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Uterine fibroids and their treatment

Uterine Fibroids

–   Treatment Options when symptoms present

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Mainstream symptomatic treatments

General Treatments

Oral contraceptives - to help control heavy periods

Intrauterine devices (IUDs) that release the synthetic hormone progestin - to help reduce heavy bleeding and pain

Iron supplements - to prevent or treat anemiadue to heavy periods

Nonsteroidal anti-inflammatory drugs (NSAIDs) - E.g.ibuprofen for cramps or pain

Surgical Treatments

A hysterectomy is frequently advised in the U.S. -especially if a woman does not intend to have children. In fact, leiomyoma are the predominant reason for a hysterectomy in premenopausal women

MerckManual

Myomectomy - This surgery removes the fibroids. It is often the chosen treatment for women who want to have children, because it usually can preserve fertility. More fibroids can develop after a myomectomy.

Magnetic Resonance-Guided Focused Ultrasound - Magnetic Resonance guided Focused Ultrasound (MRgFUS), is a non-invasive intervention (requiring no incision) that uses high intensity focused ultrasound (HIFU) waves to ablate (destroy) tissue in combination with Magnetic Resonance Imaging (MRI), which guides and monitors the treatment.

Hysteroscopic resection of fibroids(as outpatient) –when UFs are growing inside the uterus. A small camera/instruments are inserted through the cervix into the uterus to remove the UFs.

Uterine artery embolization procedure cuts off blood supply to the UF, causing it to die and shrink.

ANTI-FIBROTIC THERAPIES

Anti-fibrotic therapies affect a change in abnormal ECM by leiomyoma cells, inhibiting and reversing the fibrotic process

Gonadotropin-releasing hormone analogues

Small studies indicate PROGESTERONE receptor antagonists decrease uterine fibroid size

–   Full PROGESTERONE receptor antagonist - Mifepristone (akaRU-486) was effective in a placebo-controlled pilot study.

Malartic, C.; Morel, O.; Akerman, G.; Tulpin, L.; Desfeux, P.; Barranger, E. (2008). "La mifépristone dans la prise en charge des fibromes utérins". Gynécologie Obstétrique & Fertilité 36: 668.

–    Selective PROGESTERONE receptor modulators - such asProgenta and Asoprisnil, have been under investigation;

Wilkens, J; Williams, AR; Chwalisz, K; Han, C; Cameron, IT; Critchley, HO (2009). "Effect of asoprisnil on uterine proliferation markers and endometrial expression of the tumour suppressor gene, PTEN". Human reproduction (Oxford, England) 24(5): 1036–44 PubMed

Alternative Therapies

AnTI-ESTROGEN THERAPIES

Read about the various ways to improve estrogen balance in thebody:

How to reduce estrogenin the body

Aromatase inhibitors have been used experimentally to reduce fibroids-The effect is believed to be due

(i) Partially by lowering ovarian production and systemic estrogen levels

and (ii) Partially by inhibiting locally overexpressed aromatase in fibroids.

Malartic, C.; Morel, O.; Akerman, G.; Tulpin, L.; Desfeux, P.; Barranger, E. (2008). "La mifépristone dans la prise en charge des fibromes utérins". Gynécologie Obstétrique & Fertilité 36: 668.Link

–    Aromatase inhibitors have also been used experimentallyin treatment of endometriosis – whichindicated that aromatase inhibitors might be particularly useful in combination with a progestogenic ovulation inhibitor.

 

Increased fiber –helps remove excess estrogen from GI tract aiding excretion. Reduce enterohepatic estrogen recirculation and/or shields estrogen absorption

A high intak of green vegetables demonstrates a protective effect

Chiaffarino et al 1999

Phytoestrogens –compete for receptors with endogenous estrogens; isoflavones daidzein and genistein are found in soy, but have been found to worsen fibroids when consumed in too high amounts. Lignans found in flaxseed.

I3C in cruciferous vegetables promotes formation of less potent estrogen metabolites

Minich DM, Bland JS A Review of the clinical efficacy and safety of cruciferous vegeatable phytochemicals. Nutrition Revei ws. June 2007; 65(6):259-267.

Reduce caffeine intake to <500 mg / day 2 cups coffee / day

Reduce alcohol consumption to 1 drink / day

Iodine can reduce uterine fibroids -Iodine has a critical role in maintaining the body's estrogen balance. Based on a controlled clinical trial with 1,365 women, 4mg daily of molecular iodine quickly resolves fibrocystic breast disease(FBD) - it makes breast lumps and cysts disappear usually within only two months for most women. Iodine can similarly reduce uterine fibroids - one of the first conventional medical treatments for severe fibroids was to “paint”the uterus with iodine.

Iodine –“The Universal Medicine”

VITAMIN D

Vitamin D3 typically deficient in many populations today - E.g. Elderly, office workers, African Americans

✔ D3 treatment has been shown to inhibit leiomyocyte proliferation at physiological doses - Leiomyomas widely express the vitamin D receptor. Decreases fibroid cell size and disrupt the formation of fibroid muscle cells

✔ Vitamin D decreases mitogenic activity of INSULIN and IGF-1

✔ Active metabolites of CALCITRIOL (Active form of Vitamin D) down-regulate epidermal growth factor receptors (EGFRs) known to be active in mitogenic pathways in uterine leiomyomas. Down-regulation of these receptors shown to decrease growth / differentiation of tumor cells

✔ Risk of developing uterine fibroids inAmerican black women REDUCED with just increased daily servings of “vitamin D-added” milk.

✔ Research shows that physiological doses of vitamin D have significant growth-inhibiting effect on leiomyomata cells

Blauer M, Rovio PH, Ylikomi T, Heinonen PK. Vitamin D inhibits mypmetrial and leimyoma cell proliferation in vitro. Fertility and Sterility. May 2009; 91(5):1919-1925

Vitamin D – “The Sunshine Vitamin”

BIOFLAVONOIDS

Inverse association between flavonoid intake and risk of malignant tumors –reportedbiological activities include:

✔  Induce apoptosis

✔  Cell cycle arrest

✔  Antiproliferative

✔  Anti-inflammatory

✔  Antioxidant protection against oxidative stress

✔  Anti-estrogenic

Asian women consume a lot of bioflavonoids and have lower incidence of hormonally dependent solid tumors - E.g. breast cancer in Asian women is 4-6 times lower than in American women, and several generations after migration to America they line up with the American statistics, suggesting an environmental rather than a genetic influence. Asian women consume a lot of soy-based foods, containing bioflavonoids that show up in blood and urine samples at significantly elevated levels.

“Bioflavonoids are . . . found in legumes, nuts, onions, apple, broccoli, red wine, grreen tea, cocoa powder, and dark chocolate. The best known anti-tumor flavonoids are epigallocatechin gallate (EGCG) from green tea, genistein (from soy and red clover), curcumin (from turmeric), silibin (from milk thistle), quercetin (from many yellow vegetables such as onions), and resveratrol (from grapes and red wine).”

–    James H. Segars, author of the book Fibroids

Quercetin, EGCG, Curcumin, Silibrinin

In berries, tea, grapes, olive oil, dark chocolate, walnuts, citrus:

✔ Inhibits IGF-1 signaling

✔ Anti-estrogenic - Estrogen receptor antagonist

✔ Alters cell cycle

In grapes, red wine, mulberries, dark chocolate:

✔ Induces apoptosis

✔ Anti-estrogenic -Weak estrogen receptor agonist / antagonist

✔ Decreases collagen production

Resveratrol (found in grapes) study-reported properties include:

✔ Anti-proliferative –mainly as a preventative; Decreases growth and increases death of fibroid cells in vitro;

✔ Cardio-protective

✔ Antidiabetic

✔ Neuroprotective –possibly by chelating copper

✔ Reduces opioid tolerance –by increasing NMDA receptors

✔ Anti-inflammatory

✔ Antiviral activity

Resveratrol found in: grapes and berries, also peanuts (not recommended because of common fungal content); produced in plants in response to injury or fungal/ bacterial presence

Curcumin (spice) decreases growth and increases death of fibroid cells in vitro. Curcumin inhibited uterine leiomyoma cell proliferation by inducing apoptosis, and inhibited production of the ECM component fibronectin.

MinnieMalik, MirianMendoza, MarkPayson, William H.Catherino, Curcumin, a nutritional supplement with antineoplastic activity, enhances leiomyoma cell apoptosis and decreases fibronectin expression Fertility and Sterility. Volume 91, Issue 5, Supplement , Pages 2177-2184, May 2009 Abstract

Kenji Tsuiji et al, Inhibitory effect of curcumin on uterine leiomyoma cell proliferation.Gyn. Endocrinolgy. July 2011, Vol. 27, No. 7 , Pages 512-517 Abstract

Licorice (contains flavonoid isoliquiritigenin) decreases growth and increases apoptosis of fibroid cells in vitro.

Green Tea (epigallocatechin gallate) decreases growth of fibroid cells in vitro.

ANTI-INFLAMMATORIES

Consume anti-inflammatory omega-3 fats and reduce inflammatory omega-6 fats

–   The primary aromatase promoter in leiomyomata tissues in non-Asian U.S. women is the inflammatory prostaglandin PGE2

Imir AG, Lin Z, Yin P, et al, Aromatase expression in uterine leiomyomata is regulated primarily by proximal promotors 1.3/II/. J. Clin Endocrinol Metab. May 2007; 92(5):1979-1982.

–   Omega-3 fat reduces release of growth hormone

RETINOIC ACID

GI TRACT HEALTH

There is a strong link between uterine fibroid growth and gastrointestinal health - leaky gut syndrome, candida (yeast), intestinal bacterial overgrowth and gut inflammation can indirectly lead to:

✔ Abnormal growth factor expression

✔ Excess estrogen

✔ Immune dysfunction.

Toxic heavy metals can lead to abnormal bacterial growth in the gut and breakdown of the mucosal lining in the intestines

Nikolas Hedberg. Renew Your Health Naturally

http://drhedberg.com/2011/07/11/uterine-fibroid-alternatives/

Herbs

There is supportive evidence that vitex, yarrow and capsella buras-pastoris can reduce menstrual bleeding and PMS symptoms.

Vitex agnus-castus (Vitex, Chaste Tree, Chasteberry)

–   Typical extract doses significantly inhibit PROLACTIN secretion – (basal and TRH-stimulated) –presumed to be via dopaminergic effects. At low doses, such as might have been used in previous centuries for suppression of sexual desire, it inhibits activation of dopamine 2 receptor by competitive binding, causing a slight increase ▲  in release of PROLACTIN. In higher concentrations, as in modern extracts, the binding activity is sufficient to reduce ▼  the release of PROLACTIN. A study found that treatment of 20 healthy men with higher doses of Vitex agnus-castus was associated with a slight reduction of PROLACTIN levels, whereas lower doses caused a slight increase as compared to doses of placebo.

Merz, PG; Gorkow C, Schrödter A, Rietbrock S, Sieder C, Loew D, Dericks-Tan JS, Taubert HD (1996). "The effects of a special Agnus castus extract (BP1095E1) on prolactin secretion in healthy male subjects". Exp Clin Endocrinol Diabetes 04 (6): 447–53.

–   A decrease of PROLACTIN influences levels of FOLLICLE-STIMULATING HORMONE (FSH) and estrogen in women, and TESTOSTERONE in men.

–   Chemical analysis of vitex agnus-castus has isolated the following compounds – flavonoids, alkaloids, diterpenoids, Vitexin, Casticin and steroidal hormone precursors, some of which are believed to affect the pituitary gland explaining its effects on hormone levels.

 

Yarrow

Capsella bursa-pastoris

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