Fibroids: What Every Women Should Know

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:

• Heavy periods

• 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

• Abdominal distention

• Constipation

• Abdominal pain

• 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.