Fibroids are one of the most common female reproductive health concerns, affecting 80% of women during their life. Although many fibroids go unnoticed, they can cause uncomfortable symptoms, anemia, and pregnancy-related complications if they grow too large. Limited conventional treatment options, often including hormone-modulating medications and surgery, lead many women with fibroids to search for alternative options. This article will discuss a functional medicine approach to managing fibroids and provide a sample protocol that doctors can implement in clinical practice.
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What are Fibroids?
Also called leiomyomas or myomas, uterine fibroids are noncancerous growths of the uterus. They are composed of smooth muscle cells and fibrous connective tissue and can appear inside or outside the uterus. Fibroids range in size and number from single seedling-sized (1 mm) growths to numerous large (20 cm) masses that can distort the shape of the uterus. (9, 34)
Fibroids are classified by their location. Subserosal fibroids project outside the uterus. Intramural fibroids grow within the muscular uterine wall (myometrium). Submucosal fibroids project inside the uterine cavity. Fibroids can be further classified as pedunculated or not. Pedunculated fibroids are the least common type of fibroid and are connected to the uterus by a thin stem resembling the shape of a mushroom. (3, 9)
Fibroid Symptoms
An estimated 50-80% of fibroids do not cause symptoms, so many women may not know they have fibroids. However, depending on their size, number, and location, fibroids can cause various symptoms, including (9):
- Heavy or prolonged menstrual periods
- Bleeding in between menstrual periods
- Painful menstrual periods
- Pelvic pain or pressure
- Low back or leg pain
- Frequent urination
- Difficulty emptying the bladder
- Pain during sexual intercourse
- Constipation
- Enlarged abdomen or a feeling of fullness
- Infertility or recurrent miscarriages (in some cases)
What Causes Fibroids?
The exact cause of fibroids is unknown, but it is believed to be a combination of genetic, hormonal, and environmental factors. Several risk factors are known to play a role in fibroid development, including obesity, early onset of menstruation, and late onset of menopause.
Genetics
There is a familial tendency for fibroids, with a higher likelihood of having fibroids in individuals who have a first-degree relative with fibroids. Additionally, genetic variations influencing hormone regulation, cell growth, and extracellular matrix components have been associated with an increased risk of fibroids; compared to their healthy uterine cell counterparts, fibroid cells have chromosomal abnormalities that promote tissue growth.
Hormonal Imbalances
Fibroids contain more estrogen and progesterone than typical uterine muscle cells; therefore, hormonal dominance of estrogen and/or progesterone can contribute to fibroid growth. This is why fibroids tend to develop during the reproductive years and often shrink after menopause when hormone levels decrease. (9)
Exposure to persistent organic pollutants (POPs) has been correlated with an increased risk of developing fibroids. POPs are toxic chemicals that persist in the environment and accumulate in the body over time. These substances, such as polychlorinated biphenyls (PCBs) and certain pesticides, have been found to disrupt the endocrine system, which regulates hormonal balance. Endocrine-disrupting chemicals (EDCs) can mimic or interfere with natural hormones in the body, including estrogen and progesterone, which influence fibroid growth. (8, 12)
Functional Medicine Labs to Test for Root Cause of Fibroids
Transvaginal ultrasound is the gold standard for imaging uterine fibroids and has a 90-99% sensitivity for detecting fibroids (3). Other imaging techniques may also be ordered, including magnetic resonance imaging (MRI), hysteroscopy, and hysterosalpingogram.
Comprehensive Hormone Panel
Because hormones play a significant role in the development of fibroids, a comprehensive hormone panel to assess estrogen, progesterone, and other hormones that can influence their balance is warranted. The DUTCH Plus is a urinary and salivary test that assesses reproductive hormones, cortisol, and their respective metabolites to determine the body's hormonal levels. By measuring hormonal metabolites, this panel offers insight into how the body is metabolizing and eliminating hormones from the body, providing important information to guide hormone-balancing treatment recommendations.
Based on the patient's symptoms and medical history, measuring thyroid hormones and insulin may also be warranted, as thyroid dysfunction and blood sugar dysregulation can contribute to estrogen-dominant states. (10, 11)
Functional Medicine Labs That Can Help Individualize Treatment for Fibroid Patients
Functional labs can help doctors deep-dive into their patients' biochemistry and physiology to better understand how they can help optimize whole-body health and hormonal balance to create supportive plans for fibroids.
Environmental Toxin Panel
An environmental toxin panel can help identify and quantify exposure to endocrine-disrupting chemicals.
Liver Function
A healthy liver is imperative for healthy hormonal balance and detoxifying the body from toxic exposures. Among many other essential responsibilities, the liver is the body's primary "detox" organ, in charge of biotransformation. This two-phase system neutralizes and facilitates the excretion of exogenous and endogenous substances. A liver panel, methylation panel, and micronutrient panel are helpful tools in assessing liver function and identifying contributory factors to liver stagnation, which may contribute to hormonal imbalances and the accumulation of toxic chemicals in the body.
Comprehensive Stool Test
A healthy digestive tract and intestinal microbiome are imperative for toxin elimination and estrogen metabolism (12). Factors that impair nutrient absorption, regular bowel movements, and the function of the estrobolome can contribute to estrogen-dominant states. A comprehensive stool analysis measures various biomarkers related to digestive health and the microbiome.
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Conventional Treatment for Fibroids
Treatment options for fibroids depend on the severity of symptoms, desire for future pregnancy, and the individual's overall health. According to American Family Physician, the ideal plan satisfies four goals: relief of signs and symptoms, sustained reduction of the size of fibroids, maintenance of fertility (if desired), and avoidance of harm. Options may include clinical surveillance, pharmacotherapy, and surgical intervention. (15)
Functional Medicine Approach for Fibroids
Managing fibroids with alternative medicine can be challenging and inconsistent, highlighting the need for an integrative approach. While certain herbal remedies and dietary changes are often advocated as potential methods to support fibroid management, scientific evidence supporting their effectiveness is limited. Therefore, part of the role of the functional medicine doctor is to recognize the clinical situations when conventional intervention is appropriate. However, an integrative and functional strategy can be effective in providing symptom relief and stabilizing fibroid growth.
Therapeutic Diet and Nutrition Considerations for Fibroids
Nutrition plays a significant role in managing fibroids and maintaining a healthy weight, although it should be noted that dietary changes alone may not shrink or eliminate fibroids. However, a healthy diet can help support overall well-being, hormonal balance, and alleviate certain symptoms associated with fibroids. Here are some important nutrition considerations for managing fibroids:
Anti-Inflammatory Diet
Chronic inflammation has been linked to fibroid growth. Consuming an anti-inflammatory diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help reduce inflammation in the body. Incorporating foods like berries, leafy greens, fatty fish, nuts, and seeds can provide antioxidants and anti-inflammatory compounds that may positively impact fibroids.
Additionally, dietary patterns associated with increased risk for fibroid development include low intakes of fruit, vegetables, and vitamin D, as well as pollutants in food. Eating organic when possible and following anti-inflammatory dietary principles may help mitigate these risks.
Anti-Estrogenic Diet
In addition to the points made above, an anti-estrogenic diet can support liver and gut health to help maintain balanced estrogen levels in the body.
Eat a plant-based diet. Women eating a vegetarian diet have a three-fold increase in fecal estrogen excretion and 15-20% lower blood estrogen levels. Additionally, plant-based, anti-inflammatory diets, associated with a lower intake of animal fats and refined carbohydrates, are related to improvements in circulating estrogen and blood sugar metabolism.
Incorporate fiber-rich foods into the diet. High-fiber diets are associated with lower blood estrogen levels, decreased body mass index, and improved bowel regularity (22).
Cruciferous vegetables, including Brussels sprouts, cabbage, kale, and broccoli, are naturally high in a compound called indole-3-carbinol (I3C), which plays a crucial role in liver detoxification and estrogen metabolism.
Limit alcohol consumption. Alcohol consumption can lead to systemic inflammation and decreased liver function. Additionally, research has noted a correlation between higher estrogen levels in women who drink alcohol than those who do not.
Supplements Considerations for Fibroids
Nutritional supplements can support optimal hormone levels and mitigate risk factors associated with fibroids, with the goal of supporting overall health. Additionally, many natural supplements can be used to help manage symptoms related to large fibroids.
EGCG
Epigallocatechin gallate (EGCG), the anti-inflammatory, antiproliferative, and antioxidant constituent of green tea, shows promise in supporting fibroid management. In a preliminary study, four months of green tea supplementation resulted in a significant reduction in total uterine fibroid volume and symptom severity, along with improved quality of life and anemia due to blood loss.
Dose: 800 mg green tea extract (45% EGCG) daily
Duration: at least four months
Diindolylmethane (DIM)
The body converts I3C to a more stable molecule called DIM. Although no clinical trials exist on the use of DIM specifically for fibroids, clinical studies support its role in estrogen metabolism, breast health, and managing endometriosis.
Dose: 100 mg twice daily
Duration: at least 3-6 months
Vitamin D
Research has suggested the role of vitamin D deficiency in the development of fibroids. Furthermore, other studies have shown that vitamin D is a plausible natural option to support fibroid management.
Dose: 2,000-5,000 IU daily
Duration: at least three months
Slow Flow™
Vitanica's Slow Flow™ formula combines bioflavonoids, vitamin K, and four botanicals backed by evidence to promote clotting, prevent heavy bleeding, and support a healthy menstrual flow. This formula can be used during menses to help manage heavy bleeding associated with fibroids.
Dose: 1 capsule twice daily, increased to 3 capsules three times daily during menses
Duration: at least three complete menstrual cycles
Complementary and Integrative Treatment Referrals for Fibroids
In traditional Chinese medicine (TCM), the herbal formula Gui Zhi Fuling is commonly used to support uterine health. A systematic review including 38 trials and nearly 4,000 participants concluded that this TCM herbal formula may help manage fibroid volume and improve symptoms of painful periods when used alone or with the prescription medication mifepristone.
When to Retest Labs
In general, at least three months are required to see adequate changes in hormone and micronutrient levels with a complementary and integrative medicine approach (9). Therefore, clinical monitoring of symptoms is warranted until 3-6 months from baseline, at which point functional medicine labs are generally reordered.
While there are no set guidelines for serial imaging of fibroids, your doctor may recommend reimaging as a monitoring parameter 3-12 months after starting treatment.
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Summary
Functional medicine offers a holistic and personalized approach to managing fibroids, focusing on identifying and addressing the condition's root causes. By considering the interplay of various factors, such as hormonal imbalances, inflammation, nutrient deficiencies, and lifestyle choices, functional medicine aims to provide comprehensive and individualized plans for women with fibroids.
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