Like many uterine conditions, uterine fibroids are far too common a condition for us to have so many unanswered questions about. The cause and nature of the condition are still up for debate. Treatment options are limited and either simply mask the symptoms or are too invasive to be available to everyone. Funding, compared with other common conditions, is inadequate. Looking at our understanding of fibroids reveals the most dangerous consequence of the stigmatizations of menstruation. If we can’t comfortably discuss menstruation, then neither physician nor patient will be able to communicate. And if we continue to accept period pain as a normal part of life, research will move at a snail’s pace, only being conducted by a small part of the medical community that knows that period pain isn’t normal. That something very treatable is generally going on behind the scenes.
70-80% of womxn have uterine fibroids (UF) at some point in their lives. The condition will affect the quality of life of about 30% of those womxn.
Others may never experience a symptom at all. Fibroids, also referred to as myomas or leiomyomas, are the most common tumor of the reproductive tract but they almost never develop into cancer. But this doesn’t mean the condition should go ignored. For womxn who do show symptoms, UF can be debilitating. Heavy bleeding, severe menstrual pain, and abnormally long periods are just a few of the symptoms that can develop. Fibroids can be solitary or plenty, and they range in size from microscopic to grapefruit.
There are four types of uterine fibroids, organized by location:
- Intramural Fibroids grow into the muscular uterine wall.
- Submucosal Fibroids are the most uncommon and they grow into the uterine cavity.
- Subserosal Fibroids are the most common, extending to the outside of the uterus.
- Pedunculated Fibroids grow on small stalks inside or outside of the uterus.
What Causes Uterine Fibroids To Grow?
For most of its medical history, it was thought that fibroids developed at the onset of menarche (the first period) and grew progressively until menopause when they generally disappeared. This belief is rooted in the fact that UF is an estrogen dominant condition. Fibroid development depends on hormonal fluctuations. While the trend does remain that fibroids develop with age and can shrink with menopause, when the body slows down its production of estrogen and progesterone and menstruation stops, we now know that the life cycle of a fibroid is anything but linear.
Still, it wasn’t until 2008 that we discovered the fibroids actually shrink and grow throughout their lifetime, and grow at different rates. In 2010, researchers studied the growth rate of different fibroids and found that smaller fibroids grew faster than larger ones. A year later, a study showed that both small and large fibroids grew faster than intermediate ones. It found that short spurts of growth were a common behavior, and intramural fibroids grew the fastest when compared to subserosal and submucosal. While some research has attempted to understand whether the growth rate is affected by the number of fibroids, data is inconclusive. One study conducted in 1994, however, suggests that smaller, solitary fibroids are more likely to shrink on their own than larger, multiple fibroids.
The latest research comes from a 2020 study done by Michigan State University College of Human Medicine, Van Andel Institute, and Spectrum Health. Researchers were surprised to find that fibroid cells were very similar to cells found in the cervix. They suspect that a better understanding of the behavior of cervical cells will help them to figure out how to intervene in the growth of fibroids. A follow-up study by the National Institute of Health (NIH) is underway.
Today we know that fibroids grow and shrink spontaneously, even in a hormonally stable environment. But we need to know why. We need to fully understand the life cycle of a fibroid so that we can create methods for minimally invasive intervention. We have some information about which conditions make us likely to develop UF. There are major racial disparities. There is research that suggests that stress, known for its ability to cause disease, may influence fibroid growth and development. Age, diet, and lifestyle are all suspected to play a role while hormones like estrogen and progesterone are essential to fibroids’ survival. But we don’t know enough to mitigate the issue once it’s been diagnosed without less than desirable treatment approaches. The key to finding a minimally invasive approach that is available to all people living with fibroids is more funding and more research.
Here’s What We Know So Far: Causation Theories
We don’t know what causes uterine fibroids to develop in the first place, and so we don’t know if there are one or many factors at play. However, research points to several correlating factors that can give us a starting point for natural treatment. Age, hormones, genetics, race, stress, diet, and obesity all appear to play a part.
The first factor, age, can also be understood by looking at the role of hormone production and fluctuation. Womxn are more likely to develop fibroids as they age, and fibroids tend to shrink after menopause. As we already know, there is variation in this process and fibroids do often act independently of hormone function. However, the production of estrogen and progesterone are essential to fibroid growth. And fibroids contain more estrogen and progesterone receptors than normal uterine muscles. However, pregnancy has a reverse effect on fibroid growth. A study conducted in 2010 showed that 79% of fibroids shrunk post-pregnancy and 39% disappeared entirely. While the reason for this still needs to be fleshed out, researchers did note a decreased blood supply to the fibroids in some of the postpartum womxn.
The role of genetics has caught the eye of some researchers. Studies have shown that you’re more likely to develop uterine fibroids if a member of your family has them. Other studies have shown that fibroids contain genes that vary from the uterine muscular cells. In 2012, a study conducted by Brigham and Women’s Hospital showed that the FAS protein, known to be vital to tumor cell survival, was expressed at three times higher the rate in white womxn with uterine fibroids.
Race is a huge determining factor. In the US, black womxn are two to three times more likely to develop fibroids. But they’re also likely to develop more severe symptoms, larger fibroids, and they’re less likely to see their fibroids shrink after menopause than white womxn. To understand this racial disparity, a 2007 study looked at the correlation between the occurrence of uterine fibroids and reports of racial discrimination, which are significantly higher in black womxn as well. Subjects reported “everyday” and “lifetime” racism over the course of six years. Researchers found a strong correlation between stress from perceived racism and the risk of uterine fibroids.
Is racism-related stress to blame for a significantly high risk for UF in black womxn? Another study published in 2010 set out to understand the correlation between stress from a major life event in both white and black womxn. They found that there was a strong correlation between stress from life events, especially in white womxn. However, while they only found a correlation in black womxn who reported high levels of stress, they noted that their measure of life events didn’t include discriminatory events. Stress and racially related stress should be areas of interest for future research for several reasons. The first is that stress causes disease in the body. If we can understand how stress influences fibroid growth, then we may be able to naturally intervene or shrink fibroids altogether. The second is that stress affects hormone fluctuation and hormone fluctuation is a primary component of fibroid growth. The third is that racial discrimination is reported highly among black womxn in the US and if there is a correlation between uterine fibroid growth and the experience of racism, then that will support what many respected health organizations already recognize: that racism is a public health crisis. That disease in the body can be determined by one’s environment, and eradicating that disease means changing the environment.
Many natural approaches to fibroid treatment include stress management. Physicians know that stress can help disease progress, and that living with pain and heavy bleeding can cause stress. This leads to a self-fulfilling cycle that can make life unmanageable. Fibroid symptoms can affect sleep, work, relationships, and even the ability to be far from a bathroom.
Obesity, more prevalent among black womxn is also linked to a higher risk of developing fibroids. In 2014 the Black Women’s Health study found a positive correlation between racism and smoking, alcohol consumption, red meat, and fried foods--all factors that increase the risk for fibroids. They also found a positive correlation between everyday racism and obesity. Their study noted that residential segregation makes healthier food less accessible, fast food more accessible, and chronic stress to be more likely. Diet is very important for managing and preventing uterine fibroids. Studies have shown that a diet high in red meat, fried food, and alcohol all increase the risk of developing UF. Diets low in green vegetables and fruit also increase the risk. Most treatment plans include eating a nutrient-rich diet intended to maintain a healthy weight, manage blood pressure, regulate estrogen, and keep inflammation down.
The Symptoms Of Uterine Fibroids
How do you know if you have fibroids? Up to 80% of womxn have them at one point in their life and sometimes they resolve on their own. Not everyone shows symptoms. The most common symptoms are heavy bleeding, severe menstrual cramps, abnormally long periods, bleeding between periods, and pelvic pain or pressure. Additional common symptoms are frequent urination or difficulty urinating, anemia, bloating or swelling of the abdomen, frequent UTIs, pain during sex, backache, leg pain, and constipation. The least common symptoms are dizziness, fatigue, and nausea. A lot of these symptoms are also symptoms of adenomyosis or endometriosis. Heavy bleeding is one of the primary symptoms of adenomyosis, so the two can be confused or misdiagnosed. To complicate things further, it’s not uncommon for adenomyosis and UF to occur simultaneously. This is also true for endometriosis and fibroids.
Fibroid pain feels different for everyone. For some, pain presents itself as menstrual cramps that don’t necessarily go away when menstruation stops. For others, it can feel like an appendix has burst. Others describe it less as pain and more as discomfort or pelvic pressure. Fibroids tend to become more painful as they grow. If they outgrow their blood supply, the pain can become excruciating, sometimes followed by fever. Pressure, while not as painful, is another telling symptom. Some fibroids can grow so large that they put pressure on the uterus, bladder, and bowel, causing the abdomen to swell noticeably.
Diagnosis and Treatment of Fibroids
Fibroids are commonly found during a routine pelvic exam. A physician may feel an abnormal lump, and an ultrasound is used to confirm the diagnosis. Ultrasound, the most common imaging technology, uses sound waves to scan the uterus and ovaries. It’s quick, inexpensive, and easily accessible. But sometimes an MRI is needed to tell the difference between UF and adenomyosis, a condition where tissue similar to the uterine lining grows within the muscular uterine wall. Sometimes the MRI will reveal that both conditions are present. In some cases, a laparoscopy is needed to confirm the diagnosis. A little more invasive than other imaging techniques, laparoscopy is the gold standard for diagnosing fibroids and is still considered to be minimally invasive surgery.
Other surgical treatments for fibroids are:
- Myomectomy. This surgery is challenging but is the most ideal for womxn who want to get pregnant, as it preserves the organs while removing the fibroids.
- Hysterectomy. This is a major surgery that involves removing the uterus, and in some cases, the cervix, fallopian tubes, and the ovaries. Hysterectomy is the second most common surgery performed on womxn, with 40%-60% of all procedures being a result of uterine fibroids.
- Uterine Fibroid Embolization. This procedure is less invasive and less expensive than a myomectomy but still preserves the uterus. However, it’s controversial whether or not it’s right for womxn who want to have children. It’s also less effective if adenomyosis is also present, although 90% of people who undergo the procedure see their symptoms reduce or disappear.
- Endometrial ablation. This procedure removes the lining of the uterus and isn’t for womxn who want to get pregnant.
- Laparoscopic Morcellation. This procedure is no longer recommended because of its risks. It splits the fibroid into smaller sections so that it can be removed with laparoscopy. However, sometimes what looks like a fibroid is actually a uterine sarcoma, a type of cancer. The procedure can expedite the growth of the hidden cancer, like sprinkling seeds on the ground.
Hormonal therapy is sometimes used to stop the growth of fibroids and to treat the symptoms. Birth control and IUD both regulate the estrogen and progesterone in the body. These approaches are embraced by womxn who don’t experience adverse side effects. However, many people experience weight gain, mood and libido fluctuations, headaches, or nausea. Many people find themselves having to choose whether they want to live with debilitating pain and bleeding or depression. GnRH agonists are sometimes used to stop the production of estrogen, but they come with their own unpalatable list of side effects: bone density loss, hot flashes, and vaginal dryness. And if hormonal therapy stops, fibroids often grow back or return to their normal size.
Can You Treat Fibroids Naturally?
There is no cure-all: no one surgery will be a viable option for everyone, and hormonal treatment works for some and creates more problems for others. Research on natural approaches to uterine fibroids is certainly lacking. However, some studies have shown that exercise, diet, and lifestyle choices can alleviate symptoms. And many people embrace stress-reduction techniques to address their quality of life. Some stress reduction techniques are meditation, yoga, exercise, journaling, deep breathing, and art therapy.
When it comes to prevention, exercise is key. A study published in 2007 observed participants between 1996 and 1999. They found that those who exercised for seven hours or more a week had fewer fibroids than those who exercised two hours or less. Exercise, obesity, and stress are all linked to UF, so healthy coping skills and lifestyle choices are paramount. A study in Italy conducted from 1986 to 1997 found that uterine fibroids were associated with red meat consumption, especially when paired with a low intake of green vegetables. A study that ran from 2009 to 2011 also concluded that vegetable and fruit intake correlated to a lower risk for fibroids.
Some interesting research has been done to look at Vitamins A and D. Both appear to be protective from fibroid growth, but the significance of Vitamin A is still controversial. A study from 2013 found that womxn with sufficient Vitamin D were less likely to have fibroids than those that were deficient. The study, which looked at white and black womxn, noted that black womxn have a higher incidence of vitamin D deficiency. While some studies on Vitamin A are inconclusive, other data indicates that animal-sourced Vitamin A and fruit consumption lowers the risk of developing fibroids. Green tea extracts have been shown to limit fibroid growth in animals. However, more research is needed.
Foods that are high in Vitamin A and D are:
- Milk, yogurt, and cheese
- Cod liver oil
- King Mackerel
The typical fibroid-friendly diet is rich in vegetables, fruits, and fish and low in red meat, fried food, and processed food. Alcohol and caffeine, known for being inflammatory beverages, should be cut out. Smoking, another coping tool for stress, is suspected to be a perpetrator as well, and should be given up. People who experience anemia related to heavy bleeding will want to incorporate iron-rich foods into their diet like seafood, beans, dark leafy greens, dried fruit, or iron supplements. Cruciferous vegetables, which help to break down estrogen, are encouraged.
Cruciferous vegetables include:
- Brussel Sprouts
- Bok Choy
- Collard Greens
Fibroids and The Environment
The question remains whether or not environmental toxins promote fibroid growth. There are a handful of studies that have not found a correlation between exposure to harmful chemicals and gynecological disorders. On the other hand, several studies have found that exposure to hormone-disrupting chemicals increases one’s risk of developing endometriosis. Chemicals like DEET, BPA, DDT, estrogen-like pesticides, chemicals found in sunscreen, and dioxin, a byproduct of waste incineration, have all been linked to endometriosis. This should raise the eyebrow of anyone concerned about uterine fibroids, endometriosis, or adenomyosis.
If environmental estrogen is causing disease in 70%-80% womxn, then it becomes necessary to look at the environmental crisis as a feminist issue. We don’t have enough information, but what little science does have to say about UF and other uterine conditions hints at a larger picture. Is our approach to production, waste, and environmental care making us sick? Is systemic racism breeding disease in black womxn? These are hard questions to answer. Answering them may lead to more difficult but pressing questions. For those of us who are ready, however, the challenge is to make those questions matter to everyone enough to garner funding.
It’s important to remember what we can do in our lives to make progress towards getting our answers. It’s also important to remember that we aren’t alone in our journey. In July of 2020, US Vice President-elect Kamala Harris, then serving as US Senator, introduced the Uterine Fibroid Research Education Act. The goal of the act is to prioritize womxn’s healthcare and create more opportunities for research. It will bring in $30 million annually for the NIH to expand research and will allow the CDC, Medicaid Services, and the HRSA to make information more readily available to the public. The Society of Women’s Health Research works towards the goal of closing the gap between funding for gendered health issues. They advocate for policy change, education, and funding.
Dissolving the stigma of menstruation and topics related to the menstrual cycle is a necessary first step in solving these issues. If we can’t talk about them openly, we won’t ever resolve these urgent problems. Practice talking openly about menstruation and uterine disorders with your friends. Start with someone that feels less risky, and then challenge yourself to bring it up with people in your circle that you normally wouldn’t. Replace euphemisms like “that time of the month” with direct language like “period”, “menstruation”, or “bleeding”. Investigate your own comfort level and why you may feel comfortable or uncomfortable being direct about the topic.
Stop hiding your tampons. Hiding them sends a message (to ourselves and to others) that our period is something that must remain hidden. Make a courageous post on social media about your condition. You might create opportunities for conversation with others that share your struggle. Support or share menstrually-aware content on social media. Last, teach the children in your life that while periods are normal, pain is not. Give them the information they need to evaluate their own health. And be brave when speaking to your doctor about your symptoms. If you feel like you aren’t being heard, or your complaints are being dismissed, find a doctor who will take you seriously.