A Concealed Burden: Uterine Fibroids & Menstrual Health

The first time that I went for a pelvic ultrasound was for suspected cysts. But imagine my surprise when I found out that I was also sprouting a small fibroid. Uh, weird, I never had any problems with my menstrual health. I shared this discovery with my sister, who revealed that she also has a fibroid, which was incidentally discovered at her first-trimester ultrasound. She did not have any symptoms as well and her pregnancy progressed normally. 

Uterine Fibroids are muscular tumors that grow in the wall of the uterus, also known as Leiomyomas, are benign tumors of uterine smooth muscle (the middle layer of the 3-layered uterine wall). It is one of the most prevalent gynecological tumors in premenopausal women. Despite being a benign tumor, fibroids carry great clinical significance and may impact the quality of life. 

Uterine fibroids​ arise from three pathways

1) Genetic Abnormalities

2) Sex Hormones

3) Disordered wound healing

An inciting event will induce genetic changes, which will alter the way the smooth muscle cells would respond to hormones and growth factors. A hypersensitive response of uterine smooth muscle cells would lead to the growth phase. This would cause excessive formation and deposition of ​extracellular matrix (collagen, fibronectins, etc) within the leiomyoma, thus contributing to its growth (and at times, large size). 


The range of symptoms varies amongst women, from heavy painful periods to infertility. However, in most cases, women may not have any symptoms at all. 

The most common presenting ​symptoms​ are: 

- Heavy longer periods which can lead to anemia and fatigue 

- Painful periods or intercourse 

- Constipation, increase in urinary frequency, urinary retention (these can occur due to the mass effect of a large fibroid) 

- Abdominal protuberance 

- Reproductive problems: impaired fertility, pregnancy complications or loss, adverse obstetric outcomes 


Some symptoms can be managed conservatively, but when these symptoms become overwhelming, seeking medical treatment can be helpful.

Fibroids respond to hormones, which is why ​hormonal therapy​ will help reduce its size and control its symptoms. ​Surgical treatment​ involves the removal of the fibroid, this provides a permanent solution and improves fertility. 

However, both of these options have their adverse effects. Hormonal therapy has side effects like hot flashes, loss of bone mass, no periods (which means decreased ability to conceive while on treatment). Surgery on the other hand is costly and the procedure has its risks. 


So What Other Options Are There To Manage Fibroids?

We can control modifiable risk factors that have been ​associated​ with leiomyomas. Cessation of smoking, maintaining healthy body weight, limiting caffeine and alcohol intake, and consuming a plant-based ​diet​ are known to have protective effects against leiomyomas. 

Vitamin D​ decreases the size of the tumor and its ​deficiency​ is a known ​risk factor​ for the development of uterine fibroids. Increasing Vitamin D intake through dietary changes or high-dose supplementation will help decrease the bulk symptoms of fibroids. 

The most abundant antioxidants found in our diet are ​polyphenols​. They are present in fruits, vegetables, seeds, whole grains, beans legumes, tea, coffee, and wine. Polyphenols such as epigallocatechin gallate, quercetin, curcumin, and resveratrol may help shrink the size of leiomyoma and control the symptoms. 

Green Tea​ contains the polyphenol Epigallocatechin Gallate (EGCG), which has anticarcinogenic, anti-inflammatory, and anti-oxidative properties. ​EGCG​ decreases the proliferation of the abnormal fibroid cells thereby decreasing the volume of the tumor. 

Resveratrol​ is found in numerous plant species and red wine. It is also found in food sources such as grapes, blueberry, bilberry, cranberry, juice, and peanuts. It has been found that resveratrol ​inhibits​ the proliferation of the fibroid cells and the uterine smooth muscle cells, which decreases the growth of the tumor. Another ​study​ found that it also inhibits the proliferation of cervical cancer cells. 

Having fibroids is not a choice. Despite following every ‘rule’ in the book we may still end up being stuck with a leiomyoma. This ​burden​ is not our fault, it could be due to our

genetics, age, and race. Most of us are lucky enough to not experience any symptoms, while some of us may be stuck with the worst symptoms. 

What we can do is keep an eye on our menstrual health. 

It is not unusual for women to dismiss their heavy painful periods, most of us probably assume that this is the new normal now. However, when it does not feel normal, do seek out help. Do try every ‘rule’ in the book. And most importantly, do reach out to other women because there are others with a uterine fibroid and everyone will have a unique story and everyone uses different remedies to help them cope with it.

Reference

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