 Fibroids are the most common benign tumors in women. Then get up to a foot in diameter and affect the majority of women before they hit menopause. They tend to be asymptomatic, though, but when symptoms do occur, they tend to manifest as heavy menstrual bleeding. So much so, women may get anemic and lots of pain. So what can women do? About a half go to surgery and get their entire uterus removed, although it's generally considered a safe operation. Obviously you can't have kids anymore, and complications occur in a significant proportion of patients. The alternative is a variety of hormone-modulating drugs, which can shrink the fibroids and provide relief, but many of these drugs have significant side effects like bone loss, so you really don't want to be taking them for more than a few months. And so, bottom line, there's currently no evidence to support the routine use of drug treatment in women for fibroids. No wonder many women turn to complementary and alternative treatments such as exercise, diet, herbs, and acupuncture. Women who exercise seven or more hours a week do seem to have lower risk of having fibroids than women who exercise less than like 20 minutes a day, but it's never been put to the test for treating fibroids. And likewise, it's not a single randomized controlled trial of acupuncture for the treatment of fibroids to date to help guide us. In terms of herbs, there are two Asian herbal preparations that show promise, a five-herb combo called gizzy fooling, and a Malaysian 10 herb formula, which contains secret ingredients. So secret, they just list them. But seem to work as well as the leading drug. The problem is that traditional Asian herbal remedies may contain a few extra bonus secret ingredients, like arsenic, mercury, and lead. In most of the samples, tested off of Asian market and health food store shelves, and not just a little. Some apparently had really toxic amounts. So yeah, these two Asian herbal preparations may reduce fibroid size, but there remains insufficient evidence as to their safety. And certainly don't try to apply caustic herbs internally, as this can lead to scarring, stenosis, and ulceration. OK, but what about diet? In one of the largest studies of diets in fibroids, fibroid tumors were associated with beef and ham consumption, whereas high in takes of green vegetables seemed to have a protective effect. They figured that the association between estrogen, diet, and breast and uterine lining cancers might help us understand why. For breast and endometrial cancers, there is a similar direct association with the frequency of meat consumption, with a similar protection conferred by vegetables and fruits. Thus, there may be these shared risk factors between estrogen-responsive malignant tumors, like breast cancer, and estrogen-responsive benign tumors, like fibroids. We know the presence of fibroid seems to correlate with an increase in the amount of astrogens, for example flowing through your body, and women eating vegetarian have significantly lower levels of excess astrogen. Now they're using this to try to explain why there are lower rates of endometrial cancer, meaning lining of the uterus cancer, and possibly breast cancer among those eating vegetarian, but it could also help explain the fibroid findings. The incidence of breast cancer among vegetarian adventists is only 60 to 80% that of American women in general. And the incidence among women in Africa or Asia are even lower. Why might women eating vegetarian have lower estrogen levels? This famous study in the New England Journal concluded that it was their increased fecal output that leads to increased excretion of estrogen resulting in lower blood levels. Double the output, in fact. You can see all the heavyweight Vs compared to the welterweight omnivores. And you can put it to the test. Maybe the same reason African American women have more fibroids is the same reason they have worse breast cancer survival. Too much estrogen in their bloodstream due to a less than optimal diet. So researchers designed this study to see what would happen if they were switched to a more plant-based, higher fiber diet. The women started out with much higher estrogen levels, again helping to explain their increased mortality from breast cancer, but put people on a healthier diet and all their levels calmed down, suggesting a substantial reduction in breast cancer risk can be achieved by adopting a diet centered around more whole plant foods. And the same appears to be true for a fibroid, especially eating lots of cruciferous vegetables, broccoli, cabbage, and Chinese cabbage, as well as tomatoes and apples. Women who underwent premature puberty starting their periods before age 11 may also be at increased risk of fibroids later in life. And we know higher childhood red meat intakes associate with earlier age of starting one's period, though total and animal protein in general may contribute. For example, girls who eat meat tend to start their periods about six months earlier than girls who eat vegetarian. Those that eat meat analogues, meaning like veggie burgers, veggie dogs, started their periods nine months later on average. And a similar puberty normalizing influence was found with the consumption of whole plant foods, such as beans. It could also be the endocrine disrupting pollutants that build up the food chain. Researchers took samples of internal abdominal fat from women and there appeared to be a correlation between the presence of fibroids with the levels of a number of PCBs in their fat. So does that mean fish eaters have higher risk of fibroids? Researchers did find a small increase of risk associated with the intake of long chain omega-3 fats, mostly from dark fish consumption, by which they meant like sardines and salmon. This could be because of the endocrine disrupting chemicals commonly found in fish, or it could just be a statistical fluke. It would be consistent, though, with the increased risk among sport fish consumers. They're talking about this study, recognizing that diet and endocrine disrupting persistent organic pollutants have been associated with a variety of gynecologic conditions, including fibroids. They looked at consumers of fish fished out of the Great Lakes and found a 20% increased risk for every 10 years they've been eating the fish. This is the most comprehensive study to date. They've compared pollutant levels in fat samples of women with fibroids, compared to fat liposuction of women without fibroids, and didn't just find higher levels of PCBs in fibroid sufferers, but also long-band pesticides like DDT and hexachlorocyclohexane, PAHs, polycyclic aromatic hydrocarbons formed when coal is burned, tobacco is smoked, and meat is grilled, as well as heavy metals, arsenic, cadmium lead, and mercury, levels which correlated not only to fibroids, but to seafood consumption or excess body fat. So shedding excess weight and limiting seafood consumption might confer a protective effect on fibroid tumor development by minimizing exposure to environmental pollutants as much as possible.