Monday, March 23, 2009

Fibroids: What Can You Do About Them?

Women who are dealing with fertility issues and issues of period pain or PMS could also be dealing with fibroids as well. Fibroids do also lead to heavy bleeding and possibly low iron stores as well as feeling very tired and, if fibroids become large, abdominal pain can be experienced.

Fibroids or growths in and/or outside the uterus, have been noted in literature to be due to high levels of oestrogen, but what is often missed is most fibroids can also be due to less than optimal progesterone production. When a woman has normal oestrogen levels but low progesterone levels, this is something called oestrogen dominance because low progesterone levels make the oestrogen appear to be excessive and this is associated with the growth of fibroids.

Your oestrogen is the hormone that can cause crankiness, irritability, discomfort, and mood swings, whereas progesterone is the more calming of the hormones and, when balanced nicely with oestrogen, helps to minimise and eliminate the symptoms surrounding a period and throughout the cycle. So it is very important that these hormones are in good balance, not just within normal limits. We tend to see issues with oestrogen at the higher end of the range and progesterone at the lower end of the range and patients can be told that the hormone levels are fine when in actuality this would be considered oestrogen dominance and potentially create problems with fertility issues, fibroids, and other issues such as PMS.

Another area of oestrogen dominance that can contribute to fibroid growth is excessive oestrogen in comparison to normal progesterone. This is usually less of an issue than the low progesterone, but can contribute to fibroid formation.

In regards to fertility, the problem with fibroids if they are within the uterus is that they can create a barrier for the sperm to be able to get to the egg. Fibroids can also create a barrier to implantation depending on where they are within the uterus. Fibroids outside of the uterus many times are not a structural issue unless they are pushing on the fallopian tubes, but they do indicate that oestrogen dominance is likely and therefore the probable cause of the fibroids could be effecting fertility even if structurally the fibroids are not.

With women who experience fibroids but go into menopause which result in the oestrogen and progesterone levels lowering, it’s important to note that the fibroids will shrink. But unfortunately for some women the fibroids grow to be significant either while they’re trying to become pregnant, with pregnancy or prior to menopause and for the women who is pregnant, can cause significantly heavy periods, blood loss, and other issues.

So, to address fibroids, it is important to address the optimisation of oestrogen and progesterone balance, and to do this it is very important to look at thyroid health and adrenal health. One of the thyroid hormones, particularly T3, helps to create progesterone, so, if the thyroid is sluggish and T3 production is not optimal, then this can create a problem with fibroid formation.

In addition, iodine is very important for thyroid health, and it is found that some women who experience iodine deficiency can be susceptible to fibroid growth. So these areas should be assessed by having a blood test to look at free T4 and free T3 and thyroid antibodies as well as urinary iodine status.

Simply being in the normal range does not necessarily completely rule out thyroid issues, as some thyroid issues can be subclinical. In addition, many physicians will test only TSH (thyroid stimulating hormone), which really gives only an indication of what the brain needs for thyroid hormone but not what the rest of the body needs. If a TSH level is within normal limits, then physicians will say that the thyroid is functioning optimally when in fact it may not be, and therefore the presence of fibroids should indicate that further testing is needed.

The adrenals, as was mentioned, are also another area where the balance between oestrogen and progesterone can be affected. The adrenals sit on top of the kidneys and help to regulate stress response. If the body has been under stress for a period of time, progesterone can be converted into cortisol, with possibly less being available for reproductive purposes. If that’s the case and there’s less progesterone available to oppose oestrogen, then you have the perfect breeding ground for fibroid formation to occur.

So, if a person is dealing with fibroids, they should be having their thyroid and adrenals assessed to look at the situation fully.

A morning cortisol blood test can be done to assess adrenal function and cortisol output. Cortisol levels are normal in the morning for some women but decrease substantially before noon-time or throughout the rest of the day. Cortisol should be at its highest in the morning but then gradually decrease over time throughout the day and be at its lowest right before a person goes to sleep so they can sleep well through the night. If cortisol levels are good in the morning but drop off in the afternoon, a person may experience significant fatigue throughout the day and possibly mood swings and very low energy. Many will say this may be due to less than optimal iron, but in fact it is due to less than optimal adrenal function.

The blood test result in the morning is sometimes not as accurate because simply inserting a needle into the body to draw the blood can create a stress response, and therefore the morning cortisol test may not be as optimal as it should be. But in the case where there is a question, saliva tests can be done to assess cortisol levels throughout the day to see if they are in fact maintaining and only slowly decreasing throughout the day versus dropping significantly and leaving a person with an “empty tank”, i.e. feeling very tired throughout the day.

Adrenal function and thyroid function can be supported through natural means with herbs such as withania, rehmannia, rhodiola, licorice, bacopa, among others. However each person should have their situation assessed individually because not all herbs would be needed for each situation. Bladderwrack is an excellent herb that contains iodine and there are certainly natural iodine supplements such as kelp available if it is found that a person has mild or moderate or severe iodine deficiency.

Through the use of herbs to optimise oestrogen and progesterone balance it can be possible to shrink fibroids, but surgical removal is necessary in some cases.

Some doctors recommend a hysterectomy for those who are past child-bearing years, but oftentimes this can be avoided if the thyroid and adrenals are addressed, and the heavy blood flow will cease and the patients will be feeling much better.

If the fibroids are too big, they can be excised surgically by an experienced surgeon. If the thyroid and adrenals as well as the oestrogen and progesterone balance are addressed, then this can help the patient avoid a hysterectomy which has been correlated with the ovaries failing two years after the uterus is removed and improve fertility for those trying to become pregnant.

For fertility purposes, it’s controversial whether the excision of the fibroids will help. Really, it depends on the size of the fibroid and its placement, and an experienced surgeon should be able to give you good feedback on this.

Just know that if you are trying to become pregnant, fibroids do not mean you won’t be able to create a viable pregnancy. But fibroids do need to be investigated to see how they may be impacting your fertility. If you are not trying to become pregnant and have heavy flows, painful periods and anemic due to heavy blood loss, fibroids should be ruled out and addressed if present.

If you are simply looking at shrinking fibroids to optimise your overall health and decrease heavy flow of a period, there are some natural means to do this and some nice complementary natural methods that can be utilised with medical intervention if necessary.