Uterine fibroids, also called uterine leiomyomas, are noncancerous growths of the uterus. They are the most common benign pelvic tumor in women (Eltoukhi 2014; Bulun 2013; Mitwally 2013; Mayo Clinic 2014a; Stine 2014; Hodge 2007). Although very controversial, with some sources stating definitively that uterine fibroids do not transform into cancer, other data suggest a very rare risk for transformation (Clement 1993).
In a US study with women age 35 to 49 years, the incidence of uterine fibroids by age 35 was 60% among African-American women, increasing to greater than 80% by age 50, whereas Caucasian women showed an incidence of 40% by age 35 and almost 70% by age 50 (Day Baird 2003). Up to 75% of women will have uterine fibroids at some point during their lives, though they often do not cause symptoms (Ferri 2014; Mayo Clinic 2014a).
Symptoms associated with uterine fibroids include heavy, prolonged menstrual bleeding; pelvic pain, pressure, or fullness; frequent urination or incontinence; constipation; infertility; and back or leg pain (Mayo Clinic 2014a; Khan 2014).
Fibroids can vary in size, number, and location. There are multiple types of uterine fibroids, each characterized based on their location (Mayo Clinic 2014a):
- intramural fibroids grow within the muscular wall of the uterus
- submucosal fibroids grow toward and into the uterine cavity from the uterine wall
- subserosal fibroids grow toward the outside of the uterus
- cervical fibroids are located in the cervix of the uterus (Mitwally 2013)
Treatment of uterine fibroids is often dependent on a woman’s symptoms and desire to maintain fertility. Conventional treatment options include gonadotropin-releasing hormone agonists, which temporarily stop the menstrual cycle and help decrease fibroid size; estrogen/progestin hormone therapy when control of excessive bleeding is a primary concern; minimally invasive surgical treatment such as myomectomy to remove fibroids; uterine artery embolization to disrupt blood supply to the fibroid; and surgical procedures such as hysterectomy (removal of the uterus) (Evans 2007). Uterine fibroids are a common indication for hysterectomy, and approximately one-third of hysterectomies in the United States are performed because of symptomatic fibroids (Elsevier BV 2011).
Uterine power morcellation, which can be performed as part of a laparoscopic hysterectomy, is a procedure in which a woman’s uterus is shredded into small pieces using an electrically powered device and then removed through a small incision in her abdomen. Although this approach is less surgically invasive than the traditional abdominal hysterectomy, little-appreciated until recently is the risk for distribution of occult, cancerous uterine tissue throughout the abdominal cavity as a direct result of the procedure. During the surgical shredding process, small pieces of uterine tissue can be dispersed into the abdominal cavity. While this does not cause problems in most cases, one in 350 women with fibroids has a fibroid tumor that harbors undetected malignant tissue (ie, leiomyosarcoma) at the time of the operation. The surgical shredding can spread leiomyosarcoma cells in the abdominal cavity, which can result in the dissemination of this aggressive form of cancer (Park 2011). In light of these revelations, in mid-2014 the US Food and Drug Administration (FDA) warned against the use of uterine power morcellation procedures (FDA 2014a), and some insurers stopped covering the cost of these operations (Reuters 2014b). The July 2014 issue of Life Extension magazine contains a detailed exposé of the dangers of these potentially deadly procedures along with an account of the diligent work of Dr. Hooman Noorchashm of Harvard Medical School and Brigham and Women’s Hospital and his wife, Dr. Amy Reed, who developed a rare form of uterine cancer after undergoing uterine power morcellation. Drs. Noorchashm and Reed relentlessly campaigned to bring the shortcomings of power morcellation to light, and as a result some medical centers have modified their positions on uterine power morcellation.In this protocol you will learn about causes of uterine fibroids, how they develop, and how they are conventionally treated. You will discover several novel and emerging treatment approaches that may improve outcomes for women with fibroids. Also, we will review a number of dietary and lifestyle considerations that may help prevent uterine fibroids. Additionally, we will explore integrative and natural approaches to fibroids, such as the ability of green tea extract to significantly reduce the size of fibroids as well as the severity of fibroid symptoms.