A friend was worried when she found uterine fibroids in her recent ultrasound scan. Indeed, it can be disturbing especially when the doctor said one of the fibroids was as big as her uterus. However, this condition is more common than most people think. In fact, it affects as many as 70% of women before menopause [1]. It is especially common among women between 40 to 50 years of age.

What are uterine fibroids?

Medically, the condition is called Uterine leiomyoma. Uterine fibroids are benign tumours of the smooth muscle originated from the middle layer of the uterine wall (myometrium). What causes the formation of uterine fibroids remain unclear. It is hypothesized that the formation of fibroid is due to the abnormal response to repeated injury of the uterine wall through menstruation.

Similar to wound healing, fibroids are scar tissues formed as a reaction to injury [1]. Uterine fibroids are mostly benign, they are not cancerous. It is extremely rare (estimated to be between 0.13% to 0.29%) to find the occurrence of a cancerous tumour originated from uterine fibroids [2]. Hence, one need not be overly concern with the finding of uterine fibroids.

What are the symptoms and treatments?

The most common symptoms caused by fibroids are severe or prolonged menstrual bleeding. Some also feel severe menstrual pain or pain in the abdomen. The condition can also lead to painful sex, obstruction of the bladder, or even infertility in severe cases [1].  However, only in about 25% of the cases where the occurrence of menstrual cycles disturbance that leads to the finding of uterine fibroids [3]. Most women who have uterine fibroids do not even aware of their existence.

Medical treatment for uterine fibroids central on the use of hormonal therapies or oral contraceptives to manage the menstrual irregularities and blood loss as well as painkillers to reduce pain. For large fibroids, surgery may be used to remove the whole uterus (hysterectomy) or just the fibroids (myomectomy) [4].

Are there any natural therapies?

The use of hormonal therapies is not without side-effects and the treatment normally does not reduce the size of the fibroids [4]. Surgery can be costly and complete removal of the whole uterus is not a welcoming thought for most women. Hence many women turn to natural therapies to manage their conditions.

Herbal medicine

The use of herbal medicine to manage uterine fibroids and associated menstrual irregularities is very popular. In traditional Chinese medicine (TCM), léi gōng téng (雷公藤) (Tripterygium wilfordii) extract is commonly used and is associated with the reduction in the volume of fibroids in research trials [5]. Another potentially effective TCM preparation is Guizhi Fuling (桂枝茯苓) formula. A systematic review of 38 randomized control trials involving a total of 3816 participants found Guizhi Fuling formula to be more effective in reducing the total, average, and maximum volume of fibroids, and significantly reduce the symptoms of painful periods [6]. However, the benefits cannot be confirmed due to the high risk of bias in most of the trials.

In Western herbal medicine, the herbs that are indicated for this condition include Chaste Tree, Echinacea root, Ladies Mantle, Paeonia, Rosemary, Schisandra, and Thuja [7]. However, the use of these herbs is guided by only traditional usage. There is a lack of systematic research to validate their effectiveness.

Dietary supplement

Recent research has found some evidence to support the use of curcumin, green tea extract, and vitamin D to address the condition of uterine fibroids:

• Curcumin – curcumin is the yellow substance produced by turmeric. It has been found to possess anti-inflammatory, antioxidative, and anti-cancer activities. In laboratory studies, curcumin has been found to stop the proliferation of cells from uterine fibroids which may regulate the growth. However, there is still no human study available to date to confirm its effectiveness [8].
• Green tea extract – green tea contains the catechins including epigallocatechin gallate (EGCG). There are several promising studies which demonstrated the potentials of EGCG in fighting uterine fibroids. In one human study with 39 participants, green tea extract was found to significantly reduce total uterine fibroids volume and improve the quality of life of patients compared to placebo [8].
• Vitamin D – Insufficient level of serum vitamin D level (hypovitaminosis  D) has been found to associate with high risk of uterine fibroids [9]. Conversely, supplementation with vitamin D has been found to restore normal vitamin D serum levels in women with “small burden” fibroids and reduce the progression of fibroids development to disease state [10]. Hence, the use of vitamin D supplementation has been suggested as an effective and low-cost compound in the management of uterine fibroids [11].

Dietary therapy

The suggested diet for prevention and management of uterine fibroids is very much similar to the diet for cardiovascular health. Red meat, animal fat and high energy dense foods should be avoided whereas plant-based food which can prevent fibroid pathogenesis such as flavonoids, green vegetables, citrus fruits, soya and broad beans should be promoted [11].

High consumption of broccoli, cabbage, Chinese cabbage, tomato and apple also seems to be a protective factor for uterine fibroids [12]. It is recommended to reduce sodium intake which helps to reduce blood pressure and may also exert a protective effect on fibroid growth. Alcohol consumption should also be avoided [11].

Conclusion

Uterine fibroids affect 70% of reproductive-age women. While most women with uterine fibroids experience no symptom, about 25% of them suffer from severe or prolonged menstrual bleeding and pain that can affect the quality of life. Natural therapies which can be used to manage uterine fibroids include herbal medicine and dietary supplements including curcumin, green tea extract, and vitamin D. Eating a healthy diet low in red meats, animal fats, and alcohol but high in fruits and vegetables can also help to protect against uterine fibroids. 

References

[1]        A.R.W. Williams, Uterine fibroids – what’s new?, F1000Research. 6 (2017) 2109. doi:10.12688/f1000research.12172.1.

[2]        B.M. Bharambe, K.A. Deshpande, S.G. Surase, A.P. Ajmera, Malignant Transformation of Leiomyoma of Uterus to Leiomyosarcoma with Metastasis to Ovary, J. Obstet. Gynecol. India. 64 (2014) 68–69. doi:10.1007/s13224-012-0202-4.

[3]        M.M. McWilliams, V.M. Chennathukuzhi, Recent Advances in Uterine Fibroid Etiology, Semin Reprod Med. 35 (2017) 181–189. doi:10.1055/s-0037-1599090.

[4]        M.S. De La Cruz, E.M. Buchanan, Uterine Fibroids: Diagnosis and Treatment, Am. Fam. Physician. 95 (2017) 100–107. https://www.aafp.org/afp/2017/0115/p100.html.

[5]        J.P. Liu, H. Yang, Y. Xia, F. Cardini, Herbal preparations for uterine fibroids, Cochrane Database Syst. Rev. (2013). doi:10.1002/14651858.CD005292.pub3.

[6]        N.-N. Chen, M. Han, H. Yang, G.-Y. Yang, Y.-Y. Wang, X.-K. Wu, J.-P. Liu, Chinese herbal medicine Guizhi Fuling Formula for treatment of uterine fibroids: a systematic review of randomised clinical trials, BMC Complement. Altern. Med. 14 (2014) 2. doi:10.1186/1472-6882-14-2.

[7]        K. Bone, The Ultimate Herbal Compendium, Phytotherapy Press, Warwick, QLD, 2007.

[8]        M. Ciebiera, K. Łukaszuk, B. Męczekalski, M. Ciebiera, C. Wojtyła, A. Słabuszewska-Jóźwiak, G. Jakiel, Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids-An Up-to-Date Review, Int. J. Mol. Sci. 18 (2017) 2586. doi:10.3390/ijms18122586.

[9]        D.D. Baird, M.C. Hill, J.M. Schectman, B.W. Hollis, Vitamin d and the risk of uterine fibroids, Epidemiology. 24 (2013) 447–453. doi:10.1097/EDE.0b013e31828acca0.

[10]      A. Ciavattini, G. Delli Carpini, M. Serri, A. Vignini, J. Sabbatinelli, A. Tozzi, A. Aggiusti, N. Clemente, Hypovitaminosis D and “small burden” uterine fibroids: Opportunity for a vitamin D supplementation, Medicine (Baltimore). 95 (2016) e5698–e5698. doi:10.1097/MD.0000000000005698.

[11]      M. Ciebiera, M. Włodarczyk, M. Ciebiera, K. Zaręba, K. Łukaszuk, G. Jakiel, Vitamin D and Uterine Fibroids-Review of the Literature and Novel Concepts, Int. J. Mol. Sci. 19 (2018) 2051. doi:10.3390/ijms19072051.

[12]      Y. Shen, Y. Wu, Q. Lu, M. Ren, Vegetarian diet and reduced uterine fibroids risk: A case–control study in Nanjing, China, J. Obstet. Gynaecol. Res. 42 (2016) 87–94. doi:10.1111/jog.12834.