Uterine Fibroids: Overview and Crinum Latifolium

– A Plant that

You May Not Have Heard of

by Tori Hudson, ND

Uterine fibroids are not actually fibrous but consist of muscle, probably both smooth muscle cells and connective tissue. The growth of fibroids is thought to be stimulated by estrogen. The tendency of fibroids to arise during the reproductive years, grow during pregnancy, and regress postmenopausally implicates estrogen as one factor in their cause and growth. Fibroids often demonstrate a growth spurt in the perimenopausal years, likely because of anovulatory cycles with a relative estrogen excess that commonly occurs irregularly during this time.

Uterine fibroids occur in 20% to 25% of women by age 40 and in more than 50% of women overall, with African American women experiencing a higher incidence. Fibroids are the most common indication for major surgery in women and the most common solid tumor in women.

The cause of uterine fibroids remains poorly understood. Increases in local estradiol concentration within the fibroid itself may play a role in its cause and growth. Concentrations of estrogen receptors in fibroid tissue are higher than in the surrounding myometrium but lower than in the endometrium.

Fifty percent to 80% of fibroids do not cause symptoms. Abnormal bleeding, including menorrhagia and metrorrhagia, occurs in 30% of women with fibroids. Other symptoms are pelvic pressure, bloating, congestion, urinary frequency, backache, and pain with vaginal sexual activity. Sometimes the urinary complications may be a cause for concern because they may be due to compression of the ureter, which can then cause hydronephrosis. Fibroids are thought to be the cause of 2% to 10% of cases of infertility. Large fibroids can also interfere with a normal pregnancy by interfering with fetal growth or causing premature rupture of membranes, retained placenta, postpartum hemorrhage, abnormal labor, or an abnormal fetal lie. The incidence of miscarriage due to fibroids is estimated to be two to three times greater than that in women without fibroids.

Fibroids can undergo degenerative changes. One type of degenerative change occurs when the continued growth of the fibroid outpaces the blood supply. A more common type of degenerative change involves a loss of cellular detail as a result of a decrease in the tumor’s vascularity. Necrosis leads to cystic degeneration. Calcification can occur over time and is usually seen in postmenopausal women.

Unfortunately, there is no nice body of published research on the natural-medicine treatment of fibroids. In fact, it is downright bleak. Until the very recently published studies on green tea extract and the Vietnamese herb Crinum latifolium (see below), no specific food or dietary regimen, no herbal or nutrient protocol, no hands-on treatments can give us any real reassurance about our ability to bring about success in actually shrinking uterine fibroids, or even offering data on symptom management. Natural-medicine resource books, old and new, and occasional case reports are full of creative ideas, theoretical propositions, and anecdotal reports; but as of yet, this remains an area in which symptom management, “wait and watch,” or conventional treatment options must be considered. What natural medicine can often accomplish, as can conventional medicine, is to decrease and control bleeding, increase pelvic/abdominal comfort, and buy time until menopause, when most, but not all, uterine fibroids tend to reduce in size. Traditional and historical naturopathic approaches to uterine fibroids have included castor oil packs over the liver, low-fat/low-saturated-fat/high-fiber diets, alterative herbs (Corydalis tubers, black alder bark, mayapple root, figwort flowering herb, yellow dock root); Turska’s formula (gelsemium root, pokeroot, aconite, and bryonia – consult a botanical expert, as these are toxic herbs); and thuja, red root, mountain ash bark, prickly ash bark, Stillingia root, Helonias root, mayapple root, and ginger root. Some plants are specific to decreasing acute bleeding from fibroids and include liferoot, yarrow, periwinkle, ginger, and shepherd’s purse. Select nutrients are also based on theoretical thinking rather than scientific research and include supplements such as inositol and choline that exert a “lipotropic” effect, meaning that they promote the removal of fat from the liver. Lipotropic supplements are usually designed to support the liver’s function in removing fat, detoxifying the body’s wastes, detoxifying external harmful substances (pesticides, fossil fuels, etc.), and metabolizing and excreting estrogens.

The important clinical guides to when conventional intervention should be considered ranges from purely cosmetic (enlarged protruding pelvic/abdominal area), to discomfort (bloating, constipation, flatulence, pain with deep intercourse, urinary incontinence), to excess blood loss causing serious and poorly manageable anemia (even dangerous amounts of blood loss can occur), and to kidney enlargement and dysfunction due to obstruction of the ureters. Several surgical options exist these days, from uterine sparing to different techniques of performing a hysterectomy, some friendlier with shorter recovery times than others. Some fibroids also lend themselves to uterine embolization or hysteroscopic resection of the fibroids. These options can be discussed with a gynecologist who has broad experience with all of these methods and can remain open to all considerations and options.

Two Herbs with Hope for Symptom Management and Tumor Shrinkage

Crinum Latifolium

Crinum latifolium has been a part of Vietnamese history and folklore for generations. Numerous benefits of C. latifolium have been reported over the years but none had been clinically studied until recently. Of the 12 varieties of C. latifolium, one specific variety, “Crila” (C. latifolium L. var. crilae Tram & Khanh, named after the leading researcher), has been studied in women with uterine fibroids. A 3-month study of 195 women with uterine fibroid tumors was conducted in three hospitals in Vietnam in 2007. The C. latifolium decreased the size or stopped the growth of the fibroid tumors in 79.5% of the women. In 20.5%, tumor growth continued at a very slow rate. Whereas a heavy menstrual flow was reported by 36% of the women before taking Crila, this had decreased to only 1% after treatment. Side effects reported were slight, including nausea, headache, vaginal dryness, and hot flashes, but these decreased over time.

Tram NTN. To evaluate the effect and possibility of accepting of CRILA in uterus fibroid tumor treatment. Vietnam National Institute of Gerontology Hospital. 2007. http://www.crilahealth.com/wp-content/uploads/2011/03/Uterus-Fibroid-Tumor-research-10-09.pdf.

Green Tea Extract

This double-blinded, placebo-controlled, randomized clinical trial evaluated the efficacy and safety of green tea extract on uterine fibroid burden and quality of life in reproductive-aged women with symptomatic uterine fibroids.

A total of 39 women ages 18 to 50 years old with symptomatic uterine fibroids were recruited. Eligible women included those with a follicle-stimulating hormone (FSH) less than 10 mIU/L, at least moderately severe uterine fibroid related symptoms with a score of ≥25 on the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire subscale (UFS-QOL). All the women had at least one fibroid measuring 2 cm or larger based on transvaginal and/or transabdominal ultrasound and a total uterine volume of ≥160 mL by vaginal and abdominal ultrasound.

Twenty-two were randomized to receive green tea extract and 17 to receive placebo.

Study subjects were randomized to oral green tea extract (45% epigallocatechin gallate; EGCG) or placebo of brown daily for 4 months. Each green tea capsule contained 95% polyphenols and 45% EGCG. Women received 2 capsules daily of either green tea or placebo.

Uterine fibroid volumes were measured at beginning and end of the study. The fibroid-specific symptom severity and quality of life questionnaires were scored at each monthly visit.

The mean change in both the volume and number of uterine fibroids was assessed by transvaginal ultrasound (TVU) and/or transabdominal ultrasound at baseline and at the end of the 4-month treatment period.

The secondary measure at each visit was the mean change in the UFS-QOL and the health-related quality of life (HRQL) questionnaire. Blood loss was also assessed monthly with a menstrual log and visual assessment of quantity.

Of the 39 women, 33 were compliant and completed the 5-visit study over the 4-month period. Of the final 11 women who completed the placebo group, fibroid volume increased by 24.3% over the study period. Of the final 22 women in the green tea extract group, a significant uterine fibroid total volume reduction of 32.6% was observed. The green tea extract group also had a significant reduction in fibroid specific symptom severity of 32.4% and a significant improvement in HRQL of 18.53% compared to the placebo group. Anemia improved significantly by 0.7 g/dL in the green tea group and the average blood loss significantly decreased from 71 mL/month to 45 mL/month. There were no adverse effects or endometrial hyperplasia or pathology in either group.

Comment

: Green tea, especially its EGCG constituent, has anti-inflammatory, antiproliferative, and antioxidant effects. The study’s authors attributed the reduction in fibroid size from EGCG due to an inhibitory effect on leiomyoma tumor cell proliferation and apotosis induction.

More than half of US women ages 35 to 49 are affected by uterine fibroids. These benign growths can cause acute and chronic pelvic pain, excessive uterine bleeding, dyspareunia, iron deficiency anemia, miscarriage, infertility, constipation and/or irregular bowel habits, and urinary incontinence. The impact of these complications on a woman’s health can be significant, and currently there is no effective long-term medical treatment for these fibroids. Short-term conventional management options include gonadotropin-releasing hormone analogues but are only approved for short-term preoperative adjuvant use due to their risk of significant and irreversible bone loss, osteoporosis, and other major side effects. Progestogen or hormonal contraceptive management is sometimes helpful to control bleeding. If symptoms affect quality of life significantly, or fibroid removal could improve miscarriage and/or fertility, or there is medical urgency due to bleeding, then management options range include hysteroscopic resection of submucosal fibroids, hysterectomy, myomectomy, uterine artery embolization, or image-guided focused ultrasound thermal therapy. Milder cases usually involve just observation, especially in asymptomatic fibroids, or the patient putting up with her symptoms.

This study, of a simple and safe botanical option such as green tea extract, is a welcomed noninvasive intervention for treatment and/or prevention of uterine fibroids and could be a game changer for many women suffering from uterine fibroids.

Roshdy E, Rajaratnam V, Maitra S, et al. Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study. Int J Womens Health. 2013;5:477–486.

Dr. Tori Hudson graduated from the National College of Naturopathic Medicine (NCNM) in 1984 and has served the college in many capacities over the last 28 years. She is currently a clinical professor at NCNM and Bastyr University; has been in practice for over 28 years; and is the medical director of the clinic A Woman’s Time in Portland, Oregon, and director of research and development for Vitanica, a supplement company for women. She is also a nationally recognized author, speaker, educator, researcher, and clinician.