Fibroids, also call myomata uteri, myomas or leiomyomas, are benign growths found in a woman’s uterus. These growths can range in size from microscopic to as large as a soccer ball or more. They can occur as a solitary growth, or a collection of dozens. They can occur inside of the uterine cavity (submucous fibroids), within the muscle wall of the uterus (intramural fibroids), bulging through the outer surface of the uterus (subserous fibroids) or even hanging outside the uterus by a stalk (pedunculated fibroids).
Who Gets Fibroids?
Virtually all women are at risk for growing fibroids. Since they require the hormones estrogen and progesterone to grow, they are typically not seen in childhood, and after menopause they typically shrink due to lowered amounts of these hormones. Thus, fibroids are encountered during the menstruating years. They are seen in women of all racial groups, though they tend to be more common and occur earlier in women of African American descent. Their incidence ranges from one third to two thirds of all women.
What Causes Fibroids?
We aren’t certain what causes fibroids. Clearly, the presence of estrogen and progesterone are vital. Currently we believe that a fibroid begins as a genetic alteration of a single cell, which then grows and divides over time, resulting in a mass composed of many cells sharing the same origin. Important risk factors include race, age, family history, vitamin D deficiency, alcohol use, pregnancy, obesity, chronic inflammation, early age at onset of periods, and a poor-quality diet.
What Are Symptoms of Fibroids?
Fibroid symptoms are related to their size and location. When they are tiny, most cause no symptoms at all. Fibroids that alter the uterine cavity can cause heavy and prolonged periods, sometimes causing anemia. These submucous fibroids can cause large clots within the menstrual flow as well as bad menstrual cramps. They can contribute to infertility and recurring miscarriages. Intramural and subserous fibroids tend to cause bulk related symptoms, such as abdominal swelling, bladder pressure, rectal pressure and constipation. They can also cause excessive bleeding by altering the anatomy of the uterine cavity. Occasionally fibroids can cause pain when they degenerate due to an insufficient blood supply. If they are near the vagina, they can contribute to pain with sex. Very unusually fibroids can be associated with a cancer.
How Are Fibroids Diagnosed?
Which evaluation is most appropriate will be based on your history and exam. Common methods include:
Abdominal and Pelvic exam
Sonogram (Ultrasound) – the most common method
Saline-Infusion Sonogram (Sonohysterogram)
CT scan – typically the least useful evaluation
HSG (Hysterosalpingogram or Hysterogram)
How Are Fibroids Treated?
The standard approach to treat fibroids is based on the patient’s symptoms and goals. If the fibroids are small and without symptoms, they are typically not treated. The exception to that rule might be if the fibroids alter the uterus to the degree where they might impair fertility in a woman who desires pregnancy. Rapid growth or growth after menopause can also prompt more aggressive therapy. We will discuss which of these options are the best for you based on your anatomy, your symptoms, and your goals.
Medical Options to treat fibroids include the birth control pill, the progesterone-only pill, the levonorgestrel-IUD (such as Mirena or Liletta), Gonadotropin Releasing Hormone Agonists (such as Lupron), and Gonadotropin Releasing Hormone Antagonists (such as Oriahnn).
Surgical Options to treat fibroids include hysteroscopic resection or vaporization of fibroids, hysteroscopic ablation of the uterine cavity, myomectomy (removal of fibroids through a laparoscope or via an open abdominal incision), hysterectomy (removal or part or all of the uterus through the vagina or laparoscope or via an open abdominal incision), uterine artery embolization, and targeted high-energy ultrasound.
What Is a Functional Medicine Approach to Treating Fibroids?
Appreciating that fibroids require sex hormones to grow, we carefully evaluate the menstrual cycle and the hormones produced during that process. We frequently incorporate a thoughtful analysis of sex hormone metabolism through a urine-based Dutch Test. Supplements that reduce problematic hormone production and increase hormone clearance are frequently utilized.
Hormones are removed from the body both through enzymatic detoxification pathways and through the GI tract. We do a deep dive into your pathways which can differ in important ways in individuals based on their genetics and their nutrition. Poor bowel motility and chronic constipation reduce hormone elimination and increase hormone reabsorption, adding to the metabolic burden; these issues must also be addressed. Increasing fiber in the diet also aids in hormone elimination.
Removing phytoestrogens and xenoestrogens, plant-based and chemical-based compounds that stimulate estrogen receptors, contribute to our plan. Reducing dairy similarly decreases intake of hormones used to promote cow lactation that may have an adverse impact on fibroid growth. Testing for heavy metals and environmental pollutants may also be of benefit.
Many of the known risk factors for fibroid growth, such as obesity and excessive alcohol use, act via chronic inflammation. Reducing that inflammation through changes in diet and exercise are often part of our therapy. We can also impact that pathway through appropriate use of anti-inflammatory and improved glucose metabolism-based supplements.
There is no singular pathway to diminish fibroid growth. A personal analysis is always vital to determine your particular behavioral and metabolic contributors and the best way to mitigate those risk factors.