Want to shrink a Fibroid or prevent a fibroid from growing bigger?

‍Here is a 7-Step Nutrition Protocol from a Women’s Health Dietitian highlighting things you can add to your diet and lifestyle to help manage fibroids!

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God Didn’t Intend for Our Wombs to Have Fibroids—so Let’s Talk About What You Can Do

Lately I have been hearing about more and more women who are getting fibroids especially at a younger age. These benign tumor like growths can cause severe menstrual cramps, pain with intercourse and even complicate pregnancy, and I don't know you but I belive God designed our womb for procreation not tumors. So what is going on? Why are fibroids on the rise, especially among black women? A lot of it has to do with what we put in our bodies.

Luckily, Our bodies were created with incredible wisdom, and when we nourish them properly, we can support healing. That’s why today, I want to share practical steps to help you take control of your fibroid health based on research.

In this article, we review the current clinical research on fibroids and nutrition and combine them into a seven step nutrition protocol (plus a bonus step if you read to the end) that you can implement if you want to be proactive about managing fibroids naturally, especially if you have a fibroid that is not yet large enough to warrant surgical intervention. 

Disclaimer: While these recommendations can be helpful, everybody is unique. Not all dietary changes or supplements are appropriate for everyone, so be sure to consult your doctor or dietitian to determine what’s best for your situation.

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Step 1: Add 1/2 Cup of Fruit and 1/2 Cup of Vegetables to Lunch and Dinner.

‍(Bonus: Prioritize citrus as one of your fruit servings!)

Fruits and Vegetables: How these foods prevent fibroids:

According to a 2023 review by Jarsalow Kryzanowski and colleagues, fruits and vegetables have been shown to decrease fibroid risk in several populations, including Black women and Chinese women. A study looking at 59,000 Black women, around 6,000 of whom had fibroids, found that those who had a higher intake of vegetables and fruit, especially citrus fruit, had a lower occurrence of fibroids. Fruit and vegetables were also associated with decreased fibroid incidence among a smaller cohort of Italian women (1)

Similar outcomes were observed in a study of Chinese women, which found lower levels of fibroids in those who consumed more cruciferous vegetables like cabbage and broccoli, as well as fruits like tomatoes and apples. These are just two of several studies that have demonstrated an inverse relationship between fruit and vegetable consumption and fibroid risk (1). 

Based on the overview of literature, it seems that consuming two or more servings of fruit per day and two or more servings of vegetables per day offers the greatest benefit for fibroid risk reduction. A serving is typically considered 1/2 cup of fruit, 1/2 cup of cooked vegetables, or 2 cups of leafy greens. That’s why the first step of this protocol is to aim for one serving of fruit and one serving of vegetables at both lunch and dinner to help you meet this goal.

Takeaway

Aim for a minimum of 2 servings of fruit and 2 servings of vegetables per day. For example, add 1/2 cup of berries and ½ cup sauteed broccoli as sides for lunch, and 1 sliced orange and 2 cups of salad at dinner.  Consistency is key, so try to make this a daily habit. Your uterus will thank you!

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But, do fruits and vegetables really make that big of a difference?

Fruits and Vegetables Contain Compounds that interfere with fibroid growth:

To be honest, when I discuss fruit and vegetables with my patients for any condition, I get the “I know, I know” reaction. Because everyone knows that fruit and vegetables are good but yet most patients barely have 1 or 2 servings per day. So I want to give you a bit of background so you can know why it is critical for your health, especially as it pertains to fibroids. 

Just one piece of fruit or one serving of vegetables can contain dozens of antioxidant compounds that have been shown to protect cells from damage, support proper cell division and replication, and aid in the removal of harmful or abnormal cells. Consistently exposing your body to these compounds through fruits and vegetables likely protects uterine cells from the cellular damage and dysregulation that can lead to fibroids.

An example of this in real-time has been found with strawberries, a fruit shown to shrink fibroids in the laboratory setting. Researchers found that anthocyanin-rich strawberry extract (an antioxidant found in strawberries) interfered with specific growth proteins responsible for fibroid growth, like Collagen A1A (2).  Anthocyanins are not just found in strawberries, but also in blueberries, blackberries, beets, and other fruits and vegetables. It is likely that these antioxidants make it to our cells and interfere with these proteins in abnormal cells like fibroids. When you eat fruits and vegetables, you are literally eating medicine. That's why dietitians go on and on about plant foods!

Estrogen and Fibroids:

Additionally, excess estrogen is a well-known factor that can encourage fibroid growth, and fiber, which is found in fruits and vegetables, helps your body keep estrogen at bay.  Fiber traps excess estrogen that comes from the gallbladder during digestion, and helps it make its way to the colon for excretion. Additionally, fiber feeds beneficial gut bacteria, supporting a diverse microbiome that can further regulate estrogen levels, because too much of a certain class of bacteria (members of the estrobolome) can cause estrogen to get reabsorbed. You can read more about the role of fiber in digestion here. 

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But perhaps you're thinking, well, all this sounds great, but aren't they spraying pesticides all over our fruits and vegetables?

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What about pesticides, do pesticides cause fibroids?

To date, little association has been found between pesticides and fibroid incidence. However, to my knowledge, only a handful of studies have been done in this area. One of the largest studies I’m aware of was an observational study conducted in the US by Colette Davis and colleagues. They followed 49,927 women from the Nurses' Health Study II for 11 years (1999 to 2009) to analyze their fruit and vegetable intake and associated pesticide burden (3). 

During the study period, the women completed a food frequency questionnaire every 4 years, assessing how many servings of fruits and vegetables they consumed per day over the past year. Researchers classified these fruits and vegetables as high or low pesticide residue using a USDA pesticide database and assigned a pesticide burden score (3). 

The study found that the risk of fibroids was not correlated with consuming fruits and vegetables with higher pesticide residues. In fact, the study found an inverse relationship, meaning higher pesticide residue from fruits and vegetables was linked to a lower fibroid risk.

This study intrigued me, especially considering other research that has linked pesticide residue to reduced fertility in both men and women. Full disclaimer, there are several limitations to this study that I can think of that could have made it hard to directly study the impact of pesticides and fibroids, but it’s very possible that the benefits of fruit and vegetable consumption outweigh the potential risks of pesticide exposure when it comes to fibroids. 

Based on this research and my clinical judgment, I would advise patients to consider the following:

• Focus on increasing fruit and vegetable intake overall, regardless of pesticide residue, if you are past the stage of trying to conceive and find organic produce inaccessible due to cost or availability. 
• If you’re trying to conceive or in your reproductive prime, and have the option to buy organic produce, I recommend doing so to minimize potential pesticide exposure. This is particularly relevant given the evidence linking pesticides to fertility challenges. 

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Step 2: Have 1 serving of Yogurt Per Day!

Foods shown to prevent fibroids: Dairy

Another food that may help prevent fibroids is dairy, specifically yogurt. This might come as a big shock to you, especially since many women seek to avoid dairy due to the fact that dairy contains hormones. 

However, the Black Women’s Health Study, conducted by Wise and colleagues, one of the largest studies conducted on fibroids in this population, found that fibroid occurrence was lower in those who consumed 4 or more servings of dairy per day. They also discovered that the highest consumers of yogurt had a significantly lower risk of fibroids (4). 

These findings were later supported by a study done by Orta and colleagues, who looked at the population of 59,000 women from the Nurses Health Study II mentioned above. Orta and colleagues found that higher dairy consumption was associated with reduced risk of fibroid in Black women, regardless of whether the dairy was high or low-fat (5). 

They also found that, yet again, yogurt had the strongest relationship with reduced fibroid risk. When the data was adjusted for calcium intake from dairy versus general calcium intake, it appeared that calcium from food sources overall was linked to a lower risk of fibroids, which suggests that calcium from supplementation may not be as beneficial as getting the calcium from whole food sources. However, it’s important to note that in her study, the benefits of dairy and fibroid risk reduction were only found in women who had children prior, which was an interesting finding (5). 

How might yogurt help prevent fibroid growth?

Orta and colleagues noted that they believe calcium from dairy foods may impact cell proliferation in a positive way, especially when coupled with the synergistic effect from other beneficial compounds in dairy, such as anti-inflammatory properties. They also noted that yogurt is often rich in probiotics that may positively influence the gut microbiome and potentially lower fibroid risk. 

Since more research is coming out about bacteria and estrogen balance, I, too, would not be surprised if yogurt slows or prevents fibroid growth due to the healthy bacteria in yogurt helping shift the gut biome away from estrogen-promoting bacteria, to a more balanced distribution, but more research is needed.

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Does milk cause Fibroids?

But what about milk in particular? Is drinking milk okay for fibroids?  Interestingly, as noted above, the Black Women’s Health Study (Wise and colleagues) found that milk consumption, along with other dairy sources, decreased the risk of fibroids. However, some studies in other populations, such as one by Chiaffarine and colleagues in Italy, found no association between milk or overall dairy and fibroids, perhaps indicating that in some the effect could be neutral. 

 Orta’s study noted above did not find milk to have a significant impact on fibroid growth or reduction also.  However, a study in 2018 by Mei Gao, examining 1,273 women in Henan Province, China, found an increased risk in women who consumed dairy, soybeans, and used birth control frequently, even when controlling for each of those factors. However, from my knowledge, the study did not look at yogurt but only milk. The population was also small and was conducted in Henan Province, China, and may have been showing results more relevant to that population. 

Overall, most of the research leans toward moderate milk consumption playing a neutral role when it comes to fibroids overall. But genetic differences amongst certain populations may affect how milk affects fibroid risk, which might explain why the small cohort of Chinese women had a negative effect from milk, while the large cohort of black women seems to have a positive effect from milk and dairy as a whole 

However, since two large studies with diverse populations supported yogurt as a protective factor, aiming for one serving of yogurt per day, if tolerated, may be helpful.

If you cannot tolerate yogurt or dairy, you can still meet your calcium goal by focusing on fish, calcium-fortified foods like orange juice, and increasing your vegetable intake.

The average non-pregnant woman aged 19–50 needs about 1,000 mg of calcium per day, which is roughly 3–4 servings of calcium-rich foods. See the list of calcium-rich foods below!

• Plain yogurt (8 ounces) 415 mg or 32% daily value
• Fortified orange juice (1 cup) 349 mg or 27% daily value
• Mozarella, part-skim, 1.5 ounces 333mg or 26% daily value
• Sardines in oil (with bones) 3 oz 325mg, 25% daily value
• Milk, non-fat, 1 cup 299mg or 23% daily value
• Soy milk, calcium-fortified, 1 cup 299mg or 23% daily value 
• Pink Salmon (canned with bones, 3 ounces) 181 mg or 14% daily value
• Spinach (1 cup boiled)  246 mg or 18% DV
• Turnip greens ( 1 cup boiled) 198mg or 16% of your daily value
• Kale fresh (1 cup cooked) 94mg or 7% daily value

Takeaway

Aim for one serving of yogurt per day to help support your fibroid health. I recommend organic full-fat dairy, especially if you are trying to conceive in the near future or if you are pregnant.  If you can’t tolerate dairy, focus on getting calcium from other sources like leafy greens, fortified juices, and fish with emphasis on getting at least 1000mg per day (See list above). Calcium intake from food (not supplements) is key for fibroid prevention.

Step 3: Ensure your Vitamin D levels are close to 30ng/dl 

Vitamin D levels and reduction in fibroids:

Another step that may not just prevent fibroids, but might also help smaller fibroids shrink in size or go away entirely, is maintaining adequate vitamin D levels, or levels close to 30ng/dl. 

A 2013 study conducted by Baird and colleagues published in the Journal of Epidemiology found that women with low Vitamin D had a 32% higher risk of developing fibroids (7).

 This finding was consistent with a later study conducted in 2022 by Harmon and colleagues in the Journal of Fertility and Sterility, which examined 1,610 African American women with fibroids. The study found that 73% of participants had deficient Vitamin D levels. Over 18 months, fibroids in Vitamin D-deficient women grew by 77% in size (8).

Although the fibroids were relatively small at the start (averaging 0.56 cm in volume), by the end of the study, most fibroids had grown to around 2.2 cm in those with Vitamin D deficiency.

Interestingly, the study also found that women with serum Vitamin D levels over 20 ng/mL had a 9.7% reduction in fibroid growth. Those with levels above 30 ng/mL experienced a 22% reduction in fibroid incidence and a 32% increase in fibroid loss, a term researchers used to define a decrease in the number of fibroids noted on two successive visits, which may suggest reduced fibroid growth or complete resolution of a fibroid. (8). 

Unfortunately, only 7% of women had Vitamin D levels above 30 ng/mL, and less than 1.7% were able to maintain this level throughout the study. Still, despite the small sample size, the findings align with other research suggesting that maintaining normal Vitamin D levels may reduce fibroid growth or even shrink fibroids (8). 

Additionally, a 2023 literature review by Sayd Alsharif and colleagues found that 8 weeks of Vitamin D supplementation was linked to reductions in fibroid size, although the sample sizes in these studies were also small (9). 

Takeaway

Get your Vitamin D levels checked, and if they’re deficient, work with your doctor or dietitian to bring them within an optimal range, ideally 30 ng/mL. This is one of the first labs I check for all my patients. So, if you make your way over to my clinic, 3 In 1 Nutrition, it will be one of the very first things I ask about.

Step 4: Take Green tea extract supplement(45% EGCG)

Another thing that can help reduce fibroid size, like Vitamin D, is green tea extract. Green tea contains something known as epigallocatechin gallate, a powerful antioxidant that has been shown to shrink smaller fibroids in clinical trials.

In a randomized, double-blind, placebo-controlled trial conducted in 2013, women who took 800 mg of green tea extract daily for 4 months experienced a 32.6% reduction in fibroid size, compared to a placebo group, along with a significant decrease in monthly bleeding (10). 

Another study in 2020 by Porcaro and colleagues found that women who took 25 μg of vitamin D, 150 mg of EGCG, and 5 mg of vitamin B6 daily for 4 months saw a 34.7% reduction in fibroid size, while the control group experienced a 6.9% increase (11). 

 A similar study by Giovanni Grandi and colleagues in 2022 confirmed these results, showing a 17% reduction in fibroid size when EGCG was combined with vitamin D (12). 

While these studies had small sample sizes, the results are promising and suggest that both vitamin D and EGCG could be beneficial for managing fibroids. Additionally, a current study called the FRIEND study is investigating how EGCG may improve fertility and pregnancy outcomes.

How Does EGCG Work?

The mechanism behind EGCG's effectiveness in fibroid management is still being studied. However, research suggests that EGCG inhibits fibroid cell proliferation by regulating key signaling pathways in fibroids. Additionally, it acts as an antioxidant, reducing inflammation and protecting uterine cells from damage and abnormal cell growth.

What Are the Side Effects of Taking EGCG?

Green tea extract is generally considered safe at doses of 800 mg or less per day. However, high doses of EGCG can cause liver damage. While most studies have shown that 800 mg is safe for most women, there are some concerns about EGCG's potential to interfere with other hormones, minerals, and medications, but more studies, such as the FREIND trial, are underway (13). 

So far, the FRIEND trial, which is currently ongoing, has found no liver toxicity with EGCG at 800 mg, even when taken alongside letrozole (a medication often prescribed for fertility treatments). There were also no changes in serum iron or folate levels which can be decreased by several supplements and medications. On the other hand, animal studies have shown that EGCG may lower estrogen and progesterone levels in swine and rabbits. Interestingly, one human trial saw an increase in progesterone when EGCG was used in combination with other supplements, indicating that the effect in humans may be different depending on dose (13).

Given the limited research on EGCG's impact on fertility and pregnancy, it’s best to consult with a medical professional before using EGCG, especially if you’re pregnant or actively trying to conceive.

Takeaway: If you have a small fibroid that does not require surgical intervention, talk to your doctor or dietitian about trialing  EGCG in doses used in the protocol for the randomized control trial completed in 2013: 800 mg of green tea extract (containing 45% EGCG) daily for 4 months. I personally like to work alongside my patients' physicians to monitor markers such as liver enzymes, hormones such as progesterone and estrogen, as well as monitor fibroid size, as each person may respond differently.

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Step 5: Learn how to make mocktails!

Alcohol: The top food you should avoid with Fibroids 

This step is for my girlies who enjoy wine or margaritas with the ladies, or a nice tall glass of beer! I hate to break it to you, but research suggests a potential link between alcohol intake and uterine fibroid incidence. A systematic review looking at the link between alcohol and caffeine indicated an increased risk of fibroid among current alcohol drinkers (14.)

One of the studies included was conducted by Wise and colleagues, and looked at the risk of fibroids in black women in relation to alcohol. The study found that black women who drank alcohol for over 20 years had a significantly greater likelihood of developing fibroids compared to non-drinkers. In addition, current consumption of Beer, regardless of long-term consumption, was linked to the highest risk, with women who drank seven or more servings of beer per week experiencing about a 60% greater risk than those who abstained (15). 

Another study done in over 200 Japanese women found that the risk of fibroids was higher in women who had over 1 drink per day when compared to nondrinkers. These results are supported by another smaller cohort done in the US amongst teachers in California, which found that drinking 20g or more of alcohol (beer or wine) was associated with an increased risk of needing surgery for fibroids (14). 

While more research is needed to fully understand the relationship between alcohol and fibroids, the results are not surprising. Alcohol has been found to be carcinogenic, and is one of the only foods, along with processed meats, confirmed to cause cancer. It could be that the ability of alcohol to interfere with estrogen metabolism and receptors, as well as proper DNA replication, encourages abnormal fibroid tumor growth. 

Considering the potential risks, it may be beneficial to reduce or avoid alcohol consumption as part of a fibroid management plan.​ Instead, opt for making your own mocktails at home or if you go out to a bar with friends, ask them if they can make you a mocktail. Mocktail culture is on the rise, especially given the recent awareness about alcohol and cancer!

Takeaway

Limiting alcohol intake could be a valuable strategy in reducing fibroid risk or managing existing fibroids. Opting for non-alcoholic beverages can support overall uterine and reproductive health.

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STEP 7: If you are less than 35 years old, limit coffee intake to 2 cups per day or total caffeine intake to less than 500mg 

Does caffeine or coffee cause fibroids?

This is one of the most common questions I see about fibroids! While there is not much research, I thought I would share some insight on coffee and caffeine intake based on the study done by Wise and colleagues in black women, because not only did they look at alcohol intake as noted above, but they also looked at caffeine intake.

Their study found that caffeine was not associated with fibroids in women overall, however, they did find and association in a particular subset of women in their study which were women who were less than 35 years of age and consumed over 3 cups of coffee a day or had an intake of 500mg or more of caffeine per day (15). 

So while we need more literature on this topic, keeping caffeine to below 3 cups or below 500mg is a reasonable change you could make to improve your risk. Caffeine is also associated with hormone changes in premenopausal women that may favor excess estrogen (which I hope to address in a separate blog), so it is wise to limit consumption to a moderate range, especially as we are waiting for more research. 

For reference, 1 cup of coffee has 200 mg of caffeine, and just so we are all on the same page, 1 cup is 8 ounces, which is half the size of a standard plastic water bottle.  Many women count their coffee cup as “1 cup,” but most coffee cups or mugs hold 2 cups of fluid or more, which could easily exceed 500mg of caffeine if you are not careful.. Also, for reference, the average Celsius, a popular energy drink amongst women, contains about 200 to 270mg of caffeine per 12-ounce can. 

Takeaway: If you are less than 35 years old and want to prevent fibroids or slow fibroid growth, it may be best to keep coffee intake to 2 cups per day or less than 500mg caffeine overall. 

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Bonus Step : Set a goal from the list below that would allow you to reduce exposure to plastic (bonus if it’s a black colored plastic). 

Lastly, if you made it this far, I have a bonus step for you!! While environmental sciences is not my expertise,I would be remiss if I didn’t mention that plastics contain chemicals that can encourage fibroid growth. Plastics are rich in endocrine-disrupting compounds like phthalates, BPA, and flame retardants, which have all been linked to hormone disruption and fibroid development. While more research is needed on their direct role in fibroids, you have probably already heard that these chemicals interfere with estrogen signaling and can promote tumor growth across the board. But I want to shed light on black plastics in particular. 

Black colored plastics used to make to-go containers, plastic silverware, plastic cook utensils, and more are especially concerning because they often contain higher concentrations of flame retardant compounds, which may be associated with fibroid risk.

 In fact, another study published in Environmental Epidemiology by Orta and colleagues,  found that women with fibroids had higher levels of flame retardants and organophosphate pesticides in their urine, with flame retardants being associated with increased fibroids when compared to controls, though surprisingly again, the pesticides were associate with a lower risk (16). 

I need to do a whole blog post on this topic, but for now, here are some simple ways to reduce your plastic exposure overall, including black plastic. 

5 Ways to Cut Down on Plastic & Endocrine-Disrupting Chemicals

• Skip Hot Beverages in Plastic Cups – Heat causes chemicals from plastic cups to leach into your drink. Be especially mindful of cups with black lids or that are black in color on the outside.  It is best to stick to stainless steel or glass travel mugs instead. If you go out for coffee or tea with your friends, choose a restaurant that serves coffee in a mug or bring your own to-go cup to pour it in!
  
  
• Ditch Tea Bags – Some tea bags contain plastic and release microplastics when steeped. Opt for loose-leaf tea with a stainless steel infuser.
  
  
• Use Glass Food Storage Containers – Plastic containers, especially when heated, leach chemicals into food. Swap them for Pyrex or other glass options.
  
  
• Avoid Black Plastic Takeout Containers – These tend to have higher levels of harmful chemicals. If you can, bring your own glass container for leftovers when you eat out. Get yourself a nice glass food container with a lid and bring it in your purse for leftovers!
  
  
• Limit Synthetic Hair and Relaxers – Many hair products contain phthalates and other hormone-disrupting chemicals that cause fibroids. Synthetic hair can also be high in flame-retardant-based chemicals. More research is needed, but putting heat on synthetic hair may expose you to these chemicals, and it's possible some might get absorbed through the skin via contact on the scalp. 

Takeaway: For this bonus step/goal, choose one of the recommendations above that would allow you to make a significant impact on your health by reducing exposure to chemicals found in plastic.. 

Diet and lifestyle protocol to help with fibroids:

If you’re looking for ways to nutritionally support your body, I hope you learned something from the steps discussed in this article. Here is an overview:

• Eat at least 2 servings of vegetables AND 2 servings of fruit daily. A serving is ½ cup cooked or raw fruit or non-leafy vegetables or 1 cup for raw leafy greens. Remember that citrus fruits may be especially beneficial.
  
  
• Check your vitamin D levels and supplement with Vitamin D if deficient or to reach optimal levels of 30 ng/mL (Per your MD or RD’s discretion)
  
  
• Have a serving of yogurt per day:
  
  • Bonus points if you aim to get at least 1,000 mg of calcium daily from food overall. If you don’t do dairy, focus on non-dairy calcium sources like leafy greens, almonds, and fortified plant-based milk (see list above).
    
    
• Consider taking Green tea extract if you have a small fibroid (Per MD discretion). A randomized controlled trial suggested it may shrink fibroids at doses of 800mg with 45% EGCG. If you have fibroids that aren’t candidates for surgery, this might be worth discussing with your doctor or dietitian.
• Avoid alcohol
• Limit caffeine or coffee intake if less than 35 years old: If you are less than 35 years old, keep coffee intake to 2 cups per day or total caffeine intake to less than 500mg per day (For coffee be sure to measure how much coffee you actually put in your cup, 1 cup = 8 ounces)
• Bonus tip: Ditch plastic dishware and utensils, especially black colored plastics. Switch to glass, stainless steel, or bamboo to further reduce exposure. It may also be helpful to avoid synthetic hair.
  
  

I hope this was helpful! There are many other strategies for managing fibroids, including weight management and reducing exposure to other environmental toxins, but these are practical steps you can discuss with your doctor or dietitian and implement right away.

If you’re looking for more personalized nutrition guidance for fibroids, or just your overall health, I’d love to help. Book a free discovery call [here]!

I pray this blesses you! Stay tuned for more articles on fibroid nutrition, supplements, and answers to your biggest questions.

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-Ciara

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References:

1. Krzyżanowski J, Paszkowski T, Woźniak S. The Role of Nutrition in Pathogenesis of Uterine Fibroids. Nutrients. 2023 Dec 1;15(23):4984. doi: 10.3390/nu15234984. PMID: 38068842; PMCID: PMC10708302.

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2. Islam MS, Giampieri F, Janjusevic M, Gasparrini M, Forbes-Hernandez TY, Mazzoni L, Greco S, Giannubilo SR, Ciavattini A, Mezzetti B, Capocasa F, Castellucci M, Battino M, Ciarmela P. An anthocyanin rich strawberry extract induces apoptosis and ROS while decreasing glycolysis and fibrosis in human uterine leiomyoma cells. Oncotarget. 2017 Apr 4;8(14):23575-23587. doi: 10.18632/oncotarget.15333. PMID: 28212568; PMCID: PMC5410328.

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3. 3. Fruit and vegetable consumption, pesticide residue intake from consumption of fruits and vegetables, and risk of uterine fibroids. Davis, Colette P. et al. F&S Science, Volume 4, Issue 1, 90 - 99

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.4. Wise LA, Radin RG, Palmer JR, Kumanyika SK, Rosenberg L. A prospective study of dairy intake and risk of uterine leiomyomata. Am J Epidemiol. 2010 Jan 15;171(2):221-32. doi: 10.1093/aje/kwp355. Epub 2009 Dec 2. PMID: 19955473; PMCID: PMC2800240.

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5. Orta OR, Terry KL, Missmer SA, Harris HR. Dairy and related nutrient intake and risk of uterine leiomyoma: a prospective cohort study. Hum Reprod. 2020 Feb 29;35(2):453-463. doi: 10.1093/humrep/dez278. PMID: 32086510; PMCID: PMC8489562.

7. Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin d and the risk of uterine fibroids. Epidemiology. 2013 May;24(3):447-53. doi: 10.1097/EDE.0b013e31828acca0. PMID: 23493030; PMCID: PMC5330388.

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8. Harmon QE, Patchel SA, Denslow S, LaPorte F, Cooper T, Wise LA, Wegienka G, Baird DD. Vitamin D and uterine fibroid growth, incidence, and loss: a prospective ultrasound study. Fertil Steril. 2022 Dec;118(6):1127-1136. doi: 10.1016/j.fertnstert.2022.08.851. Epub 2022 Sep 21. PMID: 36150919; PMCID: PMC9771933.

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9. Alsharif SA, Baradwan S, Alshahrani MS, Khadawardi K, AlSghan R, Badghish E, Bukhari IA, Alyousef A, Khuraybah AM, Alomar O, Abu-Zaid A. Effect of Oral Consumption of Vitamin D on Uterine Fibroids: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutr Cancer. 2024;76(3):226-235. doi: 10.1080/01635581.2023.2288716. Epub 2024 Feb 1. PMID: 38234246.

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10. Roshdy E, Rajaratnam V, Maitra S, Sabry M, Allah AS, Al-Hendy A. Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study. Int J Womens Health. 2013 Aug 7;5:477-86. doi: 10.2147/IJWH.S41021. PMID: 23950663; PMCID: PMC3742155.

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11. Porcaro G, Santamaria A, Giordano D, Angelozzi P. Vitamin D plus epigallocatechin gallate: a novel promising approach for uterine myomas. Eur Rev Med Pharmacol Sci. 2020 Mar;24(6):3344-3351. doi: 10.26355/eurrev_202003_20702. PMID: 32271452.

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12. Grandi G, Del Savio MC, Melotti C, Feliciello L, Facchinetti F. Vitamin D and green tea extracts for the treatment of uterine fibroids in late reproductive life: a pilot, prospective, daily-diary based study. Gynecol Endocrinol. 2022 Jan;38(1):63-67. doi: 10.1080/09513590.2021.1991909. Epub 2021 Oct 16. PMID: 34658291.

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13. Hazimeh D, Massoud G, Parish M, Singh B, Segars J, Islam MS. Green Tea and Benign Gynecologic Disorders: A New Trick for An Old Beverage? Nutrients. 2023 Mar 16;15(6):1439. doi: 10.3390/nu15061439. PMID: 36986169; PMCID: PMC10054707.

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14. 14. Chiaffarino F, Cipriani S, Ricci E, La Vecchia C, Chiantera V, Bulfoni A, Parazzini F. Alcohol consumption and risk of uterine myoma: A systematic review and meta-analysis. PLoS One. 2017 Nov 27;12(11):e0188355. doi: 10.1371/journal.pone.0188355. PMID: 29176884; PMCID: PMC5703463.

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15. Wise LA, Palmer JR, Harlow BL, Spiegelman D, Stewart EA, Adams-Campbell LL, Rosenberg L. Risk of uterine leiomyomata in relation to tobacco, alcohol and caffeine consumption in the Black Women's Health Study. Hum Reprod. 2004 Aug;19(8):1746-54. doi: 10.1093/humrep/deh309. Epub 2004 Jun 24. PMID: 15218005; PMCID: PMC1876785.

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16.16. Orta OR, Wesselink AK, Bethea TN, Claus Henn B, Weuve J, Fruh V, McClean MD, Sjodin A, Baird DD, Wise LA. Brominated flame retardants and organochlorine pesticides and incidence of uterine leiomyomata: A prospective ultrasound study. Environ Epidemiol. 2021 Jan 27;5(1):e127. doi: 10.1097/EE9.0000000000000127. PMID: 33778359; PMCID: PMC7939431.

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