Fibroids

uterine fibroids leiomyoma myomatous uterus
Uterine Fibroids

What are uterine fibroids?

Fibroids, also called leiomyoma, are benign but abnormal tissue growths that can contribute to infertility by causing the inside of the uterus to be misshapen, impeding healthy implantation.  Fibroids can protrude into the uterine cavity (submucosal), can be embedded in the wall of the uterus (intramural) or protrude into the abdominal cavity (subserosal).  They are extremely common and occur in almost 70% of women of reproductive age.

What causes uterine fibroids?

The prevailing theory as to the cause of fibroids is that they are caused by a combination of inflammation-caused cell proliferation and hormonal imbalance. Traditionally they have been thought to be the result of too much estrogen.  Although more current thinking supports the notion that excess estrogen and/or progesterone may promote the growth of fibroids.

What are the symptoms of fibroids?

Symptoms of fibroids may include:

  1. A feeling of pressure in your lower abdomen
  2. On pressing on your abdomen you may be able to feel a solid mass
  3. Heavy bleeding with your period
  4. Infertility
  5. Your abdomen may protrude or look pregnant
  6. A feeling of pressure on your bladder or urinary frequency
  7. Iron deficiency anemia due to the heavy menstrual bleeding

What is the conventional fibroid treatment?

Depending on the individual patient the following your doctor may recommend:

  1. Surgery – myomectomy (removal of the fibroid(s)) or hysterectomy (removal of the uterus)
  2. Uterine artery blockage (embolization) – to shut down blood supply to the fibroids
  3. Gonadotropin-releasing hormone analogue (GnRH-a) – for example Lupron, to decrease estrogen-related fibroid growth
  4. Selective progesterone receptor modulators (SPRM) – for example Fibristal, to moderate progesterone-related fibroid growth

These treatments can all be effective for easing the symptoms of fibroids.  However, hysterectomy is obviously not the preferred method of treatment for women who wish to conceive. Embolization is only recommended in specific circumstances and is not a good choice for women who may wish to get pregnant afterwards.  GnRH-a works while taking it but can cause menopause-type symptoms, bone loss (osteopenia) and while sometimes used prior to IVF, while you are taking it it would lower your fertility.  SPRMs have historically been used as emergency contraceptive pills.  They are usually used prior to fibroid surgery.  Studies on long term use of these medications are ongoing.

What is the naturopathic treatment for fibroids?

Address the two main components contributing to fibroids: inflammation and hormone imbalance.

Inflammation:

These are significant contributors to inflammation: insulin, hormones, environmental pollutants and food sensitivities.  Correcting these through a healthy diet, exercise, vitamins, minerals and herbs can help decrease fibroids.  Berberine is an effective agent at reducing estrogen and progesterone related cell proliferation in fibroids and also helps lower insulin.

Hormone imbalance:

As a naturopathic doctor, I enhance estrogen clearance through supporting phase I and phase II liver detoxification with the appropriate vitamins, minerals and amino acids in their active forms.  I normalize estrogen production and activity through diet, exercise and stress reduction.  I can enhance progesterone production through supplemental vitamin B6 and herbs like Vitex.  Herbs help to balance progesterone if it is excessive.

The benefits of my approach to fibroids are that the underlying imbalances are being addressed.  This provides more lasting improvement, lowers recurrence rates, eliminates toxins and enhance fertility at the same time. The hormone imbalances that contribute to the formation of the fibroids is corrected to optimize fertility.

References:

Park SB, Jee BC, Kim SH, Cho YJ, Han M. Cyclooxygenase-2 inhibitor, celecoxib, inhibits leiomyoma cell proliferation through the nuclear factor κB pathway. Reprod Sci. 2014 Sep;21(9):1187-95. doi: 10.1177/1933719114542010. Epub 2014 Jul 6.

Tsigkou A, Reis FM, Lee MH, Jiang B, Tosti C, Centini G, Shen FR, Chen YG, Petraglia F Increased progesterone receptor expression in uterine leiomyoma: correlation with age, number of leiomyomas, and clinical symptoms. Fertil Steril. 2015 May 22. pii: S0015-0282(15)00297-6. doi: 10.1016/j.fertnstert.2015.04.024. [Epub ahead of print]

Vilos GA, Allaire C, Laberge PY, Leyland N; Special Contributors, Vilos AG, Murji A, Chen I. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015 Feb;37(2):157-81.

Carranza-Mamane B, Havelock J, Hemmings R; Reproductive Endocrinology and Infertility Committee, Cheung A, Sierra S, Carranza-Mamane B, Case A, Dwyer C, Graham J, Havelock J, Hemmings R, Liu K, Murdock W, Vause T, Wong B; Special Contributor, Burnett M. The management of uterine fibroids in women with otherwise unexplained infertility. J Obstet Gynaecol Can. 2015 Mar;37(3):277-85.

Wu HL, Chuang TY, Al-Hendy A, Diamond MP, Azziz R, Chen YH. Berberine inhibits the proliferation of human uterine leiomyoma cells. Fertil Steril. 2015 Apr;103(4):1098-106. doi: 10.1016/j.fertnstert.2015.01.010. Epub 2015 Feb 14.

Teixeira D, Marques C, Pestana D, Faria A, Norberto S, Calhau C, Monteiro R. Effects of xenoestrogens in human M1 and M2 macrophage migration, cytokine release, and estrogen-related signaling pathways. Environ Toxicol. 2015 May 26. doi: 10.1002/tox.22154. [Epub ahead of print]