Fibroids & Adenomyosis

Think of these as uniquely troublesome tenants in the uterus—each with its quirks:

Fibroids (Uterine Leiomyomas):

• Solid, non-cancerous tumours made of muscle and fibrous tissue, found in or on the uterine wall. They can vary from the size of a seed to a melon, and their location (inside the cavity, within the wall, or bulging outward) shapes symptoms: heavy bleeding, bulk pressure, and pelvic pain. Fibroids are notorious for crowding the space and sometimes pushing on neighbours (bladder, bowel) too.

Adenomyosis:

• Here, endometrial tissue (the cells that normally line your uterus) invades into the muscular wall, turning the uterus itself boggy, enlarged, and more tender. Think of it as an overzealous DIY home reno—walls thicken, become inflamed, and the uterus as a whole gets heavier periods and more cramps, but without distinct "lumps" like fibroids.

Endometrial Polyps:

• Small, soft, and often fragile overgrowths on the endometrial (uterine) lining. Polyps are usually less dramatic but can cause unpredictable or prolonged light bleeding between periods. Some are single, some are multiple, almost like the potholes of the uterine lining.

Other benign growths:

• Rarely, the uterus can harbour other non-cancerous lesions, such as cysts or adenofibromas, but fibroids, adenomyosis, and polyps are the three main players.

Each condition disrupts menstrual peace—but fibroids create visible masses in the muscle, adenomyosis thickens and softens the wall itself, and polyps are more like little projections from the lining. Your symptoms and best treatment often depend on which “tenant” has taken up residence and how much remodelling they’re trying to do!

Not exactly: About 70% of women will develop fibroids by age 50 (Canadian prevalence is 20–40% for symptomatic cases). Risk factors include genetics, age, and estrogen exposure. Regular exercise and a Mediterranean-style diet may lower risk by ~20% according to observational studies.

Absolutely! Evidence-based options include:

• Tranexamic acid: Non-hormonal and proven to reduce menstrual blood loss by 40–60%.

• Levonorgestrel IUD: Decreases bleeding up to 80–90%, making it one of the most effective choices for ongoing management.

• Uterine artery embolization: Effective for fibroid-related bleeding—shrinks fibroid size and decreases symptoms by up to 70%.

For severe ongoing bleeding, keeping up with iron loss through diet and oral supplements can be very difficult. Studies show that up to 60% of women with heavy periods develop iron deficiency, and more than 1 in 5 will have iron-deficiency anemia—often requiring intravenous iron infusions for rapid and reliable correction.

Naturopathic adjuncts such as anti-inflammatory nutrition and acupuncture show moderate improvements in flow and pain, but typically aren’t strong enough on their own for severe bleeding.

Bottom line: Heavy monthly bleeding is tough on iron stores—measuring and treating with iron infusions can restore levels and energy far more effectively than food or pills alone, especially if labs show anemia or severe depletion.

Fibroids and adenomyosis can both cause heavy bleeding, pelvic pain, and bulk-related symptoms. Diagnosis typically starts with a detailed history and pelvic exam, followed by imaging:

• Ultrasound is the first-line tool to visualize fibroids and assess uterine size/structure.

• MRI may be used for complex cases or when adenomyosis is suspected but not confirmed by ultrasound.

• Blood tests may check for anemia due to heavy bleeding.

Treatment depends on severity and your goals (relief, fertility, symptom control):

• First-line medical options:

  • Tranexamic acid: Non-hormonal, reduces menstrual bleeding.

  • Levonorgestrel IUD: Often recommended, reduces flow (80–90%), relieves pain for both conditions.

  • Oral contraceptives, progestins, or GnRH agonists: May help control bleeding and shrink fibroids temporarily.

  • NSAIDs: Reduce pain and cramping.

• Procedural and surgical options:

  • Uterine artery embolization (UAE): Targets fibroids; shrinks them and reduces bleeding/pain (typically 70% symptom reduction, per RCTs and guidelines).

  • Endometrial ablation: For selected women (no future fertility desired), may reduce bleeding.

  • Surgical therapies: Myomectomy (removal of fibroids, fertility-sparing) or hysterectomy (removal of uterus; definitive solution).

• Adenomyosis management:

  • Hormonal IUD, oral progestins, and sometimes GnRH agonists provide symptom relief.

  • Hysterectomy is considered for severe or refractory cases.

Naturopathic supports such as anti-inflammatory diets, acupuncture, and magnesium can be adjuncts to improve pain or mild symptoms, but are not substitutes for medical therapy in moderate-severe cases.

Monitoring:
Regular follow-up and repeat imaging are often needed to track symptom control and uterine changes. Iron tests are standard if bleeding is heavy, as iron deficiency is common.

There’s genuine synergy to be found—no turf wars here!

Iron-Rich Diets & Vitamin C: 

• In heavy bleeders, dietary iron (lentils, leafy greens, grass-fed meats) is key. Vitamin C (from peppers, berries, citrus) enhances absorption of plant-based (non-heme) iron in the gut. However, a major RCT found that while vitamin C helps absorption, oral iron alone is as effective for raising hemoglobin as iron with vitamin C.
• Evidence (and Gravity Health) now favours IV iron infusions, which restore ferritin/hemoglobin levels 3–4 times faster and with fewer GI side effects than oral, particularly in those with ongoing blood loss. 

Ginger: 

• Multiple randomized controlled trials and meta-analyses show that 750–2000 mg of ginger powder daily (taken in early menses) is as effective as NSAIDs for treating moderate-to-severe menstrual pain, including pain from fibroids and adenomyosis. Ginger can reduce pain intensity by up to 2 points more than placebo on a 10-point scale.

Green Tea Extract (EGCG):

• A well-conducted RCT (using 800mg/day) found green tea extract (epigallocatechin gallate) reduced total fibroid volume by ~33% over 4 months, reduced bleeding by 37%, and raised hemoglobin by 0.7 g/dL versus placebo, with improved quality of life and no significant side effects. Another ongoing phase III trial uses 1650mg/day as an adjunct to fertility treatment.

Evidence-based naturopathic therapies, including nutrition and selected herbs, can reduce symptoms and improve well-being when used alongside mainstream medications—especially for pain, anemia, and quality of life. Key is transparency: always share your supplement list with your care team to avoid hidden interactions, optimize benefit, and keep every treatment—natural or conventional—singing from the same songbook.

• Ulipristal acetate (selective progesterone receptor modulator): can shrink fibroids ~25–35% and reduce bleeding, but long-term safety monitoring is required.
• GnRH antagonists and agonists: potent volume/bleeding reduction, but risk of bone loss with prolonged use (add-back estrogen often needed).
• Iron infusions: Directly correct severe anemia from chronic heavy bleeding. 
  • Studies show IV iron repletes stores 3–4 times faster than oral, is better tolerated, and helps optimize energy/prep for surgery if needed.

Monitoring progress is a key part of safely and effectively managing these conditions. Here’s how we keep track—so you know what’s working and can catch issues early:

Symptom & Flow Tracking:

• Period-tracking apps or a simple calendar help record bleeding patterns, pain, and changes in period heaviness. These tools allow both you and your provider to see trends, measure improvement, and alert you early if things worsen. 

Lab Tests:

• Bloodwork—including ferritin and a complete blood count (CBC)—checks your iron levels and screens for anemia, which is common after months of heavy bleeding. Low ferritin means low iron stores, even before you’re anemic. If your values drop, treatments (like iron infusions) can be tailored quickly to boost your energy and prevent complications.

Imaging:

• Ultrasound is the gold standard for tracking fibroid size, number, and location, and for checking the overall shape and thickness of the uterus.
• In selected cases, an MRI may be used to clarify adenomyosis changes or when the ultrasound is unclear.

What to expect:

• With effective treatments—like the levonorgestrel IUD, tranexamic acid, or uterine artery embolization—most patients see improvements in bleeding and pain within several months. On average, modest-size fibroids typically shrink by 10–30% within 6–12 months of starting proper therapy, and many patients experience lighter, less painful periods.
• Levonorgestrel IUD: Can reduce menstrual blood loss by 80–90% over the first year.
• Uterine Artery Embolization: RCTs show shrinkage of symptomatic fibroids by about 20–40% in 1 year, with relief of bleeding and bulk symptoms in 70–90% of patients.

Regular check-ins:

• Most guidelines recommend re-checking iron, doing an ultrasound, and following up on symptoms after 3–6 months of new treatment—then spacing out visits as you improve.

Bottom line:
Monitoring isn’t just busywork—it ensures your treatment is on track, catches side effects early, and helps you and your care team celebrate real progress!

Surgery isn’t always the first step—most people get relief from medications, IUDs, or procedures like uterine artery embolization. But surgery is considered when:

• Fibroids are very large (“symptom bully”)—think uterus larger than a 12-week pregnancy, causing severe pain, pelvic pressure, bladder/bowel issues, or a visibly enlarged abdomen.

• You have persistent anemia: If heavy bleeding causes low iron or anemia that doesn’t improve with medical treatments or iron infusions, surgery may be the safest way to restore your health.

• Fertility is affected: Some fibroids or adenomyosis make it harder to get pregnant or carry a pregnancy; surgery may improve fertility chances in select cases.

• Symptoms severely disrupt daily life: If pain, heavy periods, or pressure limit your work, relationships, or mental health—even after trying other options—surgery is a strong consideration.

Surgical Options:

• Myomectomy: Removes fibroids only, leaving your uterus in place. It’s preferred for those who want future pregnancies. Minimally invasive (laparoscopic or hysteroscopic) techniques are often possible for smaller or fewer fibroids.

• Hysterectomy: Removes the entire uterus. This is a definitive solution—no more periods, fibroids, or adenomyosis—but is reserved for those who do not wish to preserve fertility. It is now considered a last resort, only after other treatments fail or aren’t suitable.

How common is surgery?

• Only about 20–30% of women with fibroids require surgery.

• Hysterectomy rates have dropped as more effective non-surgical options have become available.

• Myomectomy improves bleeding and bulk symptoms for most patients, with low risk of serious complications in experienced centers.

Risks & Recovery:

• Most surgeries are safe, but risks can include blood loss, infection, injury to nearby organs, or (rarely) need for further surgery.

• Recovery from laparoscopic myomectomy/hysterectomy is generally 2–4 weeks; open surgery may require longer.

Surgery is needed when symptoms are severe, bleeding causes ongoing anemia, or quality of life is significantly affected. There are often conservative (uterus-sparing) options available, and your care team will help you choose what’s best for your body and goals.