Benign fibroid tumors of the uterus (also called myomas) are present in 30–50 percent of women in the United States. They occur in women of all races and backgrounds, but they are more common in women of African–American or Caribbean descent. Fibroids arise from the smooth muscle and connective tissue of the uterine muscle itself. They can form on the inside or outside of the uterus; above, below or on the side of it. Though they can occur in women as young as their late teens or early twenties, they are most often diagnosed when a woman is in her thirties or forties.1 During pregnancy, preexisting ﬁbroids can grow rapidly and can sometimes cause uterine contractions that can result in premature delivery. The good news is most fibroids don’t cause symptoms, don’t require any fancy treatment, and almost never require a hysterectomy, despite what you may have heard.
Most women with fibroids don’t even know they have one until their doctor discovers it during an annual pelvic exam. Of course, depending upon the size, number, and location of the fibroid, some women experience pain, heavy bleeding, or pressure. If the fibroid is large, 10 cm. or greater, the lower abdomen can swell slightly and make it appear that a woman is a few months pregnant.
Whether a fibroid is symptomatic has to do with its size and location within the uterus. Those that are located in the muscle wall of the uterus just under the surface (subserosal) may not be symptomatic. But those growing into the uterine lining itself (submucosal) often cause heavy or irregular bleeding. Women with both fibroids and endometriosis may experience menstrual cramps, pelvic pain, or both. A fibroid may start to degenerate if it outgrows its blood supply, causing the nerves at the center of the fibroid to register a lack of oxygen as pain, in the same way that frostbitten toes do. Sometimes the positioning of the fibroid causes symptoms by pushing on another organ, such as the rectum or the bladder, leading to a sensation of pressure or fullness in the rectum, lower back, or abdomen. A fibroid's positioning can also interfere with pregnancy in some cases.
Fibroid growth is stimulated by estrogen, and in women with estrogen dominance, they can grow quite quickly and become quite large, especially during perimenopause. The baseline energetic patterns that result in fibroids are related to blockage and stagnation of the energy of the second emotional center. Caroline Myss, Ph.D., teaches that fibroid tumors represent our creativity that has never been birthed. Fibroids may also result when we are flowing life energy into dead end jobs or relationships we have outgrown. Fibroids are often associated with conﬂicts about creativity, reproduction, and relationships.
If you have fibroids, ask yourself the following questions: What are the creations within me that I want to put out in the world before I’m no longer here? If anything at all were possible, what would my life look like? If I had six months to live, what relationships would I release from my life immediately? What relationships would I give more of my time and attention to? What relationships truly feed and nourish me? Which ones drain my energy? Write your answers in a journal. Discuss them with supportive friends. Deep within you, you have all the answers you need. You just need to be open to hearing them.
One effective way of treating fibroids is through hormones. Hormonal treatments may include bioidentical progesterone or low-dose oral contraceptive pills, which can smooth out the estrogen dominance that so often causes fibroids to grow or become symptomatic. GnRH agonists, such as Lupron or Synarel, can also be used to shrink fibroids and are sometimes effective as alternatives to surgery.
Fibroids that cause heavy bleeding can be treated through a number of surgical options. Endometrial ablation causes destruction of the uterine lining by heat, laser, or other techniques. It results in the cessation of menstruation and infertility. Myomectomy is a surgical procedure in which fibroid tumors are removed, but the uterus is repaired and left in place. Small fibroids can be removed through laparoscopic surgery or sometimes by surgical removal through the vagina (hysteroscopic surgery). Larger ones may require more extensive abdominal surgery or uterine artery embolization, a catheterization procedure that blocks blood flow and causes them to shrink.
A new treatment for fibroids called ExAblate combines MRI imaging to map out uterine fibroids followed by high-intensity, focused ultrasound that heats up and destroys fibroid tissue. The procedure is done on an outpatient basis and is noninvasive, leaving the uterus and ovaries intact. It involves lying on your abdomen in an MRI tube for up to three hours while ultrasound waves heat up and destroy the uterine tissue. Side effects may include blisters on the abdominal skin, cramping, nausea, and some pain that can be managed with over-the-counter medication. Studies show that ExAblate successfully reduces fibroid symptoms in about 70 percent of women, but that 20 percent will require additional surgery within a year. Note: Do not use ExAblate if you want to get pregnant because not enough data is available to determine what happens to the uterine wall and lining following the procedure.
Hysterectomy is probably the option most commonly offered to American women who have fibroids, but one which deserves careful consideration. Hysterectomy should be the last resort, reserved for those women who, in addition to their fibroids, also have intractable bleeding or pain problems that simply have not responded to other measures. When this is the case, hysterectomy can be a real blessing, dramatically enhancing the quality of a woman’s life.
The first thing to consider is that a fibroid may not need to be treated. A watch-and-wait attitude is not unreasonable in many cases; you can live with fibroids for years with no adverse health consequences if they are not bothering you. (And the falling estrogen levels that come in late perimenopause and menopause often shrink fibroids considerably.) There are times, however, when you may wish to seek treatment for a fibroid. You may not want to live with a growth that makes you look pregnant, or you may want to take action if your symptoms include pain, heavy bleeding, cramping, or backache.
Dietary change is the mainstay of my treatment approach for women interested in alternatives to drugs and surgery. Since the uterus is estrogen–sensitive, any dietary or alternative approach that counteracts estrogen dominance often works for fibroids. Eating a diet high in protein and healthy fats and low in high-glycemic carbohydrates such as sugar and starch can help. "White" foods like sugar and starch increase insulin, which changes the way estrogen is metabolized, creating compounds that are more likely to cause cellular inflammation and fibroid symptoms, including enhanced growth of existing fibroids. (Further evidence of the diet-estrogen-fibroid connection is the fact that fibroids are more common in overweight women.)
Nearly all women can benefit from taking phytoestrogens—plant-based hormones found in soy and flaxseed. Not only are phytoestrogens a safe alternative to synthetic hormones, these phytoestrogen-rich foods decrease the effects of estrogen levels naturally by blocking the estrogen receptors on the cells in fibroids and other estrogen-sensitive tissues. Studies have shown that eating soy and flax helps the body produce smaller amounts of unhealthy estrogens. Flaxseed is high in both fiber and omega-3 fats, which help reduce inflammation and tumor growth throughout the body and rid the body of toxins, including excess estrogen.
A wide variety of herbs help balance estrogen levels naturally. These include chasteberry, dong quai, and black cohosh—all of which have been used for centuries for various gynecological conditions. Other effective alternatives include weight loss, aerobic exercise, tai chi, meditation, acupuncture, castor oil packs, polarity therapy, homeopathic medicine, and massage.
A relatively new therapy known as NAET (Nambudripad Allergy Elimination Technique) has been used to treat ﬁbroids and a wide variety of other illnesses as well. NAET was developed by Devi Nambudripad, an acupuncturist and chiropractor who had very severe allergies herself. It is based on the premise that allergies (and other illnesses such as ﬁbroids) are the result of allergic and emotional reactions that are originally programmed in both the brain and body simultaneously. Using a process known as kinesiology (muscle testing), the NAET practitioner pinpoints the offending allergens and the accompanying emotional pattern. Then, using speciﬁc acupuncture or acupuncture points, these patterns are cleared from the body. The philosophical basis for this technique makes a great deal of sense, and I recommend it if used by a well-trained practitioner.