Fibroids are non-cancerous growths originating from uterine smooth muscle cells (myometrium). They are a common women's health concern, contributing to high rates of hysterectomy and significant annual health care costs. While the exact reasons behind fibroid development are not fully understood, certain risk factors and associations have been identified. Functional medicine labs can provide useful information regarding these factors, making them helpful tools in managing fibroids.
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What Are Uterine Fibroids?
Uterine fibroids, or leiomyomas, are non-cancerous growths composed of smooth muscle cells and fibrous connective tissue that grow inside or outside the uterus. They are the most common type of reproductive tract growth, affecting up to 80% of women at some point during their lives.
There are three distinct types of fibroids, classified by their location. Submucosal fibroids grow inside the uterine cavity. Intramural fibroids grow inside the uterus's muscular wall. Subserosal fibroids grow and project from the outside of the uterus. (2, 4)
Fibroids can be further classified as being pedunculated or not. Pedunculated fibroids are the least common type of fibroid and can grow inside or outside the uterus. They have a distinct look, resembling a mushroom because they are connected to the uterus by a thin stem. (2, 4)
Fibroids grow at different rates and can occur as a single growth or in clusters. They can range in size from as small as a seed (1 mm) to as large as a watermelon (20 cm). (2, 16)
What Causes Uterine Fibroids?
Fibroids are thought to be influenced by a combination of genetic, hormonal, and environmental factors. Certain factors may increase the likelihood of developing fibroids, including age between 30-40 years, maternal family history of fibroids, African-American ethnicity, and obesity. (16)
Because fibroids express increased estrogen and progesterone receptors, imbalances in either or both hormones may contribute to their development and growth (4). Chronic stress, inflammation, inadequate nutrition, and exposure to environmental factors (endocrine-disrupting chemicals) can all contribute to hormonal imbalances (1). The likelihood of fibroids decreases, and fibroids tend to shrink after menopause when estrogen and progesterone levels naturally diminish because the uterine cells no longer receive hormonal stimulation.
Vitamin D deficiency may promote DNA damage and genetic mutations, which could activate pathways involved in cell proliferation and remodeling of the extracellular matrix, potentially leading to fibroid growth.
Evidence suggests a potential association between insulin resistance, metabolic syndrome, and the development or growth of uterine fibroids. Insulin resistance is a condition in which the body's cells do not respond effectively to the hormone insulin, which can lead to higher insulin levels in the blood. Insulin resistance can lead to an overproduction of insulin and other hormones, such as insulin-like growth factor-1 (IGF-1). Both insulin and IGF-1 are known to have growth-promoting effects on various tissues, including the uterus. Insulin resistance is often associated with chronic low-grade inflammation and obesity. Inflammation can stimulate the production of growth factors and cytokines that may play a role in the growth and proliferation of fibroid tissue, and excess body fat can lead to changes in hormone production and metabolism, influencing fibroid development (9, 12).
Uterine Fibroid Symptoms
Many women with fibroids will experience no symptoms and are only aware they have fibroids after they are found incidentally on routine pelvic exams. Large or numerous fibroids, however, may contribute to the following symptoms:
- Heavy or prolonged menstrual bleeding (menorrhagia)
- Bleeding between periods
- Pelvic pain and pressure
- Low back or leg pain
- Frequent urination and difficulty emptying the bladder
- Constipation
- Pain during sexual intercourse
- Infertility
What Are the Benefits of Regular Lab Testing for Patients Who Experience Uterine Fibroids?
Regular lab testing for patients experiencing uterine fibroids can provide valuable information to the patient and their healthcare provider. While lab tests may not directly diagnose uterine fibroids, they can help monitor the patient's overall health, assess the impact of fibroids on various systems, and guide treatment decisions. Hysterectomy, surgical removal of the uterus, is the most common gynecological procedure, with one study reporting that 35% of hysterectomies are performed to manage fibroids. Holistically evaluating patients with fibroids with the help of functional medicine tests can identify underlying imbalances contributing to fibroid growth and guide targeted integrative treatment plans. This could increase the fibroid-managing capacity of less invasive treatment interventions, improving patient outcomes and potentially reducing the need for surgical intervention.
Top Labs to Run Bi-Annually on Patients With Uterine Fibroids
The following labs can be ordered bi-annually to help effectively manage fibroids.
Comprehensive Hormone Panel
Because hormone imbalances may play a significant role in fibroid development, assessing estrogen, progesterone, and testosterone levels is a critical first step in evaluating and monitoring patients with fibroids. Using a combination of serum and urine tests can help accurately assess systemic hormone levels and evaluate the essential pathways involved in hormone metabolism and elimination.
Thyroid hormones play a crucial role in regulating metabolism and hormone balance. Some symptoms of uterine fibroids, such as irregular menstrual cycles, can overlap with thyroid disorders. Thyroid function tests, including TSH, free T4, and free T3, can help identify thyroid function abnormalities and guide treatment if necessary.
Anemia Panel
Uterine fibroids can sometimes cause heavy menstrual bleeding, leading to iron deficiency anemia. Regular monitoring for anemia and iron deficiency with a CBC (including red blood cell count, hemoglobin, and hematocrit) and an iron panel can aid in the early detection of iron deficiency and anemia.
Comprehensive Stool Analysis
Poor gut health is associated with systemic inflammation, nutrient deficiencies related to poor digestion and absorption, hormonal imbalances, and metabolic conditions. A comprehensive stool test evaluates various markers of overall gut function and the microbiome, detecting gastrointestinal inflammation, malabsorption, and a dysbiotic estrobolome that may influence fibroid growth.
Cardiometabolic Assessment
Because fibroids can be associated with metabolic syndrome and insulin resistance, a comprehensive metabolic assessment, including a CMP, lipid panel, diabetes panel, and hs-CRP, helps provide insight into the patient's cardiovascular health, dysglycemic patterns, and systemic inflammation levels.
Vitamin D
Measuring serum vitamin D can help identify vitamin D deficiency and ensure the patient has levels within an optimal range to support critical body functions.
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Summary
Regular lab testing offers a multifaceted approach to optimizing the care and management of women with fibroids. These tests provide valuable insights into various aspects of a patient's health, aiding in the early detection of health complications and underlying factors associated with fibroid development and growth. Healthcare providers can tailor treatment plans by monitoring key biomarkers more precisely, ensuring the most effective interventions to alleviate symptoms and enhance overall well-being.
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