THE NATUROPATHIC VIEW: UTERINE FIBROIDS AND FERTILITY by Dr. Judith Fiore, ND - SUMMER 2011

THE NATUROPATHIC VIEW: UTERINE FIBROIDS AND FERTILITY
by Dr. Judith Fiore, ND

Uterine fibroids are benign tumour growths, made up of smooth muscle tissue, that are found in approximately 70% of Caucasian women and 80% of African-American women by the age of 40. They are the most common reason for major surgery. It is thought that the growth of fibroids is stimulated by estrogen. This is supported by the fact that uterine fibroids tend to appear during the reproductive years, and may have a period of rapid growth during pregnancy, when estrogen levels are increasing. Fibroids occur so frequently that they could be considered a normal irregularity. The majority of fibroids are small, about the size of a walnut, and are not likely to cause symptoms. In fact, most women with uterine fibroids do not have fertility problems. In some cases, when fibroids have become large enough or are located in a particular area of the reproductive system that causes occlusion of the routes of conception, then a woman may experience problems related to her fertility.1

In the majority of women who have uterine fibroids, the symptoms are often mild and sometimes there are no symptoms at all. The most common symptom is heavy bleeding during the menstrual period, and often the length of the period can be seven days or more. Some women report a feeling of congestion or pressure in the lower abdomen, or a sensation of discomfort and heaviness. There can also be pain with intercourse, increased urinary frequency, back pain and constipation.

Uterine fibroids have been implicated in up to 10 percent of infertility cases. There are a number of scenarios in which fertility is compromised by fibroids. Depending on their size and location, these tumours may interfere with implantation, or they may also grow large enough to cause compression on the fallopian tubes and interfere with conception. It has even been estimated that women with uterine fibroids have a miscarriage rate that is two to three times greater than normal.2 Periodic anovulation or abnormal uterine blood flow can also be associated with uterine fibroids.

Although this is an article about naturopathic help for uterine fibroids, the fact is that this condition is extremely difficult for naturopaths to treat. If the fibroids are fairly small, meaning they are less than 4 cm in diameter, then as naturopaths we can be fairly optimistic about preventing the fibroids from increasing in size, and in some cases these smaller fibroids will shrink. However, when dealing with larger fibroids that are creating severe symptoms and are affecting fertility, and a brief trial (three to six months) of alternative therapies has not provided relief, then often the best option is to consider surgery.3 This is when naturopathic care can help women become well-prepared for surgery, and help in their recovery.

Because estrogen is considered the main hormone that will encourage fibroid growth, it is important for naturopathic treatment to focus on the health of the liver. The liver is very important because of its role in metabolizing estrogens. The liver breaks down estrogens by converting them to a different, weaker type of estrogen that will not stimulate the uterus. If we do not take care of our liver, then its ability to break down these stronger estrogens is compromised, and it is possible that the uterus will become over stimulated or overestrogenized, and uterine fibroids will form and/or increase in size.

Nutrition and Lifestyle

Having a healthy liver means that we choose to eat a diet that is low in saturated fats, high in fibre, low in refined sugars, and we avoid alcohol and caffeine. For most people living in Canada and the United States, this can be easier said than done. Everywhere we turn there are fast-food restaurants and other burger chains promising a quick, tasty meal. As soon as we see the selections, it takes strength to skip the fries, milkshakes, colas, double burgers, and instead ask for a salad and a veggie burger. Oh, and a bottle of water with that, please. Our modern world is brimming with easy access to high-fat and high-sugar foods that in our grandparents’ generation were an occasional treat, not an everyday indulgence.

Good nutrition includes whole grains such as brown rice, millet, oats, buckwheat, and rye. They are all good sources of B vitamins, and they’re high in fibre. Your liver needs both to function well, and the extra fibre ensures that excess estrogens are excreted through the bowel. This is why women who eat a high-fibre, low-fat diet, with plenty of fruits and vegetables, have lower levels of estrogen in their blood, and are seen to decrease their risk of developing uterine fibroids.4

For women who have a severe case of uterine fibroids, it is advisable to follow a vegan diet, which is a vegetarian diet but without animal products such as eggs and dairy. You should supplement with B12, as this nutrient is found only in animal products. If this is too extreme for you, then try to eat vegan four to five days per week. Any animal products you do consume MUST be organically raised, to avoid the potential threat of xenoestrogens which show up in animal fats where the animals have been given feed that was grown with pesticides. It is these pesticides that have estrogen-like activity in the body, hence they are known as xenoestrogens.

Exercise

We are also becoming a much more sedentary nation. People are adjusting to sitting in their cars or on buses and subways to get to and from work, to and from the grocery store, to and from wherever they need to go. We’re not walking enough and we’re not exercising enough. Moving our bodies, at the very least, gets the blood moving and the heart pumping. It fills us with oxygen and improves the body’s ability to take in nutrients and push out waste. Exercise keeps us clean and alive. Tt also has been shown to lower circulating level of estrogens, and women who engage in regular physical activity are less likely to develope uterine fibroids.5 Often patients with uterine fibroids who also have severe menstrual cramps find that exercise helps decrease the severity of period cramps. Therefore it’s a good idea to get moving. Start a walking program, join a gym, get into biking or swimming or tennis, or just put on some amazing music and dance until your heart sings.

Green Tea for Uterine Fibroids

A recent study has shown that the primary oxidant in green tea, known as epigallocatechin gallate or EGCG, appears to reduce the number and size of uterine fibroid tumours.6 The EGCG in green tea seems to induce apoptosis or cell death of the fibroid tumours. Green tea is a natural therapy that has been studied in the prevention of cancer, and to gain these protective effects you need to drink a minimum of four cups of green tea daily. There are numerous types of green tea now on the market, many flavoured with mint or jasmine or ginger, and they are quite delicious and easy to add to your diet. Since coffee is a beverage that appears to be linked to uterine fibroids, and green tea does contain some caffeine, it might be a good idea to switch from coffee to green tea when you need to get going in the morning or have a “pick-me-up” in the afternoon.

Acupuncture

Acupuncture, which is probably the best known therapy of Traditional Chinese Medicine (TCM), is certainly one of my favourites to employ. It is recommended that you seek out a reputable acupuncturist or naturopathic doctor trained in acupuncture. Usually it is best to have weekly acupuncture sessions. Acupuncture can be performed whether you are on fertility medications or not, and very often excellent results are obtained. I have seen great improvement of uterine fibroids with acupuncture. As with exercise, the simplest explanation of how acupuncture works is that it increases blood flow to the uterus and ovaries. Obviously, with increased blood flow there is increased nutrient intake to these reproductive tissues along with increased waste output. In addition, better blood flow means that more estrogens will be released into the bloodstream which in turn allows the liver to metabolize more estrogen. It is truly a win-win situation. I highly recommend acupuncture.

One study looked at the use of Traditional Chinese Medicine (TCM) for the treatment of uterine fibroids. Thirty-seven patients seeking complementary care including TCM were followed for six months, and were matched with another thirty-seven patients undergoing conventional treatment. In the complementary treatment group, thirty-two of the thirty-seven patients experienced either improvement (reduced number and size of fibroids) or complete cure (for three women). With the conventional treatment group, thirteen of the thirty-seven patients had either improvement or complete cure (one patient). In this particular study, it appeared that complementary therapies such as acupuncture can have very positive effect in helping patients with uterine fibroids.6

Physical Therapies to Consider

The number one physical therapy is the use of castor oil packs. You simply soak flannel in castor oil, place it on your lower abdomen/pelvis, then place a layer of saran wrap or other plastic wrap around your body to hold the pack in place, then put a source of heat such as a hot water bottle or heating pad on top. Make sure you’re well covered with a blanket, and that you’re in a comfortable position, either sitting or lying down. It is best to keep the pack in place for at least 30 minutes, once per day. If you are trying to conceive, please do not use the pack past ovulation. And be sure to protect the furniture you’re laying on with a plastic sheet such as an old shower curtain. Castor oil will permanently stain your furniture and your clothing, therefore I also recommend that you wear an old pair of shorts and t-shirt or halter top. Please don’t put stained clothes into your machines, because they have been known to ruin washers and dryers!

Another helpful physical therapy is abdominal massage such as the Arvigo massage technique. You can go to their website at www.arvigomassage.com to see if there is a practitioner near you. If not, I will often suggest that you consider regular massage with a registered massage therapist, or you can get out some wonderful massage oil that has a few drops of lavender and rose oils, and ask your partner to massage you.

A tried and true naturopathic therapy is contrast hydrotherapy. You simply alternate three minutes of heat with one minute of cold to the abdomen. The heat source could be a hot water bottle or heating pad, or a towel soaked in hot water that is wrung out before being placed on your belly. The cold could be a cold pack or simply a bag of frozen peas or corn wrapped in a thin kitchen towel, or a towel soaked in very cold water that is wrung out and then placed on your belly. The important thing is to always end with cold to ensure plenty of blood flow to the uterus.

In all of these physical therapies, the main effect is to increase circulation to the uterus. Just as with exercise and acupuncture, increasing circulation to the uterus appears to help manage uterine fibroids and decrease symptoms.

The Final Word

Treating uterine fibroids can be a difficult endeavour for complementary health care professionals and of course very frustrating for the women who suffer from them. To date the cause is still unknown, and although there is a hormonal connection, the causal relationship is unclear. Excess estrogen seems to be the biggest culprit, but it has been shown that progesterone can also increase the growth of fibroids.7 Therefore the hope that progesterone medicines will have an anti-estrogenic and consequently an anti-uterine fibroid effect has not panned out. Other than acupuncture, physical therapies, and nutritional support, it can be difficult to really pinpoint what type of therapy will best help each person. However, it is impossible to know what could work without trying, and I encourage women who are dealing with uterine fibroids to consider naturopathic and complementary care as part of their health care treatment plan.

All references are listed on the IAAC website at iaac.ca/content/library

About the author
Judith Fiore, ND, a registered naturopathic doctor, owns and operates the Naturopathic Fertility Centre in downtown Toronto in close proximity to the Create and LifeQuest fertility clinics. She is 100% focused on fertility issues, and her practice is dedicated to providing naturopathic therapies and acupuncture to individuals and couples with fertility concerns. Dr. Fiore and her associates provide on-site acupuncture treatment to IVF patients at TCART and are available for on-site acupuncture at the Mount Sinai Centre for Fertility and Reproductive Health, and at the LifeQuest and Create fertility clinics. She can be reached at 416-231-4477, or through her website at www.naturalfertility.ca.