Uterine fibroids (also called myomas or leiomyomas) are benign growths in the uterine muscle. They are a common gynecologic problem affecting 20-50% of women. Most women with fibroids have other family members with fibroids. It is likely there is a genetic link. Fibroids are more common in women of color especially African Americans.
Fibroids are diagnosed by pelvic exam and ultrasound. Fibroids can grow into the uterine cavity (submucosal), within the uterine wall (intramural) and on the outer uterine wall (subserosal). Fibroids can also be pedunculated or grow on stalks. When this happens they can become twisted or try to pass through the cervix, this may require emergency removal. Most women with fibroids do not know that they have them. Some women develop symptoms. The most common symptoms are: heavy menstrual bleeding, menstrual cramping, fullness in the pelvis, and urinary frequency. Some women will have difficulty getting pregnant or staying pregnant. Since fibroids are thought to respond to the hormones estrogen and progesterone, they can become larger in pregnancy and shrink after menopause. There are a number of conventional treatments available for uterine fibroids. The type of treatment offered usually depends on the type of symptoms experienced, size and location of the fibroids, desire for future pregnancy, and personal preferences.
Each woman should discuss her situation with her provider and decide what is best for her. Fortunately, there are a lot of new treatments available that are less invasive, preserve the uterus, and pose fewer risks. Let's briefly discuss some of the options:
Hormones. Oral contraceptive pills, Depo-Provera, and the IUD called Mirena can improve symptoms such as heavy, painful or irregular bleeding. When contraceptive pills are given continuously menstrual periods can be avoided altogether. Depo-Provera and the Mirena also decrease menstrual bleeding. This can be very important for women with heavy bleeding and anemia due to fibroids.
A type of drug called a GnRH agonist (Ex. Lupron Depot) can be given by injection monthly to shrink fibroids and decrease symptoms such as heavy bleeding and fullness or pressure. It does not permanently shrink fibroids but can be used before surgery to make the surgery less invasive or to bridge a woman to menopause. These drugs should not be used over a long period of time because they put the body into "early menopause" by blocking the production of estrogen and as a result, cause bone loss.
Uterine artery embolization. This procedure involves using a catheter to inject small particles that block the vessels that supply blood to the fibroids. Blocking off the vessels starves the fibroids of their blood supply making them shrink. This procedure is not usually offered to women who have pedunculated or submucosal fibroids or women who wish to become pregnant.
Myomectomy. Fibroids can be removed with surgery either by opening the abdomen or laparoscopy (a scope and instruments that are inserted through small openings in the abdomen) or hysteroscopy (a scope inserted through the cervix). The type of surgery chosen depends on the size and location of the fibroids, desire for pregnancy, and other health problems. Another factor that is very important to consider is the expertise of the surgeon, some gynecologists specialize in minimally invasive surgeries and are very experienced. For instance, UCSF has the
Comprehensive Fibroid Center. For information about fibroids and the services they have to offer, look at their website.
Hysterectomy should be considered when other methods of treatment unsuccessfully control symptoms and it is the patient's preference. Hysterectomy can be performed through the abdomen, the vagina or in some cases, laparoscopically.
Alternative Treatments. Unfortunately there has been little research into alternative treatments for fibroids. The Cochrane Database has a review of research of herbal treatments for fibroids. They found two randomized controlled trials involving 150 women with the goal of shrinking fibroids. An herbal preparation called Nona Roguy was compared to a GnRH agonist and was found to have a similar effect on the shrinkage of fibroids. Another herbal remedy called Huoxue Sanjie was compared to mifepristone, a drug not commonly used to treat fibroids and was also found to have a similar effect on fibroid size. These findings are promising but more research is needed regarding herbal remedies and their ability to treat fibroids. Women with fibroids should consider getting treatment by a Traditional Chinese Medicine practitioner.
Western herbs such as yarrow and shepherd's purse can be very helpful for heavy bleeding. Cramp bark can help with menstrual cramps. Anti-inflammatory herbs such as ginger, turmeric and garlic also have anti-prostaglandin effects so they help with heavy bleeding and cramping. Avoid dong quai during times of heavy bleeding (it is contained in many women's supplements). Note: NSAIDS such as ibuprofen and naproxen not only help with menstrual cramps but decrease bleeding because they are anti-prostaglandins. Always take them with food. If you have stomach issues with NSAIDS, the anti-inflammatory herbs are a nice alternative.
Nutrition is another important consideration. Women who are overweight harbor more estrogen in their fat cells. Thus it is important to maintain a normal weight. Eat lots of fiber, fresh fruits and veggies and include one serving of soy food daily. Hormones are processed in the liver so promote healthy liver function by avoiding alcohol, sugar and saturated fats. Avoid exogenous hormones (hormones from outside the body). The non-organic meats and dairy we consume contain hormones and we absorb them. In addition, there are many chemicals in the environment (including the plastics that we eat and drink out of) that contain endocrine disrupting chemicals (EDC's). For more information about EDC's see the Endocrine Society's 2009
scientific statement.
Engaging in physical activity is always important. Keeping the blood flowing in the pelvis is essential. Stretching can be very soothing during menstruation. The yoga pose supta baddha konasana opens the pelvis and can help with menstrual cramping. This can be a very relaxing pose. Use a bolster to support your back. Avoid poses that raise the hips over the head during menstruation.
If you would like a consultation regarding an integrative approach to the management of your fibroids please give me a call at 415-457-1451 or make an appointment at the Osher Center 415-353-7700.
