibroid sitting on the outer wall.

Modern classification uses the FIGO system (types 0 through 8) based on exact location within the uterine wall.

Uterine fibroids in four places: inside the muscle wall, under the lining, on the outer surface and on a stalk

Intramural (within the muscle wall, most common)

FIGO type 3 to 5. The most common fibroid type, sitting entirely within the myometrium (uterine muscle wall). Symptoms depend on size: small intramural fibroids may be silent, while larger ones distort the uterine cavity and produce heavy bleeding, cramping and bulk symptoms.

  • โ†’Hallmarks: Heavier periods, cramping, enlarged uterus on exam, bulk pressure as size increases

Submucosal (under the endometrium, heaviest bleeders)

FIGO type 0 to 2. Sit just under the uterine lining and distort or protrude into the cavity. Even small submucosal fibroids cause the heaviest, most prolonged periods and the strongest links to anemia, recurrent miscarriage and subfertility. Most likely to benefit from hysteroscopic removal.

  • โ†’Hallmarks: Soaking-heavy bleeding, large clots, prolonged periods, iron-deficiency anemia2, fertility impact
  • โ†’Imaging: Saline infusion sonohysterogram (SIS) or hysteroscopy best characterizes cavity involvement

Subserosal + Pedunculated (under the outer surface)

FIGO types 6 and 7. Sit on the outer surface of the uterus and bulge outward into the pelvis. Often relatively quiet from a bleeding standpoint but produce significant bulk pressure on the bladder, bowel and back. Pedunculated subtypes hang from a stalk and can twist (torsion).

  • โ†’Hallmarks: Pelvic pressure, urinary frequency, constipation, low back pain, palpable abdominal mass when large
  • โ†’Imaging: Subserosal mass on transvaginal ultrasound, MRI helpful for surgical planning of large or pedunculated lesions

Cervical + Intracavitary (specialty locations)

FIGO type 8 (cervical, outside the corpus) and pure intracavitary (entirely within the cavity: FIGO type 0, also counted with the submucosal types above). Cervical fibroids can obstruct the cervix and complicate delivery; intracavitary fibroids cause severe bleeding and recurrent pregnancy loss.

  • โ†’Hallmarks: Cervical pressure, dyspareunia, postcoital bleeding (cervical); severe bleeding and miscarriage (intracavitary)
  • โ†’Imaging: MRI usually required for full anatomic mapping pre-procedure
By the Numbers

Uterine Fibroids by the Numbers

70 to 80%
of women develop fibroids by age 50 on ultrasound screening: nearly 70% of white women and over 80% of Black women19
About half
of women seeking care for fibroids have symptoms that affect their quality of life20
2 to 3ร—
higher rates in Black women than in white women, with fibroids developing at earlier ages9
#1
reason for hysterectomy in the US19
$34B
a year in US fibroid costs at the upper end of a $5.9 billion to $34.4 billion estimate, treatment plus lost productivity8
3.7ร—
higher odds of vitamin D deficiency in women with fibroids, in a 2024 review of observational studies15
Signs & Symptoms

Symptoms of Uterine Fibroids

Many fibroids are silent and found incidentally. When symptomatic, the typical pattern is heavy bleeding + bulk pressure + iron-deficiency fatigue.

SymptomWhat happens
Bleeding, Reproductive & Pain Symptoms
Heavy Menstrual Bleeding (Menorrhagia)Soaking through a pad or super tampon every 1 to 2 hours, periods lasting more than 7 days, large clots (greater than a quarter) and bleeding onto bedding or clothing. Soaking a pad or tampon every hour for more than 2 hours needs a same-day appointment; call 911 or go to the emergency department if it comes with dizziness, fainting, chest pain or breathlessness.
Severe Period Cramps & Pelvic PainIntense cramping that over-the-counter NSAIDs do not fully relieve, often radiating into the back and thighs. Sudden severe pain can mean a fibroid has lost its blood supply or twisted, and needs emergency assessment13.
Intermenstrual & Postcoital BleedingSpotting or bleeding between periods or after intercourse often points to submucosal or cervical fibroids. Always warrants evaluation to rule out other causes (polyps, endometrial pathology).
Painful Intercourse (Dyspareunia)Deep pelvic pain with intercourse, depending on where the fibroids sit.
Subfertility & Recurrent Pregnancy LossSubmucosal and intracavitary fibroids raise the risk of implantation failure and miscarriage.
Pregnancy ComplicationsFibroids can grow rapidly in pregnancy, occasionally cause painful "red degeneration" and raise the risk of malpresentation, preterm labor, placental abruption and cesarean delivery. Most such pregnancies still go well with monitoring.
Bulk, Urinary, GI, Systemic Symptoms
Pelvic Pressure & BloatingA constant fullness, "something taking up space" in the lower pelvis.
Urinary Frequency & Incomplete EmptyingAnterior fibroids compress the bladder, producing constant urgency, frequent small voids, nocturia (waking to urinate) and incomplete emptying.
Constipation & Bowel PressurePosterior fibroids press on the rectum and sigmoid colon, causing new-onset constipation, straining, painful bowel movements and rectal pressure.
Iron-Deficiency Anemia & Profound FatigueHeavy bleeding drains iron faster than diet replaces it, causing fatigue, brain fog, breathlessness on stairs, restless legs, brittle nails and hair shedding.
Low Back Pain & SciaticaLarge posterior or fundal fibroids can press on lumbosacral nerves and the pelvic floor, producing low back pain, sciatica-like leg pain and pelvic floor dysfunction.
โš ๏ธ Red flags worth urgent evaluation: Call 911 or go to the emergency department for sudden severe pelvic pain, or if heavy bleeding comes with chest pain, breathlessness or dizziness (feeling lightheaded or faint)13. Get a same-day appointment if you soak through a pad or tampon every hour for more than 2 hours13. See a doctor promptly about rapid growth of the abdomen or any bleeding after menopause. Rapid growth in postmenopausal women warrants rule-out for leiomyosarcoma (rare but serious).
Causes

Causes of Uterine Fibroids

No one knows exactly what causes fibroids; hormones and genes are thought to be involved, and several things make them more likely21.

CauseHow It Contributes to Uterine FibroidsWhat Helps
Estrogen and progesteroneFibroids grow in the reproductive years, may grow in pregnancy and usually shrink after menopause21; no food or supplement has been shown to change this4Hormonal treatments from a gynecologist: some reduce bleeding without treating the fibroid, and others shrink fibroids only while they are taken3
Ancestry and family historyRates are 2 to 3 times higher in Black women, who also develop fibroids earlier919; an Asian background or a close relative with fibroids also makes them more likely22Earlier assessment of heavy bleeding or pelvic pressure, with the ultrasound the diagnosis section describes
Reproductive historyNot yet having reached menopause and never having had a full-term pregnancy both make fibroids more likely22Nothing to change here; knowing the risk is a reason to have heavy or painful periods checked rather than put up with them
Weight, blood pressure and diabetesBeing overweight, high blood pressure and diabetes are each linked with fibroids22; whether changing them shrinks fibroids has not been shown4The eating pattern and activity in this guide for general and heart health, and usual care for blood pressure and diabetes
Low vitamin DWomen with fibroids have lower vitamin D levels; in 3 small trials in women low in vitamin D, 8 to 12 weeks of high-dose vitamin D reduced fibroid size slightly more than no supplement over 2 to 6 months, with results varying widely between trials15A dose your clinician sets, as the supplement section describes; it is not a proven fibroid treatment
Heavy bleeding and iron lossHeavy bleeding from fibroids can cause iron-deficiency anemia, which brings tiredness and shortness of breath22A ferritin test, iron replacement with the cautions in the supplement section, and treatment of the bleeding itself2
Diagnosis

How Uterine Fibroids Are Diagnosed

Diagnosis combines symptom history with imaging and bloodwork. The goal is to confirm the fibroids, characterize their location and size (FIGO type), assess for anemia, and rule out other causes of heavy bleeding.

TestWhat it shows
At-Home Screening
Period & Flow TrackingTrack at least 3 cycles, noting flow heaviness, cycle length, period duration, clot size, pad/tampon use per day and breakthrough bleeding. A period-tracking app or a paper chart works. Persistent menstrual flow greater than about 2.7 fl oz (80 mL; roughly soaking more than 16 normal pads or tampons per cycle), periods longer than 7 days or large clots strongly suggest fibroid-grade bleeding worth imaging.
Lab & Clinical Tests
Transvaginal & Transabdominal Ultrasound (first-line)The initial imaging test of choice. Identifies fibroids, gives a reasonable estimate of size, count and broad location. Transvaginal gives best detail for smaller fibroids and the cavity; transabdominal is needed when the uterus is enlarged beyond what TVUS can image.
Saline Infusion Sonohysterogram (SIS) & HysteroscopyWhen bleeding is heavy or fertility is at stake, SIS (saline injected into the cavity during ultrasound) and diagnostic hysteroscopy are the gold standards for assessing submucosal and intracavitary involvement. Required for accurate FIGO classification of submucosal fibroids (types 0, 1, 2).
Pelvic MRI (pre-procedure mapping)The gold standard for full anatomic mapping. Required before uterine artery embolization3, MRI-guided focused ultrasound, complex myomectomy or when ultrasound is inconclusive. Also helps distinguish fibroids from adenomyosis and rare leiomyosarcoma.
Iron, CBC & Anemia PanelComplete blood count (hemoglobin, hematocrit, MCV), ferritin (best marker for iron stores, target greater than 50 ng/mL, ideally 75 to 100), serum iron, TIBC, transferrin saturation.
Reproductive Hormone & Thyroid PanelEstradiol, progesterone (day 21), LH, FSH, prolactin, testosterone, SHBG, TSH, free T3, free T4, TPO antibodies. Identifies anovulation and rules out thyroid disease as a contributor to heavy bleeding.
Nutrient & Inflammation Status25-⁠OH-D where deficiency is suspected (low D is associated with fibroids in observational studies), magnesium RBC, B12, hs-CRP, homocysteine. Endometrial biopsy is added if bleeding is atypical or for women over 45 to rule out endometrial hyperplasia or cancer.
Treatment Comparison

Conventional and Holistic Treatment for Uterine Fibroids

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Ease symptoms, rebuild iron and support general health; effects on fibroid growth are unproven4

Primary Role
Anti-inflammatory whole-food nutrition + iron repletion (iron-rich food + vitamin C) + endocrine-disruptor reduction
Duration
3 to 6 months for bleeding improvement and iron repletion; fibroid shrinkage is not a reliable expectation
Effect on Underlying Pattern
May ease symptoms; slowing growth or reducing recurrence has not been shown4
Fertility Outcome
Preserves the uterus; no evidence that it improves fertility outcomes

Full Holistic Approach Includes

  • Anti-inflammatory whole-food eating: protein at every meal, half the plate non-starchy vegetables, minimize refined sugar and processed meat
  • Vegetables and green tea: cruciferous vegetables daily, green tea extract (in one small pilot trial, fibroids shrank by about a third over 4 months while they grew on placebo)14
  • Iron repletion: iron from beans, lentils, leafy greens, fatty fish and poultry, paired with vitamin C18; targeted iron bisglycinate 25 to 50 mg if ferritin is low (target greater than 50 ng/mL, ideally 75 to 100)
  • Gut health: 30 to 40 g fiber/day, fermented foods, regular bowel movements matter for comfort and general health; any effect on fibroids has not been shown
  • Vitamin D: correct a low level with your clinician; in 3 small trials in women low in vitamin D, high-dose vitamin D4 reduced fibroid size slightly, with inconsistent results15
  • Endocrine-disruptor reduction: glass and stainless instead of plastic, fragrance-free personal care, filtered water, organic produce where affordable
  • Stress support: breathing exercises, daylight and 7 to 9 hours of sleep
  • Serial ultrasound monitoring every 6 to 12 months to track size; coordinate surgical consult if size, symptoms or fertility timeline demands
โš ๏ธ Side effects: Mild GI changes the first 2 weeks as fiber and cruciferous rise; iron may produce nausea or constipation (take with food, hydrate, use bisglycinate form); cycle changes are possible. High-dose green tea extract can affect the liver, and several of these supplements interact with medicines.
Supplement Protocol

Evidence-Based Supplements for Uterine Fibroids

No supplement has been shown to shrink fibroids reliably4. The list below is mainly about replacing what heavy bleeding takes, with the two supplements tested in fibroid trials reported as the trials found. If you are pregnant or trying to conceive, check each one with your midwife or doctor.

Supplement What it is for Typical range Timing Notes & cautions
Green Tea Extract (EGCG)In a 4-⁠month pilot trial, total fibroid volume fell 32.6% in 22 women taking it and rose 24.3% in 11 on placebo, and monthly blood loss fell from 71 to 45 mL; only 33 women finished, and it has not yet been repeated14.800 mg green tea extract per day (45% EGCG, the dose used in the trial)14Split, with mealsEvidence is limited to a small trial. Supplements supplying 800 mg or more of EGCG a day have raised liver enzymes in trials, so do not exceed the trial dose, take it with food, avoid it with liver disease, and stop and seek advice if you notice dark urine or yellowing skin. Pregnant or trying to conceive: check with your midwife or doctor first.10
Vitamin D3 (with K2)In 3 small trials in women low in vitamin D, 8 to 12 weeks of high-dose vitamin D reduced fibroid size slightly more than no supplement over 2 to 6 months, with very inconsistent results; it corrects a deficiency, and is not a proven fibroid treatment154.D3: set the dose with your clinician; most adults need no blood test first; K2 (MK-⁠7): 100 to 200 mcg per dayWith a fat-containing meal, morning preferredSevere deficiency is corrected under clinical supervision. The adult tolerable upper intake level is 4,000 IU/day; higher intakes need a blood test and a clinician. If you take warfarin, clear any vitamin K supplement with the clinician managing your anticoagulation before starting or stopping it: vitamin K antagonizes warfarin, and changing your intake destabilizes the INR. Consistency matters more than avoidance. This does not apply in the same way to direct oral anticoagulants such as apixaban or rivaroxaban, but tell your prescriber about any supplement you take.
Iron BisglycinateThe most absorbable and gentlest form of supplemental iron. Critical for repleting stores depleted by heavy menstrual bleeding. Target ferritin greater than 50, ideally 75 to 100 ng/mL.25 to 50 mg elemental iron per dayMorning, away from coffee/tea, with vitamin CBisglycinate causes less GI distress than ferrous sulfate. Retest ferritin after 3 months. Stop at target to avoid overload. In pregnancy or when planning one, your midwife or doctor sets the dose. The top of this range sits above the 45 mg/day tolerable upper intake level for adults. That is appropriate only when correcting a confirmed deficiency under clinical supervision, not as general supplementation. Test ferritin first, and retest rather than staying on it indefinitely.
Vitamin CIncreases non-heme iron absorption, supports collagen and uterine tissue integrity, antioxidant for menstrual blood loss recovery.500 to 1,000 mg per dayWith iron-containing meals or supplementsFood sources (bell peppers, citrus, kiwi) work just as well; supplement when intake is low.
Curcumin (Turmeric Extract)Anti-inflammatory; the fibroid data come from laboratory studies, not trials in women.500 to 1,000 mg curcumin per dayWith a fat-containing mealPlain curcumin is poorly absorbed; liver injury has been reported mainly with high-dose, high-absorption formulations such as those with piperine, so stop and seek advice if you notice dark urine or yellowing skin.11 Caution if on anticoagulants. Turmeric supplements may be unsafe in pregnancy16.
Omega-⁠3 EPA/DHANot shown to help fibroids.2 g combined EPA+DHA per dayWith mealsChoose a product with independent third-party purity testing. Prefer fish or algal oil to cod liver oil at this dose, since cod liver oil also supplies preformed vitamin A, whose adult upper limit is 3,000 mcg a day; avoid it in pregnancy, when too much vitamin A can harm a baby1712. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day24, so check this dose with your clinician first. At higher doses fish oil can increase bleeding risk; tell your clinician if you take a blood thinner or have heavy bleeding.
Magnesium GlycinateMay ease cramping and support sleep.300 to 400 mg elemental magnesium per dayEvening, 30 to 60 min before bedIn pregnancy, check the dose with your midwife or doctor. Magnesium oxide is poorly absorbed. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
B-ComplexSupports homocysteine metabolism. Useful for anemia recovery where B vitamin levels are low.1 capsule per day per product labelMorning with foodEnsure 400 to 800 mcg folic acid if trying to conceive; it is the form proven to prevent neural tube defects. B12 especially important if vegetarian.
LactoferrinIron-binding glycoprotein that improves iron absorption and modulates inflammation. Randomized trials, mostly in pregnancy rather than in fibroid-related heavy bleeding, report iron repletion comparable to oral iron with fewer gastrointestinal side effects. Reasonable when oral iron is not tolerated, and less well studied in this specific setting.5200 to 400 mg per dayMorning, away from mealsEspecially helpful when oral iron causes GI distress. Often combined with iron bisglycinate.
What to Expect

What to Expect Over Time

Fibroids without symptoms may need no treatment; otherwise the plan depends on symptoms, fibroid size and position, and whether you want children21.

Treatment and supportive care, together
First Weeks

An ultrasound confirms the fibroids and a blood test checks for anemia22. Heavy bleeding is usually treated first with a hormonal IUD, the combined pill or a medicine that reduces bleeding, plus pain relief; if ferritin is low, iron starts now2.

Months 1 to 3

These treatments reduce bleeding without treating the fibroid itself3. Iron stores take months to rebuild, so ferritin is rechecked. Green tea extract and vitamin D have only small trials behind them and do not replace this care4.

Months 3 to 12

If medicine does not help, fibroids are large or symptoms worsen, options include removing the fibroids, uterine artery embolization or hysterectomy, which affect future pregnancy differently22. Hormone treatments that shrink fibroids work only while taken3.

Long Term

Removing fibroids keeps the uterus but does not stop new ones from growing, so symptoms are rechecked21. Fibroids usually shrink after menopause6.

When to Seek Care

Call 911 or go to the emergency department for sudden severe pelvic pain, or if heavy bleeding comes with chest pain, breathlessness or dizziness (feeling lightheaded or faint)13. Get a same-day appointment if you soak through a pad or tampon every hour for more than 2 hours13. See a doctor about any bleeding after menopause23.

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Next Steps

Treat the Bleeding, Check Your Iron

Fibroids without symptoms may need no treatment. No dietary approach has been shown to shrink established fibroids, but diet influences symptoms, iron status and general health alongside effective medical and procedural options. Ask for a ferritin, because anemia from heavy bleeding is the most common real harm.

Explore Menopause โ†’ Explore Ovarian Cysts โ†’ Explore Iron-Deficiency Anemia โ†’

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.7 Fibroids are benign, extremely common, and the trouble they cause depends far more on where they sit than on how large they are. Two practical points. First, the most common real harm is iron-deficiency anemia from heavy bleeding, which is frequently under-recognized and is very treatable, so ask for a ferritin rather than just a hemoglobin. Second, be clear-eyed about what diet can do: no dietary approach has been shown to shrink established fibroids. Diet and lifestyle influence symptoms, iron status and general health, and there are effective medical and procedural options if symptoms are significant. Sudden severe pelvic pain, or bleeding heavy enough to soak through protection hourly, needs urgent assessment.

  1. On location over size: submucosal fibroids distorting the cavity produce the heaviest bleeding and have the strongest association with anemia, miscarriage and subfertility, and are often the most amenable to hysteroscopic removal. Large subserosal fibroids may cause bulk symptoms with little bleeding. The FIGO classification describes this and is worth asking about. ↩
  2. On anemia. Chronic heavy menstrual bleeding is a leading cause of iron deficiency in premenopausal women, and iron deficiency without anemia also causes fatigue and reduced exercise tolerance. Ferritin is the appropriate test and is often not ordered. Alternate-day rather than daily oral iron dosing improves absorption by reducing hepcidin elevation, and intravenous iron is appropriate where oral is not tolerated or repletion is urgent. ↩
  3. On medical and procedural options: tranexamic acid and the levonorgestrel intrauterine system reduce bleeding without treating the fibroid; GnRH agonists and oral GnRH antagonists with add-back shrink fibroids temporarily, with regrowth after stopping; uterine artery embolization, myomectomy and hysterectomy are procedural options with different implications for fertility. Choice depends on symptoms, fibroid position and whether pregnancy is planned. ↩
  4. On diet, honestly. Observational studies associate higher vitamin D status, greater fruit and vegetable intake and lower red meat intake with lower fibroid prevalence, and vitamin D deficiency is common in women with fibroids. Small trials of vitamin D supplementation report slowed growth, and green tea extract has one small randomized trial. No dietary intervention has been shown to shrink established fibroids reliably, and the observational findings cannot establish cause. Eat well for the reasons that are supported, and treat the bleeding properly. ↩
  5. On lactoferrin: randomized trials, conducted largely in pregnancy rather than in fibroid-related heavy bleeding, report iron repletion comparable to oral ferrous sulfate with fewer gastrointestinal side effects. It is a reasonable option where oral iron is poorly tolerated, and the evidence in this particular setting is thinner than the general claim suggests. ↩
  6. On what does not need doing: fibroids typically shrink after menopause. Asymptomatic fibroids found incidentally generally need monitoring rather than treatment, and rapid growth, particularly after menopause, warrants assessment because it raises the question of leiomyosarcoma, which is rare. ↩
  7. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  8. On the cost of fibroids: a systematic review estimated that uterine fibroids cost the United States $5.9 billion to $34.4 billion a year in 2010 dollars, PubMed 22244472. ↩
  9. On dairy, soy and fibroids: among 22,120 premenopausal women in the Black Women's Health Study, higher dairy intake was associated with lower fibroid risk and soy intake was unrelated to it, PubMed 19955473. ↩
  10. On green tea extract and the liver: the European Food Safety Authority concluded that supplements providing 800 mg or more of EGCG a day raised liver enzymes in clinical trials, and that rare liver injury has also been reported with green tea, PubMed 32625874. ↩
  11. On curcumin and the liver: in a case series and systematic review of acute hepatitis linked to Curcuma longa supplements, every case in the Tuscany series involved high-bioavailability, high-dose formulations, PubMed 32656820. ↩
  12. On cod liver oil and vitamin A: cod liver oil supplements provide vitamin A and vitamin D as well as omega-⁠3s, and the adult upper limit for preformed vitamin A is 3,000 mcg a day, NIH Office of Dietary Supplements. ↩
  13. On when bleeding or pain is an emergency: ACOG advises seeking emergency care right away for changing pads or tampons every hour for more than 2 hours in a row together with chest pain, shortness of breath, light-headedness or dizziness; Cleveland Clinic advises that bleeding through pads or tampons each hour for two to three hours in a row is a reason to see a provider or seek emergency care; and MedlinePlus notes that severe pain or very heavy bleeding from fibroids, or a fibroid that twists, can need emergency surgery, ACOG, abnormal uterine bleeding, Cleveland Clinic, heavy menstrual bleeding, MedlinePlus, uterine fibroids. ↩
  14. On green tea extract: in a 4-⁠month pilot randomized trial, 22 women with symptomatic fibroids who took 800 mg of green tea extract a day (45% EGCG) saw total fibroid volume fall by 32.6%, while it rose by 24.3% in 11 women on placebo; average menstrual blood loss fell from 71 to 45 mL a month and hemoglobin rose by 0.7 g/dL. Of 39 women recruited, 33 completed the trial, and a larger multicenter trial has since been planned, PubMed 23950663, PubMed 38216200. ↩
  15. On vitamin D: a 2024 systematic review pooled 3 randomized trials (328 women, all with low vitamin D, given a high prescribed dose weekly or every two weeks for 8 to 12 weeks) and 23 observational studies (5,650 women). With supplementation, fibroid size fell by about 5.7% more than in controls, measured as the percentage change in diameter or volume, over 2 to 6 months, with very high inconsistency between trials; women with fibroids had lower vitamin D levels and 3.7 times the odds of deficiency. These doses are prescribed treatment for deficiency, not general supplements, PubMed 39128544. ↩
  16. On turmeric: NCCIH states that ordinary turmeric or curcumin is likely safe in recommended amounts for 2 to 3 months, that highly bioavailable formulations may harm the liver, and that turmeric supplements may be unsafe during pregnancy, NCCIH, turmeric. ↩
  17. On liver and vitamin A: NHS guidance advises not eating liver or liver products more than once a week and not taking supplements containing vitamin A (including fish liver oil) in weeks you eat liver; it advises avoiding liver altogether in pregnancy, because its high vitamin A content can harm a baby, NHS, vitamin A, NHS, foods to avoid in pregnancy. ↩
  18. On iron-rich foods: MedlinePlus lists dried beans, dried fruits, eggs, iron-fortified cereals, liver, lean red meat, oysters, poultry, salmon, tuna and whole grains among the best sources of iron, and among plant sources beans, peas, lentils, soybeans, broccoli, spinach, kale and collards. Eating some lean meat, fish or poultry with beans or dark leafy greens can improve absorption of the plant iron up to three times, and foods rich in vitamin C such as citrus, strawberries, tomatoes and potatoes also increase absorption, MedlinePlus, iron in diet. ↩
  19. On how common fibroids are: in an ultrasound screening study of 1,364 randomly selected women aged 35 to 49, the estimated cumulative incidence of fibroids by age 50 was over 80% for Black women and nearly 70% for white women, fibroids developed at earlier ages in Black women, and fibroids were the leading reason for hysterectomy in the US, PubMed 12548202. ↩
  20. On symptoms: a 2021 review of vitamin D and fibroids estimates that half of women presenting with fibroids have symptoms that negatively affect their quality of life, and notes that clinical studies support only in part the idea that vitamin D reduces fibroid growth, PubMed 33670322. ↩
  21. On fibroids and their treatment: MedlinePlus notes that no one knows exactly what causes fibroids, that hormones and genes are thought to be involved, that fibroids may grow in pregnancy and often shrink after menopause, that fibroids without symptoms may need no treatment, that the choice of treatment depends on symptoms, fibroid type, size and location and wishes for future children, that removing fibroids does not prevent new ones from growing, and that severe pain or very heavy bleeding, or a fibroid that twists, can need emergency surgery, MedlinePlus, uterine fibroids. ↩
  22. On risk factors, diagnosis and treatment: NHS guidance lists not having reached the menopause, never having had a full-term pregnancy, being overweight, high blood pressure or diabetes, a Black or Asian background and a close relative with fibroids as making fibroids more likely. Diagnosis is usually by ultrasound; heavy bleeding is treated first with painkillers, a medicine to reduce bleeding or a hormone medicine such as the combined pill, and surgery or embolization follows if these do not help, with effects on future pregnancy that differ between treatments. Heavy bleeding can cause iron-deficiency anemia, NHS, fibroids. ↩
  23. On bleeding after menopause: NHS guidance advises that any vaginal bleeding after the menopause needs checking by a doctor, even if it happened only once or was only spotting; it is not usually serious but can be a sign of cancer, NHS, postmenopausal bleeding. ↩
  24. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩