Hello from a sunny hot Monday in an East London coffee shop, where I’m doing my best to stay cool and productive. This is going to be a bit of an educational one 🤓 - definitely worth bookmarking for later if you don’t have time to read it now.
I wanted to take the opportunity before the end of the July to talk about uterine fibroids since July is Fibroids Awareness Month.
This is also pretty relevant to me, as I was diagnosed with fibroids four weeks ago, after experiencing worsening heavy bleeds for the past year or so.
My ultrasound scans found a total of five fibroids. The image below shows the largest one (around 5 cm), located in the submucosal layer of my uterus and bulging into my uterine cavity.
What are uterine fibroids?
Fibroids are benign, non-cancerous* tumours or growths that develop in and around the uterus. Sometimes referred to as uterine polyps or myomas, they are made up of smooth muscle cells and fibrous connective tissue.
They vary greatly in size, from a tiny seed to the size of grapefruit, and in rare cases, as large as an 8 month pregnancy!
Fibroids tend to be located either:
in the muscular wall of the uterus (intramural fibroids),
on the outside of the uterus (subserosal fibroids),
under the uterine lining, bulging into the uterine cavity (submucosal fibroids)
Around 70-80% of women will develop fibroids by the time they are 50, although many may not be aware of them, especially if the fibroids are very small. This condition tends to be more common (and cause more problems) during perimenopause and disproportionately affects Black women, who experience a much higher prevalence, earlier onset, and greater severity of symptoms.
*Less than 1 in 1,000 uterine fibroids are cancerous.
The symptoms that can occur with fibroids include:
heavy periods (the most common symptom, and most likely to occur with intramural or submucosal type of fibroids),
painful periods,
fertility complications,
pelvic pressure or pain,
frequent urination and/or urinary incontinence,
pain during sex,
bloating or swelling of lower abdomen,
back or leg pain,
constipation
Note: if you feel you can handle it, here is an image of removed fibroids of various sizes - be warned, it’s pretty graphic! But this is the unfortunate reality for many women.
What causes fibroids?
The main culprit behind fibroid growth is excess oestrogen and poor detoxification of oestrogen due to gut or liver issues. Hormone imbalances caused by stress, poor diet, lifestyle, obesity, and environmental toxins can all contribute to this state of oestrogen excess.
Perimenopause, with its fluctuating hormones and particularly wild swings in oestrogen, further exacerbates the issue (lucky us).
Additionally, there may be a genetic component or predisposition to fibroids, with certain gene mutations (such as the COMT gene) known to impact oestrogen detoxification.
There are still many unknowns and understanding the exact cause of fibroids remains an active area of research.
How do you get a fibroids diagnosis?
The standard procedure to diagnose fibroids is with a transvaginal (internal) and transabdominal (external) ultrasound scan. It is best to have both types of scans to find all potential fibroids and whether they are impacting other organs like the bladder, rectum, kidneys or stomach.
Natural treatments for fibroids*
The treatment of fibroids depends on their size, location, severity of symptoms and future fertility concerns.
If the fibroids are small (less than 2-3 cm) and do not cause any symptoms, a “watch and wait” approach may be recommended, with regular check-ups to monitor growth. This approach can be complemented with lifestyle and nutrition optimisation.
If the fibroids cause symptoms but are relatively small (5 cm or less), they are likely to still respond well to lifestyle and nutrition therapy.
This is the case for me personally and I am currently focusing on these foundations:
Optimising gut health to facilitate oestrogen removal.
Optimising liver health to support proper oestrogen breakdown and detoxification.
Managing stress to reduce high cortisol and support healthy progesterone levels.
Using medical herbs to aid optimal oestrogen detoxification.
In practice, this could look like the below lifestyle and nutrition interventions:
Increasing cruciferous vegetable intake, which super important for healthy and effective ostrogen metabolism, breakdown and detoxification in the liver
Supporting gut health with enough fibre (to keep things moving!), a variety of fruit and vegetables rich in micronutrients like vitamin A, and probiotic rich food
Eating quality protein (preferably from organic grass-fed animal sources) to support healthy liver and detoxification processes
Taking supplements that support oestrogen detoxification such as NAC, sulforaphane, glutathione and calcium-D-glucarate
Taking supplements shown in studies to reduce fibroid size including green tea extract (ECGC), resvervatrol, turmeric, and vitamin D
Reducing xenoestrogen exposure like BPAs (plastic bottles, food containers, takeaway coffee cups), phthalates (personal care products, hair relaxers and perfumes) and parabens (cosmetics, lotions, shampoos, and other personal care products) - I find the Yuka app** really helpful with this one
Reducing alcohol and other environmental toxins like cigarette smoke, unfiltered drinking water and air pollution and eating organic produce where possible
Supporting toxin removal through sweating (sauna and exercise are great for this)
Working with a qualified medical herbalist (something I will be personally starting soon)
Reducing stress with adaptogens like ashwagandha and reishi, breathwork and tapping, finding enjoyable ways to unwind like dance, sauna and cold plunge, epsom salt baths, time in nature, walking etc
Maintaining a healthy weight as obesity can often be associated with higher oestrogen levels
Using castor oil packs which support lymphatic drainage and liver detoxification
* Not medical advice. Please speak to your doctor or functional medicine practitioner if you have a fibroids diagnosis. These recommendations do not replace medical treatments prescribed by your healthcare professional.
** Yuka is a very useful app that checks the ingredients of personal care products. You simply scan the barcode, and it will show you if the product contains BPAs, phthalates, parabens, or any other endocrine disruptors. I use it to vet all my products!
Medical treatments for fibroids
It may be necessary to go down the medical treatment route, especially if the fibroid is large and impacting organs or causing severe symptoms.
However it is worth noting that surgical interventions still carry their own risks - read the story of Christine Garvin's experience, a functional medicine nutritionist who nearly died after a myomectomy and now specialises in helping women with fibroids.
Medical treatments offered by the GP or gynaecologist include:
Birth control pill or IUD - oral contraceptives or other hormonal birth control methods can help control symptoms like heavy bleeding and pain but do not shrink fibroids
Transexamic acid - medication that reduces heavy bleeding to prevent iron deficiency and anaemia, but do not shrink fibroids
Hormone blockers - medications like gonadotropin-releasing hormone (GnRH) agonists can shrink fibroids by reducing oestrogen and progesterone levels. These are usually temporary solutions and can cause menopausal-like side effects.
Fibroid embolisation (UFE) - works to block the blood supply to the fibroids, causing them to shrink
MRI-Guided Focused Ultrasound Surgery (FUS) - this non-invasive procedure uses high-frequency ultrasound waves to destroy fibroid tissue.
Endometrial ablation - destroys the lining of the uterus to reduce bleeding but is typically only effective for smaller fibroids located in the lining and not effective for large fibroids elsewhere
Myomectomy - surgery which removes the fibroids while preserving the uterus
Hysterectomy - complete removal of the uterus
Is it possible to prevent fibroids?
It may not be possible to completely prevent any fibroids from forming, but I believe it is possible to reduce the risk of developing them—especially larger fibroids—and manage the growth of smaller ones through the natural lifestyle and nutrition approaches listed above.
I hope this information has been both helpful and educational. While most medical establishments primarily promote the medical options mentioned above, I believe it is crucial to also consider natural lifestyle and nutrition treatments, especially if fibroids are detected early and are relatively small (5 cm or less).
References:
Influence of Ethnicity on Clinical Presentation and Quality of Life in Women With Uterine Fibroids
Intake of fruit, vegetables, and carotenoids in relation to risk of uterine leiomyomata
Treatment of symptomatic uterine fibroids with green tea extract
Natural Antioxidant Resveratrol Suppresses Uterine Fibroid Cell Growth