Fibroids
What are uterine fibroids?
Uterine fibroids (Leiomyomas) are benign growths found on your uterine muscle. The vast majority of the time fibroids do not cause symptoms or pain, and won’t be noticed unless seen on an ultrasound. Fibroids, if they grow large enough, can cause pain and obstructions by pressing on other pelvic organs such as the bladder. It’s more common to have fibroids after the age of 35, and this does not necessarily mean that these fibroids need to be treated or removed, especially if they are not painful for you.
Only about 10% of fibroids grow inside the uterine cavity where they can cause heavy bleeding.
90% of fibroids are growing inside the uterine muscle, and do not produce excess endometrium.
So why is heavy bleeding associated with fibroids?
Because they both share a root cause:
Estrogen Excess (Impaired Estrogen Metabolism)
Fibroids and Heavy Bleeding
Heavy bleeding is not only caused by the existence of a fibroid, but rather by too much estrogen.
Estrogen’s normal function is to create uterine lining. Instead of making the right amount of lining, excess estrogen instructs the body to make too much. This results in heavier-than-normal menstrual bleeding when it comes time to release that lining.
At the same time, excess estrogen is at the root of fibroid growth. It is common to see fibroids and heavy bleeding together, though fibroids themselves are not the sole cause of the heavy menstrual bleeding.
The Basics of Estrogen Metabolism
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Estrogen is produced primarily in the ovaries and in smaller amounts in the adrenal glands and fat tissues. This estrogen will travel through the bloodstream.
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Estrogen receptors are found in various tissues throughout the body and performs diverse roles in physiological processes. Not just the reproductive system, the breasts, bones, cardiovascular system, central nervous system and brain all benefit from regular production of estrogen.
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Once estrogen is produced, it circulates in the bloodstream and eventually reaches the liver.
In the liver, estrogen undergoes a process called conjugation, where it is combined with substances like glucuronic acid or sulfate. This conjugation is part of Phase II liver metabolism.
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After conjugation in the liver, the now water-soluble, deactivated form of estrogen is excreted into the bile. Bile is a digestive fluid produced by the liver and stored in the gallbladder.
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In the small intestine, the deactivated estrogen that was excreted into the bile is present in the intestinal contents.
Some of the conjugated estrogen is further metabolized by bacteria in the gut through processes such as deconjugation and dehydroxylation. This can result in the reactivation of estrogen metabolites.
The remaining estrogen metabolites, along with other waste products, are then either reabsorbed into the bloodstream or excreted in the feces.
We call the microbiome which deals directly with estrogen the estrobolome.
Typical Estrogen Metabolism
Impaired Estrogen Metabolism
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If liver is functionally impaired, this can lead to problems inactivating estrogen, leaving more estrogen circulating in its active form and impairing the rest of the process. Toxins that negatively effect the livers ability to detoxify estrogen include alcohol and endocrine disrupting chemicals as well as prescription drugs.
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When you have an abundance of bad bacteria in your gut, they make an enzyme called beta-glucuronidase, which reactivates estrogen and sends it to recirculate through the body, resulting in estrogen excess. Maintaining a healthy gut microbiome is essential to excreting estrogen properly and making sure it doesn’t recirculate, a process called enterohepatic recirculation.
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Hypersensitivity to estrogen occurs most often with iodine deficiency or chronic inflammation. Either of those issues should also be addressed if need be to deal with estrogen in excess.
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Perimenopause, the time of transition before menopause, causes swings in estrogen, and this may be why it is more common to see fibroids above the age of 35.
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Insulin resistance can also upregulate the type of estrogen called estrone, putting you at risk for uterine cancer later in life.
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Estrogen stimulates the creation of more histamine while downregulating the enzyme that clears histamine. This becomes a vicious feedback cycle where more estrogen makes more histamine which makes more estrogen. And this is why dealing with histamine intolerance is another thing to pay attention to in this process of estrogen metabolism.
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Another cause of excess estrogen is hormonal birth control containing ethinylestradiol, a xenoestrogen that is stronger than the body’s own homemade estradiol which can damage the gut microbiome and impair estrogen metabolism.
Symptoms & Diagnosis
Some fibroids are small and entirely asymptomatic
Irregular abnormal bleeding, pelvic pain, pelvic mass
Infertility
Anemia from heavy bleeding
Increased urinary frequency if fibroid compressing urinary bladder
When pregnant, it may cause miscarriage, obstructed labor, or postpartum hemorrhage
Estrogen excess may also cause tender breasts, heavy bleeding, premenstrual irritability, and depression
Single or multiple fibroids are identified through ultrasound, MRI, or pelvic exam
Types
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Present immediately below the endometrium. Likely to be a direct cause of heavy bleeding
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The most common type of fibroid found within the myometrium. This fibroid is unlikely to directly cause heavy bleeding.
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Fibroids that lie beneath the serosal surface and are connected via a long stalk of tissue (pedunculated) and attached to the serosa.
These fibroids may lose ther connection and forma parasitic leiomyoma
Treatment
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At the root of all of this is prevention. We are trying to restabilize the normal path of estrogen metabolism so that estrogen can come in, do its job, and properly be excreted afterwards.
Be gentle with your liver during the healing process and avoid alcohol, which can vastly increase your exposure to estrogen. Support your liver with herbs like milk thistle, dandelion and burdock. These can be taken as infusions or tinctures. Or you can try taking glycine.
Work on healing your gut by eating a gentle diet, dealing with gut permeability, histamine intolerance, or gut dysbiosis where bad bacteria are able to wreak havoc allowing estrogen to be reabsorbed in your body.
Support your gut with gentle warming foods like bone broth and other animal foods like meat, shellfish, fish, eggs, animal fats, fermented foods like kimchi and kefir, fruit and cooked vegetables. Sugar, grains, beans, legumes, and raw vegetables, should be avoided during gut healing protocols.
Avoid antibiotics and pharmaceuticals if possible, which can damage healthy gut bacteria
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Reduce inflammatory foods like sugar, gluten, Holstein conventional cows dairy, and other histamine containing foods to avoid the effects of insulin resistance and histamine intolerance
Take magnesium and zinc to reduce inflammation.
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This procedure involves blocking the blood vessels that supply blood to the fibroids, causing them to shrink.
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This surgical procedure involves removing the fibroids while leaving the uterus intact. It is often recommended for those who want to preserve their fertility.
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Progesterone naturally counteracts the effects of estrogen. Maintaining a healthy ovulatory cycle will help prevent reoccurrence.
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Work with B-vitamins, calcium d-glucarate, selenium, and eat iodine rich foods.
Take a probiotic containing lactobacillus casei
Gui Zhi Fu Ling Wan (Cinnamon and Hoelen) reduces fibroid growth
Try micronized progesterone in the post-ovulatory phase to help counterbalance the effects of estrogen.
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Avoid endocrine disruptive chemicals found in personal care and home products, plastics, pesticides, and even hormonal birth control, which is technically a xenoestrogen.
Post Op Care
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After working with your healthcare team, devise a post-operative strategy to support healthy estrogen metabolism and the excretion of estrogen. Work to support your menstrual cycle and improve progesterone health.
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Assess personal care item ingredients. Eliminate use of items that contain endocrine disruptors.
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Include foods rich in antioxidants and anti-inflammatory properties, such as fruits, vegetables, greens, meat and organs, seafood, dairy, and seeds, nuts, and legumes.
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Drink herbal teas known for their anti-inflammatory and calming effects, such as stinging nettle, burdock, dandelion root, slippery elm, ginger, or turmeric tea.
How Charting Helps with Fibroids
Use your charts to describe the color and consistency of your blood and bleeding patterns
Use cervical fluid as a diagnostic sign to measure estrogen levels throughout the cycle
Look for multiple patches of cervical fluid that are sporadic or extend beyond the fertile window
Some people observe mucus every single day, identifying high estrogen
Monitor basal body temperatures to better understand if your cycles are ovulatory and if you are making adequate progesterone
Collect other kinds of health data and symptoms. If you notice tender breasts, or heavy bleeding, premenstrual irritability, and even depression are other markers of estrogen excess
Follow the healing process and changes in your charts after improving estrogen metabolism, supporting progesterone, and reducing exposure to xenoestrogens
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