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Science 302 , 19636, doi:10.1126/science.1091176 (2003)

Factors that increase estrogen activity include: Low Sex Hormone Binding Globulin (SHBG), which can be caused by blood sugar dysregulation and higher insulin production, allowing higher free estrogen Xenoestrogen exposure (environmental endocrine disruptors like BPA from plastic) Excess adipose (fat) tissue (aromatase activity converts androgens to estrogen in fat cells) Impaired hepatic estrogen metabolism Chronic Inflammation Fibroid tissue has a distinct inflammatory microenvironment