Fibroids- Womens Encyclopaedia of Natural Medicine

[SydT]

Taken from Chapter 19, Fibroids, "Women's Encyclopaedia of Natural Medicine," T Hudson ND, 2008. (Foreward by Christiane Northrup).

(I will post this in parts. It is an interesting read). I'd be interested in any comments, discussion about her suggestions.

OVERVIEW
Uterine fibroids (also known as leiomyomas or
myomas) occur in 20 to 25 percent of women by
age 40,1 more than 50 percent of women overall.
They are the most common solid pelvic tumors
in women and the most common indication for
major surgery in women, and they account for
approximately one-third of hysterectomies each
year.2 According to some studies, in African-
American women the incidence of fibroids is
three to nine times higher and the fibroids’ rate
of growth is increased.3, 4

You would think for a condition as common
as this that we would have a good understanding
of the cause and cure. Nevertheless, the cause of
fibroids remains poorly understood. Uterine
fibroids are not actually fibrous but consist of
muscle, probably uterine smooth-muscle cells
but possibly connective tissue or the smoothmuscle
cells of uterine arteries. The growth of
fibroids may be stimulated by estrogen. The tendency
of fibroids to arise during the reproductive
years, grow during pregnancy, and regress postmenopausally
does implicate estrogen as one
factor in the cause and growth of fibroid tumors.
A growth spurt in fibroids is frequently seen in
the perimenopausal period and is likely due to
anovulatory cycles with a relative estrogen excess
that commonly occur during this period. Pregnancy
is a condition of elevated estrogen and
progesterone, and even though progesterone is
an antiestrogen, the increased blood supply
during pregnancy leads to an overall stimulating
effect on the uterine fibroids.5

There have been reports that concentrations
of estrogen receptors in fibroid tissue are higher
than in the surrounding uterine muscle tissue
(myometrium)6 but lower than in the uterine
lining (endometrium). Although these findings
may help to explain why fibroids are sensitive to
estrogen, they have not been consistently substantiated
in other studies.7, 8 This higher concentration
of estrogen receptors may be due to
changes in estrogen metabolism within the fibroid
itself. Pollow and colleagues8 demonstrated a significantly
lower conversion of estradiol into
estrone in fibroids than in the myometrium, suggesting
that local, concentrated estradiol increases
within the fibroid may play a role in the cause and
growth of fibroids.

The prevalence and size of fibroids are greater
in women who do not ovulate or who have
endometrial hyperplasia or a granulosa cell tumor
of the ovary. Even though fibroids do not lead to
cancer and are not a cause of uterine cancer, they
are associated with a fourfold increase in the risk
of endometrial carcinoma. This is probably
because too much estrogen without any or enough
progesterone (called unopposed estrogen) is a contributing
factor in both conditions.

Fibroids come in all sizes and shapes and usually
occur as multiple tumors, although each
fibroid is discrete. Most discernible fibroids are
between the size of a walnut and the size of an
orange, but unusual tumors have been reported
up to 100 pounds.

Fibroids are classified according
to their location. They are either submucosal
(just under the endometrium), intramural (within
the uterine muscle wall), or subserosal (from the
outer wall of the uterus). They can also be
intraligamentous (in the cervix between the two
layers of the broad ligament), pedunculated and
dangling from a stalk into the uterine cavity
(pedunculated submucous), or pedunculated on
the outside of the uterine wall (pedunculated subserous).
The pedunculated submucous fibroids can on occasion protrude through the cervix into
the girl thingy. Other pedunculated fibroids on a long
stalk outside the uterus can be mistaken for an
ovarian mass or attach to the bowel.

The majority of fibroids (an estimated 50 to
80 percent)9 don’t cause any symptoms, but when
symptoms do occur they often begin as a vague
feeling of discomfort and may include a feeling
of pressure, congestion, bloating, heaviness, pain
with girl thingyl sex, urinary frequency, backache,
abdominal enlargement, and abnormal bleeding.
Abnormal bleeding occurs in only 30 percent of
women with fibroids. Heavy bleeding (menorrhagia)
results when intramural tumors enlarge
the endometrial cavity and increase the surface
area of endometrium and blood supply to the
uterus.
Intermenstrual bleeding (metrorrhagia)
results when submucous fibroids ulcerate through
the endometrial lining or cause congestion of the
surrounding blood vessels.

Fibroids can undergo degenerative changes.One type of degenerative change is when the continued
growth of the fibroid outgrows the blood
supply. A more common type of degenerative
change is when there is a loss of cellular detail
(hyaline degeneration) as a result of a decrease in
the vascularity of the tumor. Necrosis (cell death)
results in cystic degeneration, which lends itself to
a softer than usual consistency and can be confused
with an ovarian mass on exam or pelvic
ultrasound. Calcification can occur over time and
is usually seen in postmenopausal women.

The historical perspective has been that
fibroids are not usually associated with pain except
when degeneration occurs or when the uterus
contracts in its efforts to expel a submucous
fibroid. Feelings of pressure pains may develop if
the uterus becomes excessively enlarged with
fibroids, or if a single fibroid is larger than 5 cm at
its greatest diameter.10 However, if we look a little
harder at some of the research, clinic-based studies
suggest that gynecologic pain is often related to
the presence of fibroids.11–15 Fibroids are commonly
found in women with chronic pelvic pain,
although they may not be the cause or the only
cause of the pain.16, 17

There may also be racial differences when it
comes to pelvic pain and uterine fibroids. One
study reported that 41 percent of white and 59
percent of black hysterectomy patients with a
presurgical diagnosis of fibroids reported severe
pelvic pain.18 Another study reported a series of
studies in which pelvic pain and/or menstrual pain
was experienced in 34 percent of patients with
fibroids.19 In a recent study, the first populationbased
study of gynecologic pain symptoms and
fibroids, dyspareunia (pain with girl thingyl sexual
activity) and noncyclic pelvic pain, but not dysmenorrhea
(menstrual pain), increased in severity
with the presence of uterine fibroids.20 Pregnant
women with fibroids also have reported pelvic
pain more frequently, and it seems that the pelvic
pain is related to the size of the fibroid(s) and their
location.21, 22

So you might now be confused: do fibroids
cause pelvic pain or not? The majority of the
time, uterine fibroids do not cause pelvic pain;
however, if you have chronic pelvic pain, fibroids
may in fact be a cause of that chronic pelvic pain,
especially if they can be palpated on the pelvic
exam. Some of the urinary complications that
occur in 5 percent of fibroids are cause for concern
because they may be due to compression of
the ureter (outflow tract from kidney to bladder)
that can cause enlargement of the kidneys and
compromise of kidney function.

Fibroids are thought to be the cause of 2 to 10
percent of cases of infertility. There are several possible
reasons for this. The tumors may interfere
with implantation of the fertilized ovum, they may
cause compression on the fallopian tubes and interfere
with motility of sperm or egg, or they may
cause early miscarriage. They may also cause periodic
anovulation or abnormal uterine blood flow
and may obstruct sperm. Large fibroids may affect
pregnancy by interfering with the fetus growth,
leading to potential intrauterine growth retardation,
premature rupture of membranes, retained placenta,
postpartum hemorrhage, abnormal labor, or an abnormal lie of the fetus.

Not all practicing obstetricians would agree with these reports, and
their main observations with pregnant women and
large fibroids are an abnormal lie or postpartum
hemorrhage. The incidence of miscarriage due to
fibroids is unknown but estimated to be two to
three times greater than normal.

If a fibroid uterus is present, it can often be
felt during a pelvic examination. It usually feels
firm but can vary from soft to rock-hard. The
uterus can be irregularly shaped or irregularly
enlarged and often feels like it has protrusions.
Most of the time it is not painful during the
exam. Many times women don’t realize they have
a fibroid until the practitioner finds it. This is not
cause for alarm. Fibroids are benign growths
most of the time. The worrisome fibroid is a rapidly
growing one; the rare malignant uterine sarcoma
may have to be considered in these cases.

After the pelvic exam, a pelvic ultrasound is
the most useful tool in diagnosing a fibroid. This
imaging test is able to identify fibroids and delineate
the size and to some degree the location, as
well as identify that the ovaries are normal in size.
The ultrasound detects the contours of the
uterus, the fibroids (called hypechoic masses),
compression of the ureters, any potential enlargement
of the kidneys caused by the compression,
and, of course, the presence of an enlarged uterus.
It is difficult for the ultrasound to detect fibroids
smaller than 2 cm. A magnetic resonance imaging
(MRI) test is more accurate in assessing the
number, size, and location of fibroids, but it does
not provide significant enough additional information
to be worth the cost. A hysteroscopy can
detect submucous tumors. An x-ray can diagnose
calcified fibroids.

The main diagnostic consideration is differentiating
a possible fibroid from the following conditions: ovarian malignant tumor, an abscess in the fallopian tube/ovarian region, a diverticulum from the colon, a pelvic kidney (rare), endometriosis,
adenomyosis (endometriosis within the muscle wall of the uterus), congenital anomalies, adhesions in the pelvis, or a rare retroperitoneal tumor. Not all of these considerations can
be distinguished from the medical history, physical
exam, and pelvic ultrasound. Surgery may be
required to distinguish one condition from the other. Laparoscopy is the definitive method of excluding these other diagnoses from fibroids, even though laparoscopy is not typically done to
diagnose fibroids. Only when there is great concern
or lack of clarity about the diagnosis will the procedure be warranted.

KEY CONCEPTS
• Uterine fibroids are benign and common.
• We do not know what causes fibroids.
• Fibroids are estrogen dependent (some may even
be progesterone dependent).
• The majority of the time there are no symptoms,
but when there is pelvic pain, abnormal bleeding,
or infertility, uterine fibroids must be
considered.
• Abnormal bleeding may be caused by uterine
fibroids.
• Abnormal bleeding warrants a visit to your
health-care practitioner.
• There are several kinds of fibroids based on
location.
• An enlarged uterus or abnormal finding on a
pelvic exam may require further testing to
determine the diagnosis.
• Less than 1 percent of fibroids are malignant,
but rapidly growing fibroids warrant further
exploration.

PREVENTION
• Ensure regular ovulation.
• Avoid situations that promote lack of ovulation,
such as stress.
• Avoid estrogen-only medications.
• Dietary phytoestrogens (soy, flax, red clover) do
not appear to stimulate the growth of fibroids.
• Practice good nutritional habits with a diet that
is higher in complex carbohydrates, higher in
fruits and vegetables, and low in saturated fats,
alcohol, sugar, or other foods that interfere with
the liver’s role in metabolizing hormones.
• Maintain a healthy weight. Obesity can lead to
higher estrogen effects on the uterus.

[SydT]

continued...

OVERVIEW OF ALTERNATIVE MEDICINE
Over the more than 23 years I have been in clinical
practice, not many health problems have
eluded successful treatment as consistently as
uterine fibroids. Women who are seeking an
alternative to drug or surgical treatment for uterine
fibroids will not find an easy, reliable alternative
to shrink the tumors with natural medicine.
Using the protocols in this book, we are usually
able to successfully resolve or improve most
symptoms that relate to the fibroids such as
abnormal bleeding, pelvic pain or pressure, and
backache. In addition, there are natural therapies
that may be able to slow the growth of the
fibroids to avoid further problems.

Using the protocols in this book, we are usually
able to successfully resolve or improve most
symptoms that relate to the fibroids such as
abnormal bleeding, pelvic pain or pressure, and
backache. In addition, there are natural therapies
that may be able to slow the growth of the
fibroids to avoid further problems.

When it comes to shrinking fibroids, especially
the large ones, natural therapies can only
significantly shrink a small minority of cases.

There are individual cases that report reduction
in size on pelvic ultrasound, disappearance of
symptoms, and even total disappearance of any
evidence of fibroids. I myself can report cases
where fibroid growth and the size of the uterus
have been significantly reduced. The problem is
that the results are very inconsistent. Often the
cases that have shown the most dramatic
improvements are the women who are nearing
menopause or postmenopausal whose fibroids
shrink because of the natural decrease in their
estrogen levels.

It may be possible to reduce uterine fibroids
through alternative means and avoid a surgery or
drug treatment that your gynecologist has recommended,
but, more likely than not, large fibroids that are causing symptoms
that have not been successfully dealt
with will indeed require some kind of
conventional intervention.

My main goals with women who have large fibroids
are to (1) deal with problem symptoms, (2) try to
stabilize the situation and hold out until menopause,
and (3) recognize the clinical situations
when conventional treatment intervention is
appropriate and reasonable.

One aspect of being a naturopathic physician
is to more fully educate patients about their
health and health problems so that they can
make informed decisions about their health care.

With uterine fibroids, I have often been in the
position of discussing surgical options or procedures
that not all gynecologists discussed with
their patients. Educating the woman who is
faced with a possible hysterectomy and finding a
surgeon or gynecologist who is skilled in these
alternatives may be the most important service
an alternative provider can offer. There are many
new conventional therapies that can be alternatives
to a hysterectomy in many cases. These
new therapies include hysteroscopic resection,
embolization, and laparoscopic surgery. However,
not all cases of fibroids may be successfully
treated with these methods.

[SydT]

continued...

Nutrition
Even though diet changes alone are unlikely to
shrink fibroids, good dietary habits are still
important. Clinical observation has taught me
that all natural therapies work best in the context
of a healthy lifestyle. Improving one’s diet may
help in small ways, to decrease heavy bleeding or
the pain and discomfort caused by the fibroids.
Besides these potential benefits, dietary improvements
will improve your general well-being.

Also, women with uterine fibroids may be at
higher risk for endometrial cancer due to the
higher estrogen levels. A diet high in saturated
fats is associated with higher blood levels of estrogen,
potentially exacerbating the problem. Lowfiber
diets are associated with elevated estrogen
levels and poor excretion of estrogen. Poor nutritional
habits can also lead to dysfunctional estrogen
metabolism and inhibit the body’s ability to
break down and excrete excess estrogen.

The tradition of naturopathic medicine holds
that the health and vitality of an individual
depends on the health of the liver and the whole
digestive system. The liver’s basic functions are
vascular, secretory, and metabolic. As a vascular
organ, the liver is a major reservoir of blood
and filters over one quart of blood per minute.
The liver removes bacteria, endotoxins, antigen antibody
complexes, and other particles from the
circulatory system. The liver’s secretory functions
are the synthesis and secretion of bile. The liver
manufactures about one quart of bile daily. Bile
is required for the absorption of fat-soluble substances,
including some vitamins. The majority
of the bile secreted from the liver into the intestines
is reabsorbed. The metabolic functions of
the liver are involved in carbohydrate, fat, and
protein metabolism; the storage of vitamins and
minerals; the formation of numerous biochemical
factors; and the detoxification or excretion
into the bile of hormones such as estrogen as well
as histamines, drugs, and pesticides.

The liver not only has to process the foods
that we eat every day but also detoxifies harmful
substances, both those we produce from normal
metabolism and those we are exposed to in our
environment. In addition, it metabolizes and
deactivates hormones. The liver metabolizes
estrogen so it can be eliminated from the body by
converting it to estrone and finally to estriol, a
weaker form of estrogen that has very little ability
to stimulate the uterus. If the liver cannot
effectively metabolize estradiol, the uterus may
become overestrogenized and respond with
fibroid growths.

Saturated fats, sugar, caffeine, alcohol, and
junk foods are unhealthy and problematic for two
reasons: (1) they interfere with the body’s ability
to metabolize estradiol to estrone to estriol, and
(2) some of these foods are deficient in B vitamins
or interfere with B-vitamin metabolism. If B vitamins
are lacking in the diet, the liver is missing
some of the raw materials it needs to carry out its
metabolic processes and regulate estrogen levels.

A recent animal study suggests that lycopene supplementation
(high in yellow/orange fruits and
vegetables and especially high in tomatoes,
tomato sauce, and tomato juice) may decrease the
incidence and size of leiomyomas.23

Another study extolled the benefits of a vegetarian diet by
finding that women who suffered from fibroids
were more likely to have high consumption of red
meat and ham and have low consumption of
fruits and green vegetables.24

Whole grains such as brown rice, oats, buckwheat,
millet, and rye are excellent sources of B
vitamins. Whole grains also help the body to
excrete estrogens through the bowel. The role of
whole-grain fiber in lowering estrogen levels was
first reported in 1982.25 This study found that
vegetarian women who eat a high-fiber, low-fat
diet have lower blood estrogen levels than
omnivorous women with low-fiber diets. Once
again, we can see why a high-fiber diet might
prevent and perhaps reduce uterine fibroids
through the estrogen connection.

A high-fiber diet may also help relieve some
of the bloating and congestion associated with
fibroids. By bulking up the stool and regulating
bowel movements, some of these symptoms may
improve. Some women have a hard time tolerating
increased fiber in their diet because of compromised
digestive function. In these cases, it
may be necessary to increase fiber slowly and
include digestive support such as enzymes or
acidophilus.

Because there is an association between
having uterine fibroids and a fourfold increase in
the risk of endometrial cancer,1 three dietary recommendations
stand out above all else: increase
fiber, decrease dietary fat, and increase soy products
and other legumes.

Researchers at the
Cancer Research Center at the University of
Hawaii published a case-controlled, multiethnic
(Japanese, Caucasian, Native Hawaiian, Filipino,
and Chinese) population study to examine the
role of dietary soy, fiber, and related foods and
nutrients on the risk of endometrial cancer.26

The diets of 300 women with endometrial
cancer were compared with women in the general
multiethnic population. The researchers
found that high fat intake was positively associated
with endometrial cancer, whereas a diet rich
in fiber, soy, and other legumes reduced the risk
of endometrial cancer. The study concluded that
plant-based diets low in calories from fat, high in
fiber, and rich in legumes (especially soybeans),
whole-grain foods, vegetables, and fruits reduce
the risk of endometrial cancer.

While I can’t say that lowering fat and
increasing soy and fiber intake will definitely prevent
or treat fibroids, these nutritional habits do
lower the risk of endometrial cancer. Since uterine
fibroids are associated with an increase in the
risk of endometrial cancer, it logically follows
that these diet recommendations could help with
fibroids.

Some people have raised the concern that
women with uterine fibroids should avoid soy
foods for their high content of phytoestrogens
(specifically isoflavones) because phytoestrogens
may have a weak estrogenic effect. The answer
appears to be that this is not necessary. Soy
phytoestrogens do not have an estrogenic effect
on the uterus, at least in the usual doses.

This was most recently confirmed in a Chinese study.27
This population-based, case-controlled study
obtained detailed information from a foodfrequency
questionnaire on soy food intake over
five years. The participants were 832 women,
ages 30 to 69, who were diagnosed with endometrial
cancer from 1997 to 2001. This group was
compared with 846 control-matched women
selected from the Shanghai Residential Registry,
who had an average intake of 42.5 mg of soybased
isoflavones per day.

This study demonstrated that regular consumption
of soy foods, as either soy protein or
soy isoflavones, was inversely associated with the
risk of endometrial cancer. Moreover, this study
indicated that isoflavones are selectively estrogenic
and antiestrogenic; they have an estrogenic
effect on some tissues and organs and an antiestrogenic
effect on others. Soy foods may be
analogous to a class of drugs called selective estrogen
receptor modulators (SERMs). In the uterus,
soy isoflavones appear to have an antiestrogenic
effect, with the possible exception of when they are
used in high doses daily for a longer term.
Long-term high-dose use of soy may be different
than the usual average typical daily consumption
of soy.

In one study, one group of
postmenopausal women were given soy tablets
containing 150 mg of soy isoflavones per day
for five years.28 The second group received an
identical placebo tablet for five years. Results of
endometrial biopsies were obtained at baseline,
30 months, and five years after the beginning
of the treatment. At the five-year endpoint, 70
percent of the women on the 150 mg of soy
isoflavones had atrophic tissue versus 81 percent
who received the placebo. After five years, the
incidence of endometrial hyperplasia was significantly
higher in the isoflavone-treated group,
3.37 percent versus 0 percent. There were five
cases of simple hyperplasia and one of complex
hyperplasia. No cases of atypical hyperplasia or
endometrial cancer occurred during the five
years. This is the first study that raises concerns
about long-term, high-dose isoflavone supplementation
and its effects on the endometrium. It
would typically take three to five servings of soy
foods per day to achieve 150 mg. One serving
per day of soy foods is only 25 to 60 mg per day,
depending on the soy food item.

Isoflavones appear to be able to act as a partial
agonist, binding to the estrogen receptor.
Because the action of isoflavones is weaker than
that of endogenous estrogens at low doses and for
short durations, these phytoestrogens seem to
be antagonistic. They are able to counteract the
effects of endogenous estrogens. When treatment
is prolonged and at a higher dose, the agonist
effects are more evident and the isoflavones have
an estrogenic effect. It is important to note that
at 30 months there was no difference between
the isoflavone-treated group and the placebo
group. It was only after five years that the dose
of 150 mg per day produced an estrogenic effect
in a small number of women.The subject of phytoestrogens is discussed in
more detail later in this chapter and in Chapter
12 in the discussion of menopause.

[SydT]

continued....

Nutritional Supplements

As mentioned earlier, many of the symptoms of
enlarged fibroids can be effectively treated using
natural therapies. For abnormal bleeding and
pelvic pain, refer to Chapters 1 and 13. In this
section, I will largely be discussing the traditional
naturopathic methods of trying to reduce the size
of uterine fibroids or to inhibit their growth.
These recommendations are based more on tradition,
theory, logic, and clinical experience than
on scientific evidence.

Lipotropic Factors. Supplements such as
inositol and choline exert a lipotropic effect,
meaning they promote the removal of fat from
the liver. Lipotropic supplements are usually a
combination vitamin and herbal formulation
and sometimes an animal liver extract designed
to support the liver’s function in removing fat,
detoxifying the body’s wastes, detoxifying external
harmful substances (pesticides, fossil fuels,
etc.), and metabolizing and excreting estrogens.

These lipotropic products vary in their formulations
depending on the manufacturer, but they
are all similar and have the same uses in mind.
Because the liver is the most important organ of
metabolism, naturopathic physicians believe that
when the liver function improves, metabolism
improves, making this treatment fundamental to
the treatment of many chronic diseases.

Pancreatic Enzymes.
There are three categories
of pancreatic enzymes:
• Lipases: enzymes that help digest fats along
with bile. A deficiency of lipase results in
malabsorption of fats and fat-soluble
vitamins.
• Amylases: enzymes that break down starch
molecules into smaller sugars.
• Proteases: trypsin, chymotrypsin, and carboxypeptidase
break down protein molecules
into single amino acids.

Supplementation with pancreatic enzymes is
usually done to treat pancreatic insufficiency.
Pancreative insufficiency manifests itself in
symptoms of abdominal bloating, gas, indigestion,
undigested food in the stool, malabsorption,
and nutrient deficiencies. Other clinical
uses of pancreatic enzymes are for treatment of
cystic fibrosis, rheumatoid arthritis, athletic
injuries, and—one of the most controversial
uses—the treatment of cancer.

The logic for the treatment of uterine fibroids
is similar to the logic for the treatment of cancer.
Enzyme preparations have been used at the Contreras
Clinic in Mexico and by Drs. William
Kelley and Nicholas Gonzalez as part of a cancer
treatment protocol. There is little evidence in
the scientific literature to support their use, but
the logic is that the pancreatic enzymes will
digest the protein cell membrane surrounding
the malignant cells. By doing so, the immune
cells will then be able to enter the cancer cells and
alter the abnormal cell division of the cancer
cells.

In the case of uterine fibroids, the belief is
that the pancreatic enzymes will help to digest
the fibrous/smooth muscle tissue and dissolve the
fibroids. When used for this purpose, the pancreatic
enzyme supplement must be taken between
meals rather than with meals.

Lipotropic Factors
1–4 tablets per day with meals

Pancreatic Enzymes
2–4 capsules 3 times per day between meals

[SydT]

Botanical Medicines

Traditional Herbs. Many plants have been
used in traditional herbal medicines designed to
treat women with uterine fibroids. The plants
and herbal formulations talked about here are
used to try to shrink uterine fibroids; herbs used
to deal with abnormal bleeding and uterine
cramping are discussed in Chapters 1 and 13.

Scutellaria barbata, commonly used in traditional
Chinese medicine for its purported antitumor
properties, was shown to inhibit the
proliferation of uterine smooth muscle cells and
act as an aromatase inhibitor contributing to
decreased fibroid growth in vitro.29–31

Other
botanicals used in traditional Chinese medicine
that show some promise in treating fibroids in
vivo include poria and cinnamon.32

Traditional herbalists have developed various
botanical uterine fibroid protocols and report
modest success in reducing the size and number
of uterine fibroids. I have used many herbs and
herbal formulations over the years in an attempt
to shrink fibroids, and I present the protocol
below from one of the traditional herbalists, Rick
Scalzo, as an option for your consideration. (See
the Resources for a listing of herbal companies.)

Scalzo’s Protocol

Scudder’s Alterative:
Corydalis tubers (Dicentra canadensis)
Black alder bark (Alnus serrulata)
Mayapple root (Podophyllum peltatum)
Figwort flowering herb (Scrophularia nodosa)
Yellow dock root (Rumex crispus)
Add 30–40 drops to a small amount of warm water
and take 3 times daily.

Echinacea/Red Root Compound:
Echinacea (Echinacea spp)
Red root (Ceanothus americanus)
Baptisia root (Baptisia tinctoria)
Thuja leaf (Thuja occidentalis)
Stillingia root (Stillingia sylvatica)
Blue flag root (Iris versicolor)
Prickly ash bark (Xanthoxylum clava-herculus)
Add 30 drops to a small amount of warm water and
take 3 times daily.

Fraxinus/Ceonothus Compound:
Mountain ash bark (Fraxinus americanus)
Red root (Ceanothus americanus)
Life root (Senecio aureus)
Mayapple root (Podophyllum peltatum)
Helonias root (Chamaelirium luteum)
Goldenseal root (Hydrastis canadensis)
Lobelia (Lobelia inflata)
Ginger root (Zingiber officinale)
Add 30 drops to a small amount of warm water and
take 3 times daily.

Turska Formula:
Gelsemium root (Gelsemium sempervirens)
Poke root (Phytolacca americana)
Aconite (Aconitum napellus)
Bryonia root (Bryonia dioica)
Add 5 drops to a small amount of warm water and
take 3 times daily.

Other Herbal Extracts to Consider:
Chaste tree (Vitex agnus castus)
Nettle (Urtica dioica)
Burdock root (Arctium lappa)
Dandelion root (Taraxacum officinale)
Oregon grape (Berberis aquifolium)

Topical Preparations:
Poke root oil: rub onto the belly over the uterus
nightly before bed.
Castor oil packs: apply over pelvis 3–5 times per
week. (See Appendix D for instructions.)

[SydT]

continued...

Herbal Phytoestrogens.

There are three types
of naturally occurring estrogen-like substances
called phytoestrogens found in plants: resorcylic
acid lactones, steroids and sterols, and phenolics.

Phytoestrogens are present in virtually every plant
in at least modest levels, with some plants having
particularly high levels. Resorcylic acid lactones
are not true phytoestrogens but are mycotoxins
produced by soil-dwelling molds. Their presence
in plants is the result of contamination with
molds. Steroids are the classic steroidal estrogens
(estradiol and estrone) and are found in very
minute amounts in a few plants such as apple seed,
date palm, and pomegranate seed in the range of
one to ten parts per billion.26, 33, 34 Diosgenin is a
steroid derivative and is found in at least 20 plants,
including wild yam species. Beta-sitosterol is the
most common phytosterol and is distributed
widely through the plant kingdom. It is found in
plant oils such as wheat germ oil, cottonseed oil,
and soybean oil. Beta-sitosterol is the dominant
phytosterol found in garlic and onions. Herbal
sources include licorice root, saw palmetto, and
red clover. Stigmasterol is closely related to betasitosterol.

Soybean oil is an important source of
stigmasterol and is a better source for laboratory
synthesis of progesterone than is beta-sitosterol.
Some herbal sources include burdock, fennel,
licorice, alfalfa, anise, and sage.

The phenolic phytoestrogens are members of
the flavonoids, the largest single family of plant
substances, which has over 4,000 individual members.
The term flavonoid derives from the Latin
flavus meaning “yellow” because the flavonoids are
responsible for the yellow, red, white, and blue
pigments in plants. Phenolics include isoflavones,
which are higher in legumes and especially soybeans
than any other plants; coumestans, with one
known estrogenic member (coumestrol) that is
approximately six times more estrogenic than the
isoflavones;35, 36 and lignans, high in grains and
cereals and highest in flaxseed.

There has been some concern and controversy
about how phytoestrogens affect the uterus;
if they have an estrogenic effect, they should be
avoided by women with uterine fibroids or
endometrial cancer. We talked earlier about soybeans
and how they are actually associated with a
reduced incidence of uterine cancer.26 I do not
believe that eating a high soy diet is something to
be concerned about; in fact I recommend
increasing the soy foods in the diet in order to
reduce the estrogen burden in the body.
Most of the research on the effects of phytoestrogens
on the uterus is found in relationship
to the agricultural industry and the health of
grazing animals.

In the 1940s, it was reported
that the red clover sheep grazed on in Australia
was responsible for their infertility.37 A Finnish
study of pasture legumes determined that red
clover contained the highest concentrations of
phytoestrogens38 and that abundant intake of red
clover resulted in fertility problems in cattle.39

In one study on the effects of phytoestrogens in
sheep, it was noted that both coumestans and
isoflavones produce changes in the typical stimulation
with steroidal hormones such as estradiol in
all of the target organs.40 Among these changes was
an increase in uterine weight. Other investigators
have examined the binding of phytoestrogens to
the uterus and girl thingy. Coumestrol has temporarily
enhanced the uptake of estradiol by the uterus and
girl thingy only one hour after being injected into
mice.41 Researchers also noted that coumestrol
actually inhibited the uptake of estradiol by the
uterus over the long term, and they postulated that
there was actually an inhibitory effect at the estradiol
receptor sites. Other researchers have noted
that coumestans and isoflavones compete with
estradiol for uterine receptor sites but have less
affinity for them than estradiol.42

Coumestrol has been found to increase uterine
weight at a 100 mcg dose when given to rats at a
certain time in the development of glands.43 It
appears that the weak estrogenic effect of phytoestrogens
is variable and can even be weakly antiestrogenic.
Variability is based on dose, target tissue,
the woman’s hormonal environment, and more.

Higher does of phytoestrogens have stimulated
some concern. However, it is reassuring that
in countries with a high intake of phytoestrogens
(Japan, Thailand, China), women do not have an
increase in uterine fibroids. However, they do
have a four- to sixfold lower incidence of breast
cancer44 (also an estradiol target tissue), although
how a substance affects one tissue is not necessarily
translated to how it affects another.

Again, though, I must come back to the
effects of soy on the endometrium, which may be
different than some of the other plants, most
notably red clover. Like data on breast cancer,
data on women of different cultures support the
conclusion that soy phytoestrogens are not an
estrogen stimulus for the endometrium. Rather,
they probably act as an estrogen antagonist and
are associated with low rates of endometrial
cancer in countries where soy phytoestrogen
intake is high.45

Based on these studies, my recommendation
to those with uterine fibroids is to eat a diet high
in soy products; however, my current cautionary
advice would be to avoid the use of red clover.

In cases where conventional treatment with
GnRH inhibitors is needed, thus causing a pharmaceutically
induced menopause, Ipriflavone (a
semisynthetic soy derivative) supplementation
has been helpful at preventing side effects such as
bone loss and increased LDL.46, 47

[SydT]

continued....

Natural (Bio-Identical) Progesterone.

Historically, studies have suggested that progesterone
may inhibit growth of uterine fibroids.

A. Lipschutz demonstrated that progesterone
administered to guinea pigs prevented formation
of tumors that had been induced by estrogen.48
In 1946, A. Goodman reported six cases of clinically
diagnosed uterine fibroids that regressed
after using progesterone therapy.49
Dr. John Lee proposes that because uterine
fibroids are a result of estrogen stimulation and
what he calls estrogen dominance, progesterone
is the solution. He asserts that estrogen dominance
is a much greater problem than is recognized
by conventional medicine. “Since many
women in their mid-thirties begin to have
nonovulating cycles, they are producing much
less progesterone than expected, but still producing
normal (or more) estrogen. They retain water
and salt, their breasts swell and become fibrocystic,
they gain weight (especially around the hips
and torso), they become depressed and lose sex
drive, their bones suffer mineral loss, and they
develop fibroids. All are signs of estrogen dominance
relative to a progesterone deficiency. When
sufficient natural progesterone is replaced,
fibroid tumors no longer grow in size (they generally
decrease in size) and can be kept from
growing until menopause, after which they will
atrophy. This is the effect of reversing estrogen
dominance.”50

The preferred form of natural
progesterone for treating fibroids (unless heavy
bleeding is involved) is a topical cream with at
least 400 mg of progesterone per ounce.

Be advised, however, that there is a counter
theory about the relationship of progesterone to
uterine fibroids. Dr. Mitchell Rein and his colleagues
at Brigham and Women’s Hospital published
a report in 1995 stating that not only is
there no evidence that estrogen directly stimulates
myoma growth, but that it is actually progesterone
and progestins that promote the growth
of fibroids.51

The authors cite the biochemical,
histologic, and clinical evidence that supports an
important role for progesterone and progestins in
the growth of uterine myomas. Their comprehensive
hypothesis is based on an analysis of
many different technical studies, which they conclude
suggest that the development and growth
of myomas involves a multistep chain of events.

Since both of these schools of thought are
theoretical, I encourage all women and their
health-care practitioners to educate themselves so
as to make the best individual decision. Fibroids
are generally not urgent or life threatening, so
there is room for experimentation and observation
to determine the best course of treatment.

Natural (Bio-Identical) Progesterone Cream
1⁄4 tsp of a cream containing at least 400 mg/oz 1 to 2
times daily for 1 week after menses; 1⁄4 to 1⁄2 tsp twice
daily for the next 2 weeks. Discontinue for 1 week during
menses. Apply the cream to the inner arms, chest,
inner thighs, and/or palms.

[SydT]

continued....

Sample Treatment Plan for Uterine Fibroids

Diet
• Eat a high-fiber, low-fat diet.
• Eat a diet high in whole grains (brown rice,
oats, buckwheat, millet, rye, whole wheat).
• Eat a diet high in fruits and vegetables.
• Eat a diet high in flaxseed, particularly ground
flaxseed.
• Eat a diet high in legumes, especially soy
products, 1 serving per day.
• Avoid saturated fats, sugar, caffeine, alcohol,
and junk foods.

Nutritional Supplementation
• Lipotropic factors: 1–2 tablets twice daily with
meals
• Pancreatic enzymes: 2–3 capsules3 times per
day between meals

Botanicals
See the Resources section for sources.
• Scudder’s Alterative: 30 drops 3 times per
day
• Echinacea/Red Root Compound: 30 drops 3
times per day
• Fraxinus/Ceonothus Compound: 30 drops 3
times per day
• Gelsemium/Phytolacca Compound (Turska
Formula): 5 drops 3 times per day
See Chapter 1 for abnormal bleeding problems. See
Chapter 13 for pelvic and menstrual pains.

[SydT]

continued...

CONVENTIONAL
MEDICINE APPROACH

Small fibroids that cause few symptoms require no
treatment, only observation of growth, which can
be done with annual pelvic exams. If the patient
notices new symptoms, or the physician thinks
there is a change in the fibroid, ultrasound can
follow and assess the location and size of fibroids.
Because there is some concern about estrogen’s
role in promoting the growth of fibroids, use of
oral contraceptives in premenopausal women and
hormone therapy in postmenopausal women
should be prescribed with care, close follow-up,
and the lowest doses possible.

In cases of fibroids where heavy bleeding exists,
progestogens or estrogen is used to manage the
bleeding, and any anemia is treated with iron
supplements. Treatment of fibroids with progestational
agents (norethindrone, megestrol, medroxyprogesterone
acetate) has been used, but there is
no consensus regarding the routine use of these
drugs to shrink fibroids. The progestational agents
produce a hypoestrogenic effect by inhibiting
gonadotropin secretion and suppressing ovarian
function. They may also have a direct antiestrogen
effect.

Even though estrogen and progestogens
may be necessary to control bleeding from
fibroids, most practitioners do not consider them
useful in shrinking fibroids. When used to control
bleeding, there is always a concern about the possible
effect on the increase in growth of the fibroid,
so fibroids need to be periodically evaluated by
physical exam and/or pelvic ultrasound.

Agents such as leuprolide acetate (Lupron)
have been used to temporarily control bleeding,
correct anemia, and shrink tumors. This allows a
large tumor to shrink to a more manageable size.

Lupron can be used to change the need for an
abdominal hysterectomy to a girl thingyl or laparoscopic
type, which shortens patient recovery.

Lupron suppresses ovarian estrogen secretion,
thereby causing temporary and reversible medical
menopause.

The use of GnRH analogs has
successfully reduced uterine and tumor size by
40 to 65 percent. Most reduction occurs within
8 weeks, and maximum reduction occurs within
about 12 weeks. After the treatment is discontinued,
the uterus and fibroids often return to their
original size within three months. On occasion,
the use of Lupron may make surgical treatment
unnecessary, but usually the solution is temporary
and surgery is inevitable.

One of the most significant disadvantages of
Lupron is that it is expensive, costing approximately
$600 per month. The other is that it puts
the patient into an instant menopausal state with
hot flashes and other side effects, which can be
controlled with very small add-back doses of
either estrogen or a progestogen. The GnRH
analogs cannot be used long-term (more than six
months) because they can lead to irreversible
bone loss and elevated total cholesterol.

The standard surgical treatments for uterine
fibroids are a hysterectomy or a myomectomy.

Hysterectomy, the removal of the uterus, is the
only approach that provides a permanent solution
for fibroids. Myomectomies are surgeries that
remove the fibroids but leave the uterus. There are
two basic approaches: abdominal myomectomies,
which are used primarily for the removal of subserous,
pedunculated, or intramural fibroids, and
a hysteroscopic myomectomy, which is used for
removal of submucous myomas.

Hysterectomies can be done with an abdominal
incision, a girl thingyl incision, or by laparoscopy.

Except in girl thingyl hysterectomies, it is possible
to leave the cervix, removing the uterine fundus
(body) only, which contains the uterine fibroids.

There is really no reason to remove either ovaries
or cervix to treat the symptoms of fibroids. By
leaving the cervix, the normal length and sensations
of the girl thingy are maintained. With a girl thingyl
hysterectomy, the entire uterus, including the
cervix, is removed. In either case, the decision to
leave the ovaries depends on the patient and her
doctor. Most doctors would recommend leaving
ovaries in women under 45 and might recommend
removing them in women over 45 because
they will soon be menopausal, oftentimes to prevent
ovarian cancer. However, we cannot remove
all of our organs to reduce the risk of cancer. Since
the lifetime risk of ovarian cancer is 1 in 70,
women with healthy ovaries should be encouraged
to leave them in place when possible. Special circumstances,
such as a strong family history of
ovarian cancer, might warrant their removal.

Myomectomies are particularly appropriate
for women who wish to retain their childbearing
option or in women with a small submucous
myoma that causes a bleeding problem. Most
myomectomies for large intramural fibroids are
done abdominally. Laparoscopic myomectomies
for intramural or subserosal fibroids are very rare,
and there are only a few physicians in the United
States capable of performing them. Abdominal
myomectomies have many of the same risks associated
with a hysterectomy and can often be
associated with more blood loss.

Many women
feel much more comfortable with retaining their
reproductive organs and should be encouraged
to find a physician who is comfortable with
the concept of myomectomy when the patient
prefers that approach.

Hysteroscopic myomectomies are done with
an instrument inserted through the girl thingy, up
the cervical canal, and into the uterine cavity,
providing a view of the interior of the uterus and
an instrument that can slice or cauterize the submucous
fibroid. Sometimes, when a woman is
past childbearing age, an associated destruction
of the uterine lining tissue is performed at the
same time. This is called an ablation and further
helps to reduce menstrual flow.

There are other treatments for fibroids, some
of which are gaining more popularity and some
of which are still experimental.

Uterine artery
embolization is designed to reduce fibroids by
obstructing the blood supply that nourishes
them. The procedure is done by a radiologist in
the x-ray department. It entails making a small
incision in the groin and threading a small
catheter into the femoral artery. The doctor
works the catheter up to the vessels that supply
the uterus under guidance with dye and x-rays.
Microscopic plastic particles are injected to close
off the uterine vessels, temporarily creating a
condition of shock for the uterus. Because
fibroids only have one blood supply, the shock is
often enough to cause them to begin to degenerate
(necrose). The uterus, however, has blood
supply through the uterotubal ligaments and
girl thingyl arteries as well and recovers from the initial
loss of blood flow most of the time.

Embolizations have been done for about 10
years, and now there is enough data to indicate
that there is a less than 1 percent chance that a
woman will need an emergency hysterectomy
because of uterine necrosis after an embolization.

There is a 1 to 5 percent chance that the patient
could become menopausal because of a decrease
in the blood supply to the ovaries occurring
unintentionally at the time of the embolization.

The patient can expect significant pain or cramping
for up to six months, treatable with pain
medications and anti-inflammatories, and most
fibroids will reduce approximately 50 percent in
their size. This is more successful for treatment of
pain from fibroids than bleeding, but it can
improve bleeding.

The new fibroid treatment that conventional
medicine is investigating is selective progesterone
receptor modulators (SPRMs). Ru-486, the only
currently used SPRM, is in investigative trials for
treatment of fibroid pain and bleeding and helps
by reducing the size of fibroids. Most of these
trials suggest that the medication is well tolerated
with minimal side effects. A second SPRM called
asoprisnil has been shown to significantly shrink
fibroids with minimal side effects and is currently
in phase III trials. It is not known if this is a temporary
or permanent treatment.

The other area of medical research involves
antifibrinolytic agents. There are other fibrin
deposition diseases such as keloids (excessive
growth of scar tissue) and pulmonary fibrosis
that serve as fibrin disease models. Researchers
are beginning to look at medications that reduce
the growth and deposition of fibrin for treatment
of fibroids. There are no significant investigational
trials underway at the present time.

The newest nonmedical technique being used
to treat fibroids is high-intensity focused ultrasound.This is done in the radiology department
with MRI-guided high-intensity focused ultrasound.
The uterus is scanned for fibroids and
divided into plains at different depths, and the
ultrasound is directed in small increments into
the fibroid. It is completely noninvasive and is
just beginning to be used. The setups are very
expensive and the machines are few and far
between at this point.

The thermal ablation treatment techniques
that transfer laser, radio frequency, microwave, or
cryotherapy through either a percutaneous or a
transgirl thingyl probe (which were evaluated
between 2000 and 2003) are largely outdated
now and are not thought to be an effective form
of treatment.

[SydT]

continued...

SEEING A LICENSED PRIMARY
HEALTH-CARE PRACTITIONER
(N.D., M.D., D.O., N.P., P.A.)

Four clinical problems that require special consideration
in fibroid cases are heavy, prolonged,
or frequent bleeding; infertility; enlarged kidneys;
and pregnancy complications.

Menstrual flows that are longer than 7 days in
duration, more frequent than every 21 days,
involve intermenstrual spotting/bleeding or
excessive blood loss (more than 80 ml per cycle
compared to the normal average of 33 ml)
deserve a visit to your licensed primary care practitioner.

It is difficult to quantify the number of
pads or tampons used as a criterion for determining
excessive blood loss. Bleeding that meets or
exceeds saturation of a super tampon or heavy
pad every hour for six to eight hours or more
requires immediate intervention. Bleeding that
exceeds this deserves an immediate phone call to
your practitioner and urgent management for
hemorrhage. Some women tolerate excessive
blood loss better than others. If you are feeling
lightheaded, this is cause for concern. A hemoglobin
and hematocrit test can determine if you
are anemic from blood loss. Additional tests may
be done to determine if your iron stores are low.

Infertile women who have uterine fibroids
may need to consider the causal relationship. Even
though fibroids may be a cause of only a small percentage
of infertility cases, if it is the cause, the
solutions aren’t particularly optimistic. It is
reported that only a 16 percent pregnancy rate follows
myomectomy for infertility. Postoperative
adhesions and the low return question the value of
myomectomy for this set of circumstances.

Pregnancy in women with uterine fibroids is
generally problem-free, but each situation is different.
Even though fibroids can grow during pregnancy,
only a very few actually do have continued
growth. Six weeks after delivery, many uterine
fibroids will decrease in size to become similar to
the size it was prior to pregnancy.

That said, some complications can occur
during pregnancy. An enlarging fibroid during
pregnancy can degenerate and cause pain, infection,
and fever. Though debatable, the presence
of fibroids can also affect implantation of the fertilized
egg with the potential for an early miscarriage,
bleeding later in the pregnancy, premature
rupture of membranes, and postpartum hemorrhage.

Other potential complications include a
decrease in the ability of the uterus to contract
during labor or obstruction of the birth canal. In
women who have previously had a myomectomy,
the safety of a girl thingyl delivery is controversial.
One school of thought holds that if there has
been an incision into the uterine cavity, the delivery
must be by cesarean section. Other practitioners
believe that if there was no infection after
the myomectomy, the incision into a nonpregnant
uterus is of no concern in subsequent girl thingyl
deliveries.

Remember, the mere presence of uterine
fibroids does not require treatment. If you have
symptoms, they can most often be managed with
alternative therapies, although excessive bleeding
may require drug or surgical intervention. Even
if you have no symptoms, a licensed primary
health-care practitioner should examine you
every six months to rule out rapid enlargement.
This is especially true for women who are planning
pregnancies or approaching menopause.

Rapidly enlarging fibroids warrant special attention
because of the potential for malignancy. A
young woman whose uterus is larger than a 12-
to 14-week pregnancy should carefully monitor
the fibroid growth and consider the need for surgical
intervention, because there are many more
years for potential further growth and the bigger
the uterus and fibroids, the more technically difficult
the surgery.

Women rarely need to rush to any decision
about surgical intervention, except in the case of
excessive bleeding problems, a rapidly enlarging
fibroid uterus, or prolonged or severe pain. If surgical
intervention becomes appropriate, remember
that you may have a number of surgical
options and explore some of the newer techniques.

If a hysterectomy is indeed the best
option, and sometimes it is, then be sure to discuss
with your surgeon whether you would like
to keep your ovaries; most of the time, there is no
pressing medical need to remove them.

[SydT]

continued...

References for article:

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