#131: What Causes Fibroids?

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome.

All right, this week we're going to talk about fibroids. I had a patient recently who came to me for a second opinion before having a hysterectomy. So she had multiple large fibroids in her uterus, and she was trying to figure out what the heck was causing these fibroids. She didn't really know. So what are fibroids? First of all, what causes them? What can we do about them? You know, conventionally or alternatively. So fibroids, the medical term is called leiomyomata. It's, you know, I don't know why we have to have big fancy words for everything, but the word means it's a muscle tumor. So we have 2 parts of our uterus that we have the muscle myometrium part. That is what grows when you get pregnant and houses the baby. And then there's the endometrial. lining, which is the endometrium that grows every month in response to estrogen and progesterone, and then you shed off and bleed as a period. So that comes and goes every month, whereas the myometrium should stay pretty stable, those muscle cells. Sometimes the endometrial cells can get into the muscle cells, and that's called adenomyosis. That's a whole nother issue. But essentially, these myometrial cells, they start to grow tumors inside of them called leiomyomas, and those are fibroids. So fibroids are very circular, they're very dense, they're heavy, and they have a lot of blood supply to them. They're almost always benign. It's very rare to have malignant fibroids. Those usually grow quickly. They don't have a nice uniform pattern to their growth. They look very disoriented and heterogeneous on ultrasound or MRI. So there's some differences to them. But the only way to know for sure is to give it to the pathologist. They look under the microscope and they can tell you whether it's benign or malignant. But fibroids are always almost always benign growths of the muscle of the uterus. They can grow right into the meat of the myometrium. They can grow hanging off of it. It's called a pedunculated fibroid. They can grow pushing out toward the outside of it. That is called a subserosal fibroid. They can grow into the cavity where the endometrium is growing, where that's where the baby, you know, would potentially implant and grow. That's called submucosal. So sometimes it even grows into the cervix, which is the bottom part of the uterus. So fibroids can grow all over the place. They have different names depending on where they're growing. It's really common for women to have fibroids and not even know it. There's Evidence that up to 75% of women have fibroids, and it's even higher in the African American community. When autopsies are done, they realize that a lot of women have fibroids and never knew it. So it's not usually a concern, but it becomes a concern if you have so many of them that your overall uterus gets to be enlarged, or you have fibroids that are themselves really large. So they can be as small as like an almond, they can be as big as a grapefruit or even a watermelon. So you can imagine once they get to be bigger size that they take up space in your pelvis, they can actually push on the bladder and cause you to have bladder symptoms, leakage, unable to empty your bladder. Or just an annoyance, like you have to go all the time. They can block the bowels and cause constipation. They can irritate the bowels and cause increased peristalsis and diarrhea. So any kind of bladder and bowel changes associated with large fibroids can really start to interfere with life. Fibroids, because they have so much blood supply, they can lead to bleeding in between periods. They can cause heavier periods. They can cause longer Longer periods, so you're lasting like you know over a week. It can be really painful with intercourse. You know, a lot of times when the cervix is being pushed physically by penetration, that is moving the whole uterus and all the fibroids in it, and that can be really painful. Sometimes women will complain of. Leg aches, pains down their legs, heaviness in their pelvis, or feeling and looking pregnant when they're not—all of those from fibroids. So it's not fun. And what happens is most of the time these are slow growing, and so you're not really aware that they're. growing until they get to a big enough point where they're actually causing those symptoms. It's really uncommon to have quick growth. Like I mentioned, that's more often associated with malignant process. So you definitely want to have an evaluation with an ultrasound and possibly an MRI to see what these fibroids look like, where they're at, what are they pushing on. And see, are they growing over time? So that's the biggie. You know, if they're small and they're not really interfering with things, a lot of times you can just let them be. And I've seen many women get pregnant over the years with fibroids and carry their pregnancies to terms and not have issues, but they definitely have the possibility of interfering with placental growth if you have multiple fibroids in the submucosal area, or they sometimes can be associated with preterm labor because they can cause the uterus to contract and be irritated. So that is something, you know, they will look for if you are pregnant or if you are having recurrent miscarriage or issues. They'll evaluate for fibroids. So When I went to medical school a long, long time ago, I was taught that fibroids were only from estrogen and that the birth control pill was the treatment. So we would give you synthetic estrogen and progestins to combat the excess estrogen to prevent those fibroids from growing. Then we started using synthetic progestins by themselves. And then we started using GnRH agonists, which puts you in a menopausal-type state and prevent you from making estrogen and progesterone. Women do not enjoy being on those medications because they put you in a menopausal state. It causes hot flashes, night sweats, mood swings. It can cause bone loss, hair loss. skin thinning, vaginal discomfort. And those medications can only be used for so long. They recommend 1 to 2 years max and then going off of them. So it's kind of a temporary solution, but once you go off of those, the fibroids tend to grow again. So the question would be then, what is causing the fibroids to grow? It's not just Estrogen, so it's more an imbalance of your hormones. It's too much estrogen, not enough progesterone—not synthetic progestins—but not enough actual normal natural progesterone. But there are other major factors because what we now see is that fibroids were not common 50 to 70 years ago the way they are now. Their incidence has. tripled. And the major reason for this is environmental factors, endocrine disrupting chemicals. So all of the plastics and the phthalates, the fragrances, the cash register receipts, all these different things that didn't exist 70 years ago. Are now in our environment, and as women, we get bombarded with these chemicals all day, every day, and they disrupt our hormones. So the U.S. National Institute of Environmental Health Sciences defines endocrine disrupting chemicals as chemicals that interfere with the body's endocrine system and produce adverse developmental, reproductive, neurological, and immune effects. Effects. So this contributes to estrogen overload signaling at the receptor sites and causes fibroids to develop and grow. So that is why we're seeing so many fibroids, um, that we never saw before in previous generations. It's all of these endocrine disrupting chemicals, all the persistent organic pollutants, all of their breakdown products. So it's super important, like, don't take the register receipts unless you absolutely need to, because the chemicals on that receipt go directly into your skin, into your system, and send estrogen signals. Same thing with plastics. Don't heat your food in plastic. Try not to drink out of plastic water bottles. Get rid of the chemicals in your hair products and skin products. I have a nice little pamphlet on how to decrease your toxic burden. It's got all of this information. I'll put it in the show notes because it's really important to get control of your environment. That is what's feeding these fibroids. Okay, so diet also seems to play a huge role. Vitamin D deficiency is a big factor when it comes. To fibroids. Also, your dairy consumption. So unfortunately, the dairy industry has really messed with our hormones. It is very common to get a lot of insulin-like growth factor in dairy because that's what's used to fatten cows up and keep them pregnant, which keeps them in a nursing state so that you constantly have milk production from these cows, and all of the insulin-like growth factor and hormones that are injected into these animals goes into us, and insulin-like growth factor feeds those fibroids. So really try to minimize your dairy significantly. Like, literally, as an adult woman, I do not recommend you drink cow's milk. At all, I recommend you if you are going to eat dairy, try to make sure that it is non-GMO, so they're not being fed you know pesticide-laden corn feed. That they are grass-fed cows. That they are antibiotic and hormone-free. So if all of those are true, then you're probably a little bit better off. But you really got to be careful with the dairy. So get your vitamin D, minimize your dairy, focus on inflammation, getting that down. Like I mentioned all the time, if your gut's inflamed, your pelvis is going to be inflamed, and that's going to contribute to fibroid growth. The other piece of it seems to be associated with hypertension and metabolic syndrome. So like I said, fibroids have a lot of vascular supply, a lot of blood vessels. And what we see in women with hypertension or elevated blood pressure is they have cardiovascular issues. Their blood vessels are stiffer, they're not as elastic, and So that can be associated with fibroids. So if you have hypertension, you really want to work on getting your cardiovascular system back to a healthy state, and that looks like having your hormone levels balanced and taking omega-3s and decreasing your inflammation with quercetin and turmeric and all of those things and getting your gut inflammation in check. all of that impact your cardiovascular system and they seem to be associated. So decrease the inflammation, decrease the hypertension, decrease the metabolic syndrome. So the other piece of it is if you have insulin resistance, you tend to have excess weight or fat cells. Fat cells make testosterone that gets converted into estrone. And so our fat cells actually make too much of bad estrogen called estrone, and that can feed the fibroids as well. So carrying extra weight contributes to this imbalanced hormone picture and fibroid growth. So let's see, conventionally, like I said, they'll give you medicines or offer surgery. It's Actually, one of the most common reasons to have a hysterectomy is for fibroids. But if you could focus on reducing the reasons that you're growing these fibroids, you're probably going to make some good headway. So decrease your endocrine disruptors, eat an anti-inflammatory diet, eliminate the dairy, increase your vitamin D, get rid of the alcohol. So alcohol. Elevates your blood sugar, causes insulin resistance. It causes inflammation in your gut, which, you know, is directly associated with these fibroids. There are some herbs and supplements I love to use. Like I mentioned, vitamin D, you want to get your levels like 60 to 80. And then I love to support the estrogen metabolism in the liver with diindolylmethane, indole-3-carbinol, sulfur Sulforaphane from broccoli extracts. All of those are going to help you metabolize your estrogen more efficiently so that you decrease that bad 4-hydroxyestrone that can feed those fibroids. And the other piece of it is that we have different types of estrogen receptors in our bodies. So we have estrogen receptor alpha and estrogen receptor Beta cells. So alpha receptors are more often associated in the breast and uterus, whereas beta receptors are in other places like our bones, our brain, our cardiovascular system. And what's really interesting is the colon only has estrogen receptor beta. And so that's why in the studies that were done on hormone replacement therapy, hormone replacement actually decreases your risk of colon cancer because it's stimulating those beta receptors. So opposite of breast and uterus. And the cool— other cool thing is that phytoestrogens from plants actually bind to the beta receptors and not the alpha receptors. Less stimulation of breast and uterine tissue with phytoestrogens than regular estrogens. So going back to fibroids, you want to make sure that you're not stimulating too much of the alpha receptors. And what happens is if you don't have enough natural progesterone production and you're only getting estrogen, estradiol, and estrone production, those alpha receptors actually up regulate and you make more alpha receptors, whereas if you have progesterone, progesterone actually downregulates those alpha receptors and you make more beta receptors. And so estrogen is kept in check by progesterone, and progesterone protects the uterus and the breast tissue by decreasing the amount of alpha receptors available. And so, you know, that's just one way that progesterone is protective against breast and uterine cancer. So, and, and I'm not talking about synthetic progestins. It does not do that. I'm talking about bioidentical progesterone. So progesterone is key to keeping these fibroids from growing, from overgrowing. And the other piece of it is Zinc is necessary for the activation of the receptors. So you want to have enough zinc in your diet or in supplementation as well. Zinc is necessary for so many other things as well. I could go on. It's for like thyroid hormone and everything else. So that was just a little side note. was helpful in the treatment of fibroids because it's binding those beta receptors and downregulating those alpha receptors. So there was a study in 2014, and it gave women black cohosh every day, 40 milligrams, and they had an average decrease in fibroid size of 30% after 3 months. Months. So that's pretty impressive. That's awesome. So obviously you shouldn't use that in pregnancy, but if you are using micronized progesterone and black cohosh and maximizing the good metabolism of your estrogens through liver support and watching your diet, decreasing your inflammation and getting rid of those xenoestrogens, all those chemical endocrine disruptors in your diet, you can positively make an impact on those fibroids and they will— their growth will slow down and sometimes they'll even regress. So I hope that was helpful. I want to give you more options than just a synthetic pill or surgery. And the best thing to do is to tackle these things before they get too big. So I do recommend regular pelvic exams because I will tell you, as a physician, if I do a pelvic exam, I can feel the uterus and know whether it feels like a normal shape and size or not. And if it doesn't, then we can order an ultrasound and you can know that you have fibroids when there are lots smaller and you can get proactive and do all the things we just talked about, as opposed to waiting like the poor patient I just saw this week who, you know, all of a sudden had 8 and 10 centimeter fibroids. Like, they're big, they're the size of a cantaloupe. So, um, You know, going to the doctor, talk to your girlfriends, talk to your family members, talk to your coworkers. See if you can find another physician that you are comfortable going to. They are out there. There's tons of amazing doctors who want to help women. They're they might be stuck in a broken system and be dealing with the confines of that, but they're out there. So. Advocate for yourself. Make sure you're getting exams, making sure you're getting checkups, all of that good stuff. So I hope you found this helpful. Let me know, you know, what your golden nugget was from this episode and keep adding it to all the amazing things you're doing. Share this with your friends, with everybody, everyone you know. You know, and Let me know what else you want to hear about. Okay, so go have an amazing kick-ass week, and I'll see you next time. Bye, ladies.