State of the science and research opportunities on dietary patterns in endometriosis and uterine fibroids

Endometriosis We retrieved 11 studies from six countries, which employedfive different study designs to examine the relationship between dietary patterns and endometriosis from 2012 to 2025. Twelve dietary patterns, organized by low-quality and high-quality, were examined for their association with at least one of five endometriosis-related outcomes, including endometriosis incidence/prevalence, gastrointestinal health, pain perception (dyschezia, dysmenorrhea, dyspareunia, dysuria, and non-menstrual pelvic pain), and QoL. The studies included 25–81,997 participants. Low-quality dietary patterns . An estrogen-associated dietary pattern was established using reduced rank regression in a subsample of par- ticipants from the Nurses ’ Health Study II 49. The dietary pattern including cream soup, alcohol, red meat, pizza, and nuts was positively associated with luteal E2 levels, which is associated with breast cancer 32,49,50. The estrogen-associated dietary pattern and endometriosis diagnosis were tested in 2024 also in the Nurses ’ Health Study II cohort, and the authors reported a significantly lower risk for the fourth (hazard ratio [HR]: 0.85; 95% CI: 0.76 –0.93) and fifth quintiles (HR: 0.82; 95% CI: 0.74 –0.91) versus the first32.T h e s efindings are contrary to expec- tations, given the positive correlation with higher luteal estrogen, and may indicate that exogenous estrogen exposure is not relevant to disease risk 32. Ap r o - i nflammatory diet, de fined via an algorithmic assessment named the Dietary Inflammatory Index (DII), can be used to quantify the inflammatory potential of a person’sd i e t ;ah i g h e rD I Is c o r er eflects greater pro-inflammatory potential33.W ei d e n t ified two studies that investigated a pro-inflammatory diet pattern using a data-driven approach32 and DII51,52 in relation to endometriosis incidence/prevalence32,33. In the Nurses ’ Health Study II, a higher pro-inflammatory diet was associated with a higher risk of endometriosis diagnosis for the third (HR: 1.15; 95% CI: 1.04 –1.28) and fourth (HR: 1.20; 95% CI: 1.08–1.33) versus the first quintile32. In a cross- sectional analysis using data from the U.S. NHANES (1999–2006), Liu et al. reported that individuals in the highest DII tertile (versus lowest) had a 57% higher odds of endometriosis (95% CI: 1.14–2.17)33. These studies suggest that a pro-in flammatory diet pattern, characterized by higher intakes of refined carbohydrates, added sugars, saturated and trans fats, processed meats, and lower intakes of fiber and antioxidant-rich foods, was con- sistently associated with a greater likelihood of endometriosis. This aligns with a key mechanistic pathway in which excessive proin flammatory cytokines may amplify peritoneal immune dysfunction, creating a feedback loop with sex hormone dysregulationand lesion growth that is associated with increased risk of endometriosis 15,32,33,52,53. A Western dietary pattern is characterized by high-fat dairy, fried foods, red and processed meats, processed foods, sugar-sweetened bev- erages, sweets and desserts, and lower intake of fruits, nuts, vegetables, and whole grains 27,32. Using principal component analysis to de fine diet, one U.S.-based prospective cohort study found that consuming a Western dietary pattern was associated with a higher risk of a laparoscopically confirmed endometriosis (15% and 27% higher for the fourth and fifth quintiles, respectively, versus thefirst) 32.T h e s efindings align with evidence that a Western dietary pattern is associated with diminished immune function, which upregulates proinflammatory signaling, heightens inflam- matory activity, and sex hormone dysregulation, including higher E2 levels and lower sex hormone binding globulin levels, consistent with greater consumption of red meat and eggs 27,30,32,54,55. https://doi.org/10.1038/s44294-026-00133-y Review npj Women's Health | (2026) 4:12 2 Table 1 | Dietary patterns, endometriosis, and uterine fibroids Dietary pattern(s) Author; country of participants Study design Participants Outcomes of interest Key findings: ↑ for statistically signi ficant positive associations, ↓ for statistically significant inverse associations, and — for no significant result Endometriosis: 1. AHEI-2010/Harvard Healthy Eating Plate 2. DASH 3. Estrogen-associated pattern 4. Pro-inflammatory pattern 5. Prudent diet 6. Western diet Dougan et al. (2024); U.S32. Prospective cohort study  N = 81,997  Premenopausal  Age: 25–42 years Endometriosis incidence 1. AHEI-2010: ↓ 2. DASH: — 3. Estrogen-associated pattern: ↓ 4. Pro-inflammatory pattern: ↑ 5. Prudent diet: — 6. Western diet: ↑ Alternative Healthy Eating Index Ghoreishy et al. (2025); Iran64 Case-control study  N = 313  Age: 18–49 years Endometriosis prevalence ↓ Endometriosis diet van Haaps et al. (2023); Netherlands48 Cross- sectional study  N = 211  Age: ≥ 18 years old Endometriosis-related QoL: daily functioning, physical functioning, psychological functioning, quality of life, social participation, and spiritual functioning ↓ (reverse measured) 1. Endometriosis diet 2. Low-FODMAP van Haaps et al. (2023); Netherlands47 Non-randomized interventional trial  N = 72  Mean age: Endometriosis diet (39.1 y) Low-FODMAP diet (36.9 y)  Control group (37.6 y)  Presence of endometriosis- related pain symptoms (VAS- score ≥3, 0–10 cm) Endometriosis-related symptoms: 1. Pain perception: bloating, chronic pelvic pain, deep dyspareunia, dysmenorrhea, dysuria, tiredness 2. GI health 3. QoL: children, emotional wellbeing, infertility, medical profession, pain, powerlessness, self- image, sexual intercourse, social support, treatment, and work life Endometriosis diet: 1. Pain perception: bloating ↓ 2. GI Health: — 3. QoL: 2 out of 11 domains (social support and medical profession) ↓ Low-FODMAP: 1. Pain perception: deep dyspareunia ↓ 2. GI Health: — 3. QoL: 1 out of 11 domains ↓ Low-FODMAP Keukens et al. (2025); Netherlands35 Single-arm, interventional trial  N = 47  Age: ≥18 years old  Presence of debilitating GI symptoms Endometriosis-related symptoms: 1. GI symptoms: constipation and bloating 2. QoL: children, emotional wellbeing, infertility, medical profession, pain, powerlessness, self- image, sexual intercourse, social support, treatment, and work life 1. GI symptoms: constipation ↓, and bloating — 2. QoL: 7 of 11 ↓ Low-FODMAP (first phase only) Varney et al. (2024); Australia 36 Crossover feeding trial  N = 40  Age: 18 years to menopause  Presence of poorly managed GI symptoms  Low-FODMAP diet = < 5 g/day FODMAPs  Control condition = 20 g/day FODMAPs Endometriosis-related symptoms: 1. GI symptoms 2. Overall health-related QoL , 1. GI symptoms: ↓ 2. QoL: overall health-related QoL ↓ Gluten-free diet Marziali et al. (2012); Italy 45 Pre-post interventional trial  N = 330  Age: 18–40 years  Presence of pain symptoms Endometriosis-related pain perception: dysmenorrhea, deep dyspareunia, and non- menstrual pelvic pain ↓ MCT-modified ketogenic diet Naeini et al. ( 2025); Iran37 Randomized controlled trial  N = 50  Age: 25–35 years  Presence of pain symptoms Endometriosis-related pain perception: dyschezia, dyspareunia, and pelvic pain Pelvic pain: — Dyschezia or dyspareunia: — Mediterranean diet Cirillo et al. (2023); Italy 34 Interventional trial  N = 35  Reproductive-aged women Endometriosis-related pain perception: dyschezia, dyspareunia, dysuria, and non-menstrual pelvic pain At 3 months, pain perception in all domains: ↓ At 6 months, dyspareunia ↓ and dyschezia ↓ https://doi.org/10.1038/s44294-026-00133-y Review npj Women's Health | (2026) 4:12 3 Table 1 (continued) | Dietary patterns, endometriosis, and uterine fibroids Dietary pattern(s) Author; country of participants Study design Participants Outcomes of interest Key findings: ↑ for statistically signi ficant positive associations, ↓ for statistically significant inverse associations, and — for no significant result MIND diet Noormohammadi et al. (2025); Iran46 Case-control study  N = 313  Age: 18–49 years Endometriosis prevalence ↓ Pro-inflammatory diet Liu et al. (2023); U.S 33. Cross- sectional study  N = 3410  Median age [IQR]: 40.0 years [32.0, 47.0] Endometriosis prevalence ↑ Uterine fibroids: Vegetarian diet Lee et al. (2022); Taiwan 74 Prospective cohort study  N = 1997  Premenopausal women with complete data  Age: 30–59 years Uterine fibroids prevalence — Summarizes the dietary patterns, study characteristics, participant demographics, outcomes of interest, and direction of associations across the literature included in this review. Symbols indicate statistically significant positive associations (↑), inverse associations (↓), or null findings (—). Acronyms: AHEI-2010: Alternative Healthy Eating Index-2010. DASH: Dietary Approaches to Stop Hypertension. EHP-30: Endometriosis Health Pro file-30 is a quality of life (QoL) assessment tool, range 0 –100, 0 = best possible health status. GI Health: gastrointestinal health. IQR: interquartile range (25th –75th percentiles). Low-FODMAP: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. MCT-modified ketogenic diet: Medium-Chain Triglyceride (MCT)-modi fied ketogenic diet. MIND diet: Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. QoL: quality of life measured using ‘My Positive Health’, a non-validated tool for endometriosis QoL, scale 0 –10, 10 = best possible health status. https://doi.org/10.1038/s44294-026-00133-y Review npj Women's Health | (2026) 4:12 4 High-quality dietary patterns . The Dietary Approaches to Stop Hypertension (DASH) diet was developed to treat hypertension 56 and includes low-fat/fat-free dairy products, beans, nuts, and vegetable oils, while limiting foods high in saturated fat (e.g., full-fat dairy), tropical oils (e.g., coconut, palm), sodium to 1500 mg/day, sugar-sweetened bev- erages, and sweets 56,57. We identi fied one prospective cohort study investigating adherence to the DASH diet and endometriosis incidence32. No statistically signi ficant association was observed between those quintiles of the DASH eating pattern and endometriosis 32. The findings were contrary to hypotheses, given that a DASH diet is associated with lower inflammation and improved metabolic health 58. The endometriosis diet is an avoidance dietary pattern, popular among women experiencing pain in the Netherlands 48. In general, the pattern recommends avoidance of red meat, gluten, cow’s milk, sugars, nutrients high in estrogen (e.g., soy), and limiting caffeine to 200 mg/day47,48.E v i d e n c e consists of one cross-sectional study and one non-randomized interven- tional trial with a control group. In t he cross-sectional study, higher QoL scores (range 0 –10, 10=most positive health) across six domains were reported among participants who adhered to the endometriosis diet (versus not)48. In the interventional trial, the d iet was associated with lower pain perception from bloating (mean difference [MD]: −0.99; 95% CI: −1.94, −0.04), and lower scores for 2 of 11 Q oL domains (social support MD: −15.47; 95% CI: −23.89, −7.06, medical profession MD:−18.71; 95% CI: −32.79, −4.63) [range 0–100, 0 = best possible health status], compared to controls47. Given the absence of a standardized approach to following the diet, the existing studies do not provide suf ficient evidence to propose a specific mechanistic pathway to support the improved symptoms47. A gluten-free diet restricts gluten, a protein found in barley, malts, rye, and wheat (e.g., pasta, bread) 59,60.W ei d e n t ified a single-arm, pre-post interventional trial that examined the association between a gluten-free diet and pain perception for dysmenorrhea, deep dyspareunia, and non- menstrual pelvic pain. Marziali et al. found that adhering to a gluten-free diet was associated with lower pain perception among 75% of patients, while 25% reported no change, and no patient reported higher pain perception 45. Gluten avoidance may reduce intestinal permeability, which in turn may lower immune activation 61 and the cytokine-driven nociceptive pain sig- naling in endometriosis62. The Alternative Healthy Eating Index (AHEI) quantifies adherence to the Harvard Healthy Eating Plate (HHEP)63.I nt h eA H E I ,c o n s u m p t i o no f alcohol, sweetened beverages, long-chain fatty acids, polyunsaturated fatty acids, trans fats, fruits, red and processed meats, sodium, and vegetables is scored from 0–10 (none to optimal consumption, respectively, score range: 0–110) 32.W ei d e n t ified two studies that examined the AHEI and the like- lihood of endometriosis32,64. One prospective cohort study found that a higher AHEI-2010 score was associated with a lower risk of endometriosis (HR: 0.87; 95% CI: 0.78 –0.96) in the fifth versus first quintile 32.Ac a s e - control study observed that each one-unit increase in the AHEI score was associated with 19% lower odds of endometriosis (95% CI: 0.78–0.88) 64.T h e protective effect of the HHEP32 is likely linked to two mechanisms. First, attenuation of inflammatory burden, achieved through lower circulating inflammatory markers as a result of the antioxidant-rich foods characteristic of higher AHEI scores 64. The second mechanism is the facilitation of estrogen metabolism; as Fung et al. report, higher AHEI scores were asso- ciated with lower E2 and higher sex hormone-binding globulin levels, a hormone which binds and inactivates estrogens 55. The low-FODMAP (fermentable oli gosaccharides, disaccharides, monosaccharides and polyols) diet eli minates short-chain carbohydrate foods, which are poorly absorbed by the small intestine and can result in gastrointestinal symptoms 35,65. The second phase reintroduces foods indi- vidually to determine tolerance, and phase three maintains the personalized plan, including tolerated high-FODMAPs 35,66.H i g h - F O D M A Pf o o d s include asparagus, cauliflower, mango, nectarines, cow and soy milk, most legumes, some seafood, wheat bread, honey, and cashews67.W ei n c l u d e d three studies: one crossover feeding t rial, one non-randomized interven- tional trial with a control group, and on e single-arm, interventional trial, which examined the association o f a low-FODMAP dietary pattern on gastrointestinal health, QoL, and pain perception 35,36,47. In the crossover feeding study by Varney et al., a low-FODMAP diet (<5 g/day FODMAPs) was associated with a decrease in gastrointestinal symptoms among 60% of participants compared to only 26% of participants who consumed the control condition (20 g/day FODMAPs), both modeled on the Australian dietary guidelines 36. In the non-randomized interventional trial by van Haaps et al., there was no improvement in GI health following the diet47.T h e single-arm, interventional trial by Keukens et al. reported lower constipation scores (7.0 at baseline and 5.0 at di et completion) following the low- FODMAP diet, with no statistically signi ficant association reported for bloating35. Related to QoL, Varney et al. reported improvement from baseline (median: 55.6; 95% CI: 48.0, 62.0) for participants on the low- FODMAP diet (median: 45.3; 95%; CI:29.6, 50.9) compared to the control condition (median: 47.1; 95% CI: 37.8, 56.7), although the results did not reach statistical significance based on the trial’sap r i o r ip - v a l u eo f0 . 0 136.v a n Haaps et al. reported a lower score in one out of 11 domains observed (MD: 17.14; 95% CI: -31.27, -3.00) compared to controls 47. Keukens et al. reported lower scores in 7 of 11 domains, compared to baseline ( p values≤ 0.001–0.04)35. The non-randomized interventional trial by van Haaps et al. was the only study to examine pain perception, and reported significantly lower scores for deep dyspareunia, one of the six domains assessed (MD:−1.15; 95% CI: −2.2, −0.10) 47.B e n efits of a low-FODMAP diet may re flect the reduction of fermentable carbohydrate load, which decreases intestinal distension and limits immune activation in the gut 68. Fermentable carbohydrates can also have positive health benefits and sup- port immune balance; therefore, restriction and reintroduction should be individualized69. The Medium-Chain Triglyceride (MCT)-modified ketogenic dietary pattern focuses on high-fat and protein foods, and low-carbohydrate intake with the addition of MCTs as a fat source37,70. In a randomized controlled trial, Naeini et al. tested a 70–80% fat, 15–20% protein, and 5–10% carbo- hydrate diet supplemented with 500 ml of MCT oil over three days, every three weeks for the 12-week intervention as adjunct therapy to traditional treatment with an oral contraceptive pill 37. Women were randomized by endometriosis stage (I or II) and diet (MCT-modi fied ketogenic diet or control diet), then assessed for dyschezia, dyspareunia, and pelvic pain36. There was no statistically significant effect on these domains between par- ticipants randomized to the MCT-modi fied ketogenic diet group when comparing mean differences to the control group37. Within-group differ- ences were examined, and a decrease i n all pain perception domains was observed in both groups. While this study did not observe an association between groups, the MCT-modified ketogenic diet can increase ketone body production, which is associated with lower systemic inflammation in other contexts 37,70. A Mediterranean dietary pattern is characterized by high intake of beans, minimally refined breads and cereals, fruits, nuts, olive oil as the main fat, seeds, and vegetables; moderate consumption of dairy, eggs,fish, poultry, and red wine; and low consumption of red meat 71. One Italian-based interventional trial examined the association of consuming a Mediterranean diet and pain perception 34. Cirillo et al. observed lower pain perception scores in all domains compared to baseline; dyschezia, dyspareunia, dysuria, and non-menstrual pelvic pain at three months, with continued lowering of scores in two domains (dyspareunia and dyschezia) after six months of following the diet 34. It is possible that thefiber, antioxidants, and healthy fats characteristic of a Mediterranean diet support immune regulation, reduce inflammatory activity, and promote sex hormone metabolism through improved fecal excretion of excess estrogen and increased sex hormone binding globulin production 34,71,72. Researchers combined the Mediterranean and DASH diets to promote brain health for Alzheimer ’s patients, resulting in an anti-in flammatory pattern low in fat and sodium, high in fiber, with an avoidance of pro- inflammatory foods such as butter, fried foods, red meat, and sweets known as the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet 46. In one case-control study from Iran, with each one-unit https://doi.org/10.1038/s44294-026-00133-y Review npj Women's Health | (2026) 4:12 5 increase in MIND score, there was a 47% lower odds of endometriosis (odds ratio [OR]: 0.53; 95% CI: 0.42 –0.67)46.T h i sfinding is consistent with the biological plausibility described above for the Mediterranean diet; moreover, features of the MIND diet further enhance potential results, as the DASH addition is even stricter in its restriction of red meats and high-fat inflam- matory food items, which directly correlate to sex hormone homeostasis 34,46,58,71. A prudent diet is characterizedby higher intake of legumes,fish, fruit, vegetables, and whole grains, and lower intake of high-fat dairy, fried foods, red and processed meat, processed foods, sugar-sweetened beverages, sweets, and desserts 32,73. In a U.S. prospective cohort, principal component analysis was used to de fine the prudent diet, and the pattern was not associated with reduced risk of endometriosis 32.T h i sfinding was unex- pected, as Chandler et al. observed metabolic signatures associated with the Fig. 1 | PRISMA flow diagram for dietary patterns and endometriosis study selection. Illustrates the identification, screening, and inclusion of studies evaluating dietary patterns in relation to endometriosis conducted in Covidence. Two duplicate records were removed before screening, titles and abstracts were reviewed for relevance, and a review of full texts assessed eligibility. Acronym: PRISMA: preferred reporting items for systematic reviews and meta-analysis https://doi.org/10.1038/s44294-026-00133-y Review npj Women's Health | (2026) 4:12 6 prudent dietary pattern consistent with anti-inflammatory and antioxidant properties73.F u r t h e r ,h i g hfiber in this diet may plausibly have sex hormone- regulating benefits as described earlier72,73. Uterine fibroids The search yielded one Taiwanese study that analyzed adherence to a vegetarian dietary pattern with uterine fibroid prevalence from 202274.A vegetarian diet ( https://www.nal.usda.gov/human-nutrition-and-food- safety/vegetarian-nutrition) is typically characterized by plant-based foods, including fruits, beans and pea s, grains, nuts, and vegetables, and generally excludes animal products such as meat, poultry, and seafood. The study utilized a national biobank database with demographic and lifestyle information, and matched participant info to their disease diagnosis through the national health insurance research database 74.T h e r ew a sn o Fig. 2 | PRISMA flow diagram for dietary patterns and uterine fibroids study selection. Depicts the identi fication, screening, and inclusion of studies evaluating dietary patterns in relation to uterine fibroids conducted in Covidence. One duplicate record was removed prior to screening, title and abstracts were reviewed for relevance, and a review of full texts evaluated eligibility. Acronym: PRISMA: preferred reporting items for systematic reviews and meta-analysis. https://doi.org/10.1038/s44294-026-00133-y Review npj Women's Health | (2026) 4:12 7 statistically significant association between self-reported vegetarian diet adherence and fibroids prevalence (OR: 1.09; 95% CI: 0.77–1.55)74.W h i l e Barnard et al. state that a vegetarian diet is associated with sex hormone metabolism driven by elevated levels of sex hormone binding globulin 75,a n d there are many health benefits associated with the pattern76, a vegetarian diet is not inherently higher quality and can include low-quality processed foods. For example, Hargreaves et al. identified over 10 patterns ( e.g., lactovege- tarian, semi-vegetarian) 77, and the Academy of Nutrition and Dietetics notes that vegetarian diets may reduce intakeof certain nutrients, and underscores the need to follow nutritional guidelines to avoid deficiencies78.

We identified 11 studies examining dietary patterns and endometriosis, and one study examining dietary patterns and uterinefibroids. This indicates a paucity of studies examining the role of dietary patterns in these all-too- common uterine health conditions. This was surprising, given the diet ’s relationship to inflammation, metabolic health, and obesity, all of which contribute to the development and severity of both conditions. Of the five observational studies identified, associations were mixed. Diets with higher in flammatory potential (e.g., Western diet) were asso- ciated with a higher likelihood of endometriosis32, whereas higher adherence to dietary patterns deemed high-quality (e.g., HHEP/AHEI) was associated with a lower likelihood32,46,64. Common limitations included selection and recall bias, measurement error, residual or unmeasured confounding, and temporality limitations32,33,46,48,64,74.I nt h eu t e r i n efibroids study, there was a lack of strati fication of vegetarian status by age, a limitation given the potential variation in disease prevalence with menopausal status74. Six interventional studies also showed mixed results. Avoidance patterns (e.g., gluten-free) reported better QoL and lower pain perception 35,45,47. Similarly, the low-FODMAP trials consistently improved QoL and lower pain perception 35,36,47. A Mediterranean diet intervention had minimal effects on pain 34. There are several limitations to the interventional trials, incl uding heterogeneity and mostly non- randomization, with small samples, short follow-up, and variable protocols. Further limitations include participant diet self-selection in the van Haaps study 47, unassessed effectiveness of blinding in the Varney crossover feeding trial 36, and very narrow age inclusion criteria with a high drop-out rate in the only randomized controlled trial 37. Notably, there was no dietary pattern-focused interventional trial among women with uterine fibroids. The existing evidence reviewed begins to suggest that high-quality dietary patterns rich in antioxidants and anti-inflammatory compounds are associated with a lower prevalence and symptom severity of endometriosis; conversely, some low-quality dietary patterns may be associated with higher prevalence and more severe symptomology. However, research on uterine fibroids remains extremely limited, while endometriosis findings offer a conceptual framework for future research. Qualitative analysis is necessary to center the perspectives of women living with endometriosis and uterinefibroids, and the clinicians who care for them. Through interviews and focus groups studies should examine 1) patient thoughts and interest in dietary interventions to manage symptoms, 2) patient perceptions of feasibility and acceptability of following a dietary pattern, and 3) clinician views on implementing dietary strategies in the context of clinical care. Rigorously designed randomized controlled trials are needed to understand what dietary patterns positively affect symptoms and the QoL of women suffering from endometriosis and uterinefibroids. Future studies must recruit partici pants representative of national racial, ethnic, and socioeconomic populations with intentional inclusion of multicultural women. Stratification by insurance status may further clarify how access to, and navigation across the continuum of endometriosis and uterine fibroid care intersect with structural, upstream exposures, and individual behavior to shape diagnosis, progression, treatment, and out- comes. This approach would provide a more comprehensive understanding of the modi fiable factors that shape uterine health in the U.S. to inform policy, prevention, and equitable delivery of food as medicine in clinical practice.

In this review, we used the following search terms to assess the current research available for dietary patterns and 1) endometriosis and 2) uterine fibroids solely in PubMed: ( “diet” [mesh] OR diet *[tiab]) AND (Endo- metriosis[tiab] OR “endometriosis” [MeSH]) and ( “diet” [mesh] OR diet*[tiab]) AND (Leiomyoma[tiab] ORfibroid*[tiab]), see Figs.1–2.T h e inclusion criteria for both searches included English-language, peer- reviewed studies of women aged 18 –64, in any geography/publication year. The search for dietary patterns and endometriosis yielded 413 studies, of which two duplicates were removed, 308 were irrelevant per title/abstract screening, 92 were excluded in full-text review, and 11 were extracted. Dietary patterns and uterine fibroids generated 178 studies, of which one duplicate was removed, 150 were irrelevant per title and abstract screening, 27 were excluded in full-text review, and one study was extracted. Screening and extraction were conducted by a single reviewer utilizing a pre- designed form. Data availability No datasets were generated or analysed during the current study. Code availability Not applicable. Received: 17 September 2025; Accepted: 6 February 2026;

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