Uterine Fibroids, Endometriosis, and Thyroid Health
Published June 25 2016
Uterine fibroids and endometriosis are two common conditions found in women with thyroid and autoimmune thyroid conditions. Both of these conditions appear to be caused by imbalances of estrogen metabolism, although inflammation is also a big factor. In this article I’ll talk about these factors, along with how uterine fibroids and endometriosis relate to thyroid health. I’ll then wrap things up by discussing how to address these conditions naturally.
Uterine fibroids are the most common benign uterine tumor, with an estimated incidence of 20%–40% in women during their reproductive years (1) (2). Although they frequently don’t cause any symptoms, in some women they will cause uterine bleeding, a feeling of pelvic pressure, urinary incontinence or retention, or pain (1). The main reason why fibroids are considered to be due to estrogen metabolism issues is because they rarely appear before the onset of puberty, and they usually resolve after menopause, although this isn’t always the case.
Endometriosis is defined as the presence of endometrial-type mucosa outside of the uterine cavity, and they are also considered to be estrogen-dependent since this condition usually appears during the reproductive years (3), although they occasionally form during postmenopause. These endometriotic lesions usually cause pelvic pain and infertility.
The Problem With Elevated Estrogen Levels
Just to be clear, estrogen is a hormone, and all hormones are important to our health. However, too much or too little of these hormones leads to problems, and this definitely is the case with estrogen. While having an estrogen deficiency can lead to uncomfortable symptoms such as hot flashes and vaginal dryness, and more severe problems such as osteoporosis, too much estrogen can be problematic. With regards to uterine fibroids and endometriosis, it appears that excessive estrogen can stimulate the growth of these (4) (5). And these conditions are typically associated with an increase in aromatase activity. Aromatase is an enzyme that converts testosterone into estrogen, specifically estradiol, and so having increased aromatase activity leads to higher amounts of estrogen. So essentially a vicious cycle develops.
But why do women develop high estrogen levels in the first place? Well, there are three main reasons:
1) Increased aromatase activity. As I just mentioned, aromatase is the enzyme that converts testosterone into estradiol, and so increased activity will lead to higher estrogen levels. One of the main causes of increased aromatase is being overweight, although there can be other factors as well.
2) Exposure to xenoestrogens. Unfortunately, xenostrogens are everywhere, as they are used in pesticides and herbicides, many cosmetics and household cleaners, and of course most people are aware that plastic bottles commonly contain Bisphenol A (BPA), which is a xenoestrogen. Even BPA-free plastic bottles have xenostrogens, such as bisphenol S (BPS) and bisphenol F (BPF).
3) Bioidentical hormone use. I’m not suggesting that every woman who takes bioidentical estrogen will have problems, but it is common for women who take bioidentical estrogen to have elevated levels of estradiol. So while I realize that in some cases taking bioidentical estrogen may be necessary, most women don’t need to take bioidentical estrogen, and when a medical doctor prescribes bioidentical estrogen they do need to be careful with the dosing, and it also is a good idea to monitor the estradiol levels.
The Role of Inflammation in Uterine Fibroids and Endometriosis
In addition to problems with estrogen metabolism, inflammation is a factor with both uterine fibroids and endometriosis. With regards to uterine fibroids, many cytokines, including tumor necrosis factor alpha (TNF-α) and interleukin 6, play a role in the development of uterine fibroids (6). Another study confirmed the presence of inflammatory cells in uterine fibroids (7). Another study mentioned how dysregulation of inflammatory processes are thought to be involved in the initiation of fibroids, and the authors of the study discussed how dietary phytochemicals can be used to target inflammation, fibrosis, proliferation, and angiogenesis (8). Cyclooxygenase-2 (COX-2) is an inflammatory marker, and one study showed that COX-2 expression in uterine fibroids was significantly higher than in healthy uterine smooth muscles (9). Yet another study showed that a Th1/Th2 cytokine genetic defect can increase the risk of developing uterine fibroids (10).
It also appears that chronic inflammation plays a role in the pathogenesis of endometriosis. One study demonstrated that women with endometriosis have elevated levels of key proinflammatory cytokines, including IL-1β, IL-6, and TNF-α (11). Another study suggested that menstruating tissue might be the trigger for inflammatory pain in endometriosis through the activation of innate immune cells and peripheral nerve endings (12). Another study showed that dual suppression of estrogen and inflammation can help to restrain endometriosis (13). A few studies suggest that something called mitogen-activated protein kinase (MAPK) signaling pathways should be a target for endometriosis treatment (14) (15).
Do Genetics Play A Role In The Development Of Fibroids and Endometriosis?
There is some evidence that genetics can be a factor in the development of both uterine fibroids and endometriosis (16) (17) (18). However, keep in mind that genetics is also a factor with conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, yet not everyone who has a genetic predisposition will develop these conditions. And the same is true with uterine fibroids and endometriosis, as even if someone has a genetic predisposition, lifestyle and environment seem to be greater factors. `
In fact, numerous studies have discussed how epigenetics play a role in the development of both endometriosis and uterine fibroids (19) (20) (21) (22). This essential means that certain environmental factors will affect gene expression, which in turn can increase the risk of developing these conditions. Certain enzymes such as catechol-O-methyltransferase (COMT) play a role in the degradation of estrogens, and so it would make sense that a genetic polymorphism of COMT might increase the risk of developing uterine fibroids and endometriosis, although the research in this area seems to suggest that this might not be the case (23) (24) (25). More research is probably needed in this area.
How Do These Conditions Relate To Thyroid Health?
There are a few different ways in which uterine fibroids and endometriosis relate to thyroid health. As you now know, two big factors which are responsible for the development of uterine fibroids and endometriosis are inflammation and problems with estrogen metabolism. Proinflammatory cytokines are present in both of these conditions, and they are also a factor in the autoimmune thyroid conditions Graves’ Disease and Hashimoto’s Thyroiditis. In fact, inflammation is an issue with most, if not all chronic health conditions, and so getting rid of the inflammation is a key factor.
In addition, estrogen might play an important role in thyroid nodule formation (26). As a result, correcting estrogen dominance not only can play a big role in helping people with uterine fibroids and endometriosis, but it also can help with thyroid nodules. This is especially true if someone has a thyroid nodule that is growing in size, as this is almost always due to estrogen metabolism problems.
The Conventional Treatment Approach For Uterine Fibroids
After uterine fibroids have been diagnosed, the conventional treatment approach depends on the person, as well as the treating doctor. For example, if a woman has a small uterine fibroid that is resulting in little or no symptoms then they might choose not to undergo any treatment. Sometimes oral contraceptives or a hormone IUD might be recommended to reduce the blood loss that comes with uterine fibroids (27). Since estrogen is a factor, aromatase inhibitors might be used in some cases (27). However, surgery is commonly recommended for larger uterine fibroids. And while a hysterectomy might be necessary in some cases, this should be a last resort, as there is no question that too many hysterectomies are performed these days (27).
For those women who have very large fibroids and are considering surgery, uterine fibroid embolization might be an option to consider. In fact, numerous studies show that uterine fibroid embolization is a safe and effective nonsurgical alternative to hysterectomies (28) (29) (30). Of course even if someone chooses to receive this procedure it is a good idea to address the cause of the problem (i.e. estrogen metabolism issues, inflammation, etc.).
The Conventional Treatment Approach For Endometriosis
Laparoscopy is the standard method to visually identify endometriotic lesions under magnification within and outside the minor pelvis (31). This involves using something called a laparoscope through a small incision. Laparoscopic ablation is commonly used to remove the endometrial lesions, although other techniques might be used.
How Can Natural Treatment Methods Help With Uterine Fibroids and Endometriosis?
By reading this information you should know that the two primary ways to improve the health of those with uterine fibroids and endometriosis involve doing things to improve estrogen metabolism and reduce inflammation. If someone has healthy estrogen levels and doesn’t have chronic inflammation then they usually won’t have fibroids and/or endometriosis. So let’s go ahead and discuss how to improve estrogen metabolism and reduce inflammation.
1) Detect and remove the inflammatory trigger. This perhaps is the biggest challenge when it comes to eliminating the inflammation. While I’ll be discussing a few other things below that can help with inflammation, the most important factor is to try to find out what is triggering the inflammation, and then of course remove this trigger. Some of the common factors which cause inflammation include food allergens, infections, environmental toxins, and trauma. It’s also important to understand that while healthy levels of estrogen can have a positive effect on the immune system, high levels of estrogen can have a proinflammatory effect (32).
2) Eat an anti-inflammatory diet. Eating a healthy diet consisting of whole foods, while avoiding refined foods and sugars will greatly help to reduce inflammation. Even if a food allergen such as gluten or dairy isn’t the primary factor responsible for the inflammation, if you eat a lot of refined foods, sugars, and fast food, then you can be pretty certain that this is resulting in inflammation. In addition, you want to try eating as many organic foods as possible, as this will help you to minimize your exposure to endocrine-disrupting pesticides. And of course try not to drink regularly out of plastic water bottles, as the xenoestrogens from the plastic can also be a factor. In fact, there is some evidence that BPA and phthalates can promote the growth of uterine fibroids and endometriosis (33) (34).
3) Take nutrients and herbs that help to reduce inflammation. In addition to eating healthy foods, you can supplement with certain nutrients and herbs to help reduce inflammation. These include fish oils, vitamin D, turmeric, resveratrol, and ginger.
4) Decrease insulin resistance and obesity. Because insulin resistance and obesity are associated with high estrogen levels, it makes sense that improving insulin resistance and decreasing body fat can greatly help with the reduction of estrogens. For more information on insulin resistance I would read a blog post I wrote entitled “Insulin Resistance, Hypoglycemia, and Thyroid Health“.
5) Improve Glururonidation and Decrease Beta-Glucuronidase. Having healthy detoxification pathways is important with regards to getting rid of excess amounts of estrogen. I’ve spoken a lot about glutathione in the past, and while you want to do everything you can to increase glutathione levels, you also want to support a process called glucuronidation. Glucuronidation plays an important role in phase 2 detoxification, as it is involved in the metabolism of many substances, including drugs, bilirubin, androgens, and estrogens.
Beta-glucuronidase is an enzyme that plays a role in the enterohepatic recirculation of toxins, steroid hormones, drugs, and carcinogens. So under normal circumstances the process of glucuronidation should result in the excretion of estrogens and other substances from the body, but high levels of beta-glucuronidase can interfere with this process. Some inhibitors of beta-glucuronidase include calcium D-glucarate, silymarin, licorice, and lactic acid probiotics.
6) Downregulate aromatase activity. Aromatase is the enzyme that converts testosterone into estradiol, and if this enzyme is upregulated then you want to do everything you can to decrease the activity of this enzyme.
In summary, many women with thyroid and autoimmune thyroid conditions have uterine fibroids and endometriosis. These are both usually found in premenopausal women, and problems with estrogen metabolism is a big factor, although inflammation also plays a role in their development. And since chronic inflammation is a factor in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, people with thyroid autoimmunity are more likely to develop uterine fibroids and/or endometriosis. As for how to treat uterine fibroids and endometriosis naturally, it can be challenging at times, but the goal is to address any estrogen metabolism issues, and to also do things to reduce inflammation.