A Functional Medicine Approach to Uterine Fibroids
Uterine fibroids (myomas and leiomyomas) are the most common benign tumor in women, affecting 60% of reproductive-aged women and 80% of women at some point in their lives. Black women are much more likely to develop fibroids and report more severe symptoms.
Uterine fibroids can cause pelvic pain, heavy or long periods (leading to anemia), infertility, and/or recurrent pregnancy loss. Though its very common to have no symptoms in early stages and fibroids can’t be diagnosed on physical exam.
Estrogen dominance, metabolic syndrome (think high cholesterol, high blood pressure, obesity, insulin resistance), inflammation, and low vitamin D are all related to an increased incidence of fibroids. Increased intake of vegetables is associated with a lower risk of fibroids. Increased body fat (especially abdominal visceral fat) increases the risk of fibroids.
Air pollution, heavy metals, persistent organic pollutants (POPs), and possibly PCBs are correlated with increased risk of fibroids. One study showed that 23% of women of child-bearing age had levels of at least 3 of the above toxicants at or above the known safety level. There is also a significant dose-dependent connection between hair relaxers and fibroid risk, which suggests that Black women may be exposed to more and different chemicals than many other women, leading to the increased incidence of fibroids.
Treatment often includes surgical or radiologic interventions. In the US, fibroids are the leading cause for hysterectomy. Some studies suggest though that lifestyle interventions may improve symptoms.
In Functional Medicine, we always start with lifestyle factors to address the root causes of pathology.
Focus of lifestyle changes should include:
-Decreasing body fat, especially abdominal visceral fat
-Balancing blood sugar and normalizing insulin
-Promoting detoxification (optimizing liver and gut function)
Diet should focus on organic, whole foods in a rainbow of colors, especially cruciferous vegetables like broccoli sprouts, cabbage, and kale, which help detoxify estrogen. Avoiding high glycemic foods and added sugar are necessary to lower insulin and inflammation. Inflammatory foods and those containing exogenous estrogens, like milk, should also be avoided. Eating fiber from whole plant foods will also help the detoxification of estrogen metabolites and other toxins. Constipation and microbiome imbalance can lead to reabsorption of estrogen. That means more estrogen back to the fibroid. Drinking or supplementing with green tea can also be beneficial.
Nutraceuticals can be helpful in addition to good nutrition. Things like alpha lipoic acid, cinnamon, chromium, vanadium, and berberine can help balance insulin. Supplements to promote phase 1 and 2 detoxification include DIM, resveratrol, methylated B vitamins like methylcobalamin (B12) and methyltetrafolate (folate, not synthetic folic acid), magnesium, and SAMe.
For my patients with fibroids or at higher risk for fibroids, I recommend hormone testing through urine to look at estrogen metabolites. We often will also check for nutrient deficiency through micronutrient testing to optimize detoxification and methylation. If there are any signs of gut dysfunction, we’ll also do GI testing as this is a common source of inflammation and reduced detoxification.