Q) I've been diagnosed with four uterine fibroids. My gynaecologist advised me to have a hysterectomy, but the doctor I saw for a second opinion advised me to wait to see if they are growing. I have no symptoms apart from occasional soreness. I am postmenopausal and a bit concerned that they haven't reduced naturally due to a drop in oestrogen. Can you help?-A.W., via e-mail
A) Uterine fibroids, also called 'leiomyomata' or 'myomas', are the most common type of benign tumour in women (Harefuah, 2008; 147: 725-30, 748). Although they are not life-threatening and often asymptomatic, they can lead to debilitating symptoms such as abnormal bleeding, abdominal pain, constipation and frequent urination. In some women, fibroids can even cause miscarriage and infertility (Acta Obstet Gynecol Scand, 2008; 87: 812-23).
No one knows what causes fibroids, although genetic, environmental and hormonal factors-such as oestrogen and progesterone-are thought to play a role (Bailli`eres Clin Obstet Gynaecol, 1998; 12: 225-43), which explains why they usually regress after the menopause.
The standard treatment of fibroids is surgical removal by myomectomyor total hysterectomy (removal of the entire uterus), but both operations are associated with numerous risks-from wound infections and internal scarring to incontinence and vaginal prolapse (JAMA, 2009; 301: 82-93). For this reason, it's a good idea to follow your doctor's advice and avoid the knife for now. If your fibroids aren't growing and you continue to have only mild discomfort, you may require no treatment at all.
A natural approach
Alternative therapies for fibroids is a poorly researched area (J Comp Med, 2005; 4: 87-90, 92). However, based on the evidence so far, you might consider trying the following courses of action.
- A change of diet. A large Italian study found that women who often ate ham, beef and other red meats were more likely to develop fibroids than those who did not. Also, high intakes of fish, green vegetables and fruit appeared to be protective (Obstet Gynecol, 1999; 94: 395-8). Other studies suggest that soy products might contribute to fibroids due to soy's oestrogenic effects (Comple-ment Ther Clin Pract, 2008; 14: 132-5). As the evidence remains conflicting (Eur J Clin Nutr, 2001; 55: 773-7), consult an experienced nutritionist.
- Curcumin. Found in turmeric, this has demonstrated inhibitory effects on human fibroid cell proliferation in the lab, so curcumin could offer
a novel direction for future fibroid therapies (Fertil Steril, 2008 Jun 12; Epub ahead of print).
- Lycopene. This carotenoid, found primarily in tomatoes, can reduce the size and incidence of fibroids in Japanese quails, a species prone to fibroids of the oviduct (Nutr Cancer, 2004; 50: 181-9). Although this may not necessarily apply to humans, try adding lycopene supplements to your diet, or eat more cooked tomatoes, as they also contain other compounds that may be of benefit to your health (Nutr Cancer, 2007; 59: 70-5).
- Testing for heavy metals. Exposure to heavy metals could be linked to fibroids as one study found that women with fibroids and infertility tended to have higher levels of cadmium, found in enamelled pans, cigarette smoke and heavily pollut-ed environments (J Toxicol Environ Health A, 1998; 54: 593-611).
- Chinese herbs. It may be worth seeing a qualified Traditional Chi-nese Medicine practitioner. In one study of over 100 premenopausal women, kuei-chi-fu-ling-wan (keishi-bukuryo-gan, KBG)-a compound of the bark of Cinnamomum cassia, roots of Paeonia lactiflora, seeds of Prunus persica, pistils of Poria cocos and root bark of Paeonia suffruticosa-improved the clinical symptoms of fibroids in more than 90 per cent of cases. What's more, around 60 per cent had their fibroids shrink with this remedy (Am J Chin Med, 1992; 20: 313-7). In a study of lei gong teng (Tripterygium wil-fordii Hook f), 70 per cent of women had smaller fibroids after five to six months of using the herb (Zhonghua Fu Chan Ke Za Zhi, 2000; 35: 430-2).
- Mind-body medicine. Body therapy (somatic therapy, body work), guided imagery and weekly Tradi-tional Chinese Medicine was more effective than conventional care in treating fibroids in a controlled US study of 74 women (Altern Ther Health Med, 2002; 8: 34-6, 38-40, 42, 44-6).
- Homeopathy. Remedies known to slow or halt the growth of fibroids are Thuja Occidentalis, Conium Maculatum, Ustilago Maydis and Silica. For symptomatic relief, try Thlaspi Bursa Pastoris, Cimicifuga Racemosa and Magnesium Phos-phoricum (J Comp Med, 2005; 4: 87-90, 92). However, it's better to see a qualified homeopath for an individualized prescription.
- Acupuncture. On comparing this with other medical treatments, acupuncture achieved a total rate
of effectiveness in 98 per cent of cases, with a cure rate of 73 per cent (Zhen Ci Yan Jiu, 1994; 19: 14-6).
- Exercise. Obesity and low levels of physical activity have been linked
to fibroids, so get moving (Wiad Lek, 1993; 46: 592-6).
Conventional alternatives to surgery
- Uterine artery embolization (UAE). This uses radiological techniques to block the blood flow to the main artery supplying the uterus, resulting in fibroid shrinkage, and was successfully used in postmenopausal women (J Vasc Interv Radiol, 2007; 18: 451-4).
- High-intensity focused ultrasound (HIFU). This uses ultrasound waves in conjunction with magnetic resonance imaging (MRI) to destroy fibroids with pinpoint accuracy (Srp Arh Celok Lek, 2008; 136: 193-5).
- Drug therapy. Hormonal therapies and gonadotropin-releasing hormone agonists have proved effective in some women with fibroids (Acta Obstet Gynecol Scand, 2008; 87: 812-23).