At age 46, after years of problem-free periods, Denise suddenly started experiencing extreme bleeding every month, “enough that I would have to wear a heavy pad and a tampon, and change them every hour or two,” she recalls. A sonogram revealed uterine fibroids; a blood test confirmed anemia. The recommendation: hysterectomy. “But that seemed overkill to me,” Denise says. “I did some research and found that estrogen feeds fibroids. Being so close to menopause, I figured I should try to find a stop-gap treatment until my estrogen dropped naturally and the fibroids would shrink on their own.”

Uterine fibroids—benign tumors that grow inside or outside the uterus and that range from tiny and unnoticed to enormous and problematic—affect up to 80 percent of women, most commonly between age 30 and 40, and are the reason behind nearly 39 percent of all hysterectomies, according to the American College of Obstetricians and Gynecologists. “The jury’s still out” on why fibroids form, says Svetlana Kogan, MD, a holistic internal medicine specialist in New York, but several factors may contribute, including genetics, diet, and excess or “misappropriated” estrogen.

While it’s nearly impossible to eliminate fibroids entirely without surgery, natural therapies, such as reducing or balancing estrogen, improving circulation, and managing stress, can mitigate symptoms. “Knowing what a normal, healthy menstrual cycle looks like is the first step,” says Aimee Raupp, New York–based licensed acupuncturist, herbalist, and author of Chill Out and Get Healthy (Penguin, 2009). Then, keep track of changes, such as abdominal cramping, heavy menstrual bleeding, dizziness, palpitations, unusual fatigue, lack of sexual drive, or painful intercourse. If you experience something out of the ordinary, see your doctor. “A lot of fibroids caught earlier on can be dealt with quite easily, but often they’re not identified until they’re too big and causing issues,” says Raupp.

“Hysterectomy should be used as a last resort for women who have tried everything under the sun alternatively,” adds Kogan. “If all else fails and a woman is losing a lot of blood, and if that woman already has a child or knows she doesn’t want a child, then she could consider it. Fortunately, only a very, very small percentage of people belong to that category.”

See a qualified complementary and alternative medicine practitioner for therapies specific to your case, and keep in mind that gentle, natural treatments are not quick fixes—but they can work over time to bring your body into balance and health.

Eat organic, and limit estrogen-mimicking chemicals

“One of the first things I urge women to do is to eat as organic as possible because anything that’s not organic has pesticides, which can mimic estrogen,” says Raupp. This especially includes conventionally produced meat, eggs, and dairy products. In addition, keep an eye on external estrogen sources, such as BPA-based plastics, which cause hormone disruption; and because estrogen accumulates in fatty tissue, keep weight in check. Support your body’s estrogen-eliminating system—the liver—by focusing on leafy greens, grains, and antioxidant-rich vegetables and fruits, and avoid stressing the liver with too much alcohol, sugar, or caffeine. Although some experts warn patients to avoid soy and soy products such as tofu, tempeh, or soymilk due to phytoestrogens (estrogen-like compounds found in plants), recent studies suggest that there actually may be an inverse relationship between phytoestrogen consumption and fibroids.

Get herbal and homeopathic relief

“I’m a big believer in sitz baths,” says Kogan. She recommends sitting in a hot bath once or twice a day, adding one packet of Aveeno milled oatmeal or a couple of granules of potassium permanganate (available from homeopathic pharmacies), both of which works as anti-inflammatories. She also advises vitex or chasteberry, traditional herbal remedies “for helping people who have estrogen irregulation: either too much estrogen or a body that doesn’t know what to do with the estrogen.” The combination of sitz baths and chasteberry supplements, she says, can help shrink fibroids and decrease inflammation in surrounding tissue. “I’d give [chasteberry and sitz baths] a trial of two months,” says Kogan. “If conditions don’t improve you can resort to acupuncture, which is a little more expensive.” Other anti-inflammatory herbs used for uterine issues include dong quai, ginger, turmeric, and mullein. Because each woman’s hormone profile is unique, it’s important to see a qualified practitioner for recommendations and doses.

Try acupuncture or Mayan massage

An ancient modality, acupuncture works to reduce fibroids by increasing blood flow and circulation to the lower abdomen and then throughout the entire body, says Raupp. “Generally speaking, a woman with fibroids should expect to undergo at least three months of acupuncture, once per week, plus herbal therapy to see the fibroids and her menstrual cycle change. Fibroids vary a great deal, so depending on size and the patient’s compliance following herbs and other lifestyle modifications, it may take more or less time.” At Kogan’s practice, a board-certified acupuncturist uses a series of eight to ten treatments, twice per week for one month, to improve pelvic circulation, in conjunction with massage to the lower back and upper legs to stimulate release and elimination of toxins through the lymphatic system.

Arvigo, or Mayan abdominal massage, is a noninvasive, hands-on approach specific to healing the reproductive and digestive organs. “You need to find a specialized practitioner; often they’re nurse-practitioner midwives,” says Raupp. “The gentle, Arvigo-style manipulation of the tissues and muscles of the lower abdomen helps to improve blood flow and circulation to the reproductive organs, break up adhesions, and improve the overall health of the tissues in the abdominal area. Again, the length of treatment will vary depending on the patient’s fibroids.” Go to arvigomassage.com for more information and to find a practitioner near you.

Heal your emotions

“In Chinese medicine gynecology, there are a lot of energy pathways running through the uterus that definitely are affected by emotions,” Raupp says. “If you’re not expressing emotions completely, that’ll create stagnation, and that can cause an accumulation of substances in certain areas, like fibroids. And then you have to explore that and deal with it.” Stress, too, may play a significant role. “Every woman has a weak spot, and because stress causes hormonal fluctuations, for some women it could manifest in fibroids,” says Kogan. If this strikes a chord with you, consider consulting a licensed acupuncturist or someone trained in energy-medicine, such as a Reiki or qigong practitioner.

Less invasive options for fibroids

• Endometrial ablation.To end heavy bleeding, several outpatient methods exist for removing the uterine lining through the vagina. Ask your gynecologist to detail these different techniques, including microwave, balloon, and hot- or cold-water ablation.

• Hysteroscopic myomectomy (also called resection).Some fibroids can be removed directly through the vaginal opening and cervix, using a scope that allows the doctor to see exactly what he or she is doing. Laparoscopic myomectomy (using tiny abdominal incisions) is also available for smaller fibroids.

• MRI-guided focused ultrasound surgery (FUS).This technique uses high-intensity ultrasound waves to destroy fibroids. Results look promising, but no long-term studies on this method or possible fibroid recurrence yet exist.

• Uterine artery embolization (UAE).A recent and specialized technique, this entails a radiologist inserting miniature granules that block blood flow to the fibroid. UAE may not be appropriate for submucosal fibroids (bulging into the inner cavity of the uterus) because dead tissue can detach into the uterus, causing infection and possibly requiring later removal.