Fibroids are benign tumors originating from uterine smooth muscle cells (myometrium). They are a prevalent women's health concern, responsible for high hysterectomy rates and annual health care costs. While the exact pathophysiology behind fibroid development is unclear, certain risk factors and associations have been identified. Functional medicine labs provide important and relevant information regarding these factors, making them invaluable tools in effectively managing fibroids.

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What Are Uterine Fibroids?

Uterine fibroids, or leiomyomas, are benign tumors composed of smooth muscle cells and fibrous connective tissue that grow inside or outside the uterus. They are the most common type of reproductive tract tumor, affecting up to 80% of women at some point during their lives. 

There are three distinct types of fibroids, classified by their location. Submucosal fibroids grow inside the uterine cavity. Intramural fibroids grow inside the uterus's muscular wall. Subserosal fibroids grow and project from the outside of the uterus. (2, 4) 

Fibroids can be further classified as being pedunculated or not. Pedunculated fibroids are the least common type of fibroid and can grow inside or outside the uterus. They have a distinct look, resembling a mushroom because they are connected to the uterus by a thin stem. (2, 4)

Fibroids grow at different rates and can occur as a single tumor or in clusters. They can range in size from as small as a seed (1 mm) to as large as a watermelon (20 cm). (2, 16)

What Causes Uterine Fibroids?  

Fibroids are thought to be caused by a combination of genetic, hormonal, and environmental factors. Certain factors increase the risk of developing fibroids, including age between 30-40 years, maternal family history of fibroids, African-American ethnicity, and obesity. (16) 

Because fibroids express increased estrogen and progesterone receptors, imbalances in either or both hormones can contribute to their development and growth (4). Chronic stress, inflammation, inadequate nutrition, and exposure to environmental toxins (endocrine-disrupting chemicals) can all contribute to hormonal imbalances (1). The risk of fibroids decreases, and fibroids tend to shrink after menopause when estrogen and progesterone levels naturally diminish because the uterine cells no longer receive hormonal stimulation.

Vitamin D deficiency promotes DNA damage and genetic mutations, which may activate pathways involved in cell proliferation and remodeling of the extracellular matrix, ultimately leading to fibroid growth.

Evidence suggests a potential association between insulin resistance, metabolic syndrome, and the development or growth of uterine fibroids. Insulin resistance is a condition in which the body's cells do not respond effectively to the hormone insulin, which can lead to higher insulin levels in the blood. Insulin resistance can lead to an overproduction of insulin and other hormones, such as insulin-like growth factor-1 (IGF-1). Both insulin and IGF-1 are known to have growth-promoting effects on various tissues, including the uterus. Insulin resistance is often associated with chronic low-grade inflammation and obesity. Inflammation can stimulate the production of growth factors and cytokines that may play a role in the growth and proliferation of fibroid tissue, and excess body fat can lead to changes in hormone production and metabolism, influencing fibroid development (9, 12).

Uterine Fibroid Symptoms

Many women with fibroids will experience no symptoms and are only aware they have fibroids after they are found incidentally on routine pelvic exams. Large or numerous fibroids, however, hold the potential to cause the following symptoms:

• Heavy or prolonged menstrual bleeding (menorrhagia)
• Bleeding between periods
• Pelvic pain and pressure
• Low back or leg pain
• Frequent urination and difficulty emptying the bladder
• Constipation
• Pain during sexual intercourse
• Infertility

What Are the Benefits of Regular Lab Testing for Patients Who Suffer From Uterine Fibroids?

Regular lab testing for patients suffering from uterine fibroids can provide valuable information to the patient and their healthcare provider. While lab tests may not directly diagnose uterine fibroids, they can help monitor the patient's overall health, assess the impact of fibroids on various systems, and guide treatment decisions. Hysterectomy, surgical removal of the uterus, is the most common gynecological procedure, with one study reporting that 35% of hysterectomies are performed to manage fibroids. Holistically evaluating patients with fibroids with the help of functional medicine tests can identify underlying imbalances contributing to fibroid growth and guide targeted integrative treatment plans. This could increase the fibroid-shrinking capacity of less invasive treatment interventions, improving patient outcomes and preventing the need for surgical intervention. 

Top Labs to Run Bi-Annually on Patients With Uterine Fibroids

The following labs can be ordered bi-annually to help effectively manage fibroids. 

Comprehensive Hormone Panel

Because hormone imbalances play a significant role in fibroid development, assessing estrogen, progesterone, and testosterone levels is a critical first step in evaluating and monitoring patients with fibroids. Using a combination of serum and urine tests can help accurately assess systemic hormone levels and evaluate the essential pathways involved in hormone metabolism and elimination. 

Thyroid hormones play a crucial role in regulating metabolism and hormone balance. Some symptoms of uterine fibroids, such as irregular menstrual cycles, can overlap with thyroid disorders. Thyroid function tests, including TSH, free T4, and free T3, can help identify thyroid dysfunction and guide treatment if necessary.

Anemia Panel

Uterine fibroids can sometime cause heavy menstrual bleeding, leading to iron deficiency anemia. Regular monitoring for anemia and iron deficiency with a CBC (including red blood cell count, hemoglobin, and hematocrit) and an iron panel can aid in the early detection of iron deficiency and anemia.

Comprehensive Stool Analysis

Poor gut health is associated with systemic inflammation, nutrient deficiencies related to poor digestion and absorption, hormonal imbalances, and metabolic diseases. A comprehensive stool test evaluates various markers of overall gut function and the microbiome, detecting gastrointestinal inflammation, malabsorption, and a dysbiotic estrobolome that can fuel fibroid growth. 

Cardiometabolic Assessment

Because fibroids can be associated with metabolic syndrome and insulin resistance, a comprehensive metabolic assessment, including a CMP, lipid panel, diabetes panel, and hs-CRP, helps provide insight into the patient's cardiovascular health, dysglycemic patterns, and systemic inflammation levels.

Vitamin D

Measuring serum vitamin D can rule out vitamin D deficiency and ensure the patient has levels within an optimal range to support critical body functions.

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Summary

Regular lab testing offers a multifaceted approach to optimizing the care and management of women with fibroids. These tests provide invaluable insights into various aspects of a patient's health, aiding in the early detection of health complications and underlying factors associated with fibroid development and growth. Healthcare providers can tailor treatment plans by monitoring key biomarkers more precisely, ensuring the most effective interventions to alleviate symptoms and enhance overall well-being.