Introduction – The premise of this article is to expound on the further understanding of how uterine fibroids impact women’s health and what available interventions exist so far to alleviate the suffering from this condition.
Uterine fibroids or adenomyomas are benign growths in the uterus that around found in up to 80% of women of reproductive age, causing morbidity in up to 30% of women. Studies have shown that fibroids are monoclonal tumors which are a mass of cells that grow from a single aberrant cell or monocyte but the precipitating event for the neoplastic change of a monocyte is unknown at this time. It is found that more than 200,000 surgical procedures are conducted for the treatment of fibroids with estimated yearly costs of $5.9-34.4 billion. The exact cause of fibroids remains indefinable and there are no long-term treatments available currently. What is known is that there may be familial history and that people who are of African descent area also at higher risk of fibroids than other ethnicities. It is known that the growth of these tumors are steroid-hormone dependent and a defining characteristic of fibroids are that they are responsive to estrogen and progesterone, which is an attribute most of the therapies currently available exploit.
Fibroids can originate in the muscular lining of the uterus intramurally, outside of the uterus attached by a stalk of tissue, in the cervix, submucosally, and in the outside serosal area of the uterus. Fibroids vary in number and size. You can have a single fibroid or more than one. Some of these growths are too small to see with the eyes. Others can grow to the size of a grapefruit or larger. A fibroid that gets very big can distort the inside and the outside of the uterus. In extreme cases, some fibroids grow large enough to fill the pelvis or stomach area and can make a person look pregnant. According to the Mayo Clinic, anemia from excess blood loss from the fibroids puts strain on the heart leading to problems. Fatigue and even body image issues are not uncommon in women with this condition. Fatigue not only tires the body, but it does the mind as certain activities that could be executed with ease in the past now become more cumbersome. Reduced quality of health follows as fatigue becomes a familiar barrier in daily life.
Many women have uterine fibroids sometime during their lives. But they might not know they have them as smaller ones may cause no symptoms. Your health care professional may just happen to find fibroids during a pelvic exam or pregnancy ultrasound. There are a number of uncomfortable symptoms that accompany larger fibroids that includes heavy bleeding during periods or between them, clotting, longer periods, increased cramping, lower back or pelvic pain, pressure or abdominal fullness, increased urination from pressure of the fibroids on the bladder and painful intercourse. Left untreated, the heavy bleeding from periods can cause iron deficiency anemia. Also untreated, this can then become severe enough to cause problems during a pregnancy and heart problems like an irregular or rapid heartbeat as the heart tries to compensate for the lack of oxygen in the blood. Eventually this can lead to heart enlargement.
Currently treatments for uterine fibroid include surgical interventions like myomectomy and hysterectomy are most common with a chance of recurrence of the condition with myomectomy surgery. Also, fertility preservation is a concern so other alternatives may be sought out before attempting surgery. Robotic surgeries for laparoscopic removal option offer a shorter recovery time than an open myomectomy though with any surgery it is not without certain risks notably infection, bleeding, scarring, or formation of adhesions. Acupuncture has been a known modality along with herbs for this condition and is something that I’ve recently started to implement as well.
Cellularly, the formation of fibroids is complex with many estrogen-related pathways being available to signal the growth of these tumors. In the case of fibroids, there are aberrations in the pathways that signal tissue overgrowth instead of appropriate apoptosis or cell death. Also, through aromatase activity, fibroids can produce estrogen which can cause the tumors to sustain themselves. Knowing this, interventions like aromatase inhibitors have been used as treatment to inhibit estrogen formation and reduce tumor size but they are not without side effects notably amnesia, osteoporosis, and loss of memory with long-term use.
Other measures include stress reduction techniques, supplements, and nutritional protocols involving using a vegan diet for a time, as it is thought that animal products contain hormones that could potentiate the formation of fibroids due to estrogenic activity. It was noted that in black women that soymilk, sweeteners, and food additives can increase fibroid risk, but the risk may be reduced with increased consumption of fruit.
Herbs such as chaste tree or vitex, sulforaphane, and NAC also come up as well although these are noted to not always be effective or may not work nearly enough to stop progressive growth of the fibroids. Castor oil packs applied to the lower abdominal area are also a noted remedy although for larger or more numerous fibroids, it may not prove to be a favorable treatment so surgical intervention may be warranted. Vitamin D has even been considered in high doses to reduce the formation of fibroids as well as recent studies have shown that Vitamin D deficiency, is 10 times higher among African American women than among other races and that fibroids are 3 times more likely to occur in African American women than white women. Vitamin D deficiency is an important risk factor for fibroids as the uterine fibroids have lower levels of vitamin D receptors compared with the myometrium of the uterus. Studies have shown the uterine fibroids are hormonally regulated and a major factor in their growth is their over-expression of progesterone and estrogen receptors verses normal myometrium. This was found to lead to increased expression of proliferation-related genes, increased DNA damage, and the promotion of fibrosis. Vitamin D has been noted to influence certain enzymatic processes to regulate expression of genes to deter growth of these tumors.
In a study conducted in the Obstetrics and Gynecology Department in Isfahan Alzahra and Shahid Beheshti Hospitals in Central Iran in August 2014 to December 2019, it was noted that vitamin D administration in the intervention group significantly reduced the size of the fibroids as compared to the control group that had not received the 50,000 IUs of Vitamin D for the same 10 week study period as evidenced 7.14mm reduction in 6 fibroids as observed in ultrasounds done after 6 months for follow up in the 69 premenopausal woman that participated.
Mitochondrial health and quantum biology are modalities I’ve started to tinker with in the recent past in the hopes to create balance alongside the interventions of nutrition and some supplementation. While it has not definitively been established that there is one way that works for most women, or even a way that would prevent recurrence of fibroids there is at least a known root cause of them and for many it appears to be the hormonal pattern of estrogen dominance. Exposure to xenoestrogens which can be present in plastics along with endocrine disruptors like phthalates, chemicals in certain sunscreens –avobenzone, cleaning products, and cosmetics, fertilizers, nonstick coating from cooking pans, and even hormones given to animals in conventionally raised livestock) and even synthetic hormones from birth control can all have an impact and have been linked to endocrine related disorders and reproductive problems in women.
Conclusion - More research needs to be done for such an unfortunate yet common condition that, although benign, can have dire consequences in the long term. Hopefully more effective interventions besides surgery or the use of drugs with unwanted side effects can be on offer to women in the future dealing with uterine fibroids. Also, hopefully there would also be more choices so that the added stress of choosing one potentially burdening decision over another does not dissuade more women from seeking treatment and earlier to prevent complications.
Assessed and Endorsed by the MedReport Medical Review Board