Integrative Approaches for Reproductive Health: Focus on Uterine Fibroids

(September 2010)

A woman's reproductive system is both complex and delicate. Its optimum function relies upon a woman's overall health. As part of the body's intricate network of hormone production, the reproductive system is paramount in ensuring a woman's wellbeing. Integrative gynecology embraces all safe and effective healing modalities, from acupuncture, mind/body medicine and nutrition, to conventional drugs and surgery. The ultimate goal of integrative gynecology is to support and encourage the body's innate healing power.

Routine gynecologic check-ups are important to screen for various vaginal/uterine/and ovarian conditions. Uterine fibroids are one common problem for many women. Fortunately there are many integrative approaches to the treatment of fibroids.


What are uterine fibroids?
Uterine leiomyomas - or fibroids - are non-cancerous tumors that come from the muscle tissue (myometrium) of the uterus. These tumors come in many shapes and sizes, from as small as a pea to as large as a cantaloupe, and 70-80% of women will have fibroids by the time they are 50. Fibroids can be found in different areas of the uterus, and are classified based on their location. There are three types of fibroids: intramural (in the uterine wall), submucosal (jetting into the uterine cavity) and subserosal (on the outer surface of the uterus). Fibroids may cause a variety of symptoms such as heavy bleeding, pelvic pressure, and pain.


What causes uterine fibroids?
The molecular biochemistry of fibroids and the influence of the environment on the development and growth of these tumors largely remains a mystery. It is known that fibroid growth is related to estrogen, and fibroids tend to get smaller after menopause. Anything that influences the body's hormones -- namely estrogen and progesterone -- could affect fibroids' presence or growth. Also, a genetic predisposition to fibroids is likely. Studies have also shown that obese women and non-smokers are more susceptible to fibroids.


What do I do if I have fibroids?
If the fibroids aren't bothersome, the only recommendation is to keep an eye on them with regular exams to make sure they are not growing rapidly or causing new symptoms. If problems develop, there are a variety of treatments available to alleviate discomfort and slow fibroid growth. At the Raby Institute we recommend using an integrative approach to treatment - as it is comprehensive and it focuses on nutrition, lifestyle, and supplements as methods to restore the body's natural hormonal milieu and eliminate the estrogen dominant state that contributes to fibroid growth.


Nutrition and Functional Medicine:
Inflammatory and acidic foods such as red meat and dairy products may encourage fibroid growth by elevating the level of inflammatory prostaglandins in the body. Prostalglandins in turn cause hormonal changes that increase the development of new blood vessels supplying the fibroids. Also, foods that have a high glycemic index, such as white bread and potatoes, raise insulin levels, which can contribute to estrogen dominance and fibroid growth. Foods with genetically engineered gluten, such as wheat, rye and barley, as well as some medicines can also contribute to higher estrogen levels and fibroid growth by interfering with the enzyme systems that helps break down and rid estrogens from the body. Supplements that support hormone metabolism include B vitamins, magnesium, vitamin D, vitamin A, citrus bioflavonoids, Zinc, and essential fatty acids.


Exercise is an important part of an integrative approach to treating fibroids because it improves how the body uses sugar, improves insulin resistance, and helps to decrease fat cells in the body. Fat cells produce estrogen and inflammatory mediators, so decreasing the number of fat cells will improve the body's hormone balance and reduce fibroid growth.


Other integrative modalities:
Combinations of herbs can also be used to treat various symptoms of fibroids. For example, chaste berry can reduce fibroid growth, black haw can ease painful periods, and red raspberry leaf and yarrow can temper heavy bleeding. Some homeopathic remedies such as aurum muriaticum natronatum can be effective in reducing the symptoms of fibroids. Acupuncture and traditional Chinese medicine also can support and restore pelvic energy and the body's natural balance.


Conventional Medical and Surgical Treatments:
Depending on the symptoms and types of fibroids, there are many conventional treatment options. Medical treatment includes hormonal therapies, such as birth control pills or hormone injections. The goal of these medications is to decrease the amount of bleeding a fibroid causes, or to halt the tumor's growth. Surgical treatments include myomectomy, hysterectomy, hysteroscopy, and endometrial ablation. A myomectomy is a surgery that removes the fibroids themselves. However, this is not a permanent solution because often more fibroids will grow with time. A hysterectomy (removing the uterus) is definitive, but only an option for women who don't want any more children. Depending on the patient, both of these procedures can be performed in a minimally invasive fashion (laparoscopy-using small abdominal incisions and small cameras/instruments) or through a laparotomy- a larger incision on the abdomen. Submucosal fibroids can be removed by a surgery called hysteroscopy, where a small camera and instruments are placed into the uterus through the vagina and cervix. Endometrial ablation, destroying the tissue that lines the uterus, is an option for women whose main symptom is heavy bleeding. There are also interventional radiology treatments for fibroids including uterine artery embolization (where the blood flow to the fibroids is blocked) and MRI focused ultrasound.

Though uterine fibroids are common among women, each woman - and her fibroids - is unique. Treatments should be carefully discussed and solutions customized to take into account individual needs and lifestyles. The first and most important step to maintaining optimal reproductive health is to schedule regular visits with your integrative gynecologist.


If you would like to experience an integrative approach to gynecology, contact the Raby Institute at 312-276-1212 or and schedule an appointment with Dr. Katherine Thurer, MD, FACOG.


"Dr. Raby's approach to patient care is advanced far beyond that of other physicians. She has a softened, holistic approach to healing. She is caring, takes her time with patients and incorporates the spiritual aspects, which is a very important part of healing."
- Raby Institute patient