Humans in Conversation: Dietary Management of Uterine Fibroids — A Healthier Chapter
Disclaimer: Consider this a case study and conversation starter not direct medical advice. Please consult the right medical professional (PCP, dietician, Gynecologist etc.) to put your overall health in context.
Omolara Ajayi and I met in a public transit bus — K-Bus heading to the Arundel Mills in Maryland in 2014 and have remained best of friends. We were at different points in our lives — I, a mother of a toddler, who moved to Maryland from North Carolina for work after a graduate program at Duke, she — a graduate student completing her Masters Program at Morgan State University. In common though, we had both immigrated from Nigeria and share love for great aspects of culture like the Yoruba language, Faith (though of different religions) and of course FOOD. Food is very personal, more so for foodies like us and with the variety Nigeria has to offer including jollof rice, fufu, egusi, efo riro, poundo yam, plantain and more, a restricted diet can be challenging. Beyond the need for survival, food plays a huge role in health and quality of life. As someone articulated recently, our body evolves, I think so does its relationship with the food we eat.
Omolara shares with me the story of her journey with fibroids. From development of symptoms to diagnosis and the several challenges she faced before coming to great health with dietary changes.
Briefly About Fibroids
Uterine myomas (fibroids) affect many women of reproductive age and though non-cancerous can constitute a significant morbidity when symptomatic, leading to reduced quality of life and reduced productivity. Symptoms include: heavy or prolonged menstrual bleeding (leading to anemia), abdominal cramps, abdominal distension, urinary frequency etc. It may also cause infertility, high risk pregnancy or pregnancy loss, depending on location and when of significant size. Like many other medical conditions, research has been (and is being) conducted to understand the association between nutrition and fibroids.
The Interview
Bilikis: Prevalence of fibroids varies geographically. Generally in the US, more than half the population of women will have fibroids by age 50, only a fraction of this is diagnosed (~35%) and an even smaller fraction of that (~25%) is symptomatic. It is also known to be more prevalent in black women. How did you find out about fibroids?
Omolara: In February of 2019, I had my period twice in one month both with what I‘d call super heavy flow. After the second cycle, I started feeling lightheaded and tired that at a point I could not get out of bed. I contacted my Primary Care Physician (PCP) who referred me to an Obstetrics/Gynecologist (ObGyn). Let’s call him Dr. A. Blood tests revealed I had anemia.
Dr. A examined me but did not order any scan or probe further. He told me the heavy bleeding was due to acute stress and prescribed oral contraceptive pills (OCP).
I was not convinced that stress was responsible for the heavy bleeding, because even after long hours of rest and sleep, sometimes up to 9 hours, I still experienced a general feeling of unwell and fatigue. I did not pick the prescription for OCP from the pharmacy and continued to live with the bleeding and poor health. I changed my PCP that year because I was not getting quality care.
In 2021, one of my sisters called from Lagos to inform me that on a self-directed routine abdominal ultrasound, some fibroids were discovered in her uterus. She encouraged me to pay attention to my health too. I took her advice and had a conversation with my PCP who assured me that fibroids were common especially in women my age and of my race and that if asymptomatic, there’s no need for investigation or intervention.
Bilikis: That must be tough to know something was wrong but not having the proof and not feeling satisfied by the Doctor’s impression. What did you do next and when did you receive formal diagnosis?
Omolara: I carried on in my poor state of health for 3 years from the first ObGyn visit before seeking a second opinion from another ObGyn, let’s call her Dr. B.
She ordered an ultrasound and finally gave me a diagnosis of fibroids in January 2022, three years after my first symptoms. Her main recommendation was that I undergo an hysterectomy.
When I requested some time to decide, she offered options of either a hormonal or non-hormonal pill in the interim. Given my previous experience, I opted for the non-hormonal option — Tranexamic acid. She prescribed the medication and sent me my merry way. I used the Tranexamic acid pill on the first day of my next period as prescribed and shortly developed symptoms similar to those of acute severe malaria fever (fever, restlessness, loss of appetite, lightheaded, headache, etc.). Unfortunately, this happened to coincide with me starting a new job.
My new boss, upon seeing my state of health, offered to take me home. I became concerned about my job.
I couldn’t bring myself to take a second dose of the medication given how the first dose made me feel. The heavy bleeding, exhaustion, and feeling of unwell did not subside. So in September 2022, I went to my new PCP again and shared my dissatisfaction. She decided at this point that I needed a Gynecologist that was culturally competent and better suited to my needs. She referred me to another Gynecologist, Dr. C., a black physician.
Bilikis: While not always the case, there have been a few research studies suggesting a correlation between patient-provider concordance (same race, gender etc.) and better care experience and health outcomes. How was your experience with Dr. C?
Omolara: Not long after leaving the visit with my PCP, I received a phone call from Dr. C’s office, I had never experienced that level of proactivity before. I was used to chasing appointments down after multiple calls. She is a part of a rare setting, an independent practice affiliated to a major hospital run by two black women physicians. Despite her eagerness to see me sooner, the first available spot with Dr. C was in 5 months. Another difference was that prior to my appointment, she ordered an MRI to get a better insight into the number and range of sizes of my fibroids.
In January 2023, I went for my visit with Dr. C. She explained fibroids to me in lay terms, with emphasis on how mine presented, providing multiple options of treatment. She shared that the MRI result showed several fibroids, the sizes of grapefruit, eggs, oranges and some additional smaller sizes. She shared that her approach to managing fibroids for patients like me is through lifestyle changes to reduce inflammation, if fertility is not a concern. She offered to consider other options if my situation changes. At one point after I narrated my ordeal with Dr. A and B, she asked to see the pill I was prescribed by Dr. B, she looked at the pill, shook her head and returned it.
Bilikis: Wow! The way you describe your visit with Dr. C seems like an experience you had never had before. What were her actual dietary recommendations? How have you coped and what changes have you observed?
Omolara: For the first time since the beginning of my symptoms in 2019,
…I felt finally heard and seen. I understood my condition better and was determined to try whatever Dr. C. recommended.
She is a strong advocate of lifestyle change. I remember she told me “I don’t recommend medication/procedure for a condition that lifestyle change can cure”. She shared that she was concerned that her no-medication approach may not be endorsed by my PCP and my PCP may refuse to send her patients in the future on that grounds.
For diet, she explained that the goals were [a] to avoid estrogen-rich or estrogen-containing food, [b] avoiding food that predispose to inflammation and [c] to eat more anti-inflammatory food. For me, she recommended:
- Drinking one shot of organic ginger juice (not store bought) first thing in the morning daily (ginger is a great anti-inflammatory that could shrink the tumors)
- Eating fish, legumes, nuts and organic poultry protein (the estrogen hormone given to animals could increase the hormone level that could increase the growth of fibroids).
- Avoiding meat and dairy
- No caffeine, bread, white rice or pasta (these promote inflammation)
- Exercise at least 3 times weekly (sedentary lifestyle has been linked to development of fibroid)
At first, it was really hard missing out on all the variety of food I loved and grew up eating, as well as newer food from fast food and restaurant chains.
Now, after expanding my menu creatively within the dietary recommendations, I don’t think I can go back to a different diet even when given the option.
I had another MRI in September 2023 which showed a reduction in rate of growth of the fibroids. The excessive bleeding had stopped, my blood level was back to normal — no more need for iron supplements. More importantly, I feel healthier, bursting with energy, the tiredness and exhaustion, gone. I am able to function fully at work and play to my heart’s content.
Bilikis: We are both of Nigerian origin and immigrated to the US as adults. Like in many cultures across the world, women are socially conditioned not to share publicly about personal journeys in health. Why did you agree to share your story for publishing when I requested? What do you hope readers take away from your story?
Omolara: Who silence epp? (a Nigerian slang meaning ‘who is helped by silence?’). Silence does not serve us in matters of health.
It is high time women shared their health journeys for the benefit of others. It would make me happy if my story empowers another woman to take charge of her health and be more proactive — seeking timely second, third or more opinions.
I had my doubts about Dr. A’s management, but it took me 3 years to seek a second opinion. Do your research, understand your body and don’t settle for inadequate care. I also got to understand through Dr. C that the main thing I craved was to be genuinely listened to and cared for. I love how I look, feel and how active I am now, and hope every woman can live healthy lives.
About Omolara
Omolara Ajayi is an accountant who resides in Maryland, United States. She obtained her undergraduate degree in Finance from the University of Ilorin, Nigeria and her graduate degree in Accounting from Morgan State University, Maryland US. She currently works as a Finance Director at Afya Baltimore, Inc. She also consults on bookkeeping and audit. She is very active in giving back to her communities, especially in support of education and women-owned small businesses. LinkedIn.
Further Reading
- Aninye IO, Laitner MH. Uterine Fibroids: Assessing Unmet Needs from Bench to Bedside. J Womens Health (Larchmt). 2021 Aug;30(8):1060–1067. doi: 10.1089/jwh.2021.0280. PMID: 34410867; PMCID: PMC8432600. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432600/
- 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10708302/
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