Here at Trace, we are serious about providing people with periods with beyond sustainable menstrual products for the wellbeing of the earth. As a physician and a nurse practitioner ourselves, the health of people with periods is paramount in our lives and our work. We are constantly learning from and partnering with like-minded healthcare providers to spread the word about health concerns for people who menstruate. This guest blog features Dr. Cheruba Prabakar, an OB/Gyn fibroid specialist,  discussing the question “is there a link between environmental toxins and fibroids?” Read on to hear from a physician regarding reproductive health, period care products, and the ongoing effort to find the root of many common women and mestruators’ health issues. 

Is there a link between environmental toxins & fibroids?

By Dr. Cheruba Prabakar

I get asked about the possible link between environmental toxins and fibroids a lot. 

“That’s the million-dollar question!” I answer. 

“We don’t know why”. 

“More research is being done”. 

These are some of my responses to the very difficult questions patients with fibroids ask when I counsel them in my office.  Fibroids are a major health burden for women today across the world, and yet we are unable to tell them why and what caused them. Did you know that up to 80% of women will be diagnosed with a fibroid by the age of 50? That’s four out of your five girlfriends! Fibroids cost up to 35 billion dollars/per year in the United States and drastically decrease the quality of life for those who suffer from them. 

What are fibroids anyway?

Fibroids are benign tumors of the uterus that can pose a significant health risk to women. They often cause severe bleeding, pain, cramping, urinary retention, painful intercourse, and can also lead to infertility. Sometimes, they do not cause any problems, but more often than not they are burdensome in the above ways. Their size and location in the uterus also affect how severe the symptoms may be. When they cause severe bleeding, women have to spend large amounts of money buying feminine hygiene products, leading to “period poverty,” which can adversely affect the lives of so many women.

Many women soak through their clothes and have to carry an extra set in their car. Due to the heavy bleeding and pain, they have to call in sick, stay home from important meetings, and lose out on family vacations and other important events.  Women with fibroids sometimes end up in the emergency room needing a blood transfusion. They may even need oral or intravenous iron which can lead to constipation. 

When fibroids cause severe pain, they lead to increased use of pain medications including narcotics, frequent ER visits, and lost time from work. When they cause infertility, they lead to surgery, and a fortune spent on assisted reproduction technology to achieve the family they want. Needless to say, fibroids can greatly impact the life of a woman and her family.

What causes fibroids?

So if fibroids are so prevalent and cause so many problems, why don’t we know more about what causes them? Medical research is rapidly advancing, but it seems like it’s simply not fast enough to give us the answers we need. We have a plethora of medications, injections, pills, devices, procedures, and surgeries to help abate fibroids symptoms, but how can we stop them in the first place? After all, prevention is better than cure.

As a gynecologist and minimally invasive surgeon, I see many women in my practice with fibroids, but also other complex conditions for which we don’t know have a cause. Examples of these other medical conditions that are prevalent yet difficult to fully understand include:

• Endometriosis
• PCOS
• Pelvic pain
• Infertility

There are many ways to manage and treat these conditions, but we wish we could prevent them! While fibroids seem to be increasingly common, human fertility is declining worldwide. Did you know that one out of every 7 couples in North America suffers from infertility? It is a growing problem. We have theories about some of the underlying causes, but we know there’s more to it than what meets the eye. Apart from genetic causes, environmental factors have been implicated in the growing cause of infertility. Our diet, lifestyle, and environmental toxins could potentially play a large role.

Are environmental toxins implicated in infertility or fibroids?

Environmental toxins are implicated in several ways: endocrine disruption, damage to the reproductive system, and decreased fetal viability. Some of the disruptors that have been identified include chlorinated pesticides, dioxins, and polychlorinated biphenyls (PCBs). PCBs alone have been identified to decrease the ability to conceive by 50%. 

It is becoming more and more important to “eat clean”, and live “BPA, plastic, and chemical free.” The ways in which toxins enter our bodies are innumerable. 

Based on available evidence, here are some of the steps that we have taken as a society to reduce potentially harmful influences on our bodies:

• Reduced use of plastics
• Eating more plant-based diets
• Consuming organic and farm-to-table food
• Using personal products that are organically sourced
• Paying attention to the labels of cosmetics and personal hygiene products we use

Could the factors that affect fertility also be adversely affecting the uterine muscle and thus increasing the prevalence of fibroids? What other critical toxins are we missing and what other disease states are they causing? Most importantly, how else are these chemicals entering our bodies?

Personal feminine products are under scrutiny.

Personal feminine products are under scrutiny for containing potentially harmful chemicals that are absorbed into the female reproductive system. Women use these products for several days at a time if they have regular menses, and months at a time for those who suffer from fibroids or other uterine abnormalities that cause heavy bleeding. These products are directly in contact with the vulva and the vagina for days. Does repeat exposure to materials in these hygienic products month after month cause long-lasting consequences by the time a woman is ready to conceive? Women also use liners for abnormal vaginal discharge or urinary incontinence. Some post-menopausal women use liners for decades. Does repeat exposure cause reproductive tract cancers? These are questions that need to be studied further. 

Tampons are also purported to contain dioxin, which is shown to be potentially very toxic to the reproductive system. Where exactly are the dioxins found? Current studies yield conflicting results as to how and whether these toxins increase disease of the reproductive tract, but the jury is still out.  Will it make a difference if we know where these materials are sourced and under what conditions these products are manufactured? 

Perhaps, we can dream of a future where we have more information about the products that enter our body, especially ones that we use for a large portion of our life. 

The questions raised in this post are just a smattering of what we wish to know in the arena of environmental toxins and women's health. Research is being done actively in the area of feminine hygiene products to better understand if and how they may be affecting us. Since women use liners, tampons, or pads for up to 16-20% of their lives, this information could change how and what we use instead.

My hope is that like the research done on food and health, we now prioritize environmental toxins and how they affect us. May we make headway in learning why fibroids and infertility are on the rise, and that we may learn more about what may be causing them. 

•••

Dr. Cheruba Prabakar is a board certified OBGYN and minimally invasive surgeon. She helps women with fibroids live a life with reduced bleeding, pain, and improved fertility. In October 2023, she opened her own Gynecology & Surgery practice in the bay area, where she provides highly personalized, accessible care to women through all phases of life. She is able to provide care in creative ways: in the office and via online coaching programs (www.lamorindagyn.com). She can be reached at thefibroiddoc@gmail.com and can be found on social media @thfibroiddoc (Instagram & Youtube).

Statements and beliefs are the writer's own and do not represent Trace Femcare, Inc. Statements should not be taken as medical advice and are for educational and entertainment purposes only. Please see your medical care professional for any medical advice and/or diagnosis.

Here at Trace, we offer environmentally-friendly tampons that are a piece of a larger ideal of what health looks like for all living things on our planet—one that includes soil restoration, regenerative farming, and ultimately, a healthier earth, humans included. We believe that period products made from cleaner, more sustainable sources and most importantly, made without dioxins, bleach, glyphosate, and other potentially harmful chemicals, with full ingredient transparency to the user, are a step in the right direction.