Uterine fibroids are the most common benign tumor in the uterus. Most do not cause any symptoms and don’t require any investigation or treatment. But, for some women, maybe about a third, women with uterine fibroids, also called uterine myomas may need a therapy—either to control abnormal uterine bleeding, reduce the size due to pressure and effects on bladder and/or digestive function, interference with fertility, or just plain aesthetics and discomfort due to size and abdominal distention. Conventional treatment options included medications to control bleeding or shrink the fibroids temporarily or surgical options. All of this depends on the scope and severity of the symptoms, the size, number and desire for pregnancy. Minimally invasive surgical procedures are possible for some but not all fibroids. Others might require a hysterectomy- either abdominally or vaginally.
Women often seek alternative or integrative medicine options to see if non-surgical or non pharmaceutical treatments may help. The research is sparse, and the success is hit and miss. The most likely help we can offer is to help control abnormal bleeding. The least likely help we can offer is actually reducing the size of fibroids, especially larger ones. However, a small amount of research has emerged, including in the area of green tea. In the current study, vitamin D and epigallocatechin gallate (EGCG) offers some hope with women who had symptomatic fibroids.
Women were included in the study if they were 18 or older, premenopausal and had at least one myoma > 2 cm (either intramural or subserosal and/or submucosal fibroids), as detected on a vaginal and abdominal ultrasound, with moderately severe myoma related symptoms and required no other treatment.
This pilot study enrolled 30 women with myomas, who were divided into two groups. One group (n=15) received one tablet of 1,000 IU (25 mcg) vitamin D plus 150 mg EGCG + 5 mg vitamin B6, twice daily for 4 months. The second group (n=15) received no treatment for 4 months.1 The primary outcome was the change in volume of myomas as detected by transvaginal and/or transabdominal ultrasound. The secondary outcomes were variation of the number of myomas, heavier menstrual bleeding, pelvic pressure, fatigue, quality of life and the severity of any of these symptoms.
None of the women dropped out of the study in either group and there were no discernable side effects of the treatment. The total number of myomas in the treated and control group was 23 and 21, respectively. In the treated group, the incidence of intramural myomas was 43.7%, subserosal 12.5% and submucosal 43.75%. In the control group it was 47.4% intramural, 10.5% subserosal and 42.1% submucosal.
A significant reduction in the volume of myomas in the treated group was 10.84 cm at baseline to 8.04 cm after 4 months. The reduction of the volume of myomas was unrelated to the type of myomas. In the control group, the volume was 10.17 at baseline to 10.94 after 4 months of treatment. This translates to a 34.7% reduction in the volume of myomas in the treatment group and an increase of 6.9% in the control or untreated group. The number of myomas did not change in either group.
While the specifics were vaguely reported, there was an improvement in quality of life and reduction in severity of symptoms in the treatment group.
Commentary: Uterine myomas, aka uterine leiomyomas, aka uterine fibroids are monoclonal tumors of the smooth muscle cells of the myometrium. Myomas consist of an accumulation of collagen, fibronectin and/or proteoglycan that can form in or on the uterus. Where they form determines the classification of intramural, subserosal or submucosal. A woman can have any combination of these or just one kind. They are most common between the ages of 35 and 50 and may vary by ethnic groups with African American women having 3-4 times higher risk of developing myomas as compared with Caucasian American women. Uterine fibroids are the leading cause of hysterectomies in the US accounting for about 39% of all hysterectomies. Clearly, we are not doing enough to understand the cause and offer successful treatments.
The exact cause of myomas is still unknown but their development and growth is at least in part affected by estrogen and progesterone. But also, we must consider the roles and influence of the hormone receptors and that the dysfunction is at the receptor rather than any particular rise or fall of the hormones. It is a mistake to think that fibroids are only under the influence of estrogen. For some women, it’s progesterone that can actually adversely affect growth of myomas. It’s a much longer discussion, and discussion and theories are the name of the game rather than true knowns. But we might consider growth factors, cortisol dysregulation, dysfunctions in hormone metabolizing enzymes, environmental endocrine disruptors, body fat and obesogens… and more. And speaking of more, a robust research effort would be welcomed to explore these theories, questions and attempts at solutions.
Back to vitamin D and EGCG. There is at least one study showing an association between hypovitaminosis D and a higher prevalence of uterine fibroids, along with more severity related to the fibroids.2 Mild symptomatic fibroids may be able to improve once an outright vitamin D deficiency (< 30 ng/mL) is corrected.3 In one previous green tea study, EGCG for 4 months reduced the myoma size in premenopausal women.2
The current study, along with support of the small amount of previous data on vitamin D and EGCG supports the possibility that a simple and safe approach could at least offer something more than wait and watch, and possibly for some, may spare them a surgery and improve their myoma symptoms and quality of life. In addition, we could consider an integrative plan, offering the herbal/nutraceutical treatment along with other pharmacological therapies that are being used to control heavy bleeding. A uterus is worth saving, if possible, and avoiding any surgery if possible, is wise and worth an effort. If surgery is necessary, a good surgeon with a broad understanding of pelvic floor support and implications for menopause, is an important part of an integrative treatment team.
References:
- Porcaro G, et al. Vitamin D plus epigallocatechin gallate: a novel promising approach for uterine myomas. European Review for Medical and Pharmacological Sciences 2020; 24: 3344-3351.
- Sabry M, et al. Serum vitamin D3 level inversely correlates with uterine fibroid volume in different ethnic groups: a cross-sectional observational study. Int J Womens Health. 2013; 5: 93-100.
- Ciavattini A, et al. Hypovitaminosis D and “small burden” uterine fibroids: Opportunity for a vitamin D supplementation. Medicine (Baltimore). 2016 Dec; 95(52): e5698.
