Although the etiology of UFs is not fully understood, several risk factors, including age, race, obesity, parity, hypertension, vitamin D deficiency, hormonal imbalances, exposure to endocrine-disrupting chemicals (EDCs) (organophosphate esters and plasticizers) [10,11], genetic polymorphism, and lifestyles involving a worse diet, lack of physical activity, and high stress have been identified [12,13]. Furthermore, some of the variations in UFs’ risk and the racial disparities associated with UF traits can be attributed to genetic differences among various geographic populations. UFs disproportionately affect black women, who not only experience UFs at an earlier age but also face a higher overall risk [14,15]. Given these factors, even seemingly healthy individuals should be mindful of preventive measures.

Primary prevention involves measures to prevent disease in healthy individuals by either reducing risk exposure or enhancing immunity. It aims to halt the disease’s development in high risk before it even starts [16]. Currently, there is no well-established screening test for UFs and, as such, no viable approach for primary prevention, However, scholars are pursuing this important goal [17]. UFs are diagnosed mostly by bimanual pelvic test, especially in advanced disease in thin patients. Imaging usually using ultrasonography and occasionally using magnetic resonance imaging (MRI), or computed tomography (CT) is the most common method to diagnose UF [2,18,19]. Imaging allows proper evaluation of the disease such as the size, location, and multiplicity of UFs. Two crucial aspects in contemporary approaches to optimal treatment include the concepts of shared decision making and the availability of personalized therapy options, which may include a “watchful waiting” approach determined by the patient’s symptoms, their individual treatment objectives, and the physician’s assessment. Medical treatment included non-hormonal and hormonal approaches. Non-hormonal like catechol-O-methyl transferase. (COMT) inhibitors, vitamin D [20,21], vitamin D receptors (VDR) agonists, epigallocatechin gallate (EGCG), localized gene therapy, nanoparticles, and localized bacterial collagenase [22,23,24,25,26]. Hormone therapy such as gonadotropin-releasing hormone (GnRH) agonists and antagonist, selective progesterone receptor modulators (SPRMs), aromatase inhibitors or progestin-releasing intrauterine devices (IUDs) [27,28]. Surgery consists of traditional (abdominal myomectomy and hysterectomy) or minimally invasive or noninvasive procedures (laparoscopic or robotic myomectomy and hysterectomy, uterine artery embolization, radiofrequency ablation or endometrial ablation, MRI or ultrasound guided focused ultrasound surgery (FUS), may sometimes be necessary to remove or shrink large or symptomatic UFs [29,30,31,32,33]. Annual direct and indirect UFs costs range from $5.9 to $34.4 billion for United States of America women seeking treatment. UFs complicated by HMB were associated with significantly higher direct health care costs compared with UFs or HMB alone [34,35].

Secondary prevention involves detecting early-stage diseases in individuals with subtle signs of illness. This phase is especially relevant for women concerned about UF recurrence post-surgery. Strategies are pursued to prevent disease advancement or recurrence [36]. In the context of secondary prevention, screenings are frequently employed as a mean to achieve early disease detection and intervention. Currently, there is no validated method for screening pre-symptomatic health women for risk of future UFs development [37,38].

Following long-lasting RCT or a long cohort showing that nutrition plays a crucial role in the management of UFs, adopting a personalized dietary regimen that includes specific foods, supplements, and vitamins can help reduce the risk of UFs, prevent their further growth, and alleviate symptoms [225]. A low intake of fruit and green vegetables and pollutants ingested with food is linked to a higher risk of myoma formation [226,227]. This includes incorporating vegetables rich in fiber, such as leafy greens, cruciferous vegetables, carrots, sweet potatoes, and bell peppers, which provide essential nutrients and antioxidants that combat inflammation and support hormonal balance [228]. Based upon observational and epidemiological investigations [135], adding fruits like berries, citrus fruits, apples, pineapple, and kiwi to the diet contributes antioxidants, anti-inflammatory compounds, and enzymes that may reduce the risk of UF growth [229]. Omega-3 fatty acids found in fatty fish, flaxseed, chia seeds, walnuts, nuts, and seeds have anti-inflammatory properties that can modulate inflammation associated with UF development [230]. Incorporating fish and lean meats like skinless chicken and egg whites provides high-quality protein and essential nutrients [231]. By following a comprehensive approach that includes a UF-preventive diet along with exercise, stress management, and medical guidance, individuals can promote gynecological health and potentially reduce the risk of UFs.

In contrast, there are certain food items that women are advised to decrease or eliminate intake as they may potentially worsen the condition. Red meat, particularly processed and unprocessed beef and pork, contains high levels of saturated fats and potentially harmful compounds that can promote inflammation and hormonal imbalances in the body [232]. While more research is needed to establish a definitive link between red meat and UFs, it is generally recommended to maintain a balanced and varied diet with moderate red meat intake [233]. High-fat dairy products, which can contain high levels of estrogen and contribute to inflammation, are also believed to have a negative influence on fibroids. Choosing low-fat or skim dairy products as part of a balanced diet may be beneficial for individuals with UFs [15]. Caffeine, found in coffee, tea, energy drinks, and some sodas, has conflicting evidence regarding its impact on UFs [234]. Some studies suggest an increased risk with high caffeine intake, as caffeine can affect estrogen levels [233]. However, individual responses to caffeine can vary, and reducing caffeine intake may help alleviate symptoms for some women. The relationship between alcohol consumption and UFs is not fully understood, but excessive alcohol intake can lead to hormonal imbalances and impair liver function, potentially impacting hormone levels and UF development or progression. Moderate alcohol consumption may not have significant adverse effects, but excessive or chronic intake can be detrimental to overall health. It is important for women with UFs to discuss alcohol consumption with their healthcare provider to make informed decisions [235,236,237].

The utilization of natural compounds in the prevention and management of UFs holds promise for improved gynecological health. Curcumin, a natural phenol found in turmeric, exhibits anti-inflammatory and antioxidant properties that may have therapeutic potential in managing UFs [238,239,240]. Flaxseed, rich in lignans, is believed to have anti-inflammatory and antioxidant effects that could benefit individuals with UFs [241]. Resveratrol, present in mulberries, peanuts, and grapes [242], shows promise as an anti-fibrotic therapy by reducing ECM-related proteins and inhibiting UF cell proliferation [243,244]. Berberine, derived from plants like Scutellaria barbata, selectively inhibits UF cell proliferation induced by estrogen and progesterone, making it a potential targeted therapeutic option [245,246]. Methyl jasmonate obtained from jasmine plants demonstrates anti-EZH2 activity, suggesting its potential as a UF treatment [247]. Quercetin, found in various fruits and vegetables, modulates UF cell migration and gene expression [248], while sulforaphane, abundant in cruciferous vegetables, inhibits fibrotic processes associated with UFs [249]. Fucoidans, derived from brown seaweeds, exhibit antioxidant and anti-inflammatory properties and may attenuate UF progression [250]. Indole-3-carbinol, commonly found in cruciferous vegetables, regulates ECM components and cellular proliferation in UFs [251]. Isoliquiritigenin, present in licorice family plants, inhibits UF cell proliferation and activates apoptotic pathways [252,253]. Anthocyanins, lycopene, and vitamin A found in fruits and vegetables may contribute to UF prevention, but further research is required [254]. Chinese herbal preparations like Gui Zhi Fu Ling and Nona Roguy show potential in UF management [255,256]. Genistein, derived from soybeans, induces novel cell death pathways in UF cells [257]. Minerals like selenium and magnesium may have therapeutic effects on UFs, while probiotics promote a healthy gut microbiome, potentially reducing UF risk [258]. Incorporating whole grains into the diet may help maintain hormonal balance and reduce UF risk. It is important to consult healthcare professionals for personalized guidance on the usage of these natural compounds for UFs.