Fibroids and Fertility: How Traditional Chinese Medicine Addresses Uterine Fibroids

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

Uterine fibroids are the most common benign tumours of the female reproductive system, affecting up to 70% of women by the age of 50 — with a particularly high prevalence in women of African and Caribbean origin. Most fibroids cause no symptoms and require no treatment. However, their location, size and number can significantly affect fertility and pregnancy outcomes, and for women who are trying to conceive, understanding the role fibroids may be playing is essential to making informed decisions about treatment.

Conventional management ranges from watchful waiting to surgery (myomectomy), with uterine artery embolisation, MRI-guided focused ultrasound, and medication as intermediate options. Traditional Chinese medicine (TCM) offers a complementary approach that has been used for thousands of years to address uterine masses classified under the category of zheng jia — fixed abdominal accumulations — treating the root patterns that create the environment in which fibroids form and grow.

On this page

1. What fibroids are
2. Types of fibroids and their fertility impact
3. Symptoms and diagnosis
4. What causes fibroids
5. TCM understanding of fibroids
6. Acupuncture for fibroids
7. Chinese herbal medicine for fibroids
8. Diet, lifestyle and supplements
9. When surgery is needed and TCM support
10. My Fertility Guide
11. References

1. What fibroids are

Uterine fibroids (also called leiomyomas or myomas) are non-cancerous growths composed of smooth muscle and fibrous connective tissue that develop within or on the wall of the uterus. They range from microscopic to grapefruit-sized or larger, and may occur as a single fibroid or as multiple lesions. Fibroids are oestrogen-sensitive — they tend to grow during the reproductive years when oestrogen levels are high and typically shrink after menopause when oestrogen declines.

Despite being benign, fibroids can cause significant problems depending on their size and position. Heavy menstrual bleeding, pelvic pain or pressure, urinary frequency, constipation, and reproductive difficulties are all potential consequences. The relationship between fibroids and fertility is complex and depends critically on where in the uterine wall the fibroid is located.

2. Types of fibroids and their fertility impact

Fibroids are classified by their location relative to the uterine wall:

• Submucosal fibroids grow into the uterine cavity and are the type most consistently associated with impaired fertility. Even small submucosal fibroids distort the endometrial surface, disrupt implantation, and are associated with recurrent miscarriage. Myomectomy to remove submucosal fibroids consistently improves pregnancy rates and is generally recommended before IVF.
• Intramural fibroids grow within the muscular wall of the uterus. Large intramural fibroids (generally over 4 cm) can distort the uterine cavity even without reaching the endometrial surface, impair uterine blood flow, and are associated with reduced IVF success rates. Smaller intramural fibroids that do not impinge on the cavity are generally considered less problematic for fertility.
• Subserosal fibroids grow outward from the outer surface of the uterus. Unless very large or causing anatomical distortion, subserosal fibroids have the least impact on fertility. However, they can cause pelvic pain and pressure symptoms, and very large subserosal fibroids may compress adjacent structures.
• Pedunculated fibroids are attached to the uterus by a stalk and may be subserosal (external) or submucosal (internal, sometimes described as polyp-like). Pedunculated submucosal fibroids within the cavity are treated similarly to other submucosal lesions.
• Cervical fibroids are uncommon but can obstruct the cervical canal, affecting sperm transport or, if large enough, the descent of the fetus during labour.

3. Symptoms and diagnosis

Many fibroids are completely asymptomatic and discovered only during pelvic ultrasound performed for another reason. When symptoms do occur, they typically include:

• Heavy or prolonged menstrual bleeding (which can lead to iron deficiency anaemia)
• Pelvic pressure or bloating
• Urinary frequency or urgency (from pressure on the bladder)
• Constipation or rectal pressure
• Lower back or leg pain
• Pain during intercourse
• Abdominal enlargement in cases of large fibroids

Fibroids are diagnosed primarily by pelvic ultrasound. MRI provides a more detailed assessment of fibroid number, size, location and blood supply, and is particularly useful when surgery is being planned. Saline infusion sonohysterography (SIS) or hysteroscopy may be used to assess whether submucosal fibroids are present and their relationship to the endometrial cavity.

4. What causes fibroids

The precise cause of fibroid formation is not fully understood, but several factors are known to contribute:

• Oestrogen dominance: Fibroids are oestrogen-sensitive and are more common in conditions associated with relative oestrogen excess — including obesity, PCOS, and endometriosis. Environmental oestrogens (xenoestrogens from plastics, pesticides, and synthetic chemicals) may also play a role.
• Progesterone: Progesterone also stimulates fibroid growth through different pathways — the interplay between oestrogen and progesterone in fibroid development is complex and both hormones appear to drive growth through separate mechanisms.
• Genetics: Fibroids have a strong heritable component. Women whose mothers or sisters have fibroids are at significantly higher risk.
• Race: Women of African descent develop fibroids earlier, at higher rates, and with greater severity than women of other backgrounds. The reasons for this are not fully understood but may involve vitamin D status, genetic factors, and differences in hormonal metabolism.
• Diet and lifestyle: Diets high in red meat and low in vegetables, fruit and oily fish have been associated with higher fibroid risk. Vitamin D deficiency is also associated with fibroid growth — fibroid tissue has been shown to express fewer vitamin D receptors than normal uterine tissue, and supplementation may slow growth.

5. TCM understanding of fibroids

In TCM, fibroids are understood as uterine masses caused by the accumulation of pathological substances in the uterus — primarily Blood stasis, phlegm-damp, and Qi stagnation. The underlying patterns that create this accumulation reflect disruptions in the flow of Qi and Blood through the reproductive organs and in the Spleen's ability to transform and transport fluids.

The most common TCM patterns associated with fibroids include:

• Blood stasis in the uterus: The primary pattern in most fibroid cases. Poor circulation of blood through the uterine vessels allows blood to accumulate and congeal, creating the fibrous, blood-rich masses characteristic of fibroids. Signs of Blood stasis include dark, clotty menstrual blood, fixed pelvic pain that worsens during menstruation, and a purple-tinged tongue with stasis spots. Treatment focuses on invigorating Blood circulation, breaking up stasis, and warming the uterus to promote flow.
• Phlegm-damp accumulation: When the Spleen's transformative function is impaired, fluids accumulate as phlegm-damp. This combines with Blood stasis to form the fibrous matrix of the fibroid. Women with this pattern often feel sluggish, carry excess weight, have a coating on the tongue, and experience a feeling of heaviness in the pelvis.
• Liver Qi stagnation: Emotional stress, frustration, and suppressed emotions stagnate the flow of Qi through the Liver channel. Stagnant Qi impairs Blood circulation and creates the conditions in which Blood stasis accumulates. This pattern is frequently present alongside the above and is often the initial trigger for fibroid development in younger women.
• Kidney deficiency: Underlying Kidney deficiency — particularly Kidney Yang deficiency — creates a cold, poorly circulated uterine environment that both allows fibroids to form and sustains their growth. Addressing Kidney Yang is often necessary for longer-term resolution.

6. Acupuncture for fibroids

Acupuncture addresses fibroids through several mechanisms:

Modulation of hormonal balance: Acupuncture has been shown to influence oestrogen and progesterone metabolism, reducing the oestrogen-dominant environment that promotes fibroid growth. By regulating the hypothalamic-pituitary-ovarian axis, acupuncture helps normalise the hormonal milieu without pharmacological intervention.

Improvement of uterine blood flow: Poor perfusion of the uterine vasculature creates the stagnant conditions that promote Blood stasis and fibroid development. Acupuncture increases uterine artery blood flow, promoting active circulation through the uterine tissue and reducing the accumulation of stagnant blood that contributes to fibroid growth.

Reduction of inflammation: Fibroids have an inflammatory component — chronic inflammation within the uterine wall promotes fibroid proliferation. Acupuncture modulates inflammatory cytokines and prostaglandins, reducing the pro-inflammatory environment.

Symptom relief: Even when complete resolution of fibroids requires medical or surgical intervention, acupuncture is highly effective for managing the associated symptoms — reducing menstrual pain, lightening heavy bleeding, improving pelvic congestion and pressure, and supporting the emotional wellbeing of women living with significant fibroid burden.

Research published in the Journal of Chinese Medicine and case series from TCM practitioners document significant reduction in fibroid size over courses of treatment lasting six to twelve months, with the most favourable outcomes in fibroids under 5 cm in diameter and in younger women with robust Kidney Qi.

7. Chinese herbal medicine for fibroids

Chinese herbal medicine has a long tradition of treating uterine masses and fibroids. Formulas are tailored to the individual pattern but typically include herbs that invigorate Blood, break up stasis, resolve phlegm-damp, and regulate Qi flow:

• Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill): The classical formula for Blood stasis in the uterus, used specifically for uterine masses and menstrual irregularity due to stasis. Contains cinnamon (Gui Zhi), poria (Fu Ling), red peony (Chi Shao), moutan bark (Mu Dan Pi), and persica seed (Tao Ren). Well-studied with clinical evidence of efficacy in fibroid management.
• Xue Fu Zhu Yu Tang (Drive Out Stasis from the Mansion of Blood): A stronger Blood-invigorating formula for more pronounced Blood stasis, particularly with pain and dark, clotted periods.
• Shao Fu Zhu Yu Tang (Drive Out Blood Stasis in the Lower Abdomen): Specifically targets Cold-Blood stasis in the lower abdomen — appropriate when cold is a significant factor and the uterus is cold to palpation.
• Er Chen Tang combined modifications: Resolves phlegm-damp and strengthens Spleen function — used when the phlegm-damp pattern is prominent alongside Blood stasis.
• Xiao Yao San modifications: Addresses the Liver Qi stagnation component while supporting Blood and Spleen — appropriate in the early stages or as a base formula when stagnation predominates.

Single herbs commonly used in fibroid formulas include San Leng (Rhizoma Sparganii), E Zhu (Rhizoma Curcumae), Yi Mu Cao (Herba Leonuri), and Ze Lan (Herba Lycopi) — all of which have Blood-invigorating and uterine-regulating properties. Some of these herbs are contraindicated in pregnancy, and any herbal treatment should only be undertaken under the guidance of a qualified practitioner.

8. Diet, lifestyle and supplements

Dietary and lifestyle changes that reduce oestrogen dominance and support Blood circulation are central to both preventing fibroid growth and supporting treatment:

• Increase fibre intake: Dietary fibre binds to oestrogen in the gut and promotes its excretion rather than recirculation. Prioritise vegetables, legumes, whole grains, and ground flaxseed.
• Reduce red meat and full-fat dairy: Both are associated with higher fibroid risk. Replace with plant-based protein sources, fish, and lean poultry.
• Support liver detoxification: The liver metabolises oestrogen. Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, kale), DIM (diindolylmethane) supplements, and avoiding alcohol and environmental toxins all support hepatic oestrogen processing.
• Vitamin D supplementation: Given the association between vitamin D deficiency and fibroid growth, supplementing to achieve levels of 75–100 nmol/L is advisable. Test levels and supplement accordingly, typically 2000–4000 IU daily.
• Green tea extract (EGCG): Epigallocatechin gallate has been shown in several studies to reduce fibroid volume and improve heavy bleeding. A dose of 400–800mg standardised EGCG daily has been studied.
• Avoid xenoestrogens: Reduce exposure to plastics (BPA and phthalates), conventional cosmetics containing parabens, and non-organic produce that carries organochlorine pesticide residue.
• Manage stress: Chronic stress drives cortisol elevation, which impairs progesterone production and worsens relative oestrogen dominance. Regular exercise, meditation, and adequate sleep all help maintain hormonal balance.

9. When surgery is needed and TCM support

Large submucosal fibroids that significantly distort the uterine cavity, fibroids causing severe anaemia from heavy bleeding, or fibroids that have grown rapidly generally warrant surgical evaluation. Hysteroscopic myomectomy (for submucosal fibroids accessible through the cervix) and abdominal or laparoscopic myomectomy (for intramural and subserosal fibroids) are the surgical options that preserve the uterus and are appropriate for women who wish to conceive.

TCM has an important role both before and after myomectomy. Pre-operative acupuncture and herbal treatment aims to reduce fibroid size, improve uterine circulation, and correct the underlying pattern that allowed fibroids to develop — reducing the risk of recurrence after surgery, which is significant (up to 30% at five years). Post-operative acupuncture and herbal medicine supports uterine healing, reduces scar tissue formation, restores Blood and Qi, and corrects the Blood stasis and Kidney deficiency patterns that remain after surgery.

10. My Fertility Guide

11. References

• Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215–1223.
• Carneiro MM. What is the role of myomectomy in the treatment of infertility? Rev Bras Ginecol Obstet. 2011;33(1):1–3.
• Aghajanova L, Giudice LC. Molecular evidence for differences in endometrium in severe versus mild endometriosis. Reprod Sci. 2011;18(3):229–251.
• Roshdy E, et al. Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study. Int J Womens Health. 2013;5:477–486.
• Sabry M, Al-Hendy A. Medical treatment of uterine leiomyoma. Reprod Sci. 2012;19(4):339–353.