On Fibroids & How to Manage Them
Fibroids, otherwise known as leiomyomas, are benign growths in the uterus. Where in the uterus they are found will determine the specific type - intramural, submucosal, subserous, etc. Despite how common they are, there is still no clear cause for why they appear but we do understand certain contributing factors. There does seem to be a genetic component. If you have a family history of fibroids, you will be more likely to have them. Black women are also more likely to have fibroids than women in any other racial group. And then there’s the hormonal factor. We know that fibroids are largest and most “symptom causing” during child-bearing years; they shrink after menopause. So how big are they? They generally vary in size from a walnut to an orange though some women have had ones much larger. Surgical interventions keep us from seeing significantly large ones these days but they can vary in size and as they grow, they can create the appearance of a pregnancy in women.
While they can be asymptomatic, growth of these masses generally causes pain and heavy periods (and consequently anemia), abnormal bleeding, back pain and - depending on where they are located - they can also contribute to pain during intercourse. Fibroids can also interfere with fertility and can contribute to complications during pregnancy.
If they are small enough, fibroids may not cause any symptoms at all. They might be discovered incidentally during your annual pelvic exam. Whatever prompts their discovery, imaging such as an ultrasound or MRI may be required to determine the size, location and total number of fibroids in order to figure out the best treatment options.
While a hysterectomy used to be the treatment of choice for women suffering from fibroids, there are now more options. There are some prescription interventions, but they are limited to either addressing the symptoms (ie Tranexamic acid to ease heavy menstrual bleeding) or stimulating early menopause (gonadotropin-releasing hormone agonist such as Lupron) for the sake of improving symptoms (while, unfortunately, creating others!). There are several different procedures that are far less invasive than a hysterectomy. Options such as MRI-guided ultrasound surgery, uterine artery embolization, myolysis and endometrial ablation are some of the possibilities your doctor might discuss with you if you’re dealing with the diagnosis of fibroids. The feasibility, risks and possible complications of these procedures depend heavily on the number of fibroids present and where they are located. Combine this with a woman’s family planning goals and the age factor and you can see that the “best” path forward is often unclear. This is part of what makes treating fibroids so complicated. Even if they are removed, this does not guarantee that new ones won’t form. Which is why, as a Naturopathic Doctor, I believe that looking more closely at a woman’s hormones and what can be done from a dietary and supplement approach is an important first step in treating fibroids.
While no diet will fix fibroids, we know that certain foods can impact our hormones. Given that fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells, it stands to reason that what we eat can influence their size to some extent. Generally speaking we know that an anti-inflammatory diet can decrease heavy menstrual flow. And improving digestion will help promote the detoxification work of the liver. The liver is responsible for recycling our hormones and breaking down the environmental toxins we come in contact with, some of which have been found to influence our hormones in certain ways. Because it is important to support these important jobs of the liver, it is best not to overly tax it by consuming alcohol or heavily processed foods.
The liver also can’t carry out its important metabolic processes without sufficient B vitamins. Whole grains are excellent sources of B vitamins and also help provide fiber necessary for elimination of hormone metabolites.
Other foods to be sure to include:
Soy is a phytoestrogen meaning that it can act estrogenic or anti-estrogenic as needed. Soy Isoflavones appear to have a weak anti-estrogenic effect on the uterus. Only opt for organic, non-GMO soy and keep your intake moderate.
Cruciferous vegetables such as broccoli, cauliflower, cabbage and brussel sprouts - Cruciferous vegetables contain indole-3-carbinol which helps with estrogen metabolism.
Cold water fish High in omega-3 fatty acids, eating cold water fish 2-3 times a week helps to mitigate inflammation.
Foods to limit:
Dairy Be sure your dairy products do not contain exogenous hormones. Buy organic and grass-fed if & when possible or look for a label that indicates no growth hormone was used.
Meat Animal products are generally higher in omega-6 fatty acids, as well as saturated fats. When we have too much meat in our diet, our balance of omega fats tilts towards a pro-inflammatory state. Buy organic, grass-fed when and if possible.
Supplements & Herbs
Because fibroids are so hormonally driven, optimizing your health by identifying and treating any nutrient deficiencies will benefit this condition in the long term. The interplay between hormones and the cyclical nature of their levels, mean that a good supplement plan should ideally be determined by working with a well trained provider who can best identify the nutrient support that your body needs. There are a couple supplements worth considering for most women dealing with hormonal imbalance issues.
Calcium D-Glucarate helps the bacteria in your gut to break down and eliminate your excess estrogens.
Vitamin D: low levels have been found to contribute to growth of fibroids so have your levels checked and supplement as needed.
In botanical medicine, there are many herbs that we use as uterine tonics to strengthen the uterus and promote healthy blood flow that can reverse the growth of fibroids. The success of natural treatments for fibroids varies considerably, but there are women for whom herbal formulas have helped them to successfully shrink their pelvic masses. It is best to work with a Naturopathic Doctor or Herbalist to pursue this kind of treatment but some herbs to consider incorporating for their tonifying qualities include:
From a hormonal perspective, fibroids are thought to grow in an “estrogen dominant” state. The initial follicular phase of your menstrual cycle is when your progesterone levels are low and your estrogen levels are higher. In the second half of the cycle, the luteal phase, your progesterone levels are supposed to rise above your estrogen levels. The exogenous estrogens in our food and hormone disrupters in our environment can push us into a more estrogen dominant state which can contribute to the growth of fibroids and exacerbate the symptoms they cause. Doing blood or urine test of your hormones can be a helpful way to address if this is a contributing piece of your symptom picture.
Fibroids are no fun but focusing on healthy living and self-care will help. A prospective study published in the European Journal of Obstetrics and Gynecology Reproductive Biology in 2014 found that complementary interventions for women with fibroids, including exercise, dietary interventions, herbs and acupuncture, significantly improved symptoms with few side effects. Complementary medicine abounds with different approaches for hormonal imbalance issues so look to our ancient medical systems for more insights on promoting pelvic health.
Brakta S, Diamond JS, et al. Role of vitamin D in uterine fibroid biology. Fertil Steril. 2015; 104(3): 698-706
- Ciebiera M, Lukaszuk K, et al. Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids - An Up-to-Date Review. Int J Mol Sci. 2017; 18
Jacoby VL, Jacoby A, et al. Use of medical, surgical and complementary treatments among women with fibroids. Eur J Obstet Gynecol Reprod Biol. 2014; 182: 220-5
Warshowsky A. Healing Fibroids: A Doctor’s Guide to a Natural Cure. New York: Fireside, 2002