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Fibroids and heavy periods

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Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

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Medication

GnRH drugs for fibroidsStrongStudied in womenVery common

Heavy bleeding with fibroids: elagolix with add-back (Oriahnn)

Shown to bring blood loss under 80 mL, with at least a 50% drop, in 69% to 77% of women with fibroids, against 9% to 11% on placebo.

Compared with placebo [5][6][7][8]; elagolix without add-back hormones [5][7]

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In Elaris UF-1 and UF-2, 68.5% and 76.5% on elagolix with add-back responded against 8.7% and 10% on placebo, and 84.1% and 77% on elagolix alone [5]. Mean blood loss fell 177 mL and 169 mL against a 1 mL rise and a 4 mL fall on placebo, and 57% and 61% had no bleeding in the final month against 4% and 5% [6]. Pooled, elagolix raised the chance of blood loss under 80 mL (RR 4.81, 95% CI 2.45 to 9.45) and of a 50% drop (RR 4.87) against placebo. Elagolix alone and with add-back did not differ for blood loss under 80 mL (RR 1.08, 95% CI 1.00 to 1.16) [7]. A second meta-analysis found the same direction against placebo [8]. In an extension, 87.9% met the end point after 12 months [9].
Population: 790 premenopausal women with fibroids and blood loss over 80 mL, median age 43, 68% Black [5][6]; 4 trials with 1,949 women [7]; 4 trials in 1,217 patients [8]; 218 women treated 12 months [9].
Sources: [5], [6], [7], [8], [9]
Caveats: The trials were funded by the manufacturer [5][9]. The two meta-analyses draw on the same pivotal trials [7][8]. The 12-month extension had no placebo arm [9].

Tranexamic acidStrongStudied in womenVery common

Heavy menstrual bleeding, against placebo

Shown to cut menstrual blood loss by about 47 to 53 mL a cycle more than placebo in women with heavy periods, about a 40% drop on the approved dose.

Compared with placebo [1][2][3][4][5]

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Against placebo, antifibrinolytics cut mean blood loss by 53.20 mL a cycle (95% CI 43.70 to 62.70, 4 RCTs, 565 women) and raised the share of women who improved (RR 3.34, 95% CI 1.84 to 6.09). If 11% improve without treatment, 43% to 63% improved on an antifibrinolytic [1]. A 2026 review found blood loss fell 47.0 mL more than on placebo (95% CI 37.4 to 56.6, 6 trials, I² 13%) [2]. In a network meta-analysis of first-line treatments, tranexamic acid cut blood loss by 80.32 mL a cycle against placebo (95% CI 32.98 to 127.67, moderate certainty) [3]. In the label trials, 3,900 mg a day cut blood loss by 65 mL (39%) against 7 mL (5%) on placebo over 3 cycles, and by 66 mL (38%) against 18 mL (12%) over 6 cycles. A 1,950 mg dose did not meet the trial's success criteria [4]. In the 6-cycle trial the drop was 69.6 mL (40.4%) against 12.6 mL (8.2%) [5].
Population: Women of reproductive age with heavy menstrual bleeding in 13 RCTs (1,312 analyzed) [1]; 17 trials of women with heavy or abnormal uterine bleeding [2]; 26 studies with 1,770 participants in the first-line network [3]; 294 and 187 evaluable women with blood loss of 80 mL or more a cycle, mean age about 40, 40% with fibroids [4][5].
Sources: [1], [2], [3], [4], [5]
Caveats: The Cochrane review rated the evidence very low to moderate quality, mainly for lack of blinding and poor reporting [1]. Women using hormonal contraception were excluded from the label trials [4].

Ulipristal acetateStrongStudied in womenVery common

Heavy bleeding with fibroids, against placebo

Shown to control fibroid bleeding in about 91% of women against 19% on placebo, with amenorrhea in 47% to 82% against 2% to 6%, over 12 to 13 weeks.

Compared with placebo [1][2][3][4]

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In anemic women with heavy bleeding, 13 weeks of ulipristal controlled bleeding (a PBAC score under 75) in 91% on 5 mg and 92% on 10 mg against 19% on placebo, with amenorrhea in 73% and 82% against 6% [1]. In a US trial, amenorrhea occurred in 47.2% on 5 mg and 58.3% on 10 mg against 1.8% on placebo [2]. Pooled across SPRM trials, amenorrhea rose from 29 per 1,000 on placebo to 237 to 961 per 1,000 (OR 82.50, 95% CI 37.01 to 183.90, 7 RCTs, 590 women) and patient-reported blood loss fell (SMD -1.11) [3]. A second meta-analysis found amenorrhea against placebo with RR 24.54 (95% CI 10.82 to 55.64, 5 RCTs, 882 participants) [4].
Population: 242 women with fibroids, heavy bleeding and hemoglobin of 10.2 g/dL or less [1]; 157 premenopausal women aged 18 to 50 [2]; 14 RCTs of SPRMs with 1,215 women [3]; 6 RCTs with 1,121 participants [4].
Sources: [1], [2], [3], [4]
Caveats: The Cochrane review pooled several SPRMs (mifepristone, ulipristal and asoprisnil), not ulipristal alone [3]. The first trial was funded by PregLem [1].

GnRH drugs for fibroidsModerateStudied in womenVery common

Heavy bleeding with fibroids: relugolix combination (Myfembree)

Shown to bring blood loss under 80 mL with at least a 50% drop in about 72% of women with fibroids, against 15% to 19% on placebo, over 24 weeks.

Compared with placebo [1][2]; controls the source abstract does not describe [3]

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In LIBERTY 1 and 2, 73% and 71% on relugolix combination therapy responded (blood loss under 80 mL and at least 50% lower), against 19% and 15% on placebo [1]. The label gives 72.1% against 16.8% and 71.2% against 14.7%. Amenorrhea occurred in 50.0% and 50.4% against 6.2% and 3.1%, and mean blood loss fell 82.0% and 84.3% from baseline against 19.1% and 15.1% [2]. A meta-analysis of 6 studies found 31 times the odds of amenorrhea against controls, with 63% of patients reaching amenorrhea [3].
Population: 770 premenopausal women with fibroids and blood loss of 80 mL or more a cycle, median age 43, about half Black, for 24 weeks [1][2]; 511 participants in 6 studies [3].
Sources: [1], [2], [3]
Caveats: The pivotal trials were funded by the manufacturer [1]. The meta-analysis pooled relugolix with and without add-back hormones [3].

GnRH drugs for fibroidsModerateStudied in womenVery common

Anemia with fibroids: relugolix combination

Shown to raise hemoglobin by more than 2 g/dL in 44% and 55% of anemic women with fibroids, against 17% and 6% on placebo, in two trials.

Compared with placebo [2]

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Among women with hemoglobin of 10.5 g/dL or less at the start, 44.2% (L1) and 55.0% (L2) on relugolix combination therapy gained more than 2 g/dL by week 24, against 17.2% and 5.7% on placebo [2]. A meta-analysis reported hemoglobin improved in 46.3% of patients [3].
Population: 43 and 40 anemic women on treatment against 29 and 53 on placebo, within 770 women [2]; 511 participants in 6 studies [3].
Sources: [2], [3]
Caveats: Iron was required for women with hemoglobin of 8 to 10 g/dL, and women under 8 g/dL were excluded [2].

GnRH drugs for fibroidsModerateStudied in womenVery common

Anemia with fibroids: elagolix with add-back

Shown to raise hemoglobin by more than 2 g/dL in 50% and 62% of anemic women with fibroids, against 16% and 21% on placebo, in two trials.

Compared with placebo [6][8]

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Among women with hemoglobin of 10.5 g/dL or less, 62% (UF-1) and 50% (UF-2) on elagolix with add-back gained more than 2 g/dL by month 6, against 16% and 21% on placebo. Over 90% of these women took iron [6]. A meta-analysis found more women met the hemoglobin end point on elagolix than on placebo [8].
Population: 52 and 48 anemic women on treatment against 31 and 24 on placebo [6]; 1,217 patients in 4 trials [8].
Sources: [6], [8]
Caveats: Nearly all anemic women also took iron, so the rise reflects the drug on top of iron [6].

GnRH drugs for fibroidsModerateStudied in womenVery common

Anemia before fibroid surgery: leuprolide and other GnRH agonists

Shown to raise hemoglobin before fibroid surgery, by about 0.9 g/dL against placebo or no treatment, and with iron 75% reached target levels against 49% on iron alone.

Compared with iron alone [10]; placebo or no pretreatment [11]

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In women with hematocrit of 30% or less or hemoglobin of 10.2 g/dL or less, Lupron Depot 3.75 mg monthly with iron raised hemoglobin by a mean 4.2 g/dL and hematocrit by 10.1% at 3 months. At week 12, 75% on leuprolide with iron reached hematocrit of 36% and hemoglobin of 12 g/dL, against 49% on iron alone [10]. Across 10 trials of GnRH agonists before surgery, preoperative hemoglobin rose 0.88 g/dL more than with placebo or no pretreatment (95% CI 0.68 to 1.08, I² 0%, moderate certainty) [11].
Population: 104 women on leuprolide with iron and 98 on iron alone [10]; 834 premenopausal women in 10 trials [11].
Sources: [10], [11]
Caveats: The Cochrane review pools GnRH agonists as a class, not leuprolide alone [11]. The label notes some women may benefit from iron alone or from 1 to 2 months of treatment [10].

GnRH drugs for fibroidsModerateStudied in women

Fibroid and uterine size, and surgery: GnRH agonists

Shown to shrink the uterus by about 175 mL before surgery against placebo or no treatment, with fewer transfusions and complications at hysterectomy. Fibroids regrew after stopping.

Compared with placebo or no pretreatment [11]; other medicines before surgery, including ulipristal [11]

The numbers and sources

Effect: GnRH agonists before surgery cut uterine volume by 175.34 mL (95% CI 131.65 to 219.04, 13 studies, 858 women) and fibroid volume by 5.7 to 155.4 mL. At hysterectomy, surgery was 10.11 minutes shorter, blood transfusions were fewer (OR 0.54, 95% CI 0.29 to 1.01) and postoperative complications fewer (OR 0.54, 95% CI 0.32 to 0.91). Before myomectomy, transfusions and complications did not clearly differ. Uterine volume fell 47% on GnRH agonists against 20% and 22% on 5 mg and 10 mg ulipristal [11]. In the label trials, leuprolide cut uterine volume 41% and myoma volume 37%, and mean time back to the pretreatment uterine size was 8.3 months after stopping [10].
Population: 41 RCTs with 3,982 premenopausal women having myomectomy, hysterectomy or hysteroscopic resection [11]; women in 4 leuprolide trials, 46 followed after stopping [10].
Sources: [11], [10]
Caveats: Most results are low certainty, from trials with poor reporting and no blinding [11].

Hormonal birth controlModerateStudied in women

Heavy periods (hormonal IUD)

Shown to lower heavy menstrual blood loss more than other medicines, about 67 mL more, with fewer treatment failures, on the levonorgestrel IUD in women with heavy periods.

Compared with oral progestins, combined pills, mefenamic acid, tranexamic acid or usual medical treatment [6]; medroxyprogesterone acetate [3]

The numbers and sources

Effect: Against other medical therapy, the levonorgestrel IUD lowered menstrual blood loss (MD 66.91 mL, 95% CI 42.61 to 91.20, low certainty), led to fewer treatment failures (RR 0.34) and fewer withdrawals (RR 0.49), and slightly raised quality of life [6]. In the label trial, Mirena reduced blood loss more than medroxyprogesterone acetate over 6 cycles [3].
Population: 2,511 women in 25 trials [6]; 160 women with blood loss of 80 mL or more [3].
Sources: [6], [3]
Caveats: Attrition bias and small numbers in several trials [6].

Hormonal birth controlModerateStudied in women

Heavy periods (combined pill)

Shown to return heavy periods to normal in 12% to 77% of women on the combined pill, against 3% on placebo. The hormonal IUD lowered blood loss more.

Compared with placebo, NSAIDs, the levonorgestrel IUD, the vaginal ring and long-course progestogens [25]

The numbers and sources

Effect: Against placebo, a combined pill with a step-down estrogen and step-up progestin regimen raised the odds of periods returning to normal (OR 22.12, 95% CI 4.40 to 111.12, 2 trials, 363 participants) and of lower blood loss (OR 5.15, 95% CI 3.16 to 8.40, 2 trials, 339 participants), at moderate quality. Where 3% improved on placebo, 12% to 77% would improve on the pill. Breast pain and other minor adverse events were more common on the pill. The levonorgestrel IUD lowered blood loss more than the pill (OR 0.21, 95% CI 0.09 to 0.48, 2 trials, 151 participants, low quality). The pill and the vaginal ring did not clearly differ, and evidence against NSAIDs was insufficient [25].
Population: 805 women with heavy periods and regular cycles in 8 trials [25].
Sources: [25]
Caveats: Apart from the two placebo trials, the evidence was low to very low quality, mainly from lack of blinding and imprecision. The review covered heavy bleeding with no other gynecological or systemic disease behind it, so it does not test bleeding from fibroids [25].

NSAIDsModerateStudied in women

Heavy menstrual bleeding

Shown to lower menstrual blood loss more than placebo in women with heavy periods. Tranexamic acid, danazol and the hormonal IUD lowered it more.

Compared with placebo, tranexamic acid, danazol, the levonorgestrel IUD, oral luteal progestogen, ethamsylate, the combined pill, an older progesterone IUD and other NSAIDs [23]

The numbers and sources

Effect: As a group, NSAIDs reduced heavy menstrual bleeding more than placebo and less than tranexamic acid, danazol or the levonorgestrel IUD. In one trial of 11 women, blood loss was 124 mL a cycle lower on mefenamic acid than on placebo (MD -124 mL, 95% CI -186 to -62). In a crossover trial, median loss was 146 mL a cycle on placebo, 123 mL on ibuprofen 600 mg and 110 mL on ibuprofen 1,200 mg. Against tranexamic acid, loss was 73 mL a cycle higher on mefenamic acid (95% CI 22 to 124, 48 women). Naproxen and mefenamic acid did not differ, and no clear difference was found against oral luteal progestogen, ethamsylate, the combined pill or an older progesterone IUD [23].
Population: 759 women with regular heavy periods not caused by a disease or treatment, in 19 randomized trials, 9 of them pooled [23].
Sources: [23]
Caveats: The reviewers rated the evidence low to moderate quality, and most trials were small and underpowered. Women whose bleeding had a disease or treatment cause, such as fibroids, were not included, so these trials do not test bleeding from fibroids [23].

Tranexamic acidModerateStudied in women

Quality of life and daily limits from heavy periods

Shown to ease limits on social, leisure and physical activities during periods in women with heavy bleeding, compared with placebo.

Compared with placebo [2][4][5]

The numbers and sources

Effect: In two trials, quality of life scores improved more than on placebo (MD 0.5, 95% CI 0.4 to 0.7, I² 0%, moderate certainty) [2]. On a 1 to 5 scale of limits, social and leisure limits fell 0.98 and 0.85 points against 0.39 and 0.44 on placebo, and physical limits fell 0.94 and 0.87 against 0.34 and 0.40 [4]. Work inside and outside the home and self-perceived blood loss also improved against placebo [5].
Population: Women with heavy menstrual bleeding in 2 pooled trials [2]; 112 and 115 women on 3,900 mg a day against 66 and 72 on placebo [4]; 187 women in the 6-cycle trial [5].
Sources: [2], [4], [5]
Caveats: The label trials were the trials behind the drug's approval. Soiling beyond underwear (large stains) did not differ from placebo [4].

Ulipristal acetateModerateStudied in women

Heavy bleeding with fibroids, against leuprolide

Shown to control fibroid bleeding in 90% to 98% of women, as often as leuprolide injections at 89%, with moderate to severe hot flashes in 10% to 11% against 40%.

Compared with leuprolide injections [3][5][6]

The numbers and sources

Effect: Over 13 weeks, bleeding was controlled in 90% on 5 mg and 98% on 10 mg ulipristal and 89% on monthly leuprolide 3.75 mg, meeting the trial's noninferiority margin. Median time to amenorrhea was 7 and 5 days against 21 days. Moderate to severe hot flashes affected 11% and 10% against 40% [5]. Fibroid symptom severity and quality of life did not differ from leuprolide (MD -3.70 and 1.06 points, 1 RCT, 281 women) [3]. Before surgery, bleeding reduction did not differ between ulipristal 5 mg and GnRH agonists (OR 0.71, 95% CI 0.30 to 1.68), and uterine volume fell 20% to 22% on ulipristal against 47% on GnRH agonists [6].
Population: 307 women with fibroids and heavy bleeding [5]; 281 women in the quality of life comparison [3]; women in trials before fibroid surgery [6].
Sources: [5], [3], [6]
Caveats: One main head-to-head trial, funded by PregLem [5].

Ulipristal acetateModerateStudied in women

Fibroid size

Shown to shrink fibroids against placebo, a median 21% and 12% on 5 mg and 10 mg against a 3% rise, though less than GnRH agonists shrank the uterus.

Compared with placebo [1][3][6]; GnRH agonists [6]

The numbers and sources

Effect: At 13 weeks, median total fibroid volume changed -21% on 5 mg, -12% on 10 mg and +3% on placebo [1]. SPRMs reduced uterine and fibroid volume against placebo in heterogeneous trials too varied to pool [3][6]. Uterine volume fell 47% on GnRH agonists against 20% and 22% on ulipristal 5 mg and 10 mg [6].
Population: 242 anemic women with fibroids [1]; RCTs of SPRMs [3]; women before fibroid surgery in 41 RCTs [6].
Sources: [1], [3], [6]
Caveats: The pooled results cover SPRMs as a class [3][6].

Ulipristal acetateModerateStudied in women

Hemoglobin before fibroid surgery

Shown to raise hemoglobin before fibroid surgery by about 0.9 g/dL more than placebo, in women taking SPRMs including ulipristal.

Compared with placebo [6]; GnRH agonists [6]

The numbers and sources

Effect: SPRMs raised preoperative hemoglobin by 0.93 g/dL against placebo (95% CI 0.52 to 1.34, 2 studies, 173 women, I² 0%, moderate certainty). Preoperative hemoglobin did not differ between GnRH agonists and other medicines including ulipristal (MD -0.02 g/dL, 95% CI -0.41 to 0.37, 242 women) [6].
Population: Premenopausal women before fibroid surgery in randomized trials [6].
Sources: [6]
Caveats: Two pooled trials, pooled across SPRMs. In one trial all women received iron [1].

Ulipristal acetateModerateStudied in women

Fibroid symptoms and quality of life

Shown to improve fibroid symptom severity by about 20 points and quality of life by about 23 points on a 100-point scale, against placebo.

Compared with placebo [2][3]

The numbers and sources

Effect: On the Uterine Fibroid Symptom and Quality of Life scale, SPRMs improved symptom severity by 20.04 points (95% CI 13.46 to 26.63, 4 RCTs, 171 women) and health-related quality of life by 22.52 points (95% CI 12.87 to 32.17, 4 RCTs, 200 women) against placebo [3]. Both ulipristal doses improved quality of life against placebo in a US trial [2]. Pelvic pain results were too variable to draw conclusions [3].
Population: Premenopausal women with fibroids [2][3].
Sources: [3], [2]
Caveats: Moderate-quality evidence, with possible publication bias [3].

GnRH drugs for fibroidsLimitedStudied in women

Staying on relugolix for 2 years, or stopping

One trial found 70% still had blood loss under 80 mL after 2 years on relugolix combination therapy. After switching to placebo, 88% relapsed, at a median of 5.9 weeks.

Compared with stopping treatment by switching to placebo [4]

The numbers and sources

Effect: Among women who had responded over 52 weeks, 78.4% who continued relugolix combination therapy kept blood loss under 80 mL through week 76 against 15.1% switched to placebo, and 69.8% against 11.8% at week 104. Through week 104, 88.3% on placebo relapsed into heavy bleeding, at a median of 5.9 weeks, and 87 of 89 who restarted responded again. Amenorrhea at week 104 was 58.3% against 10.6% [4].
Population: 229 women with fibroids and heavy bleeding who had responded in LIBERTY 1, 2 and the extension [4].
Sources: [4]
Caveats: Only women who had already responded were randomized. Manufacturer-sponsored trial.

Hormonal birth controlLimitedStudied in women

Heavy bleeding with fibroids (hormonal IUD and combined pill)

Limited evidence: in women with fibroids, the hormonal IUD lowered bleeding and raised hemoglobin more than the combined pill in one small trial, without clearly shrinking fibroids.

Compared with a low-dose combined pill and oral norethisterone acetate [27]; the levonorgestrel IUD and placebo [28]; comparisons in 11 studies the source abstract does not describe [29]

The numbers and sources

Effect: In one trial of 44 women with fibroids, the levonorgestrel IUD reduced bleeding on the alkaline hematin test by 77.50% more than a low-dose combined pill (95% CI 70.44 to 84.56) and raised hemoglobin by 1.50 g/dL more (95% CI 0.85 to 2.15) at 12 months. Fibroid size did not clearly differ (MD 1.90%, 95% CI -12.24 to 16.04). Against oral norethisterone acetate, the IUD improved a visual bleeding score and raised hemoglobin by 10.14% more at 6 months, and spotting was more common (64.3% against 30%) [27]. A review of 2 trials found the combined pill did less than the levonorgestrel IUD for bleeding, quality of life and hemoglobin, and in a single trial at high risk of bias it shrank fibroids more than placebo [28]. A review of 11 studies of 10 to 104 women each found the levonorgestrel IUD reduced menstrual blood loss and raised hemoglobin, ferritin and hematocrit, with no evidence that fibroids shrank. Expulsion was uncommon and linked to fibroids larger than 3 cm [29].
Population: 221 premenopausal women with fibroids in 4 trials [27]; women with fibroids and heavy bleeding in 2 trials [28]; premenopausal women with symptomatic fibroids in 11 studies [29].
Sources: [27], [28], [29]
Caveats: The Cochrane reviewers rated all of this evidence very low quality and wrote that they were uncertain of the effects [27]. The combined pill findings rest on single trials [28]. The 11-study review abstract does not describe the studies' designs [29].

Tranexamic acidLimitedStudied in women

Heavy bleeding in women with fibroids

One pooled analysis of the two label trials found blood loss fell more than on placebo in women with fibroids, as it did in women without them.

Compared with placebo [6]

The numbers and sources

Effect: In women with and without fibroids on ultrasound, mean menstrual blood loss fell more than on placebo in every treatment cycle (p < 0.001). The reduction against placebo was larger in women with fibroids than in women without. Adverse events were similar between groups [6]. About 40% of the women in the label trials had fibroids [4].
Population: Women with heavy menstrual bleeding in the two pivotal phase 3 trials, with fibroids assessed by transvaginal ultrasound [6].
Sources: [6], [4]
Caveats: The abstract gives no blood loss volumes, and the full text could not be read. The trials did not report fibroid size or location, so the result may not hold for large or submucosal fibroids.

GnRH drugs for fibroidsModerateStudied in women

Fibroid pain and fibroid size: relugolix

Shown to ease fibroid pain and shrink the uterus against placebo. Relugolix combination therapy did not shrink the fibroids themselves, while relugolix alone did.

Compared with placebo [1][3]

The numbers and sources

Effect: Relugolix combination therapy improved pain, distress from bleeding and pelvic discomfort, and uterine volume against placebo, but not fibroid volume [1]. Pooled across 6 studies, myoma volume fell 28.50% more than on placebo and uterine volume also fell more (reported as -30.31, p = 0.0028), with higher odds of pain relief (OR 9.02). Relugolix alone shrank myomas and the uterus more than combination therapy [3].
Population: 770 premenopausal women with fibroids [1]; 511 participants in 6 studies [3].
Sources: [1], [3]
Caveats: The pooled size results mix relugolix alone, which is not the US-approved form, with combination therapy [3].

Hormonal birth controlModerateStudied in women

Developing fibroids

Mixed results: current pill use was linked to less than half the fibroid risk of never use, while ever use was not significantly linked, in pooled observational studies.

Compared with women who never used the pill [26]

The numbers and sources

Effect: Against never use, ever use of the pill was not significantly linked to fibroids (RR 0.88, 95% CI 0.75 to 1.04), nor was former use (RR 0.96, 95% CI 0.84 to 1.08). Current use was linked to lower risk (RR 0.43, 95% CI 0.25 to 0.73), and 5 or more years of use to 17% lower risk [26].
Population: 8,990 women with fibroids among 131,055 participants in 11 cohort and case-control studies [26].
Sources: [26]
Caveats: Observational, with heterogeneity of 64% to 92% [26]. Whether a woman is prescribed the pill can depend on symptoms that fibroids cause, so confounding and reverse causation are possible.

Progestins for endometriosis and heavy bleedingModerateStudied in women

Heavy menstrual bleeding: cyclical progestin tablets

Mixed results: no trial compared cyclical progestins with placebo. Taken for 21 days a cycle, they reduced blood loss in women less than a hormonal IUD, tranexamic acid or ormeloxifene.

Compared with tranexamic acid, danazol and a progesterone-releasing IUD, for short courses [15]; a levonorgestrel IUD, tranexamic acid, ormeloxifene and the combined vaginal ring, for long courses [15]

The numbers and sources

Effect: No trial compared progestins with placebo. Short courses of medroxyprogesterone acetate or norethisterone for 7 to 10 days in the second half of the cycle reduced blood loss less than other medicines (MD 37.29, 95% CI 17.67 to 56.91, 6 trials, 145 women), with more bleeding days. Courses from day 5 to day 26 reduced blood loss less than a levonorgestrel IUD, tranexamic acid or ormeloxifene, and may be similar to the combined vaginal ring (MD 16.88, 95% CI 10.93 to 22.84, 4 trials, 355 women). Breast tenderness and bleeding between periods were more likely with the levonorgestrel IUD [15].
Population: 1,071 women with heavy menstrual bleeding in 15 trials [15].
Sources: [15]
Caveats: Most women knew their treatment, and the reviewers rated the evidence low or very low in quality. The abstract gives no units for the blood loss differences [15].

Tranexamic acidLimitedStudied in women

Heavy bleeding, against other medicines

Limited evidence: more women improved on tranexamic acid than on NSAIDs or luteal progestogens, and fewer than with a hormonal IUD, in small trials.

Compared with NSAIDs, including mefenamic acid [1]; oral luteal progestogens [1]; a levonorgestrel IUD [1][3]; ethamsylate [1]; herbal medicines (Safoof Habis, Punica granatum) [1]; long-cycle progestogens and combined pills, indirectly in a network [3]

The numbers and sources

Effect: Against NSAIDs, tranexamic acid cut blood loss 73.00 mL a cycle more (95% CI 22.65 to 123.35, 1 RCT, 49 women) and more women improved (RR 1.43, 2 RCTs, 161 women). If 61% improve on an NSAID, 71% to 100% improved on tranexamic acid. Against progestogens, more women improved (RR 1.54, 5 RCTs, 422 women): if 46% improve on a progestogen, 61% to 83% did on tranexamic acid, with fewer adverse events (RR 0.66). Against a levonorgestrel IUD, fewer women improved (RR 0.43, 95% CI 0.24 to 0.77, 1 RCT, 42 women): if 85% improve with the IUD, 20% to 65% did on tranexamic acid [1]. In the network, the levonorgestrel IUD ranked first (MD -105.71 mL against placebo), tranexamic acid second (-80.32 mL), long-cycle progestogen third (-76.93 mL) and NSAIDs lower (-40.67 mL) [3].
Population: Women of reproductive age with heavy menstrual bleeding, 42 to 422 women per comparison [1]; 26 studies in the first-line network [3].
Sources: [1], [3]
Caveats: Most comparisons rest on one or two small trials rated low or very low quality [1]. The network ranks are indirect comparisons [3].

Tranexamic acidLimitedStudied in women

Anemia and hemoglobin

Limited evidence: trials have not reported whether tranexamic acid changes hemoglobin, and one small trial was too imprecise to show an effect on anemia.

Compared with placebo or standard care [2]

The numbers and sources

Effect: Of 17 trials, none reported adequate data on hemoglobin concentration. For anemia, one small trial contributed data (RR 0.15, 95% CI 0.01 to 2.74, very low certainty) [2].
Population: Women of reproductive age with normal or abnormal uterine bleeding in 17 randomized trials [2].
Sources: [2]
Caveats: The interval is so wide that both a large benefit and none are possible. The review's authors call for trials in menstruating women with anemia [2].

Ulipristal acetateLimitedStudied in women

Pregnancy after ulipristal for fibroids

Case reports: of 71 pregnancies after ulipristal for fibroids, 50 ended in live births and 19 in miscarriage, with no comparison group.

Compared with no comparison group in the case series [10]

The numbers and sources

Effect: A systematic review found 24 pregnancies after ulipristal (19 live births, 6 miscarriages), and a case series added 47 (31 live births, 13 miscarriages, 1 fetal death, 2 terminations, 1 ongoing). Of the 71, 44 had myomectomy after ulipristal. Five women who did not have surgery had delivery complications related to their fibroids [10].
Population: 71 pregnancies from 6 case reports, 1 retrospective series and a multicenter chart review [10].
Sources: [10]
Caveats: No comparison group, so these counts cannot show whether ulipristal changed the chance of pregnancy or miscarriage.

Supplements

Vitamin DModerateStudied in women

Fibroid size in women with fibroids

Shown to shrink fibroids slightly or slow their growth against placebo over 2 to 3 months in women with fibroids, most with low vitamin D, in small trials.

Compared with placebo [56][58][59]; controls the source abstract does not describe [57]

The numbers and sources

Effect: Across 5 randomized trials (511 participants), vitamin D lowered fibroid size against placebo (SMD -0.48, 95% CI -0.66 to -0.31), more in trials lasting over 8 weeks (SMD -0.62, 95% CI -0.88 to -0.37), and raised serum vitamin D (SMD 3.1, 95% CI 0.66 to 5.55) [56]. A second review of 3 trials (328 participants) found the percentage change in fibroid diameter or volume differed from controls by -5.7 over 2 to 6 months (95% CI -10.63 to -0.76, I² 99%). The trials gave 50,000 IU weekly for 8 or 12 weeks, or every 2 weeks for 10 weeks [57]. In one 12-week trial, fibroid volume did not fall significantly on vitamin D (MD -0.71, P 0.085) and rose on placebo (MD 2.53, P 0.001) [58]. After hysteroscopic removal of fibroids, 1,000 IU a day for 12 months halved recurrence against placebo, a difference that was not significant (P 0.17), and recurrent fibroids were 7.7 mm smaller (P < 0.001) [59].
Population: 511 women with fibroids in 5 randomized trials [56]; 328 premenopausal women with fibroids and vitamin D insufficiency in 3 trials [57]; women with fibroids in a 12-week trial [58]; 109 women, mean age 37.9, after hysteroscopic myomectomy [59].
Sources: [56], [57], [58], [59]
Caveats: The trials were small and short, and heterogeneity was 99% in [57]. The two reviews share most of their trials. The abstracts do not report menstrual bleeding. The recurrence trial was a pilot, and its difference in recurrence was not significant [59].

Vitamin DModerateStudied in women

Fewer fibroids with higher vitamin D levels

Linked to fewer fibroids with higher vitamin D levels. Women with fibroids had about 6 ng/mL less vitamin D than women without, in pooled observational studies.

Compared with women without fibroids [57][60][61]; women with 25-hydroxyvitamin D below 20 or 30 ng/mL [62]

The numbers and sources

Effect: Across 23 observational studies (5,650 participants), women with fibroids had lower serum vitamin D (MD -5.50 ng/mL, 95% CI -6.99 to -4.01, I² 87%) and higher odds of vitamin D deficiency (OR 3.71, 95% CI 1.90 to 7.24) [57]. Across 9 studies (1,730 participants), vitamin D was lower in women with fibroids (SMD -0.67, 95% CI -0.98 to -0.35), and the difference was not significant in the 2 studies from Africa [60]. Across 21 clinical studies, the difference was 5.90 ng/mL (I² 97.4%), and 26 of 29 studies found a link between low vitamin D and fibroids [61]. In a 5-year ultrasound cohort of Black women, 25-hydroxyvitamin D of 20 ng/mL or more was linked to 9.7% slower fibroid growth than below 20 ng/mL (95% CI -17.3% to -1.3%). At 30 ng/mL or more, new fibroids were 22% less common, an imprecise estimate (HR 0.78, 95% CI 0.47 to 1.30) [62].
Population: Premenopausal women in 23 observational studies [57]; 835 women with fibroids and 895 controls in 9 studies [60]; women in 21 pooled clinical studies [61]; 1,610 Black women aged 23 to 35 in Detroit, 73% below 20 ng/mL at enrollment [62].
Sources: [57], [60], [61], [62]
Caveats: Observational. Most studies measured vitamin D once in women with and without fibroids, so they cannot show which came first. Vitamin D levels vary with body weight, skin pigmentation and sun exposure, so confounding is possible. Heterogeneity was high [57][61]. The cohort adjusted for reproductive factors, body mass index and smoking, and only 7% of its women had 30 ng/mL or more [62].

Green tea extractLimitedStudied in women

Fibroid size and heavy bleeding

One small trial found green tea extract shrank fibroids by about a third over 4 months in women with symptomatic fibroids. An uncontrolled study found no size change.

Compared with placebo capsules of brown rice [13]; before treatment, in the same women [14][15]

The numbers and sources

Effect: In a placebo-controlled trial, 800 mg a day of green tea extract (45% EGCG) for 4 months reduced total fibroid volume by 32.6%, while volume rose 24.3% on placebo (P 0.0001). Fibroid symptom severity fell 32.4% and quality of life rose 18.53% against placebo. In the green tea group, hemoglobin rose 0.7 g/dL (P 0.02) and average blood loss fell from 71 to 45 mL a month (P 0.001). No adverse effects or endometrial changes were seen in either group [13]. In 25 women who took green tea extract capsules for 6 months with no control group, fibroid size, symptom scores and laboratory values did not change, while the physical score of a quality of life questionnaire rose [14]. In 16 premenopausal women over 40 given 300 mg of EGCG with vitamin D and vitamin B6 for 90 days, mean fibroid size fell 17.8% and bleeding lasted 0.9 days less, with no change in flow intensity [15].
Population: 39 women aged 18 to 50 with symptomatic fibroids, 33 of them analyzed [13]; 25 women, median age 45, with few or no fibroid symptoms [14]; 16 women over 40 with fibroids [15].
Sources: [13], [14], [15]
Caveats: One small trial, with 11 women finishing on placebo [13]. The hemoglobin and blood loss changes are reported within the green tea group, not as differences from placebo [13]. [14] and [15] had no control group, and [15] combined EGCG with vitamin D and vitamin B6. The trial dose supplies about 360 mg of EGCG a day [13], within the 140 to about 1,000 mg range in liver injury case reports [8].

Vitex (chasteberry)LimitedStudied in women

Menstrual cycle complaints in routine care

One uncontrolled study by the manufacturer found most women reported lighter, less frequent bleeding and less period pain after 3 months, with no comparison group.

Compared with before treatment, in the same women [7]

The numbers and sources

Effect: After 3 months of a 4 mg extract, 83.4% reported improved bleeding intensity, 79.2% improved bleeding frequency and 85.2% less period pain. Irregular cycles fell from 9.1% to 0.1% of women and breast tenderness from 39.9% to 0.8%. Cycle and period length did not change meaningfully [7].
Population: 1,700 women with menstrual cycle complaints, mean age 30, mostly period pain (43.8%) and breast pain (21.1%), at one center [7].
Sources: [7]
Caveats: Retrospective, single center, no control group, outcomes collected partly by telephone. Five authors were employees of the manufacturer, which funded the data management, statistics and writing support [7].

Fish oilLimitedStudied in womenHow often is not known

Fibroids with higher marine omega-3 intake from food

Mixed results: two cohorts of Black women linked the highest marine omega-3 or DHA intake from food to 18% to 49% more fibroids. A larger cohort found no link.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In 12,044 premenopausal Black women followed 8 years, the highest fifth of marine omega-3 intake was linked to more fibroid diagnoses than the lowest (IRR 1.18, 95% CI 1.05 to 1.34), and dark-meat fish to IRR 1.13 (95% CI 1.00 to 1.28) [51]. In 1,171 Black women screened by ultrasound over 5 years, the highest quarter of DHA intake was linked to 49% more new fibroids (HR 1.49, 95% CI 1.04 to 2.14), and total marine omega-3 to HR 1.35 (95% CI 0.94 to 1.93) [52]. In 81,590 US nurses followed 18 years, no type of dietary fat was linked to fibroids. In 553 of them with blood tests, the highest third of red blood cell omega-3 was linked to lower odds of fibroids (OR 0.41, 95% CI 0.19 to 0.89) [53].
Population: Premenopausal Black women in the US [51][52]; premenopausal US nurses aged 25 to 42 at enrollment [53].
Sources: [51], [52], [53]
Caveats: Observational, and these studies measured omega-3 from food, not fish oil supplements. The authors of [52] note that pollutants in fish, rather than the fatty acids, may drive the link. Diet tracks other habits, so confounding is possible.

GingerLimitedStudied in women

Heavy menstrual bleeding

Small trials found mixed results: one found ginger cut menstrual blood loss more than placebo in teenage girls, another found no difference in amount added to ibuprofen.

Compared with placebo capsules [14]; ibuprofen with placebo [15]

The numbers and sources

Effect: In 92 high school girls whose heavy bleeding was confirmed on a pictorial blood loss chart over 3 cycles, blood loss fell more on ginger capsules than on placebo over the next 3 cycles (P < 0.001), and few adverse effects were reported. The abstract gives no effect size or dose [14]. In 102 women with heavy bleeding, all given ibuprofen 200 mg, adding 300 mg of ginger 3 times a day for the first 7 days of 2 cycles shortened bleeding by 1.8 days, against 0.52 days with placebo. The amount of bleeding fell in every group, with no difference between groups, and quality of life improved more with ginger than placebo [15].
Population: 92 high school girls with heavy periods [14]; 102 women of reproductive age with heavy periods, one third given frankincense instead [15].
Sources: [14], [15]
Caveats: Two small trials over 2 to 3 cycles. In [15] every group also took ibuprofen, and the change in bleeding days was tested within each group. The abstract of [14] gives no effect size.

Vitex (chasteberry)ModerateStudied in women

Heavy menstrual bleeding

Not shown to reduce menstrual blood loss against placebo in women. Loss scores were higher than on mefenamic acid in the first cycle, not the second.

Compared with placebo [6]; mefenamic acid [6]

The numbers and sources

Effect: Menstrual blood loss did not differ from placebo in the first cycle (MD 3.08, 95% CI -3.11 to 9.26) or the second (MD 0.00, 95% CI -5.75 to 5.75). Against mefenamic acid, blood loss scores were higher on vitex in the first cycle (MD 7.17, 95% CI 0.33 to 14.01) and did not differ in the second (MD 12.18, 95% CI -5.57 to 29.94) [6].
Population: Women of reproductive age without gynecologic disorders in 5 trials [6].
Sources: [6]
Caveats: The authors rated the trials of relatively low quality. The women did not have diagnosed gynecologic disease, so the result may not apply to heavy bleeding from fibroids [6].

Fish oilUntested

Fibroids

Not studied in people. In the lab, EPA and DHA changed the membranes of human fibroid cells and lowered genes tied to mechanical signaling and lipid handling.

No study in people. This rests on lab studies.

The numbers and sources

Effect: In primary human fibroid and normal uterine muscle cells, EPA or DHA raised polyunsaturated fat content, lowered membrane fluidity, and reduced expression of ABCG1, ABCA1 and AKAP13. Genes for extracellular matrix proteins such as collagen and fibronectin did not change [50].
Population: Primary human fibroid and uterine muscle cells [50].
Sources: [50]
Caveats: Cell studies only. No trial of fish oil in women with fibroids or heavy bleeding was located, and cohorts of omega-3 from food give mixed results (see Risks).

TurmericUntested

Fibroids

Not studied in people. Animal studies found curcumin in the diet slowed human fibroid tissue grown in mice and cut spontaneous fibroids in hens.

No study in people. This rests on animal studies, lab studies.

The numbers and sources

Effect: In hens, which develop fibroids naturally, 12 months of dietary curcumin at 25.8 or 53 mg per kg cut fibroid incidence from 58.9% to 37.7% and 24.5% (P 0.004) and slowed tumor growth [53]. In mice carrying human fibroid tissue, a curcumin diet led to about 60% less growth, less matrix protein and more cell death in the tissue [54]. In the lab, curcumin slowed the growth of human fibroid cells, did not slow matched normal uterine muscle cells, and lowered fibronectin [55]. It also slowed the growth of rat fibroid cells, acting through PPAR-gamma [56].
Population: 270 hens [53]; mice with human fibroid xenografts [54]; immortalized human fibroid and uterine muscle cells [55]; Eker rat fibroid cells [56].
Sources: [53], [54], [55], [56]
Caveats: Animal and cell studies. Doses per kilogram in hens and mice do not carry over directly to people, and no trial in women with fibroids or heavy bleeding was located.

Vitex (chasteberry)Untested

Fibroids

Not studied in people. A 2026 review lists vitex among herbs commonly used in traditional herbal formulas for fibroids.

No study in people. This rests on documented traditional use.

The numbers and sources

Effect: A review of ethnopharmacology for fibroids names Vitex agnus-castus among herbs commonly used in African, Asian and Latin American herbal formulas said to reduce fibroid size and regulate menstruation [8]. No trial of vitex for fibroid size or fibroid bleeding was found.
Population: Traditional herbal practice described in a literature review [8].
Sources: [8]
Caveats: Traditional use shows that people have used it, not that it changes fibroids. The pooled trials of menstrual blood loss found no effect against placebo [6].

Therapies

Uterine fibroid proceduresModerate

Heavy bleeding and satisfaction after hysterectomy

Shown to cut heavy menstrual bleeding more than a hormonal IUD or endometrial ablation, ranking first in a network meta-analysis, with low-certainty evidence.

Compared with a levonorgestrel IUD and endometrial ablation [3]; uterine artery embolization [4]

The numbers and sources

Effect: Among second-line treatments for heavy menstrual bleeding, hysterectomy ranked first for reducing blood loss (mean rank 1.2, low certainty), and minimally invasive hysterectomy ranked first for satisfaction (mean rank 1.3, low certainty). Bleeding reduction depended on the type of hysterectomy (total or subtotal), not the route [3]. Ten years after randomization, 87% of women who had a hysterectomy and 78% who had embolization were satisfied or very satisfied, and generic quality of life did not differ [4].
Population: 11 trials with 1,790 participants for bleeding and 27 trials with 4,284 for satisfaction [3]; 177 Dutch women with fibroids randomized to hysterectomy or embolization, 131 answering at 10 years [4].
Sources: [3], [4]
Caveats: The network covers heavy menstrual bleeding from any cause, not only fibroids, and the ranks rest on indirect comparisons [3]. Hysterectomy ends periods and the possibility of pregnancy.

Uterine fibroid proceduresModerate

Recovery after embolization

Shown to need fewer blood transfusions than hysterectomy or myomectomy, with shorter hospital stays and a faster return to usual activities in every trial that measured them.

Compared with hysterectomy or myomectomy [5]

The numbers and sources

Effect: Blood transfusions were less likely after embolization than surgery (OR 0.07, 95% CI 0.01 to 0.52, 2 trials, 277 women). Procedures were shorter (2 studies), hospital stays shorter (7 studies) and return to usual activities faster (6 studies), though most of these could not be pooled [5].
Population: 7 RCTs with 793 women with fibroids [5].
Sources: [5]
Caveats: The recovery outcomes were too varied to pool into one number [5].

Uterine fibroid proceduresModerate

Heavy bleeding after embolization or myomectomy

Shown to reduce heavy bleeding about as much as myomectomy at 4 years, in one randomized trial and one pooled analysis.

Compared with myomectomy [8][7]

The numbers and sources

Effect: At 4 years in FEMME, bleeding scores, rates of amenorrhea and rates of heavy bleeding did not differ between embolization and myomectomy. Of women still menstruating, 75% after embolization and 77% after myomectomy reported regular or fairly regular periods [8]. A meta-analysis found comparable improvement in abnormal uterine bleeding [7].
Population: 254 UK women randomized [8]; 13 studies [7].
Sources: [8], [7]
Caveats: One randomized trial, and a meta-analysis mostly of observational studies [7].

Uterine fibroid proceduresModerate

Laparoscopic compared with open myomectomy

Shown to cause less pain at 6 and 48 hours, about half the risk of fever and shorter hospital stays than open myomectomy, with no difference in fibroid recurrence.

Compared with open myomectomy, including mini-laparotomy [9]

The numbers and sources

Effect: Pain on a 0 to 10 scale was 2.40 points lower at 6 hours (1 study, 148 women) and 1.90 points lower at 48 hours (2 studies, 80 women), with no difference at 24 hours. Fever after surgery was less likely (OR 0.44, 95% CI 0.26 to 0.77, 6 studies, 635 women). Hospital stays were shorter, and recurrence, return to theater and conversion to open surgery did not clearly differ [9].
Population: 9 RCTs with 808 premenopausal women [9].
Sources: [9]
Caveats: No trial reported uterine rupture, clots or deaths, so these could not be compared [9].

Uterine fibroid proceduresModerate

Symptoms and fibroid size after radiofrequency ablation

Shown in pooled studies, mostly without a comparison group, to shrink treated fibroids about 65% by 12 months and to improve bleeding and quality of life scores.

Compared with before treatment, in the same women [14][15]

The numbers and sources

Effect: Fibroid volume fell 46.0% at 3 months (95% CI 40.0 to 52.1, 11 studies) and 65.4% at 12 months (95% CI 56.1 to 74.7, 10 studies). All studies reported fewer women with abnormal, heavy or prolonged bleeding, mostly within 3 months, and quality of life scores improved, with most women back to work within 2 weeks [14]. A second meta-analysis found fibroid volume fell 66% at 12 months, quality of life rose 39 points and symptom severity fell 42 points, with return to normal activities after 5.2 days [15].
Population: 30 studies, 3 of them randomized [14]; 32 articles with 1,283 women treated laparoscopically, transvaginally or transcervically, median age 42 [15].
Sources: [14], [15]
Caveats: Most studies had no comparison group, and the 3 randomized trials were not blinded [14]. Review [15] was funded by Gynesonics, maker of the Sonata system, and one author consulted for the company. Most studies excluded women wanting to keep fertility, so pregnancy data are insufficient [14].

AcupunctureLimitedStudied in women

Uterine fibroids

Limited evidence: unblinded trials found acupuncture shrank fibroids more than Chinese medicines or mifepristone in women with fibroids. A Cochrane review found no double-blind trials to include.

Compared with traditional Chinese medicine, and mifepristone in one trial [25]; Chinese herbal medicine alone, with acupuncture added to it [26]

The numbers and sources

Effect: Across 11 randomized trials (735 women), acupuncture reduced fibroid volume (MD -3.89, 95% CI -5.23 to -2.56) and uterine volume (MD -16.22, 95% CI -19.89 to -12.55) and lowered fibroid symptom scores (MD -3.03, 95% CI -3.45 to -2.60) more than the comparison treatments. Estrogen levels did not differ, and no serious adverse reactions were reported [25]. Across 9 randomized trials (640 women), acupuncture added to Chinese herbs raised the overall response rate (RR 1.20, 95% CI 1.12 to 1.30) and reduced fibroid size (SMD -0.82, 95% CI -1.36 to -0.27, I² 90%) more than herbs alone [26]. A Cochrane review searching to May 2009 found no randomized double-blind trials that met its criteria [27].
Population: 735 women with fibroids, mean age 34 to 48, in 11 trials, most treated for 3 months [25]; 640 women with fibroids in 9 trials [26].
Sources: [25], [26], [27]
Caveats: Every trial in [25] compared acupuncture with medicines taken by mouth, so no one was blinded and none used sham acupuncture, and heterogeneity was high. The authors of [26] call the trials few and of limited quality. Neither review abstract reports measured menstrual blood loss.

Uterine fibroid proceduresLimited

Symptoms after focused ultrasound

Limited evidence: symptom scores fell about 50% after MRI-guided focused ultrasound in pooled studies with no comparison treatment, and quality of life improved.

Compared with before treatment, in the same women [11][12]

The numbers and sources

Effect: Pooled, the treated share of fibroid volume (non-perfused volume) was 67.60% (95% CI 55.58 to 79.62), symptom severity scores changed about 54% (95% CI 41% to 66%) at 3, 6 and 12 months, and health-related quality of life improved [11]. Across uterine-sparing treatments, quality of life improved after every option, and least after focused ultrasound [12].
Population: Randomized, non-randomized and crossover studies of MR-guided focused ultrasound [11]; 85 studies with 17,789 women [12].
Sources: [11], [12]
Caveats: Mostly single-group studies, so part of the change may not be due to treatment. The reviewers note results improved as protocols aimed for total ablation [11].

Uterine fibroid proceduresModerate

Embolization compared with surgery: satisfaction and quality of life

Mixed results: satisfaction after embolization matched hysterectomy or myomectomy up to 5 years, but fibroid quality of life scores were lower than after myomectomy at 2 years.

Compared with hysterectomy or myomectomy [5]; myomectomy [6][7]; hysterectomy [4]

The numbers and sources

Effect: Satisfaction did not differ between embolization and surgery within 24 months (OR 0.94, 95% CI 0.59 to 1.48, 6 trials, 640 women) or at 5 years (OR 0.90, 95% CI 0.45 to 1.80, 2 trials, 295 women) [5]. In the FEMME trial, fibroid quality of life scores at 2 years were 84.6 after myomectomy and 80.0 after embolization (adjusted difference 8.0 points, 95% CI 1.8 to 14.1), and 5.0 points at 4 years (95% CI -1.4 to 11.5), not significant [6]. A meta-analysis found higher symptom severity scores after embolization than myomectomy at 4 years [7]. At 10 years, quality of life did not differ between embolization and hysterectomy [4].
Population: 7 RCTs with 793 women [5]; 254 UK women randomized to myomectomy or embolization [6]; 13 studies, 4 of them randomized [7]; 177 Dutch women [4].
Sources: [5], [6], [7], [4]
Caveats: Many eligible women in FEMME declined to be randomized because they preferred one treatment [6]. Nine of the 13 studies in [7] were observational.

Uterine fibroid proceduresLimitedStudied in women

Pregnancy after hysteroscopic removal of fibroids inside the uterus

One small trial found more pregnancies after hysteroscopic removal of submucous fibroids than with timed intercourse alone, but the difference could be chance.

Compared with expectant management with regular fertility-oriented intercourse for 12 months [10]

The numbers and sources

Effect: In women with otherwise unexplained subfertility and submucous fibroids, clinical pregnancy odds were higher after hysteroscopic myomectomy (OR 2.44, 95% CI 0.97 to 6.17, P = 0.06) and miscarriage did not clearly differ (OR 1.54, 95% CI 0.47 to 5.00). No data on live birth or complications were found [10].
Population: 94 women with unexplained subfertility and submucous fibroids [10].
Sources: [10]
Caveats: Very low-quality evidence from one small trial [10].

Uterine fibroid proceduresLimited

Pregnancy after embolization compared with myomectomy

Limited evidence: one small trial found fewer live births after embolization than after myomectomy, while a larger trial found similar small numbers of pregnancies.

Compared with myomectomy [5][6][7]

The numbers and sources

Effect: In a subgroup of one trial, live birth (OR 0.26, 95% CI 0.08 to 0.84) and pregnancy (OR 0.29, 95% CI 0.10 to 0.85) were less likely after embolization than myomectomy [5]. In FEMME, 12 women after embolization and 6 after myomectomy reported pregnancies over 4 years, with 7 and 5 live births (hazard ratio 0.48, 95% CI 0.18 to 1.28) [6]. A meta-analysis reported comparable pregnancy rates [7].
Population: 66 women in one trial subgroup [5]; 254 women in FEMME [6]; 13 studies [7].
Sources: [5], [6], [7]
Caveats: The Cochrane authors rated the live birth evidence very low quality, from a subgroup of a single study, and urged extreme caution in reading it [5]. Pregnancy was not the primary outcome of FEMME [6].

Uterine fibroid proceduresLimited

Pregnancy after focused ultrasound

Linked to lower pregnancy and live birth rates than myomectomy in pooled studies, live births 17% against 44%, with no head-to-head trials.

Compared with women who had myomectomy, in separate studies [13]

The numbers and sources

Effect: After high-intensity focused ultrasound, the pooled pregnancy rate was 23.3% (95% CI 11.5 to 37.6) and live birth rate 17.3% (95% CI 7.8 to 29.3), against 56.9% (95% CI 45.6 to 67.9) and 44.1% (95% CI 34.9 to 53.4) after myomectomy. Studies of younger women and of women trying to conceive reported better outcomes [13].
Population: Published studies of women with fibroids up to March 2024 [13].
Sources: [13]
Caveats: The groups come from different studies, which differ in age and in whether women were trying to conceive. The authors call for comparative trials [13].

Daily life

Physical activityModerateStudied in women

Fewer fibroids with more physical activity

Mixed results: more intense physical activity was linked to about 14% lower odds of fibroids, while regular activity overall was not significantly linked, in pooled observational studies.

Compared with women who did not regularly do physical activity [22]; women doing less intense activity [22]

The numbers and sources

Effect: Across 8 studies, women who regularly did physical activity did not differ significantly in their odds of having fibroids from women who did not (OR 0.93, 95% CI 0.82 to 1.05, I² 77.6%). Across 5 studies, women doing more intense activity had lower odds than women doing less intense activity (OR 0.86, 95% CI 0.75 to 0.99, I² 80.5%). The largest study, a retrospective cohort of Korean women, found a small rise in fibroids with regular exercise [22].
Population: Women in 15 studies (3 cross-sectional, 6 case-control and 6 cohort), 11 of them pooled, published 1986 to 2024 [22].
Sources: [22]
Caveats: Observational, with high heterogeneity. The reviewers rated the evidence low quality for imprecision and risk of bias [22]. Active women differ in body weight and other habits, and fibroid symptoms such as heavy bleeding and pain can limit activity, so confounding and reverse causation are possible.

Food and drink

AlcoholModerateStudied in womenHow often is not known

Fibroids

Mixed results: a 2026 pooled analysis found no overall link between drinking and fibroids, while an earlier one linked current drinking to 33% higher odds.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Across 13 studies (135,370 women, 9,944 with fibroids), ever drinking was not linked to fibroids against never drinking (OR 1.04, 95% CI 0.86 to 1.26), and across 9 studies (3,375,571 women) neither was current drinking (OR 1.09, 95% CI 0.91 to 1.32). Odds were higher in studies from China (OR 3.48, 95% CI 1.29 to 9.43) and in studies that confirmed fibroids clinically or surgically (OR 1.18, 95% CI 1.00 to 1.39) [27]. An earlier review found ever drinking not linked (OR 1.12, 95% CI 0.94 to 1.34) and current drinking linked to higher odds (OR 1.33, 95% CI 1.01 to 1.76), from 2 studies [28].
Population: Women in 13 studies for ever drinking and 9 for current drinking [27]; 5 studies, 2 of them for current drinking [28].
Sources: [27], [28]
Caveats: Observational. The authors describe the studies as heterogeneous and the evidence as limited [27]. Both reviews come from the same group, and the later one includes the earlier studies. Drinkers differ from nondrinkers in other habits, so confounding is possible.

Red meat and processed meatLimitedStudied in womenHow often is not known

Fibroids with higher red meat intake

Limited evidence: one Italian case-control study linked the most beef and red meat to 70% higher odds of fibroids, while a Korean study found no overall link.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Against the lowest third of intake, the highest third of beef and other red meat was linked to higher odds of fibroids (OR 1.7, 95% CI 1.4 to 2.2), and ham to OR 1.3 (95% CI 1.0 to 1.6). Women with fibroids also reported eating fewer green vegetables, fruit and fish [13]. In 672 Korean women examined by ultrasound, red meat intake was not linked to fibroids overall, and premenopausal women in the second quarter of intake had lower odds than the lowest quarter (OR 0.47, 95% CI 0.24 to 0.91). In postmenopausal women, higher processed meat intake was linked to higher odds (OR 2.33, 95% CI 1.21 to 4.49) [14].
Population: 843 women with fibroids and 1,557 hospital controls in Italy, 1986 to 1997 [13]; 672 Korean women aged 23 to 73, 220 of them with fibroids [14].
Sources: [13], [14]
Caveats: Observational. The Italian study asked women with a recent diagnosis about their diet, so recall can differ between cases and controls, and diet tracks other habits, so confounding is possible [13]. The Korean study was cross-sectional and its meat intakes were low [14]. No prospective cohort of red meat and fibroids was located.

Lab markers

25-hydroxyvitamin DStrongStudied in women

Uterine fibroids

Linked to lower vitamin D in women with uterine fibroids, about 5.5 to 5.9 ng/mL lower than in women without them, in three meta-analyses.

The numbers and sources

Effect: In 21 studies, women with fibroids had lower 25-hydroxyvitamin D than controls (mean difference -5.90 ng/mL, I² 97.4%), and 26 of 29 clinical studies reported an association between low vitamin D and fibroids [23]. In observational studies of premenopausal women with fibroids found by ultrasound, levels were lower than in women without fibroids (mean difference -5.50 ng/mL, 95% CI -6.99 to -4.01) and vitamin D deficiency was more common (odds ratio 3.71, 1.90 to 7.24) [24]. In 9 studies, the standardized mean difference was -0.67 (95% CI -0.98 to -0.35), largest in studies from Asia and not significant in two studies from Africa [25].
Population: 43 clinical studies within a review of 69 [23]. 23 observational studies with 5,650 participants [24]. 835 women with fibroids and 895 controls in 9 studies [25].
Sources: [23], [24], [25]
Caveats: Observational, with very high heterogeneity between studies. The abstracts do not report adjustment for body weight, season or ancestry, and the studies cannot show whether low vitamin D came before the fibroids [23][24][25].

FerritinLimitedStudied in women

Heavy menstrual bleeding

Limited evidence: heavier menstrual loss went with lower ferritin in Northern European but not East Asian women, and half of adolescents referred for heavy periods had low ferritin.

The numbers and sources

Effect: In healthy premenopausal women of genetically confirmed ancestry, a higher menstrual blood loss score went with lower serum ferritin (β -0.01 on the log scale, P = 0.004), lower total body iron and higher soluble transferrin receptor in women of Northern European ancestry, and with none of these in women of East Asian ancestry [20]. Of 114 young women referred to a US hematology clinic for heavy menstrual bleeding, 50.9% had ferritin below 20 ng/mL, and fewer than half of those were anemic [21]. In an Australian screening study of active women, 51 of the 104 who had follow-up iron tests (about 49%) had ferritin below 30 ng/mL, and women reporting a history of iron deficiency were more likely to report heavy menstrual bleeding, 36.9% of them [22].
Population: Premenopausal women aged 18 to 50 with a body mass index of 18 to 30 in the FeGenes study [20]. 114 girls and young women aged 9 to 19 [21]. 1,042 active women aged 18 to 65 [22].
Sources: [20], [21], [22]
Caveats: Observational and cross-sectional. Menstrual loss was scored from questionnaires, not measured, and the referred adolescents had no comparison group without heavy bleeding [20][21]. In the screening study, only women with low or borderline hemoglobin had iron tests [22]. The FeGenes abstract does not give the number of women [20].

HemoglobinLimitedStudied in women

Uterine fibroids and heavy menstrual bleeding

Mixed results: anemia was coded in a third of women with fibroids and heavy bleeding in US claims, while a screening study found self-reported heavy bleeding did not predict anemia.

The numbers and sources

Effect: In US insurance claims, anemia was recorded in the following year in 32.0% and 35.3% of women with fibroids and heavy menstrual bleeding (grouped by which was diagnosed first), 14.3% of women with fibroids alone and 4.4% of age-matched women with neither [20]. In screening events in the UK and Australia, where anemia was a finger-prick hemoglobin below 12.0 g/dL, self-reported heavy menstrual bleeding did not significantly predict anemia in a model that included country and age (adjusted odds ratio 1.19, 95% CI 0.89 to 1.60), while living in the UK did [21]. In an Australian screening study of active women, those reporting a history of anemia were more likely to report heavy menstrual bleeding, 39.7% of them [22].
Population: 22,057 women aged 18 to 55 in each of three fibroid groups and 110,285 controls, mean age 43.5 [20]. 1,937 women aged 15 to 50 [21]. 1,042 active women aged 18 to 65, 887 with a finger-prick hemoglobin [22].
Sources: [20], [21], [22]
Caveats: Observational. Claims record a diagnosis of anemia, not a hemoglobin value [20]. Heavy bleeding was self-reported in the screening studies, and finger-prick hemoglobin can differ from a venous draw (see Finger-prick and point-of-care testing) [21][22].

HemoglobinLimitedStudied in women

Detecting iron deficiency in young women with heavy periods

One clinic study found hemoglobin missed more than half of iron deficiency in young women with heavy periods, with 41% sensitivity against a ferritin below 20 ng/mL.

The numbers and sources

Compared with: Ferritin below 20 ng/mL
Effect: Of 114 young women referred for heavy menstrual bleeding, 58 (50.9%) had ferritin below 20 ng/mL, and only 24 of them (41.4%) were anemic. For low ferritin, hemoglobin alone had a sensitivity of 41.4% (95% CI 28.7 to 54.1) and specificity of 91.1% (83.6 to 98.5), and a complete blood count 46.3% and 83.9%. The authors conclude that fewer than half of iron deficiency cases are found by hemoglobin or blood count alone [23].
Population: 114 girls and young women aged 9 to 19 referred to one US hematology clinic for heavy menstrual bleeding [23].
Sources: [23]
Caveats: Retrospective, at one referral clinic, so the share with low ferritin may differ in young women generally. Ferritin is itself raised by inflammation (see the ferritin page), so the reference is imperfect.

High-sensitivity C-reactive protein (hs-CRP)LimitedStudied in women

Uterine fibroids

One US survey found no clear link between uterine fibroids and CRP above 3 mg/L.

The numbers and sources

Effect: In the same national survey that linked endometriosis to higher CRP, the authors report that no substantive patterns emerged between uterine fibroids and CRP above 3.0 mg/L or leukocyte telomere length [24].
Population: 2,342 women in the National Health and Nutrition Examination Survey, 1999 to 2002 [24].
Sources: [24]
Caveats: One cross-sectional analysis with self-reported diagnoses, and the abstract gives no odds ratio for fibroids [24]. No meta-analysis of inflammation markers in women with fibroids was located.

On a blood test: Hemoglobin

Every finding in the library that measured this test, including studies that were mainly about something else (leaving out those done only in men or only in children).

Shown to lower it

Limited
Alpha-blockersSmall drops in blood counts and albumin
Small drops in hematocrit, hemoglobin, white cells and albumin were seen on terazosin in trials, which the label attributes to blood dilution. PSA did not change.
Limited
Ezetimibe and fenofibrateFenofibrate: blood counts
The label reports mild to moderate drops in hemoglobin, hematocrit and white cells after starting fenofibrate that then stabilized, with rare low platelets or white cells.
Limited
Methylene blueHemolytic anemia in G6PD deficiency
In the Alzheimer's trial, dose-dependent falls in hemoglobin were the most common laboratory abnormality, described as not clinically significant.
Limited
RapamycinMouth sores, gut effects and blood count changes
Hemoglobin, hematocrit and red cell count fell on rapamycin, without clinical effects over the study.
Limited
IV vitamin therapyHemolysis in G6PD deficiency
Two patients with colorectal cancer given 1 g per kg of vitamin C developed hemolytic anemia with hemoglobin below 50 g/L, and recovered after blood replacement.

Shown to raise it

Strong
IronRaising iron stores
In iron-deficient non-anemic endurance athletes, iron raised serum ferritin (Hedges' g 1.088, 95% CI 0.914 to 1.263) and hemoglobin (g 0.695).
Moderate
GnRH drugs for fibroidsStudied in womenAnemia with fibroids: relugolix combination
Shown to raise hemoglobin by more than 2 g/dL in 44% and 55% of anemic women with fibroids, against 17% and 6% on placebo, in two trials.
Compared with placebo
Moderate
GnRH drugs for fibroidsStudied in womenAnemia with fibroids: elagolix with add-back
Shown to raise hemoglobin by more than 2 g/dL in 50% and 62% of anemic women with fibroids, against 16% and 21% on placebo, in two trials.
Compared with placebo
Moderate
GnRH drugs for fibroidsStudied in womenAnemia before fibroid surgery: leuprolide and other GnRH agonists
Shown to raise hemoglobin before fibroid surgery, by about 0.9 g/dL against placebo or no treatment, and with iron 75% reached target levels against 49% on iron alone.
Compared with iron alone; placebo or no pretreatment
Moderate
Ulipristal acetateStudied in womenHemoglobin before fibroid surgery
Shown to raise hemoglobin before fibroid surgery by about 0.9 g/dL more than placebo, in women taking SPRMs including ulipristal.
Compared with placebo; GnRH agonists
Moderate
IronStudied in pregnancyAnemia in pregnancy
In 23 studies of 4,492 non-anemic pregnant women, oral iron raised hemoglobin by 6.95 g/L (95% CI 4.81 to 9.09) and ferritin by 12.22 ng/mL, and halved the risk of anemia (RR 0.50, 95% CI 0.34 to 0.74, high certainty, number needed to treat 10).
Limited
Hormonal birth controlStudied in womenHeavy bleeding with fibroids (hormonal IUD and combined pill)
Limited evidence: in women with fibroids, the hormonal IUD lowered bleeding and raised hemoglobin more than the combined pill in one small trial, without clearly shrinking fibroids.
Compared with a low-dose combined pill and oral norethisterone acetate; the levonorgestrel IUD and placebo; comparisons in 11 studies the source abstract does not describe
Limited
Green tea extractStudied in womenFibroid size and heavy bleeding
In the green tea group, hemoglobin rose 0.7 g/dL (P 0.02) and average blood loss fell from 71 to 45 mL a month (P 0.001).
Compared with placebo capsules of brown rice; before treatment, in the same women

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On a blood test: Ferritin

Every finding in the library that measured this test, including studies that were mainly about something else (leaving out those done only in men or only in children).

Shown to raise it

Strong
IronRaising iron stores
Shown to raise ferritin in iron-deficient adults and athletes without anemia, most in those starting with very low ferritin.
Moderate
IronStudied in pregnancyAnemia in pregnancy
In 23 studies of 4,492 non-anemic pregnant women, oral iron raised hemoglobin by 6.95 g/L (95% CI 4.81 to 9.09) and ferritin by 12.22 ng/mL, and halved the risk of anemia (RR 0.50, 95% CI 0.34 to 0.74, high certainty, number needed to treat 10).
Moderate
LactoferrinIron deficiency anemia
Shown to raise serum iron, ferritin and hemoglobin more than ferrous sulfate in people with iron deficiency anemia.

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On a blood test: 25-hydroxyvitamin D

Every finding in the library that measured this test, including studies that were mainly about something else (leaving out those done only in men or only in children).

Shown to raise it

Moderate
Vitamin DStudied in womenFibroid size in women with fibroids
Shown to shrink fibroids slightly or slow their growth against placebo over 2 to 3 months in women with fibroids, most with low vitamin D, in small trials.
Compared with placebo; controls the source abstract does not describe
Moderate
Vitamin DStudied in womenExcess hair and androgens in PCOS
Not shown to change hair growth scores or SHBG in women with PCOS in one review. Total testosterone fell slightly against placebo.
Compared with placebo; placebo, metformin, short-acting contraceptives, ovulation drugs or assisted reproduction without vitamin D
Moderate
SunlightVitamin D levels
The rise in 25-hydroxyvitamin D grew with UVB dose and, at small doses, with the area of skin exposed, and was smaller when the starting level was higher.
Compared with before the exposures, in the same people; different UVB doses and skin areas; vitamin D3 800 IU daily or 100,000 IU every 3 months; care homes with no added sunlight

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