Pelvic tumors are quite common in women, with more than 70% experiencing them by the age of 50 (DayBaird et al, 2003). Many go completely unnoticed, but some cause considerable havoc, disrupting the quality of life for many women. The most common complaints are abnormal uterine bleeding, pelvic pain or pressure, and infertility. Management is largely dependent on the severity of the symptoms, and the woman’s desire for future fertility.
Conventional treatment is either hysterectomy or myomectomy. More recently, innovations have allowed for less invasive options, such as laparoscopic assisted removal of the uterus or fibroid, ablation of the uterine cavity, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery. Physicians disagree on the best management, and like many areas of women’s health, there is little evidence supporting the long-term effectiveness of most conventional medical treatments. Surgical procedures, medical therapy and watchful waiting all offer advantages and disadvantages.
Fibroids are not cancerous in nature, so there is little motivation to dump millions of dollars into researching optimal fibroid management. Our clients however, seek less expensive and minimally invasive regimens for fibroid management. More specifically, most desire complementary or alternative therapies. The challenge however, is making recommendations in light of minimal research available to support such therapies. Our desire therefore, is to blend the best of both science and art in effort to create an evidence-based plan that appreciates the individual needs of each woman.
An Integrative Approach
There are a greater number of both estrogen and progesterone receptors within the uterine fibroid, making them particularly sensitive to estrogen. Metabolism of estrogen is also altered, all of which leads to vascular abnormalities, which is thought to be why some women experience excessive bleeding.
The body of evidence is growing and convincing identifying pesticides, heavy metals, pharmaceuticals, plasticizers, and even phytoestrogen, as xenoestrogens which disrupt the endocrine system, changing gene expression without DNA sequence changes. This epigenetic change can become persistent and inherited, meaning toxins in one’s environment can negatively impact gene expression in future generations.
Uterine fibroids can be diagnosed most every time by exam with a nurse-midwife. Ultrasound can augment exam, particularly in larger women or when it is necessary to rule out other pathology. Ultrasound does not however, improve long-term clinical outcomes for fibroids. Additional diagnostic testing may be indicated, such as measuring pelvic girth and obtaining a pregnancy test. The midwife may choose to obtain a complete blood count, a metabolic panel, possibly a prolactin level and/or thyroid panel, or even coagulation studies based on the amount of bleeding. Certainly, there may even be indication for MRI, CT and HSG depending on individual circumstances.
Once diagnosis is established and other pathologies are ruled out, complementary and alternative therapies can offer relief from the discomforts caused by fibroids. They may not however, shrink the overall size of the fibroid.
Nutrition, Diet and Supplements
It should be no surprise that diet and exercise is associated with whether one may suffer from uterine fibroids or not. More than one study has made clear: the greater one’s physical activity, the less likely they are to have fibroids (Baird et al, 2007 & Flake et al., 2003). Dietary choices also influence fibroids, in that food choices influence estrogen excretion. Vegetarian women for example, have a three-fold increase in fecal excretion of estrogen and 15-20% lower serum estrogen levels (Gorbach and Goldin, 1987).
Flaxseed and whole grains may be a viable dietary strategy for reducing the risk of uterine fibroids due to their phytoestrogen nature (Atkinson et al., 2006). Whole soy foods should be prioritized to concentrated or processed options, as the literature shows mixed outcomes with regards to benefits and risks of phytoestrogens.
Interestingly, cruciferous vegetables such as broccoli, brussels sprouts, cabbage and cauliflower have a phytochemical, indole-3-carbinol (13C), that alters estrogen metabolism by promoting the formation of less potent estrogen metabolities (Minich and Bland, 2007). Green vegetables have a protective effect.
Omega 3 fatty acids should also be encouraged, while reducing intake of omega 6 fatty acids, to utilize their anti-inflammatory nature for curbing fibroid growth. Vitamin D has shown to significantly inhibit the growth of leiomyomata cells (Blauer et al, 2009). Supplementation for both can be obtained through a single food-based supplementation which our practice highly recommends.
High caffeine and coffee intake may increase early follicular phase estradiol levels compared to those with lower levels of consumption (500 mg/day compared to 100 mg/day), independent of alcohol consumption or tobacco use.
Iron-rich foods would benefit the women who suffer excessive bleeding related to uterine fibroids. Taken with vitamin C, iron absorption would be improved, and the vitamin C would additionally offer the benefit of improving blood vessel walls. Depending on the class of the bioflavonoid, antiinflammatory, antioxidant, and anti-proliferative properties may also be gained.
It may take several months to achieve significant benefit with botanicals, and the fibroids may not shrink. However, further growth may be inhibited and symptoms are quite likely to improve. Many women choose these complementary therapies as they await the natural menopause transition.
Chaste tree berry, Ginger, Turmeric, Shepherd’s Purse, Yarrow, and Red Raspberry Leaf are among the most common herbs utilized for managing fibroid symptoms. Each offers their own advantage whether balancing a hormonal imbalance or offering symptoms relief such as excess bleeding. The nurse-midwives at Believe Midwifery can discern and recommend botanicals as appropriate to each individual. If more aggressive treatments are necessary, Believe Midwifery Services is also equipped to offer necessary diagnostics and pharmaceuticals, or refer as appropriate.