Updated: Mar 24
While many women think that their fibroids only affect their 40's and older, that's not true at all. They start growing in the 20s and 30s, with the peak incidence becoming problematic in our 40s. That’s because, during these years, we have more estrogen and growth factor hormones, that in excess, feed fibroids like ‘Miracle Grow.’ As estrogen levels naturally decline in menopause, fibroids usually spontaneously shrink.
According to Dr. Romm, uterine fibroids (‘fibroids’) are solid, well-defined, non-cancerous growths of muscle tissue in the uterus. They’re highly prevalent in the US, where a woman’s lifetime risk of developing them is estimated to be as high as 75% (the often cited 20% to 50% is likely a significantly underestimated range) by age 50 and as high as an 80% lifetime risk for Black women.
Uterine fibroids are essential to understand, prevent, and know your treatment options for because not only can they cause discomfort, but they can also sometimes affect conception and pregnancy, and they are the most common cause of hysterectomies, other than uterine cancer, with approximately 17% of all hysterectomies in the US performed for uterine fibroids. The peak incidence of surgery occurs for women around age 45, making fibroids the primary cause of premenopausal hysterectomy. Most of these hysterectomies, including those done on women in their 20s and 30s, are considered unnecessary, with women remaining uninformed about medical alternatives to surgery by their physicians.
Given the remarkably high incidence of uterine fibroids, their significant impact on women's health, and the high rate of hysterectomies as a result of fibroids, it’s essential for all women to know how to prevent them and the strategies that are available to reduce them to avoid unnecessary surgery – and possibly unnecessary medications. It’s also essential to recognize that fibroids may be a symptom of reversible environmental and dietary factors associated with other medical conditions, like many chronic women's health conditions. Therefore, an integrative approach can prevent and reduce fibroids and be part of a lifetime hormonal and total health plan.
Uterine Fibroids 101
Uterine fibroids, properly calculated uterine leiomyomata, vary in size, from practically microscopic to fruit – or more significant. A fibroid uterus is described in comparison to a pregnant uterus size, as in a 16-week uterus or a 24-week uterus. They may grow singly or in clusters and can grow in various locations in the uterus.
They are classified according to their site of growth in the uterine or surrounding tissue as follows:
Subserosal are in the outer wall of the uterus (55%)
Intramural is found in the muscular layers of the uterine wall (40%)
Submucosal protrude into the uterine cavity (5%)
They may also occur in the cervix (cervical fibroids), between the broad uterine ligaments (interligamentous fibroids), or they may be attached to a stalk (pedunculated fibroids) and protrude into the uterine cavity (pedunculated submucosal fibroids) or through the cervix.
Uterine Fibroid Symptoms
While not all women will experience symptoms, it’s estimated that 1 in 3 will, and in fact, nearly 70,000 women go to the emergency department each year for signs due to fibroids, a rate that has tripled over recent years.
Symptoms may be mild or uncomfortable, negatively impacting the quality of life. Symptoms may include:
Menstrual periods lasting more than a week
Severe menstrual cramps
Bleeding between periods
A feeling of fullness in the lower abdomen
Pain during sex
Low backache, leg ache
Urinary frequency, urgency, or difficulty peeing.
Abnormal uterine bleeding – present in about 30% of all women with fibroids
Some symptoms are similar to endometriosis, so the diagnosis of one or the other may be missed. While malignancy is rarely associated with uterine fibroids, they occur with increased frequency in endometrial hyperplasia and a fourfold increased risk of developing endometrial cancer. On top of that, large fibroids may sometimes mask the diagnosis of severe gynecologic cancer.
Causes of Uterine Fibroids
It’s not clear exactly what causes uterine fibroids, but we know much about what contributes to them. Foremost, we see that they are hormone-dependent – with excess estrogen considered the primary culprit, and they are also ‘fed’ by insulin-like growth factors. And like so many hormonally driven conditions, many additional factors conspire – from genetics to environmental exposures, nutritional imbalances, and lifestyle factors – to trigger fibroids to develop and grow.
Environmental factors: Environmental exposures play a tremendous role in fibroids' root cause. Endocrine-disrupting chemicals (EDCs), defined by the U.S. National Institute of Environmental Health Sciences (NIEHS) as “chemicals that interfere with the body's endocrine system and produce adverse developmental, reproductive, neurological, and immune effects,” maybe a significant contributing factor to estrogen overload and fibroid development and growth. Several persistent organic pollutants (POPs) and their breakdown products have been detected in the endometrium of premenopausal women undergoing hysterectomies for fibroids. Additionally, EDCs alter the way your DNA works; in the case of uterine fibroids, this allows for unregulated overgrowth of uterine cells.
Genetics: If you have fibroids, it’s quiteprettyquite pretty likely your mom or sisters also have this health issue as genetics play a role in predisposing women to the development of fibroids. This also means if you have daughters, they’re more likely to be at risk of developing fibroids. We also know epigenetics plays an essential role and that we can stop this domino effect by addressing the estrogen excess, environmental exposures, and nutritional factors that contribute to fibroids.
Ethnicity: Fibroids are also three times more common in Black women than white, Asian, and Latina women, occur at an earlier age (in women’s 20s) and are associated with more severe symptoms. While this increased prevalence is not yet fully understood, a possible relationship to vitamin D deficiency is being studied. We have to consider that Black women are at higher risk of exposure to environmental toxins. Another theory is that dairy consumption, already a possible contributor to fibroids, may be more problematic due to dairy intolerance in people of African descent.
Diet: Diet plays a role in the risk of developing fibroids. Vitamin D deficiency (or insufficiency), which is very common in the general population, is considered a risk factor for fibroid development. Preliminary data suggests that Vitamin D supplementation prevents fibroid growth. Greater consumption of red meat and pork, particularly ham, and less consumption of green vegetables, fruit (mainly citrus fruit), and fish are associated with a greater likelihood of having uterine fibroids. Some studies suggest that dairy consumption, ostensibly due to hormones, especially growth factors, may play a role in but not exclusive to conventional dairy products.
Other risk factors: Evidence suggests that hypertension is involved in the pathogenesis of fibroids and precedes their development]. Hypertension is significantly more likely in women with fibroids than without, and the risk of fibroid growth increases with blood pressure. This is thought to be due to the inflammatory cells and chemicals associated with both conditions. Being significantly overweight is also a risk factor. While you can be heavy and healthy, being very significantly overweight leads to more circulating estrogen and growth factors, both of which risk fibroids. Thus, the risk is two to three times greater than average in significantly overweight women. Significant, especially very heavy women Metabolic syndrome is also a risk factor due to weight, hypertension, and increased growth factors contributing to fibroid formation and growth. Finally, the medical literature does suggest a possible association between a history of trauma (emotional, sexual) and uterine fibroid incidence in women. The reasons are unclear and may represent the high incidence of both – or there could be some relationship between immune and hormonal dysregulation resulting from stress and trauma.
Can Fibroids Affect Fertility and Pregnancy?
A common question I get is: “Will my fibroid impact my likelihood of getting and staying pregnant?” The short answer is possible, though it's unlikely, as in most cases, they are not at all problematic for either conception or during pregnancy and birth. However, they can sometimes cause a variety of problems, and because. Because fibroids are so common, prevention, primarily through lifestyle and diet, which are low-hanging fruit any of us can shift, remains vital to avoid any potential impact on conception or pregnancy complications.
Fibroids are present in 5-10% of women facing fertility challenges, suggesting the overall prevalence of fibroids in women in their childbearing years rather than their impact on fertility. According to some data, fibroids may be the sole cause of infertility in 1-2.4%; however, this is controversial. According to most studies, fibroids usually don't interfere with getting pregnant. However, it is possible that in some cases, they may obstruct the fallopian tubes, interfering with conception or implantation (because the fertilized egg cannot make its way to the uterus), or may affect implantation if uterine fibroids are significantly impacting the uterine lining. If you have struggled to get pregnant, evaluation for fibroids is an appropriate part of a workup.
Fibroids occur in 0.1-10.7% of all pregnancies. Even though fibroids usually grow in pregnancy due to high estrogen during the first trimester, most fibroids do not cause any complications. Rarely, larger fibroids may contribute to miscarriage, premature labor, malpresentation of the fetus (especially breech presentation), placental abruption, and postpartum hemorrhage; however, the preponderance of data do not show an increased risk of adverse events. Approximately 11% of women with uterine fibroids experience some pain in pregnancy due to fibroid degeneration – where the limited blood supply to the fibroid causes it to “die” or degenerate – which occurs during late pregnancy. More rare complications can happen, but complications due to fibroids in pregnancy are infrequent.
Fibroids are associated with a higher rate of cesarean section, though statistically women, with fibroids larger more significant than 10 cm can still have a vaginal delivery approximately 70% of the time, so it’s unclear whether that increased rate is due to medically necessary cesareans or inadequate knowledge on the part of obstetricians regarding vaginal birth and fibroids.
If you have large fibroids, it is essential to work with a skilled OB or Family doctor in addition to your midwife. It is necessary to work with a skilled OB or Family doctor. If you know that you have fibroids before becoming pregnant, ultrasound in pregnancy is appropriate to assess their size and location. Postpartum, fibroids may regress to less than their pre-pregnancy size or even resolve.
Conventional Treatment for Uterine Fibroids
Generally, the treatment approach depends on a few critical factors, including the type and severity of symptoms, size and location of fibroids, a woman’s age, her plans to have children, and her personal preferences for the kind of treatment she wants to engage in.
In most cases, if fibroids are small and aren’t causing symptoms or occur in a woman I am nearing menopause, no treatment is necessary and, you monitor for signs over time. Thus the very high rate of hysterectomies for fibroids has been very controversial, with leading medical agencies pushing for a reduction in unnecessary hysterectomies, signs, and a greater reliance on non-surgical, less aggressive approaches.
How do you decide between alternative and conventional therapy? Even if you require medical treatment, a diet and lifestyle approach should always be followed to prevent recurrence and address the root causes of fibroid growth. But conventional therapies can play an essential role if symptoms impact your quality of life, you’re experiencing abnormal bleeding, there’s the rapid growth of the fibroid, or the size is causing issues like fertility challenges. For example, treatment may be necessary if you're experiencing heavy bleeding.
In every case, the least interventional approach that is possible to achieve your goals and keep you safe is optimal. Options include:
For aching and discomfort, pain medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used.
Hormonal IUDs (i.e., the Mirena) are options for women with fibfibroids that do not distort the insiders inside to nd painful bleeding but do not treat the fibroids themselves. Possible side effects include acne, spotting (vaginal bleeding between periods), weight gain, abdominal pain, and breast tenderness.
Birth control pills have minimal research for fibroid treatment but may reduce heavy menstrual bleeding and prevent anemia.
GnRH agonists (e.g., Leuprolide) can reduce symptoms and fibroid size by as much as 30% to 64% after 3 to 6 months of treatment through suppression of estrogen and progesterone production. Side effects include hot flashes, headache, vaginal dryness and vaginitis, decreased libido, joint and muscle stiffness, and depression, and 30% of patients continue to have light, irregular vaginal bleeding. Bone loss occurs but is reversible, and a small number of women (2%) experience significant vaginal bleeding side effects 5 to 10 weeks after treatment commences. After discontinuation, fibroids usually return to their previous size.
Ulipristal acetate, a medication used for short-term treatment (up to 3 months), can relieve symptoms such as heavy periods and shrink the fibroids somewhat. It’s slightly less effective than GnRH agonists but tends to cause fewer side effects; fibroids grow again after treatment, and symptoms usually return. Because of the risk of life-threatening liver damage, ulipristal acetate was taken off the market throughout the European Union in March 2020 to treat uterine fibroids. It will remain off the market until further studies are done.
Surgical options include myomectomy, endometrial ablation, and hysterectomy. Pre-surgical treatment with leuprolide acetate (Lupron) may facilitate more conservative surgery for large fibroids. Between 15% and 30% experience fibroid regrowth after five years. While a rare complication, it's essential to know that uterine scarring may occur from endometrial ablation if not done by a skilled provider and can later affect fertility and conception (as the result of a condition called Asherman's Syndrome). Surgery should be reserved for past childbearing women who are heavily symptomatic and not responsive to drug therapy or suspected malignancies.
When it comes to uterine fibroids, there is, in my opinion, a time and place for hysterectomy: you’ve tried natural and, pharmaceutical options, minimally invasive surgery, and you’re past childbearing and uncomfortable, bleeding, fatigued, exhausted, tired fibroids are affecting your quality of life, sex, happiness. While it’s not a decision to rush into, it is a legitimate choice when made from a well-informed, confident place. In most uterine fibroids, it is possible to spare the ovaries and remove the uterus only, which is ideal from a long-term health perspective.
You should consult your medical provider if you experience:
Persistent pelvic pain
Spotting or bleeding between periods
Heavy, prolonged or, painful periods
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A Natural Approach to Uterine Fibroids
Medical and surgical approaches do not address or reverse the underlying causes that contributed to fibroids, and that when persistent, may contribute to a variety of other conditions that can result from its root causes, including hypertension, high estrogen, chronic inflammation, insulin resistance, the impacts of chronic Vitamin D deficiency, and more.
Natural approaches can be effectively addressed to address these causes and help av d pharmaceutical and surgical intervention. A pilot study comparing natural methods vs. conventional treatments for uterine fibroids demonstrated no statistically significant change in symptoms between the two groups when measured after six months of treatment. Both experienced improvement in symptoms and fibroid size. Those in the treatment group considered the study a success because they achieved results equivalent to pharmaceutical or surgical interventions using nonconventional methods. It is possible to reduce symptoms of small to medium-sized fibroids naturally significantly, and if symptoms are reduced, further medical and surgical treatment are then not usually needed.
Before making any decision, each person should be educated on the known risk factors for fibroids that have been shared with you shared, using a combination of dietary, lifestyle, nutritional and botanical strategies with evidence of their benefits in preventing and reducing fibroids.
Step 1: Reduce exposure to endocrine disruptors
Minimizing your exposure to environmental endocrine disruptors is a critical step in creating healthy estrogen levels so that you’re not driving fibroid growth, especially considering that they can also drive weight problems, another risk factor. Here, you can find a complete protocol for reducing your exposure to endocrine disruptors and more tips for reducing excess estrogen in this article. Here are some go-to strategies to start:
Pass on plastic. Change to glass or stainless-steel water bottles and food storage containers and avoid plastic cling-wrap.
Reduce your exposure to the toxins in our food system by choosing organic produce over conventionally grown whenever possible and always for meats, eggs, and dairy.
Wash hands well after handling receipts, which may be coated with endocrine-disrupting chemicals like BPA or BPS.
Step 2: Eat a plant-rich, anti-inflammatory diet
Choose plant-based foods and legumes over red meat and pork: Include legumes in your diet 2 to 3 times weekly to help improve estrogen levels and their high fiber content.
Eliminate dairy: Dairy contains a hormone called insulin-like growth factor 1 (IGF-1), similar to insulin. It stimulates the growth of cells while preventing unhealthy cells from doing what they’re supposed to do naturally – die. Adding to this, the dairy industry allows the use of a growth factor called rbGH, which amps up the levels of IGF-1. IGF-1. In addition to being associated with breast and other cancers, it likely plays a role in the growth of uterine fibroids.
Increase veggies and fruit to 8 to 10 servings daily: Especially emphasize leafy greens, which help reduce excess estrogen, and citrus fruit, specifically protective against fibroids.
Maximize dietary fiber intake and healthy estrogen levels with the addition of 2 Tbsp. Of ground flaxseed in your diet daily.
Include food sources of vitamin A like yellow, red, green, and orange vegetables. Vitamin A is protective for fibroids prevention – through supplementing vitamin, A it has not been shown to reduce or prevent fibroids.
Ditch the alcohol (especially beer) since it appears to be associated with an increased risk of developing fibroids. Recent data suggests it currently poses a threat rather than past alcohol use.
Step 3: Use Herbs and Supplements
Vitamin D: Not only is deficiency associated with an increased risk of fibroids, but vitamin D appears to be a powerful protectant against the development of uterine fibroids. I recommend supplementing 2000 units daily, but for best results, have your medical provider test your vitamin D level and help you increase to reach a blood level between 50 and 80 ng/dL.
Chaste Tree Berry Vitex
Broccoli Extracts [DIM, sulforaphane, Indole-3-Carbinol (I3C)]: Potently increases phase 2 detox and helps to metabolize estrogen. To help reduce excess estrogen, take either Indole-3-carbinol at 300 to 600 mg/day OR Diindolylmethane (DIM) at 100 to 200 mg/day.
Black cohosh was historically used to treat symptoms presumably due to fibroids. In a small 2014 study, women who took 40 mg daily of black cohosh experienced an average decrease in fibroid size of 30.3% after a 12-week treatment. (Not for use in pregnancy!)
Dr. Aviva’s Uterine Fibroid Blend ((Not for use in pregnancy)
Combine the following liquid extracts into a 4 oz. Tincture bottle:
Yarrow (Achillea millefolium) 40 mL
Black cohosh (Actea racemosa) 20 mL
Red raspberry leaf (Rubus ideas) 15 mL
White peony (Paeonia lactiflora) 15 mL
Ginger (Zingiber Officinalis) 10 mL
Dose: 4 mL twice daily
Step 4: Lifestyle Support
Exercise: can lead to a substantial decrease in fibroids. It encourages weight reduction, improves pelvic circulation, promotes uterine muscular tone, and regular bowel elimination. Women who exercise seven hours or more per week reduce their risk. Make sure to include a 1-hour daily walk, cardio, or another form of movement you love. Pilates postures, vigorous walking, hip circling, and pelvic thrusts can all be helpful to improve pelvic circulation and reduce discomfort.
Check for anemia: Bleeding from uterine fibroids can all cause you to get low on your iron stores and cause symptoms like fatigue, loss of concentration, depression, and in severe cases, breathing difficulties and a racing heart.
What to Expect with a Natural Approach to Uterine Fibroids
Like so many hormonal problems, 3 to 6 months is a realistic window to begin to see symptom improvement, which is the most crucial goal with treating fibroids. Symptom improvement is likely to show fibroid size shrinking, which you typically see within 2-3 menstrual cycles after treatment. In that case, I recommend continuing the above plan until you have a substantial reduction in symptoms.
If you see no improvement after 3 to 6 months, or at any time symptoms become too troublesome, you can consider a conventional medical approach. One option also is to use a medication to reduce large fibroids and then try to maintain benefits with the natural therapies.
However, if these can be much more difficult to reduce if you have vhugefibroidshuge fibroids (over a 16-week size), se symptoms aren’t causing you too much trouble. In that case, it’s still worth a go with natural therapies, but if symptoms do become a problem for you after several months or anytime, consider your medical options for more significant relief. Many women are content to have symptom control over pharmaceutical or surgical intervention, as long as the fibroids present no problems.
Fibroids, like diabetes, high blood pressure, and high cholesterol, are not inevitable – they are 21st-century chronic conditions that we can seek to prevent and, whenever possible, reverse. Addressing uterine fibroids by preventing them is s essential for our long-term health that we don’t experience unnecessary discomfort, complications, or suffering, nor become yet another hysterectomy statistic. While there’s no shame in using medications and surgery, a more natural approach is such anrtantan essential for our total health.
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