What Are Uterine Fibroids?
Uterine fibroids are benign (non-cancerous) growths that are found in or near the uterus. They are also known as leiomyomas, fibromyomas, or myomas, and are perhaps the most common of all tumors found in females. Uterine fibroids are composed of smooth muscle and other connective tissues, and can range is size from microscopic seedlings, up to that of a grapefruit. Extreme cases have been documented wherein the patient’s uterus was expanded to the point of touching the ribcage. But, most uterine fibroids are not harmful, and many women do not even know they have them. Because they can interfere with blood vessels and glands in the uterus, uterine fibroids can cause significant symptoms including pain and excessive menstrual bleeding in some women, but are rarely precancerous or an indicator of potential uterine cancer. In general, the larger the fibroids are, the greater chance they have of causing noticeable symptoms. They may form individually or in clustered groups.
Uterine fibroids are very common, and may affect up to 75% of all women of childbearing age. They are rarely found in women under the age of 20, and are most commonly found in the 30-50 age group. African American females have a significantly greater risk for uterine fibroids than those of other races, and they also tend to have a greater number of fibroids that are larger and appear at an earlier age than other women. The reasons for this racial discrepancy are not well understood.
Uterine fibroids are generally classified based on the location of the tumors. Submucous fibroids are found within the uterine cavity. Intramural fibroids manifest themselves on the wall of the uterus. Subserous fibroids are those found outside of the uterus. Some large fibroids may spill over into more than one classification due to their size.
What Are the Symptoms of Uterine Fibroids?
Symptoms will vary based on both location and size of the fibroids. Common signs include:
- Heavy uterine bleeding: This is the most typical symptom of uterine fibroids, and is found in about 30% of patients. It usually shows itself as heavier flow during the menses, and often includes longer than normal periods. Spotting or bleeding between periods is also common. Submucous or intramural fibroids are the most likely type to cause heavy uterine bleeding.
- Pelvic pressure or pain: Larger fibroids can press against other organs such as the bowel and bladder causing incontinence, pain, frequent urination, urine retention, or constipation (pressure on rectum), backache or leg pain (pressure on spinal nerves), pain during intercourse, or abdominal enlargement.
- Acute pain: Sometimes a fibroid can actually outgrow its blood supply, and it then begins to deteriorate. This results in the death of the tissues that compose the fibroid (necrosis) and can produce conditions known as cystic degeneration or calcification. The byproducts of the necrosis can seep into the surrounding area and cause pain, typically in the lower abdomen, and often fever as well.
- Pedunculated fibroid: On occasion, uterine fibroids will grow on a stalk, and hang either inside or outside of the uterus. If they get twisted and begin to turn on their stalk, intense pain can result.
When diagnosing uterine fibroids, it is important to be aware of several conditions that have similar indications:
- Hormonal dysfunction: This can result in abnormally heavy bleeding and thickening of the lining of the uterus that is not associated with ovulation. With this malady, the body fails to read and interpret hormonal signals properly.
- Uterine polyps: Also known as endometrial polyps, these too are benign growths that are found on the lining of the uterus.
- Adenomyosis: This condition involves abnormal behavior of the glands of the uterine lining. They pierce the smooth muscle walls of the uterus, and can produce pain and bleeding as the lining changes during menstruation.
Can Complications Occur From Uterine Fibroids?
The majority of uterine fibroids are harmless and asymptomatic. However, there are some possible complications that can occur. The most common ones are:
- Anemia: This is the result of the abnormally heavy bleeding associated with some fibroids.
- Infertility: Uterine fibroids will on rare occasions interfere with normal conception. They are estimated to account for about 3% of all infertility cases. Sometimes they will put pressure on the uterus or fill the uterine cavity and make it difficult for fertilized eggs to be implanted. Submucosal fibroids are especially guilty of this. Occasionally fibroids will also impede with the delivery of sperm from the cervix to the fallopian tubes, or block the fallopian tubes altogether.
- Pregnancy complications: Due to hormonal changes, fibroids will often grow quickly during pregnancy and can potentially, but rarely, cause many problems including:
- Premature labor
- Premature delivery
- Abnormal fetal position
- Separation of the placenta from the wall of the uterus
What Causes Uterine Fibroids?
The growth and development of fibroids are definitely linked to hormonal levels in the body, especially estrogen. Uterine fibroids form from the muscular tissue (myometrium) of the uterus, and eventually become a rubber-like pale mass that is different than the tissue that spawns them. Fibroids contain a greater amount of estrogen (especially estradiol) and estrogen receptors than the surrounding myometrium, and hormonal changes involved in such events as pregnancy and menopause are clearly tied to the development of uterine fibroids.
Recent research has also indicated a connection between fibroid formation and certain environmental toxins known as xenoestrogens. These substances are called by a variety of names including:
- Environmental estrogens
- Estrogenic substances
- Bioactive chemicals
- Hormonally active agents
- Endocrine or hormone disrupters
- Estrogenic xenobiotics
They are found in many common compounds that we are often exposed to including:
- Plastics (in the form of phthalates)
- Chemical solvents
- Tobacco smoke
Xenoestrogens are known to alter the normal breakdown of estrogen in the body, thus creating byproducts that are carcinogenic. They also bind to estrogen receptors in the body and make it more difficult for estrogen to bind to these receptors as they are designed to do. All of these events also are a contributing factor in the production of uterine fibroids.
Other possible risk factors for developing uterine fibroids include obesity or a family history of fibroids in your mother or sisters.
What Treatments Are Available for Uterine Fibroids?
There are many allopathic “treatments” that are often suggested for the treatment of fibroids, most of them involving medication or surgery. We can give a brief overview of the most common ones, but let me preface it with a few general comments. Many of these are either major surgeries that should be approached with caution, or experimental surgeries that are fairly new on the scene and may have hidden risks that we are not aware of yet. There are also a slew of drugs to choose from that have varying degrees of known (and unknown) side effects. The best solution, in most cases, is to simply watch and wait. Most fibroids are uneventful and not harmful or disruptive to a normal life. Even those that cause minimal symptoms might be better off left alone. But if you feel the need to intervene with your fibroids, let’s take a look at the most popular therapies available:
- Hysterectomy: This radical surgery may be appropriate in certain extreme conditions, but be careful before submitting to it. It involves removal of the entire uterus, and in some cases the ovaries as well. Either option ends your ability to conceive and bear children, and when the ovaries are removed it also triggers artificial onset of menopause. Yet, despite these drastic consequences, 25% of all hysterectomies are performed due to problematic fibroids, and in fact, hysterectomy is one of the most oft performed of all major surgeries on women.
- Myomectomy: This is a surgical alternative to a hysterectomy which involves removal of the fibroids, but leaves the uterus intact. You should be aware that myomectomy is often a very difficult surgery that can involve blood transfusions due to excessive blood loss. Sometimes the surgeon will also discover that the size and extent of the fibroids are such that it is impossible to preserve the uterus, and an unplanned hysterectomy is required.
- There are several newer types of myomectomies that are also an option, but keep in mind that there is not much data available yet regarding the safety and effectiveness of these procedures. The ovaries and other nearby organs can be negatively impacted if the blood supply to them is advertently compromised. One is called myolysis, and it involves the use of an electric current to kill the fibroids and shrink the blood vessels that supply them. The other is known as cryomyolysis, which employs the use of liquid nitrogen to freeze and destroy the fibroid tissues.
- Medications: There are two main types of drugs that are used to treat uterine fibroids, and they both have significant side effects:
- Gonadotropin-releasing hormone (Gn-RH) antagonists are naturally produced hormones that are involved with acting on the hypothalamus of the brain and the pituitary glands to stimulate the production of estrogen and progesterone. When given supplementally, they have the opposite effect by lowering the production of hormones, thereby causing fibroids to shrink. But up to 90% of all women experience negative side effects including dramatically increasing risk for osteoporosis. They are sometimes prescribed before surgery, so that fibroids will shrink prior to the procedure.
- Androgens: These synthetic “male” hormones are sometimes suggested to shrink uterine fibroids. The side effects can be severe, including growth of facial hair and the deepening of the voice. I would stay away from these dangerous drugs. They should not be introduced into a woman’s system.
Are There Any Safer Alternatives to Treating and Preventing Fibroids?
Absolutely. Studies have shown that changing your diet can have a very positive effect on uterine fibroids. Let me give you two recommendations:
- Stay away from the Standard American Diet (SAD): If you simply lower the amount of fat you consume to no more than 25% of caloric intake, and ingest at least 40 grams of fiber per day, you will be heading in the right direction. One study of women who applied this showed a decrease in blood estrogen levels of 36% in only 8-10 weeks. This can have a dramatic effect on fibroid tumors
- Increase your intake of naturally occurring phytoestrogens. Many nuts and seeds, especially ground flax seed, are a great source of these “anti-estrogens,” as they are sometimes called.