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Uterine fibroids and their treatment

Uterine Fibroids

-         Treatment Options when symptoms present

 

Related Link:

  Uterine Fibroids

 

On this page:

  Mainstream symptomatic treatments

  Alternative Therapies

 

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 anemia due 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  (aka RU-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 as Progenta 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 estrogen in 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 experimentally  in treatment of endometriosis – which  indicated 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.

 

Reducecaffeine 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 in  American 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 – reported  biological 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.

Minnie Malik, Mirian Mendoza, Mark Payson, 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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