Uterine Fibroids and Fertility

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Uterine fibroids are benign tumour growths, made up of smooth muscle tissue, that are found in about 25 percent of 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 less 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 their fertility.

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’s even been estimated that women with uterine fibroids have a miscarriage rate that is two to three times greater than normal. 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’re 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. This is when naturopathic care can help women become well-prepared for surgery, improve their recovery, and lessen the possibility of scarring or adhesions forming post-surgery.

The most important aspect of naturopathic treatment for uterine fibroids is the liver. No, that is not a typo. 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’s possible that the uterus will become over stimulated or overestrogenized, and uterine fibroids will form and/or increase in size. Therefore, the basic message of this article is take good care of your liver, and your liver will take good care of you.

Nutrition and Lifestyle

Loving and caring for our 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. And this is just one possible scenario. Our modern world is brimming with easy access to high fat and high sugar foods that in our grandparents’ generation was an occasional treat, not an everyday indulgence.

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 it is we 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. One of my patients with uterine fibroids, who also had severe menstrual cramps and irregular cycles, started an exercise program that helped rid her of the cramps and her irregular ovulatory pattern within three months.  Her fibroids didn’t disappear, but their growth was halted, and after another six months of healthy living and naturopathic help, she conceived and now has a beautiful baby boy.

So here’s the nutritional lowdown on taking care of your liver and helping to improve uterine fibroids:

• Eat 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.

• 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 at least 5 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 which have estrogen-like activity in the body, hence they are known as xenoestrogens.

• Avoid alcohol and caffeine, which suppress liver function and in turn interferes with the liver’s metabolism of estrogen.

• 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.  

Herbal Help for Uterine Fibroids

There are a number of herbal medicines that are considered helpful. If nothing else, it doesn’t hurt to drink teas that strengthen the liver such as dandelion or milk thistle. These herbs assist in the liver’s job of metabolizing estrogens.

If you choose to see a naturopathic doctor or herbalist, there are well-known herbal formulas that are employed by these practitioners. Many of the herbs are used to improve liver function, others will have a more direct effect on the uterus. As with any herbs that you consider, please do not take them while you are also taking fertility drugs. Another thing to keep in mind, it usually takes at least two months before herbal medicines start to take effect, so patience is very important.

In addition to herbal formulas, herbs such as Vitex (Chaste tree), Stinging nettles, and Burdock root can also be employed. However, I will not go into detail with them because herbal remedies are not always a “one size fits all”, and you do need a skilled practitioner to determine which herbs and which combinations will work best for you.

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’s best to have weekly acupuncture sessions. Very often a TCM acupuncturist will also prescribe Chinese herbal combinations, and as stated in the section on herbal medicine, it is important that you find a skilled herbalist and avoid taking herbs at the same time you are taking fertility medications.  However, acupuncture can be performed while you are on pharmaceuticals, and very often excellent results are obtained.

I have seen great improvement for uterine fibroids with acupuncture. As with exercise, the simplest understanding of how acupuncture works is that it is increasing 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’s truly a win-win situation. I highly recommend acupuncture.

Homeopathic Help for Uterine Fibroids

There are a number of homeopathic remedies that a naturopath or homeopath will use to improve uterine fibroids. I find homeopathy especially helpful while a woman is undergoing pharmaceutical help for her fibroids, or while she is taking fertility medications to stimulate egg production, which often increase the size of the uterine fibroids. I often instruct my patients to think of homeopathic medicine as if it is “acupuncture in a bottle”, because if properly prescribed, it can have the same energetic effects as acupuncture. Homeopathics are NOT herbs, and therefore are not contraindicated with fertility drugs.

The beauty of homeopathy is that the woman’s emotional and psychological state is as important as the physical when finding the correct remedy. A very simple thing to consider is that irregular ovulation can be correlated with uterine fibroids. Homeopathic medicine can dramatically decrease stress levels, which we know will help to regulate ovulation, and therefore it is hoped that the uterine fibroids will also improve.

There are a number of homeopathic remedies that could be considered, I think it is best that you consult with a naturopathic doctor or homeopath to find the best remedy or remedies for you to take. A simple recommendation though, if it is difficult for you to get to this kind of help, is to take “Rescue Remedy”, which is considered helpful in reducing anxiety and stress.

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!

Other helpful physical therapies include 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.

Another 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 pelvis.

There is nothing more difficult to treat in the area of natural reproductive health care than uterine fibroids. 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. Therefore the hope that progesterone medicines will have an anti-estrogenic and therefore an anti-uterine fibroid effect has not panned out. Much of the treatment today is based more on possible theory than hard fact. And we see this in our practice, a therapy that worked well with one woman, fails dismally with another. Other than acupuncture, castor oil, and nutritional support, it can be frustrating at times to really pinpoint what type of therapy will best help each person. But that doesn’t mean I would throw up my hands and quit. That does not mean that we stop trying. Success is often seen, and for the women who are able to make these significant changes in their health, the rewards are simply phenomenal.

Judith Fiore, ND, a registered naturopathic doctor, owns and operates the Naturopathic Centre for Reproductive Health, located at the Baby Point Wellness Centre in Toronto, Ontario. Her practice is focused on providing naturopathic care to individuals and couples with fertility concerns. She can be reached at 416-231-4477, or through her website at www.naturalfertility.ca