Uterine Fibroids by Ray Sahelian, M.D.

Up to 40% of women develop uterine fibroids, benign tumors that can cause pain, excessive bleeding, frequent urination, and infertility. Genetic studies hint that a woman's susceptibility to fibroids may be inherited from her father. Uterine leiomyomas are the most common gynecologic neoplasm in reproductive-age women. Uterine fibroids are the leading cause of hysterectomy, or removal of the uterus, in the US. Women with polycystic ovary syndrome (PCOS) are more likely to suffer from fibroids. PCOS is a hormone disorder that causes ovaries to develop multiple cysts, and is usually accompanied by lack of ovulation, weight gain and other problems.

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Cause of Fibroids
It is clear that hormonal factors play a prominent role in fibromyalgia, particularly estrogens. In addition to endogenous hormones, xenoestrogens in our environment (e.g., organochlorine pesticides, pharmacologic compounds) are of potential concern with regards to their impact on this disease. These environmental estrogens have been shown to promote the growth of leiomyoma.

Medical Treatment for Uterine Fibroids
Exogenous progestins can partially suppress estrogen stimulation of uterine fibroid growth. Danazol, an androgenic agonist, can suppress fibroid growth but has a high rate of adverse effects. GnRH agonists given by IM injection, subdermal pellet, or nasal spray are most helpful when given preoperatively to reduce fibroid and uterine volume.

Diet and Fibroids
Uterine fibroids are hormonally responsive; estradiol and progesterone stimulate their growth, and gonadotrophin-releasing hormone agonists shrink them. Phytoestrogens, including isoflavones and lignans, can act as weak estrogens or antiestrogens. There appears to be a modest inverse association between lignan ingestion and uterine fibroid risk. Whether this relation represents an effect of lignans per se or of other constituents of lignan-containing foods on the development of uterine fibroids remains to be determined.

Exercise and fibroids
Regular exercise reduces the severity of fibroids.

Natural options for Fibroids
Tripterygium, a Chinese herb, may be a therapeutic agent for leiomyomas. Tripterygium has a reversibly inhibitory effect on the ovary which may be one of the mechanisms of tripterygium in decreasing leiomyoma volume. Tripterygium is currently very difficult to find. If anyone comes across a source, let us know.

Surgery for Fibroids
For a woman who undergoes hysterectomy for benign disease such as fibroids, leaving both ovaries in place has long-term survival benefits, at least if she is no older than 65 years and at average risk for ovarian cancer. Ovary removal through surgery is often recommended along with hysterectomy, on the thinking that it prevents the possibility of ovarian cancer developing. However, women who undergo ovary removal before age 55 are nearly 9 percent more likely to die before age 80. Those who have their ovaries removed before age 59 have a nearly 4 percent high risk. Gynecologists who have been looking at the issue of (ovary removal) have focused on one thing -- ovarian cancer. Women are living longer and the major killer of women is heart disease, taking 25 times more women's lives than ovarian cancer.

Artery Embolization for Fibroids
For the treatment of uterine fibroids, a minimally invasive procedure called uterine artery embolization (UAE) that shrinks fibroids by cutting off their blood supply is as effective as removing fibroids with an operation called myomectomy. But UAE offers the advantages of a speedier and less eventful recovery.

Focused Ultrasound Treatment
For women with fibroids, treatment with focused ultrasound guided by magnetic resonance imaging (MRI) seems to relieve symptoms well. Investigators studied 109 women with symptomatic fibroids who underwent a single treatment session. The procedure involves imaging the uterus using MRI, then focusing high-energy ultrasound on the fibroids. This heats up the target tissue and kills it. After six months, 71 percent of the women achieved a 10-point reduction in the Uterine Fibroid Quality-of-Life scale, which measured 61 on average at the start of the study. Moreover, there was a much greater-than-expected average decrease of 23 in the score. After a year, in the 82 women evaluated, 51 percent met the goal of a 10-point improvement. The average score was 38, still significantly below that seen at the start of the study. Source: Fertility and Sterility, January 2006.

Uterine Fibroids Research Update
A minimally invasive procedure called uterine artery embolization is an increasingly popular treatment for fibroids, common benign growths in the uterus. However, new research suggests that this procedure may make future pregnancies more difficult by increasing the risk of preterm delivery. Typically, only fibroids that cause symptoms are treated. Such fibroids can be removed with an operation called myomectomy. The growths can also be "shrunk" with uterine artery embolization, which involves the injection of tiny particles to cut off the fibroid's blood supply. These days, myomectomy is often performed with "keyhole," or laparoscopic, surgery. Women seeking treatment for fibroids and who want to become pregnant at a later date should be counseled about the possible risks associated with uterine artery embolization.

Women with elevated blood pressure are at increased risk of developing fibroids, a new study shows. Hypertensive women were 24 percent more likely to develop clinically symptomatic fibroids than non-hypertensive women, and the risk increased with duration of hypertension. Fibroids are the most common gynecologic tumor and the second leading reason for hysterectomy in the US. In a study published in the American Journal of Epidemiology, Boynton-Jarrett and colleagues identified 7466 cases of fibroids over a 10-year period in more than 100,000 women participating in the Nurses' Health Study II. After factoring in age, race/ethnicity, weight, and reproductive history, the researchers found that for every 10-point increase in blood pressure, the risk of fibroids rose by 8 percent in those who did not take blood pressure-lowering medication and by 10 percent in those who did. The findings make it "reasonable" to look into novel approaches to treating fibroids, Boynton-Jarrett concluded, "and to explore whether enhanced control of blood pressure, or early detection and treatment for hypertension leads to reductions in the incidence of fibroids or complications associated with fibroids." SOURCE: American Journal of Epidemiology, April 1, 2005.

For women with troublesome fibroids, the combination of two approaches results in better improvement than does surgery alone. Surgical removal of the uterine growths -- a procedure known as myomectomy -- is commonly used when a woman doesn't want a hysterectomy because she wishes to preserve her fertility, the authors explain, but blood loss from the operation remains a significant concern. Recently, it has been shown that tying off the uterine arteries supplying blood to the womb restricts the growth of fibroids, Dr. Wei-Min Liu from Taipei Medical University and colleagues note. The team combined the two procedures -- ligation of the uterine arteries and myomectomy -- and compared the outcome of this new procedure with myomectomy only for the treatment of fibroids in 342 women. Overall, symptoms resolved after surgery for more women treated with the dual procedure (98.7 percent) than those treated with myomectomy alone (81.5 percent), the authors report in the medical journal Fertility and Sterility.

Non-surgical management of leiomyoma: impact on fertility.
Olive DL.University of Wisconsin Medical School, Madison
Curr Opin Obstet Gynecol. 2004 Jun;16(3):239-43.
This review is designed to discuss the literature, published from December 2002 to January 2004, on the non-surgical treatment of fibroid. All established and new modalities are reviewed, and all new developments in the field are discussed. The resulting impact on the treatment of infertility will also be evaluated. RECENT FINDINGS: In the past year important advances occurred in the medical treatment of uterine fibroids. It was found, in a large randomized trial, that preoperative treatment with gonadotropin-releasing hormone analogue did not improve surgical results or decrease blood loss. However, important strides were made in understanding the molecular biology of the effect of the hormone analogue on fibroids. Other medical therapies investigated include danazol, raloxifene, mifepristone, aromatase inhibitors, and the levonorgestrel-containing intrauterine device. Most promising in terms of long-term usage for reduction of size and symptoms appears to be the combination of gonadotropin-releasing hormone analogue and raloxifene, although selective progesterone receptor modulators may also achieve this aim. However, none avoid producing an anovulatory state that inhibits fertility, and none have been shown to enhance fertility following discontinuation. Uterine artery embolization is another non-surgical technique under intense investigation. The year's literature suggests that while results are comparable with hysterectomy in terms of complication rate and patient satisfaction, there may be important issues for women who wish to undergo the procedure and retain future fertility. Specifically, there is a significant rate of premature ovarian failure, as well as occasional damage to the endometrial vasculature with resulting atrophy and adhesion formation. Improvements in technique, in particular the use of larger and more spherical microspheres for embolization, may reduce these unwanted effects. However, few data exist regarding the course of pregnancy and outcome following embolization. SUMMARY: A number of non-surgical treatments exist for uterine fibroids, but none has been shown to be of value in the patient desiring future fertility. Myomectomy remains the standard of care for such women with fibroids, and all other therapies should be designated experimental and limited to appropriate investigational studies.

Endometriosis
What a woman eats can influence her risk of endometriosis. Endometriosis occurs when endometrial tissue, which normally lines the uterus, grows elsewhere in the pelvis. The new research indicates that women who eat the most green vegetables or fresh fruit have a reduction in risk for the condition, while those who eat the most beef or ham have an increased risk.. While endometriosis is relatively common, little is known about its cause, the authors explain in a report in the medical journal Human Reproduction. Dr. Fabio Parazzini from the University of Milan, Italy, and colleagues surveyed 504 women with endometriosis, and 504 age-matched "controls" regarding their dietary habits. The risk was significantly reduced among women with the highest intake of green vegetables (a 70-percent risk reduction) or fresh fruit (a 40-percent reduction), the researchers report, and significantly increased among women with the highest intake of beef and other red meat (a doubling of risk) and ham (a 1.8-fold increase).

Dysmenorrhea
The abdominal or low back pain that many women experience during their monthly menstrual periods may partly be due to stress. There is a significant association between stress and menstrual pain, which is called dysmenorrhea.

Fibroids emails
Q. One out of four women have uterine fibroids, so I am sure this will be a question of interest to many. Is there any correlation to either increase or decrease in fibroid mass when one takes a creatine supplement for weight training/exercise enhancement. Is there any contra-indication with amino acids such as l-glutamine? I am 46 have known about my fibroids for about 10 years and my doctor says they have grown, which is typical. I have no menopausal symptoms yet, so I am told that they can continue to grow. I take creatine serum - about 3gms - about three times a week prior to weight training. I also take l-glutamine - about 3 gms - every morning. My question is whether creatine has any effect on growth or decrease in the size of fibroids.
     A. This is an interesting question since fibroids are muscle tissue and creatine influences muscle size. However, most of the time creatine goes into skeletal muscle tissue that is being exercised. So, my guess would be that a creatine supplement does not have much of an influence on fibroids, but this is a guess only and I could be wrong. It would be interesting to do a study on creatine supplementation and fibroids, that would be the best way to find out if there is a relationship. As to glutamine and fibroids, the answer would be similar to creatine.

Q. I am a great fan of yours and use several of the Physician Formulas products, including Serrapeptase, which I personally believe will become one of the greatest tools to deal with fibroids & tissue build-up in the next few years. It is currently dissolving an originally grapefuit-sized fibroid that I have which is down to an approx. golf ball size after 3 months. So thank you for making this amazing & natural supplement.
     A. This is quite interesting. We really hope that it does work and we await further reports from users to see whether serrapeptase really works or not.

Q. What daily dosage of fish oil do you generally prescribe for depression?
   A. I don't have a standard amount. I evaluate the whole patient, including their diet and lifestyle patterns. I don't use fish oils by themselves, but depending on the person I will use fish oils in combination with 5-HTP or St. John's wort, or SAM-e, or Mind Power Rx, etc. As a general guideline, though, I will use three to five fish oil capsules but this varies.