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What are Uterine Fibroids?

January 7, 2019
uterine fibroids, toronto naturopath, naturopathic doctor toronto, fertility naturopath

When you think of fibroids, your brain may automatically jump to the scary C word. But fibroids are not the same as cancer.

Uterine fibroids are tumours that that come from the same tissue as the uterus. They grow at a modest rate, and are affected by hormones like estrogen and progesterone.

Uterine Fibroid Risk Factors

Some of the risk factors for uterine fibroids include:

  • Increasing age, around 40-50 years old
  • Family history of uterine fibroids
  • Getting your period before 12 year old
  • African American
  • Obesity

Types of Uterine Fibroids

Subserosal Uterine Fibroids

These fibroids project outside of the uterus. Surgical removal isn’t typically recommended and they don’t appear to impact fertility.

Submucosal Uterine Fibroids

These fibroids project within the uterus and can impact fertility in a negative way by affecting implantation rates, clinical pregnancy rates, ongoing pregnancy, miscarriage and live birth rates. Pregnancy rates may improve following surgical removal of the fibroids.

Intramural Uterine Fibroids

These fibroids are found within the myometrium (middle layer of uterine wall). They may affect fertility by negatively impacting implantation and clinical pregnancy rates.

Signs and Symptoms of Uterine Fibroids

The most common symptom is heavy, prolonged or abnormal bleeding. Unsurprisingly this can be followed by iron deficiency anemia.

You may also notice pelvic pain or pressure, although this is rare. And obstructive symptoms may present with larger fibroids.

Fertility may also be impacted depending on the type of fibroid you have.

Confirming the Presence of Uterine Fibroids

Palpation can give you an idea if you have fibroids, but you’ll need a more definitive diagnosis – preferably with imaging.

Two of the most common (and least invasive) tests are:

  • Transvaginal and transabdominal ultrasonography
  • MRI

Uterine Fibroids in Fertility

Depending on the location of your fibroid, it may decrease your fertility. Fibroids may decrease implantation and clinical pregnancy rates, based on where they present. Intramural and submucosal will affect fertility more than subserosal.

Uterine Fibroids in Pregnancy

Fibroids might remain the same size or become smaller in pregnancy. In the postpartum period, fibroids may shrink or completely disappear.

Sometimes they may have an impact on pregnancy outcomes, including an increased risk of malpresentation of your baby, increased chance of c-section, and increased risk of preterm delivery.

Treating Uterine Fibroids Naturally

Uterine fibroid treatment is dependent on the symptoms you’re experiencing.

If you’re not experiencing any symptoms, then doctors usually take a watch and wait approach. If you are experiencing symptoms, then treatment depends on your desire for fertility.

There are many drugs out there for the treatment of fibroids, and if you’re familiar with my website, I often focus on natural alternatives instead. Moreover, if you’re here because your fibroids are affecting your fertility, many of the recommended treatments wouldn’t be compatible (ex. birth control).

It’s important to note that natural therapies may not make your fibroid completely disappear. And this is one of the conditions where we’re focusing on the symptoms you’re experiencing.

Nutrition and Uterine Fibroids

One of the goals when you have fibroids is to adopt an anti-inflammatory diet. This means whole foods, fresh and organic fruits and vegetables, cold-pressed oils, oily fish, and nuts and seeds.

Sadly this leads to an avoidance of red meat, processed foods, refined carbohydrates, sugar, saturated fats, fried foods, dairy, caffeine, and alcohol.

Fibre is very important in assisting the elimination of estrogen and promoting bowel movements. Before you chug back some psyllium husk, berries and leafy greens are a great source of soluble fibre (the type of fibre that bulks up your stool). An easy way to ensure you’re getting enough fibre during the day is to start your morning off with a berry and spinach smoothie (ps. don’t forget the fat and protein!).

Lifestyle and Uterine Fibroids

Because obesity plays a role in fibroid development, it may be helpful to achieve a healthy body weight. Obviously many factors (ex. hormones) affect weight, so one of the simplest ways to start to process is to focus on nutrition.

Stored fat is often transformed into estrogen which may become stored in the body and ultimately affect hormones.

Liver Support and Uterine Fibroids

Yes, I brought up the liver because it detoxes! While we know that your liver knows how to detox. It’s important to consider that it may be burdened with outside estrogens. This may be affecting how your fibroids grow, and ultimately, this might slow down its detoxing job.

Detoxification happens in 2 steps, and if you don’t have the necessary nutrients for both, your liver may not do its best work. So what’s a person to do? Instead of tossing a pre-packaged detox into your cart, make sure you’re eating a variety of protein, getting your daily dose of B vitamins, and making broccoli (and other brassica vegetables) are you friend.

Once your liver gets these toxins out, they still need to be excreted via urine or stool. A healthy gut microbiome and frequent bowel movements will ensure that estrogen is not recirculated back into your system. But if you experience constipation (ex. less than 1 bowel movement per day) or uncomfortable digestive symptoms, then you may need some digestive support.

Nutrients and Uterine Fibroids

These vary and are based on the symptoms you may be experiencing. However, one important nutrient will be iron, especially if you’re noticing excessive menstrual bleeding (losing over 90mL of blood each cycle). Having your ferritin tested, will give your ND an idea if you should be supplementing.

Other nutrient actions that may be beneficial are anti-inflammatories, immune support, and specific antioxidants.

Herbs and Uterine Fibroids

This is another category that varies based on your symptoms and goals. We may want to consider:

  • Hormonal modulators (to improve hormonal regulation)
  • Liver tonics (to support liver detox)
  • Uterine tonics (to improve uterine tone)
  • Uterine astringents (to reduce uterine bleeding)
  • Uterine stimulants (to relieve pelvic stagnation)
  • Uterine antispasmodics (to reduce pain)

Obviously this is a huge list, and I haven’t listed off any herbs – mostly because you should be taking them under the supervision of a ND or herbalist.

Acupuncture and Uterine Fibroids

It’s no secret that I love acupuncture the most out of all my tools. This can’t be done at home, and should be done in your Naturopath’s or Acupuncturist’s office.

In the case fibroids, your ND will likely focus on ensuring the smooth flow of energy and movement of blood throughout the body. A few treatments are typically needed to see results (it’s not a one and done type of treatment).

Final Thoughts

If you’re experiencing heavy bleeding, it’s important to know that fibroids may be the reason why. Moreover, they may also interfere with your fertility.

If you’re hoping to retain your fertility and address your symptoms through a natural lens, feel free to try some of the above ways or work with a Naturopathic Doctor.

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

What should women eat for fertility?

December 17, 2018
female fertility diet, toronto naturopath, naturopathic doctor toronto, fertility naturopath

It might come as a surprise that few people think about preconception health. And to be honest, when they do, it’s usually because of fertility struggles. Diet plays a huge role in how we feel and function, and provides the necessary building blocks to support conception.

Carbs and Fertility

Carbs might make up a significant part of your diet. When it comes to nutritional science, there’s a lot of learn about carbs, but I want to focus on 2 things: the glycemic index and glycemic load. 

The glycemic index is a value assigned to a particular food on how fast or slow it causes an increase in your blood glucose level.

The glycemic load combined quality and quantity of carbohydrates. It’s calculated by the amount of food you eat and the glycemic index of the particular food.The glycemic load is also associated with higher risks of ovulatory infertility.

In PCOS, it’s been found that women will often consume foods with a higher glycemic index. When women reduce their carb intake (or perhaps choose carbs with a lower index and load), their insulin sensitivity will improve, testosterone will decrease, and ovulation will occur (this is important, because anovulation is a key symptom in PCOS).

Fats and Fertility

Let’s clear something up. Fat isn’t bad. Yes, some are better than others and there are some you should avoid completely. But you need fat to make hormones, help your eggs mature and to get that tiny blastocyst to implant! 

Unsurprisingly, you should be avoiding trans fats. They increase insulin resistance, may prevent ovulation from happening, and decrease your chance of getting pregnant.

To get into specifics, omega 3 fatty acids are associated with progesterone production in the luteal phase (this is important!) and a reduced risk of anovulation. In women undergoing IVF, omega 3 fatty acid intake was associated with better embryo morphology. 

Protein and Fertility

You should be eating at least 1g of protein per kg of body weight (more if you’re active). Protein comes in different forms: animal and vegetable. One study showed that ovulation was negatively affected by increased animal protein. While another study showed that although fish, eggs, and processed meats didn’t have an effect on ovulation, vegetable protein intake decreased anovulation. Blastocyst formation in assisted reproductive technology decreased in patients consuming more red meat. But it was positively affected by fish consumption.

Now before you head on off to the local fish monger, you want to pay attention to fish and mercury content (as it may interfere with hormones and fertility). Fish to avoid would be bigeye tuna, king mackerel and swordfish.

Soy protein often gets a bad rap, but can actually be beneficial in women seeking fertility treatments. Soy isoflavone supplements were associated with improvement in reproductive outcomes, increased live birth after clomiphene administration, and higher endometrial thickness and ongoing pregnancy rates after IVF and ICSI. 

A couple things to consider before ordering your soy latte – choose organic, non-GMO soy. And if you have a thyroid condition, it’s best to avoid dietary soy altogether.

Next Steps

It might be obvious that a diet that leans towards fast food/processed foods and few fruits and vegetables is probably not the best. And when it comes to a diet in particular, adopting a Mediterranean diet (which basically has a foundation of vegetable and fruit, whole grains and fish) has shown to be effective in a few studies. 

Pesticides and other chemicals in our foods may also affect reproductive success, so if possible, choose organic when you can. Basically, if any of the fruits and vegetables that you eat appear on the Dirty Dozen, eat the organic version instead. 

When choosing meats, aim to get your meats from local farms if possible. And grass-fed and antibiotic-free are great options too. 

 If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

References

Chiu, Y., Chavarro, J. and Souter, I. (2018). Diet and female fertility: doctor, what should I eat?. Fertility and Sterility, 110(4), pp.560-569.

Endometriosis in Teens

December 10, 2018
endometriosis in teens, toronto naturopath, naturopathic doctor toronto, teen naturopath, danforth naturopath

It’s time to listen to your body. 

Especially if you’re experiencing period pain. 

You might’ve been told that period pain is normal. But that’s not exactly true. Period pain is a common symptom, but isn’t always normal.

Cramping in your lower pelvis or back is normal around the start of your period, but experiencing severe pain isn’t. If you feel a stabbing, burning, or throbbing pain that doesn’t go away with pain killers, and is causing you to miss school or work, and affecting your quality of life – you need to figure out what’s going on.

One of the emerging causes of period pain in teens is endometriosis. Endometriosis happens in about 10% of women who menstruate (likely more!). It was previously thought that teens didn’t have endometriosis because research only looked at older women who were having trouble getting pregnant.

What is endometriosis?

Endometriosis is a gynecologic disease that occurs when endometrial tissue grows outside your uterus. This tissue can grow anywhere in your body (it’s even been found on the lungs and brain), but it’s most commonly found on the ovaries, fallopian tubes, uterine surface, bowel and the lining of the pelvic cavity.

When you experience your monthly period, you also experience internal bleeding and ultimately scar tissue will form. Sounds great, right? #noway

Common endometriosis symptoms in adults

Some of the common symptoms associated with endometriosis are:

Other symptoms include:

How does endometriosis present in teens?

You might notice pain that doesn’t quite sync with your period (aka. noncyclic pelvic pain). Also, if your mom or sister have endometriosis, or if you have a history of atopic disease (ex. eczema, asthma) – you should be checked!

Endometrial lesions might be found between your ovaries, peritoneum, pouch of Douglas, uterosacral ligaments and rectovaginal septum. Typically, the lesions may present differently than they would in adults. Yours might be more red and clear. 

Because of these differences, this may contribute to your delay in diagnosis, and ultimately treatment. Obviously this lag may negatively impact your quality of life. 

Warning signs in teens

Pay attention to these signs:

  • Extended use of anti-inflammatory drugs (ex. NSAIDs)

  • Family history of endometriosis (ex. mom and sister)

  • Frequent absence from school during your period, and skipping exercise because of pain or a heavy flow

  • Birth control prescription before you turn 18 because of pain

How is endometriosis diagnosed?

You can’t diagnose endometriosis through a blood test. Instead, the gold standard of testing is a laparoscopic exam. This is considered a minimally-invasive surgery where small incisions are made in the abdomen to both confirm the presence of and remove endometrial lesions.

Doctors may suggest ultrasounds to see if you have endo, but that test can’t completely rule endo out. 

Conventional Treatment of Endometriosis

Unfortunately there’s no cure for endometriosis. But treatment should include controlling pain and preventing lesion progression. 

The first line treatment in endometriosis is birth control (usually a combined pill). This may actually be worthwhile to try if the pain is incredibly severe, and not responding to regular painkillers. Nevertheless, there are a few things to consider if you plan on taking birth control: 

A huge study in 2016 investigated different types of birth control and how they were associated with antidepressants and a diagnosis of depression. Researchers found that teens (between 15 to 19) are more sensitive to depressive symptoms and antidepressants than adults. This was seen in teens using the combined pill or progestin-only pill. The study did show that the incidence of depression and antidepressants use decreased with age. 

Teens with endometriosis report impaired physical and mental health quality of life. As well as physical pain, difficulty in participating in daily activities, physical activities, and social events. Therefore all of these factors must be considered when determining the best treatment route, or adjunctive supportive therapies. 

Naturopathic Treatment of Endometriosis

Once again there isn’t a cure for endometriosis, but you can do a couple of things to manage the pain and improve quality of life. There are some supplements that you can take, but it should really be done under the supervision of a health practitioner like a Naturopathic Doctor. 

You may want to consider:

  • FODMAPs diet or an anti-inflammatory diet

  • Curcumin

  • N-acetyl cysteine

  • EPA/DHA

  • Selenium

  • Vitamin E

Next Steps

If you’ve been experiencing any of the warning signs, it may be time to talk to your doctor about endometriosis. 

If you found this information helpful, I would encourage you to download my 
FREE EndoDiet meal guide and plan. It goes through everything we discussed: foods that are safe and that should be avoided, and a 7 day meal plan and preparation guide!

References

Dowlut-McElroy, T. and Strickland, J. (2017). Endometriosis in adolescents. Current Opinion in Obstetrics and Gynecology, 29(5), pp.306-309.

Gallagher, J., DiVasta, A., Vitonis, A., Sarda, V., Laufer, M. and Missmer, S. (2018). The Impact of Endometriosis on Quality of Life in Adolescents. Journal of Adolescent Health, 63(6), pp.766-772.

Reid, R., Steel, A., Wardle, J. and Adams, J. (2018). Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis. The Journal of Alternative and Complementary Medicine.

Zannoni, L., Forno, S., Paradisi, R. and Seracchioli, R. (2016). Endometriosis in Adolescence: Practical Rules for an Earlier Diagnosis. Pediatric Annals, 45(9), pp.e332-e335.