Fibroids - Options for Prevention and Treatment

70-80% of women are estimated to have fibroids by the time they're 50 years of age. Leiomyomas, a medical term for uterine fibroids, simply means benign tumours growing the muscle of the uterus. While the majority of women are asymptomatic, and thus don't know they have fibroids, up to 23% of women with fibroids experience debilitating symptoms including: cramping, heavy menstrual bleeding, painful menstruation, painful clotting with menstruation, and prolonged bleeding. Fibroids are also associated with infertility, and anemia.

Causes

Although the causes of fibroids are not clear, there is evidence to support a variety of predisposing factors:

- Genetics - women with a first degree relative with fibroids are more likely to develop them herself. Up to 50% of smooth muscle fibroids have mutations in the HMGA2 gene (a driver of inflammation).

- Epigenetics (factors influencing genes) - are also thought to play a role in development of fibroids, as several tumour suppressing genes are abnormally hypermethylated in uterine fibroids. The epigenetics of environmental influences in pregnancy is of particular interest in recent studies. Bisphenol-A (BPA ) and diethylstilbestrol (DES) have been shown to affect the DNA methylation of uterine stem cells.

- Early age of menarche (earlier than 11 years of age) - Potentially related to the length of time estrogen-sensitive tissues, like your uterus, are exposed to estrogen.

- Pregnancy - Often women who have been pregnant have fewer symptoms of fibroids.

- Greater than 3 cups of coffee a day - Women over 35 years of age who drank more than 3 cups of coffee a day, had an increased risk of developing fibroids.

- Other - possible correlations: poor diet, excess alcohol consumption, environmental toxin exposure (especially those toxins that mimic estrogens), history of uterine infections, other hormone-related diseases.

Treatment

Traditional medical treatment and management of fibroids includes (but is not limited to):

- synthetic hormonal birth control (pills, IUDs)

- chemical hormone blockers (putting you in a suspended state of early menopause)

- non-hormone chemicals to slow bleeding

- ablating (destroying) your uterine lining

- surgery to remove the fibroids (myomectomy)

- removing your uterus altogether (hysterectomy)

When you have fibroids with moderate to severe symptoms, any one of these options may be a viable option.

Can naturopathic medicine offer any relief? The honest answer is: sometimes, but not always. Naturopathic doctors look at the reasons for fibroid growth. The goal is to decrease the size and discourage growth of fibroids. Some of the ways that NDs can help include:

- Helping you identify and eliminate endocrine disruptors in your environment (dryer sheets, fragrances, soaps, air fresheners, plastics, etc.).

- Supporting healthy estrogen metabolism, and elimination with key nutrients and foods (cruciferous vegetables are amazing at this, as well as Diindolemethane, and milk thistle).

- Supporting a healthy microbiome (e.g. fermented foods, probiotics).

- Supporting optimal progesterone output from your ovaries.

- Decreasing inflammation in your body, (by first finding the source of the inflammation), as inflammation exacerbates tumour growth, and pain.

- Looking at emotional and nervous system connections - Many approaches exist including psychology, Eye Movement and Desensitization Reprocessing (EMDR), Emotional Freedom technique, Neuro-Emotional Technique (NET), mindfulness and meditation, and HeartmathTM .

- Introducing lifestyle changes that can decrease inappropriate gene expression, (clean eating, meditation and mindfulness, restorative movement, effective communication).

- Optimizing vitamin D - this is a fantastic area of research. If you can maintain your vitamin D between 40-60ng/ml (approx 100-200nmol/L), you can potentially decrease the growth of fibroids. This requires testing and appropriate individualized dosing.

Research into uterine fibroids is growing as it is a costly expense to the medical system, and is one of the top reasons for missed work days. See a naturopathic doctor to get a complete picture of what your treatment options are.

References

1. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=50

2. Williams, Alistair RW. "Uterine fibroids–what’s new?." F1000Research 6 (2017).

3. Navarro, Antonia, et al. "Genome-wide DNA methylation indicates silencing of tumor suppressor genes in uterine leiomyoma." PloS one7.3 (2012): e33284.

4. Khan, Aamir T., Manjeet Shehmar, and Janesh K. Gupta. "Uterine fibroids: current perspectives." International journal of women's health 6 (2014): 95.

5. Ciebiera, Michał, et al. "Vitamin D and Uterine Fibroids—Review of the Literature and Novel Concepts." International journal of molecular sciences 19.7 (2018): 2051.

6. Yang, Qiwei, et al. "The mechanism and function of epigenetics in uterine leiomyoma development." Reproductive Sciences 23.2 (2016): 163-175.

7. Yang, Qiwei, and Ayman Al-Hendy. "Developmental environmental exposure alters the epigenetic features of myometrial stem cells." Gynecology and obstetrics research: open journal3.2 (2016): e1.

8. Velez Edwards, Digna R., Donna D. Baird, and Katherine E. Hartmann. "Association of age at menarche with increasing number of fibroids in a cohort of women who underwent standardized ultrasound assessment." American journal of epidemiology 178.3 (2013): 426-433.