[SPEAKER_00]: Hello and welcome to the Aquaman podcast.
[SPEAKER_00]: This is an exploration of woman kind.
[SPEAKER_00]: Here we discuss what it is to be a woman in the modern world while utilizing ancient and modern modalities in tandem to create a bounty of health for the body, mind and spirit.
[SPEAKER_00]: Get a everyone and welcome back to the pod hope everyone is doing well.
[SPEAKER_00]: It is international fibroid awareness month and not a day goes by that I get a DM and email a comment people are asking about fibroids and there's so much misinformation about fibroids and I was always thinking about a bookmark this and write it down and make sure to do a bunch of research on fibroids and here we are this is my
[SPEAKER_00]: Comprehensive research podcast all about fibroid.
[SPEAKER_00]: So by the end of this you'll be really confident and you'll know quite a lot about fibroids what they are, what they aren't, what the modifiable risk factors are, and how they're not really associated with estrogen dominance.
[SPEAKER_00]: Between 70 to 80 percent of women will develop at least one fibroid by the age of 50.
[SPEAKER_00]: It's not a rare condition.
[SPEAKER_00]: It's a near-universal one and most women only learn about what a fiber it actually is when a doctor tells them they have one.
[SPEAKER_00]: And there isn't wise because depending on where it is in your uterus, you cannot have any symptoms and some women can have more.
[SPEAKER_00]: Going on from that cast oil packs, seed cycling, fiberitees, worms that need cordon quote detoxing, the wellness internet has a lot to say about fiberoids and almost none of it is supported by the evidence.
[SPEAKER_00]: Today we're going to go through it piece by piece and I'll tell you what actually shrinks the fibroid, what we can do about it, what we can't do about it and everything else you will ever need to know about fibroids.
[SPEAKER_00]: Remember, this episode is education, not medical advice.
[SPEAKER_00]: If you're experiencing the symptoms of fibroids like heavy bleeding, eye deficiency or pelvic pain, please get an ultrasound.
[SPEAKER_00]: Clinical terminology is going to be
[SPEAKER_00]: Pretty in depth, I'm going to do my absolute best to slow down in those sections, so you can really soak it in.
[SPEAKER_00]: The actual clinical name for fibroids is called Lyoma.
[SPEAKER_00]: Fibroid is also the color coil, and I'm going to use both interchangeably.
[SPEAKER_00]: Let's get started.
[SPEAKER_00]: So what are fibroids actually?
[SPEAKER_00]: A fibroid is a benign monoclonal tumor of the uterine smooth muscle.
[SPEAKER_00]: Just remember, if you wanted to learn more about the actual structure of the uterus, I think the adenomyosis podcast is really great, but just so you know here, we have the endometrium, which is the part
[SPEAKER_00]: of the uterus that sloths out, so that's our period and it regenerates every single month.
[SPEAKER_00]: Very, very cool that women have an organ that can regenerate every single month.
[SPEAKER_00]: It's like having this really cool liver that also does reproductive work.
[SPEAKER_00]: How amazing is that?
[SPEAKER_00]: And then we also have the Myometrium, which is a part of this smooth muscle tissue.
[SPEAKER_00]: So this is the muscle tissue.
[SPEAKER_00]: that contracts and expands and opens up the cervix when we are on our periods and when we're giving birth and it can also move around a lot according with how much progesterone and estrogen is around it different points in the cycle.
[SPEAKER_00]: Very, very cool.
[SPEAKER_00]: But basically a fibroid going back to that is a benign monoclonal tumor of uterine smooth muscle.
[SPEAKER_00]: So we're usually seeing it in the
[SPEAKER_00]: Monoclonal means the entire fibroid grew from a single cell that acquired a mutation.
[SPEAKER_00]: So when we say mutation, we mean there's a mutation in the DNA structure and the healings of the DNA of that cell, and we code proteins from that DNA.
[SPEAKER_00]: and what we make from those cells creates its structure and thus its function.
[SPEAKER_00]: When we have a mutation, it will thus negatively or positively impact how that cell shows up and what it does.
[SPEAKER_00]: So every fibroid is genetically different.
[SPEAKER_00]: If you have five fibroids in one uterus, each one of those five started from a different foundus cell.
[SPEAKER_00]: The name fibroid is also slightly misleading, despite what the name suggests.
[SPEAKER_00]: These tumors are made mostly of myocytes, so smooth muscle cells are not fibroblasts.
[SPEAKER_00]: But they do lay down in a enormous amount of extracellular matrix in collagen, which is why they feel really dense and firm and why they are so difficult to shrink.
[SPEAKER_00]: The extracellular matrix is mostly collagen, and chronically, in remodeled.
[SPEAKER_00]: So, this matters when we discuss fibroids.
[SPEAKER_00]: They don't disappear even when you remove the hormonal drive, the collagen, scaffolding will still persist on the outside and the fibroid in the inside.
[SPEAKER_00]: can shrink and decrease in sides.
[SPEAKER_00]: Right at the outset, I just want you to understand fibroids are not cancer.
[SPEAKER_00]: They do not have any malignancy, so they don't really spread, unless you have the malignant equivalent, which is called a lio meosacoma.
[SPEAKER_00]: This is rare.
[SPEAKER_00]: It's roughly one in a thousand cases of fibroid that turns out to be a more cancerous form of fibroid.
[SPEAKER_00]: It's generally considered a completely different disease and does not arise from fibroid
[SPEAKER_00]: degeneration.
[SPEAKER_00]: So it's not a sign of a toxic uterus.
[SPEAKER_00]: There's no clinical entity of that.
[SPEAKER_00]: It's also not a punishment for anything you did or did not do.
[SPEAKER_00]: Okay?
[SPEAKER_00]: There's a lot of misinformation online saying, well you have a fibroid because you have a sexual trauma and because you have lots of shame in your womb.
[SPEAKER_00]: And I'm not going to necessarily say that's not true, because if that's your spiritual belief, I think that's valid.
[SPEAKER_00]: That's fine.
[SPEAKER_00]: If that connects you with your body, but I think it's very convenient for people online selling detox teas and things to say that this is because of shame and trauma, which,
[SPEAKER_00]: 50 to 80 percent of people have, women have, which is also the same statistic of how common fibroids are, right?
[SPEAKER_00]: So we're drawing a really wide brush stroke and we are connecting two things that aren't connected together and claiming causation that I do not support.
[SPEAKER_00]: fibroids are not a punishment for anything you did or you didn't do, that's really worth saying okay because there is a huge amount of shame attached to fibroids and I don't think it's necessary whatsoever.
[SPEAKER_00]: So what are the fibroids usually set physically in the uterine wall itself in the myometrium, right?
[SPEAKER_00]: So they could also grow into the cavity so sub-mucosal so we are in the myometrium but we're closer to the endometrium so the middle of your uterus
[SPEAKER_00]: all on the outer surface, sub-surrosal.
[SPEAKER_00]: So sub-mucosal in sub-surrosal out also on the stalk of your uterus, which is called pedumculated, or occasionally on the cervix, very very occasionally on the cervix.
[SPEAKER_00]: At the location matters more than size for symptoms as well.
[SPEAKER_00]: If you have one centimeter sub-mucosal fibride, that can create debilitating bleeding because it's closer to your endometrium.
[SPEAKER_00]: If you have a 10 centimeter sub-surrosal fibroid, it can cause almost none, and so that's quite her, I think, when women go into their doctor and they say, oh, you have a 15 centimeter fibroid, they think, huh?
[SPEAKER_00]: How can that be possible?
[SPEAKER_00]: I have no symptoms.
[SPEAKER_00]: Location matters more than size.
[SPEAKER_00]: Let's talk about prevalence who gets them.
[SPEAKER_00]: So by age 50, 70 to about 80% of women overall will at least have one fibroid.
[SPEAKER_00]: In black women, that figure rises to approximately 80% so about 10 more with earlier onset and larger more numerous vibrates.
[SPEAKER_00]: Global prevalence has increased and estimated 78.82 in recent decades from 126.41 million to 226.05 million cases.
[SPEAKER_00]: You're thinking, oh my gosh, wow.
[SPEAKER_00]: Global prevalence going from a baseline of 78 million.
[SPEAKER_00]: to 226 million.
[SPEAKER_00]: That's crazy.
[SPEAKER_00]: What's going on?
[SPEAKER_00]: I don't think that's necessarily more fibroids.
[SPEAKER_00]: I would also say I think there is some environmental factors that are increasing fibroid rate, but I think it's also the fact that we have better imaging and better diagnoses.
[SPEAKER_00]: That's a part of the picture.
[SPEAKER_00]: I don't think the burden is necessarily from heat small.
[SPEAKER_00]: I think it's just because we're noticing more.
[SPEAKER_00]: but the burden still exists and does matter.
[SPEAKER_00]: Only about 20 to 50% of women with fibroids are symptomatic, which means most fibroids are silent and then never diagnosed.
[SPEAKER_00]: The disparity story really deserves attention here, and this is why I'm an intersectional socialist feminist, because black women are two to three times more likely than white women to be diagnosed with fibroids.
[SPEAKER_00]: They are more likely to be diagnosed like younger.
[SPEAKER_00]: they are more likely to have larger and more numerous fibroids and they are more likely to end up with a hysterectomy.
[SPEAKER_00]: Okay, the factor identified in the literature, and we'll talk about this later as well, is vitamin D deficiency, and we'll talk about why that matters later as well.
[SPEAKER_00]: The higher rates due to skin melanin and dietary factors, so generally black women have lower overall dietary health and therefore lower
[SPEAKER_00]: access to vitamin D supplementation and vitamin D retreat foods, obesity, hypertension, care products use containing endocrine disrupting chemicals, socio-economic determinants of health and limited access to preventative care.
[SPEAKER_00]: That's on racism, okay?
[SPEAKER_00]: The reason why, like women have such worse health outcomes is because of racism, and that's why we always need to take race into account in our feminism and in health and in women's health as well.
[SPEAKER_00]: The hair product angle here deserves its own moment later in the podcast, which we will be
[SPEAKER_00]: The Lauren Wise Laboratory at Boston University has been producing all of the best research on this and it's been producing landmark epidemiological work specifically on this connection.
[SPEAKER_00]: What I really want to highlight here as well is that none of this reduces down to genetics.
[SPEAKER_00]: You might be thinking, well, don't black women just then have a higher incidence genetically of fibroids?
[SPEAKER_00]: No.
[SPEAKER_00]: It's mostly entirely environmental factors that can be controlled for, that white women do not have exposure to at the rates of black women.
[SPEAKER_00]: So let's talk about the economic burden.
[SPEAKER_00]: So in the United States alone direct costs for fibroid treatments, it's between four and nine billion USD annually.
[SPEAKER_00]: fibroids are the leading indication for hysterectomy globally, and 50% of hysterectomies are in the US are performed for fibroids and most of those are being done on black women.
[SPEAKER_00]: And this is a massive women's health issue that receives a fraction of the research funding of comparable conditions in male-dominant demographics.
[SPEAKER_00]: Are we surprised?
[SPEAKER_00]: No, we're not.
[SPEAKER_00]: Age patterns.
[SPEAKER_00]: So they're really rare before puberty, fibroids are hormone dependent, not necessarily only estrogen-dependent, they are hormone-dependent, so they need reproductive hormones in the milk in order to grow.
[SPEAKER_00]: Incidents rises through the 20s, peaks in the 40s, and then they typically start to shrink after menopause when ovarian estrodial and progesterine drop.
[SPEAKER_00]: New fibroids really form postmenopause, so if you are listening to this and you're
[SPEAKER_00]: I have proof from my scans that I never had this vibroid and now I do.
[SPEAKER_00]: That's a bit of a red flag and that warrants investigation.
[SPEAKER_00]: Okay, because that has a higher risk of being a lios, myosachoma, right?
[SPEAKER_00]: So that's more cancerous, malignant fibroid.
[SPEAKER_00]: That isn't necessarily a fibroid.
[SPEAKER_00]: It can look like a fibroid, act like a fibroid.
[SPEAKER_00]: Feel like a fibroid, not necessarily a fibroid.
[SPEAKER_00]: So if that's you and you're listening to this, please take care of that.
[SPEAKER_00]: So as I said before, there are three broad locations.
[SPEAKER_00]: So,
[SPEAKER_00]: So sub-mucosal, they grow into the intramutriol cavity, intramural.
[SPEAKER_00]: They grow entirely within the myometriol wall.
[SPEAKER_00]: So these are the most common overall, and they can cause both bleeding and bulk symptoms depending on the size, whereas sub-mucosal, we generally see quite a lot of heavy menstrual bleeding and infertility because it obstructs where any of them would kind of settle into the intramutrium.
[SPEAKER_00]: And we also have sub-surrosal.
[SPEAKER_00]: So those grow outward from the outer surface.
[SPEAKER_00]: so into the pelvic area.
[SPEAKER_00]: So usually cause a bulk of symptoms rather than bleeding.
[SPEAKER_00]: So that can compress the belt bladder, the bowel, and the uterus.
[SPEAKER_00]: And we can also see pedumculated fibroids growing on a stalk, and they can be pedumculated, subunicosal into the cavity.
[SPEAKER_00]: They can go into the pelvis, so the lutter, so the subcerosal, pedumculated fibroids, they can twist, and they can create quite a lot of acute pelvic pain in certain, you know, sexual positions if you go to the
[SPEAKER_00]: on your bladder.
[SPEAKER_00]: I think a lot of these people are thinking that sounds like endometriosis and that's why a lot of women with endometriosis get scanned and screened for fibroids before they do endometriosis because statistically well maybe this isn't necessarily true but with the statistics we have at the moment fibroids are more common than endometriosis.
[SPEAKER_00]: For fibroids, we have the FIGO classification.
[SPEAKER_00]: It's Type 0 through Type 8.
[SPEAKER_00]: So Type 0 is when we see a pedunculation inside of the cavity.
[SPEAKER_00]: So that's entirely within the cavity on a stalk.
[SPEAKER_00]: They can be removed with his directomy, or partial his directomy.
[SPEAKER_00]: Type 1 is submucosal, that's less than 50% intramurial, and they mostly protrude into the cavity.
[SPEAKER_00]: Type 2 again is sub-mucousal, more than 50% are intermural and their large portion on the wall still touching the cavity but more on the wall of the miometrium.
[SPEAKER_00]: Type 3 is intermural and that abutes the endometrium without protruding.
[SPEAKER_00]: Type 4 is purely intermural and there's no contact with the endometrium or the cirrocer, so the cirrocer is the outer side part, so type 4 is
[SPEAKER_00]: very much in the middle and they can have symptoms and they can also not have symptoms at all.
[SPEAKER_00]: Type 5 is sub-surrosal and more than 50% are into a mural.
[SPEAKER_00]: Type 6 is sub-surrosal and less than 50% are into mural.
[SPEAKER_00]: Type 7 is sub-surrosal and they are also pedonculated and type 8 is other.
[SPEAKER_00]: So that could be cervical for example, they're detached.
[SPEAKER_00]: and there might be getting blood supply elsewhere.
[SPEAKER_00]: Again, coming back to this fact of the matter, size matters too, but less than location.
[SPEAKER_00]: So remember, that one centimeter fiber rate at the cervix, or on the endometrial surface, can be catastrophic for fertility and for bleeding, and that can be highly associated with eye-indificancy and neemia.
[SPEAKER_00]: But you could have like a 12 centimeter fiber on the outside of the uterus.
[SPEAKER_00]: And you know, it might cause some pressure symptoms depending on where it's located, but you can still preserve your fertility completely and you might not have any symptoms at all.
[SPEAKER_00]: The instinct here is to really focus on size alone, like my fibroid group from four centimetres to five centimetres and my dog does not concern.
[SPEAKER_00]: Okay, it is concerning that it's growing so much, and I think we do need to pay attention to that.
[SPEAKER_00]: Naomi, we have something going on.
[SPEAKER_00]: Maybe we need to look at our lifestyle factors and look at this from a holistic view.
[SPEAKER_00]: I think it does matter, but it's often not the point.
[SPEAKER_00]: The growth rate does matter, the symptoms matter, the position matters, right?
[SPEAKER_00]: I slated size is a poor proxy for anything, specifically when we're talking about fibrates.
[SPEAKER_00]: So what are the symptoms, right?
[SPEAKER_00]: So the dominant symptom is heavy menstrual bleeding.
[SPEAKER_00]: So really heavy, long, painful periods around 30% of women with fibroids experience heavy menstrual bleeding.
[SPEAKER_00]: And that rises to about 40% when you include those with any abnormal uterine bleeding.
[SPEAKER_00]: The clinical dip definition of heavy menstrual bleeding is bleeding that interferes with the quality of your life.
[SPEAKER_00]: So it's deliberately subjective because volume alone misses the picture.
[SPEAKER_00]: Right, if you're changing pads every hour, if you have to get up in the middle of the night and change your period products, if you're stacking as well, so you have a cup in you have a pad on your period underwear and you're still bleeding through right that's a lot of iron loss that's a lot of bleeding if your canceling plans as soon as you get your period that's heavy bleeding.
[SPEAKER_00]: mechanistically, a fibroids increase the surface area of the endometrial cavity inwards, right?
[SPEAKER_00]: And they disrupt myometrial contractions that stop bleeding.
[SPEAKER_00]: So after your local prosthetic landins kind of calm down and then not causing the contractions in your cervix, we actually start to decrease bleeds.
[SPEAKER_00]: But
[SPEAKER_00]: When we have more tissue and it's been obstructed, that doesn't necessarily happen.
[SPEAKER_00]: We don't really have bleeding stop, it can continue and continue, and we actually start to get into a little bit of hemorrhaging here.
[SPEAKER_00]: Okay, so what about the other symptoms?
[SPEAKER_00]: So pelvic pressure or heaviness often described as a full feeling low in the pelvis.
[SPEAKER_00]: worse when standing or sitting for long periods of time, urinary frequency, so anterior fibroids can compress the bladder and they can decrease the size of your bladder, so you have less continents, constipation, or incompetent evacuation.
[SPEAKER_00]: So basically, your pose aren't as, how do I say this, complete as they used to be.
[SPEAKER_00]: If you find that you have to go multiple times in the day to do what used to just take you five minutes, right?
[SPEAKER_00]: back pain, particularly with posterior fibroid.
[SPEAKER_00]: So that's when a fibroid is sitting on the back of your uterus close towards your spine and it's pressing out.
[SPEAKER_00]: It can press on that cycle plexus there, leg plane or heaviness really large fibroids compressing veiners or lymphatic drainage and visible abdominal distension.
[SPEAKER_00]: So a fibroid uterus can enlarge the size over full-term pregnancy in really extreme cases.
[SPEAKER_00]: And yes, there are some case studies on that.
[SPEAKER_00]: It is actually incredible how large they can get.
[SPEAKER_00]: So to round up that and talk a little bit more about pain because that does sound really painful.
[SPEAKER_00]: So dysmenoria, severe period pain, a pain with penetrative sex, you might even notice that there's a position with a certain thing going into your vagina, whether that be your person or a toy.
[SPEAKER_00]: If you notice that in the exact same position with pointing a certain way it hurts, that could be a sign of a fibroid, chronic pelvic pain that often works prematurely, acute severe pain are also known in fibroids as well.
[SPEAKER_00]: So if you've noticed that when you're in a certain position standing up or working out, that could be because the fibroid is pushing on blood supply or
[SPEAKER_00]: reproductive symptoms.
[SPEAKER_00]: So, in fertility, right?
[SPEAKER_00]: Particularly with those sub-mucosal fibroids that sit in the endometrium, of course, because it's going to distort the cavity and it's going to make it harder to make that a really nice hot bed for possible implantation.
[SPEAKER_00]: And going on from that recurrent pregnancy loss, we see increased risk of miscarriage here and complications in and established pregnancy.
[SPEAKER_00]: Going on from that, there's also systematic consequences.
[SPEAKER_00]: So, number one is eye-indifficiency and eye-indifficiency and neemia,
[SPEAKER_00]: which also looks like fatigue, hairlost, brain fog, exercise intolerance, standing up and feeling really tired and wanting to faint.
[SPEAKER_00]: A PICA, breathlessness, chronic eye-independency is disabling and under-treated.
[SPEAKER_00]: And I guess one positive thing on this podcast that we can say is that I and criteria has been increased the ferret in at least from 15.
[SPEAKER_00]: to 30, which is really cool, mental health impact.
[SPEAKER_00]: So women with fibroids score significantly higher on perceived stress scales and menstrual distress questionnaires than control.
[SPEAKER_00]: We also see increased rates of anxiety and depression are elevated, which we can both connect to low iron if there is a sub-mucosal fibroid we're looking at here.
[SPEAKER_00]: Quality of life and payment as well, miswork avoidance of social activity, avoidance of sex, sleep disruption, and also increase bleeding, which is in of itself quite distressing, and sexual function decreasing as well, self-image, it concerns, relationship concerns,
[SPEAKER_00]: So, yeah, a fibroid, if it is quite large in a area that can negatively impact you or if it's quite small, and it's also in that subdued cosar area, it can be really negatively impactful on your life.
[SPEAKER_00]: And again, this sound does sound a lot like endometriosis as well.
[SPEAKER_00]: So, if you do think you have endometriosis and you're a little bit annoyed at your doctor for looking at fibroids, this is why.
[SPEAKER_00]: Okay, so you're listening to this and you're not in your head.
[SPEAKER_00]: is usually a trans vaginal ultrasound.
[SPEAKER_00]: This is the workhorse.
[SPEAKER_00]: It's fast, it's cheap, there's no radiation, it's excellent at detecting fibroids and it gives you a pretty rough sense of size and location.
[SPEAKER_00]: Second line is trans abdominal ultrasound for a very large uterie that extend beyond the pelvis.
[SPEAKER_00]: If you have a good sonographer, they will do trans vaginal and they will also do your stomach at the same time if not at different times so we can get a really good idea.
[SPEAKER_00]: There's also saline infusion, so no histograms.
[SPEAKER_00]: So this has been saline is instilled in the cavity to outline any sub-mucosal components.
[SPEAKER_00]: This is better than a plain ultrasound for identifying cavity involving fibroids are looking at the cavity inside your uterus MRI.
[SPEAKER_00]: So this is best for surgical planning.
[SPEAKER_00]: So this is when you've had everything else done.
[SPEAKER_00]: We know exactly where it is and we just want to have a look.
[SPEAKER_00]: or if there's multiple fibroids or when differentiation from a denomyosis is needed as well.
[SPEAKER_00]: I have a whole podcast on a denomyosis because again, a denomyosis fibroids and endometriosis on the surface look really similar.
[SPEAKER_00]: So it's really important that we rule it out with MRI.
[SPEAKER_00]: There's also a historoscopy.
[SPEAKER_00]: It's a direct visualization of the cavity.
[SPEAKER_00]: So that's when we're going into the cavity with a camera and having you look around by our cervix.
[SPEAKER_00]: So, all of that, but fibroids still get missed, especially even when women are presenting and saying there are problems here, I have symptoms.
[SPEAKER_00]: So number one, symptoms are dismissed as normal periods, this is so deeply annoying to me.
[SPEAKER_00]: Many women reach mid-30s before they realise their bleeding pattern is not what other women experience nor is it normal.
[SPEAKER_00]: The bulk symptoms are attributed to weight or bloating, eye-in deficiency anemia is a treated symptomatically without investigating the source of the blood loss that's also a big gripe of mine.
[SPEAKER_00]: If your eye-in keeps going low and low and low, why, where is it going?
[SPEAKER_00]: Is it your periods?
[SPEAKER_00]: Do you have high estrogen?
[SPEAKER_00]: Do you have an infection?
[SPEAKER_00]: Do you have a fibroid?
[SPEAKER_00]: Cultural minimization of women's pain, and this is really particular for black women as well.
[SPEAKER_00]: I believed significantly less than if it was the exact same symptom and presentation in a white woman, which is so frustrating, it's well documented for nominant and we really need to take that into account.
[SPEAKER_00]: So if you're a healthcare worker and you have black women coming into your clinic, when they tell you you're in pain, believe them, okay, but leave them.
[SPEAKER_00]: And the next one is first line ultrasound is not requested when it should be.
[SPEAKER_00]: And this is the most frustrating thing.
[SPEAKER_00]: If a woman is presenting and she's saying,
[SPEAKER_00]: I have these symptoms and you've studied for God knows how long.
[SPEAKER_00]: You should just order the ultrasound.
[SPEAKER_00]: I don't know why it's that hard for people to do.
[SPEAKER_00]: So go in there.
[SPEAKER_00]: If you have all your symptoms, go in there and you are asking for the ultrasound.
[SPEAKER_00]: I want to trans ultrasound.
[SPEAKER_00]: I also want a abdominal ultrasound at the same time.
[SPEAKER_00]: Please put me onto a sonographer.
[SPEAKER_00]: And if you cannot do that, please write in my notes that you are denying my symptoms and they'll put you on to someone hopefully.
[SPEAKER_00]: There's also a podcast I have on how you can navigate through the medical system that I think especially if you're a back woman listen to this, go and listen to that and make sure you apply all of the steps so you can actually get care because black women are always denied especially when it comes to fibroids especially when it comes to pain and it's not appropriate and we need to go in their prepared and knowing what the system looks like.
[SPEAKER_00]: knowing how to get through it, so you can actually help the good outcomes for your health.
[SPEAKER_00]: Okay, so all of that aside, what's the real pathophysiology?
[SPEAKER_00]: I know all of you guys and nerds.
[SPEAKER_00]: We're all nerds.
[SPEAKER_00]: Let's talk about it.
[SPEAKER_00]: What actually causes the mutation?
[SPEAKER_00]: So the initiating event in a fibroid is a somatic mutation.
[SPEAKER_00]: No a cell in your myometrium is not doing somatic workouts and has adrenal fatigue.
[SPEAKER_00]: Somatic, it means the mutation happened during your life.
[SPEAKER_00]: in a single cell, it's not inherited from your parents.
[SPEAKER_00]: And the most common mutation is in a gene called the med 12, which encodes the component of the mediator complex.
[SPEAKER_00]: And this is a part of the cellular machinery in that cell that helps to regulate which genes get switched on and off.
[SPEAKER_00]: and mid-12 mutations account for about 77% of fibroids, so generally see these have a high color occurrence rate.
[SPEAKER_00]: The second most common mutation is a HMGA2, which regulates chromatin and HMGA2 mutations account for about 10% of fibroids.
[SPEAKER_00]: So these two mutation types tend to be mutually exclusive.
[SPEAKER_00]: a fibroid has one or the other.
[SPEAKER_00]: It's not usually both.
[SPEAKER_00]: It's very rare to have both and they produce fibroids with different characteristics.
[SPEAKER_00]: So we can tell from just what the fibroid looks and feels like, which mutation it is.
[SPEAKER_00]: So the HMGA2 mutation is usually associated with quite large fibroids and the med 12 mutation has more numerous smaller fibroids.
[SPEAKER_00]: So when we just look on the MRI or we're looking at the ultrasound, we can tell which gene mutation it has with a pretty high
[SPEAKER_00]: So what does the mutation do?
[SPEAKER_00]: So the med-12 mutations, they generally disrupt a CDK kinase module in the mediator complex, which changes the chromatin landscape of the affected cell.
[SPEAKER_00]: And that essentially rewise the genes that are being read coded and then being made into proteins.
[SPEAKER_00]: So then the downstream effect of this is we generally see excessive proliferation and some altered signaling which drives collagen complexes being made and increased responsiveness to progesterine.
[SPEAKER_00]: So more collagen being made from the same input and stimulation and we're also seeing we're really, really, really responsive to progesterine.
[SPEAKER_00]: The mutated cell is now also a founder cell of a fibroid.
[SPEAKER_00]: It divides and every single cell inherits the mutation at every single fibroid is a monoclonal expansion of one such founder.
[SPEAKER_00]: So they don't differentiate.
[SPEAKER_00]: They all look the same and they're kind of just clustering together.
[SPEAKER_00]: Then we enter our hormones and this is where wellness gets it really wrong.
[SPEAKER_00]: The dominant narrative on the internet is that fibroids are caused by too much estrogen and this is not true.
[SPEAKER_00]: Estrogen and progesterone both matter here, but progesterone is arguably more direct drivers of fibroid growth, which really flies in the face of what most people are saying online, right?
[SPEAKER_00]: So the interesting thing here is that the cells that carry mid-12 mutations.
[SPEAKER_00]: So those smooth muscle cells remember it's in the myometrium.
[SPEAKER_00]: They grow in response to progesterone not estrogen.
[SPEAKER_00]: Here, estrogen, what its main job is, on a fibroid when it attaches to its receptor sites on this fibroid, it just makes that cell and the fibroid itself when we're talking about the collection and the constellation of cells in this mutated cluster of cells in the myometrium.
[SPEAKER_00]: When estrogen attaches to receptor cells, it basically tells all these cells you're really sensitive to progesterine.
[SPEAKER_00]: And it goes, cool, cool, cool.
[SPEAKER_00]: We're going to attach to one molecule of a progesterone.
[SPEAKER_00]: We're going to act like it's 10.
[SPEAKER_00]: Right?
[SPEAKER_00]: We're going to create more and more and more collagen.
[SPEAKER_00]: And we're going to create more and more and more smooth muscle in this bundle of a fibroid.
[SPEAKER_00]: Right?
[SPEAKER_00]: So estrogen enables progesterone to be more sensitive at the receptor side.
[SPEAKER_00]: Alongside those really sensitive cells with the med-12 mutation, there's also mutated smooth cells that sit kind of closer to like tumor associated fibroblasts which do not carry that med-12 mutation.
[SPEAKER_00]: And they respond directly to estrogen and they create the collagen matrix.
[SPEAKER_00]: So we have two cell types really in a fibroid depending on what type of mutation you have we're talking about med-12 year.
[SPEAKER_00]: One type of cell would be really sensitive
[SPEAKER_00]: to progesterone, and that's going to lay down more and more and more and more smooth muscle tissue.
[SPEAKER_00]: And the other one is going to be more sensitive to astrodial estrogen, and it's going to lay down more of that collagen matrix on the external part of the fibroid.
[SPEAKER_00]: So it's not one or the other, it's both of them working together.
[SPEAKER_00]: And I really want to drive home this point.
[SPEAKER_00]: It's a local hormone environment problem.
[SPEAKER_00]: It's not systemic.
[SPEAKER_00]: So multiple studies have compared plasma or astrodial estrogen between women with fibroids and women without fibroids.
[SPEAKER_00]: There is no consistent difference.
[SPEAKER_00]: Systemic estrogen levels do not differ.
[SPEAKER_00]: However, the tissue level estrogen inside the fibroid is significantly higher than the surrounding myometrium.
[SPEAKER_00]: So if we take a cell from the surrounding myometrium that's not a part of the fibroid structure, it's going to have a normal amount of estradiol.
[SPEAKER_00]: But if we take it from the fibroid, it's going to have so much more estradiol.
[SPEAKER_00]: why is this happening?
[SPEAKER_00]: Because the fibro tissue over expresses a Roma taste, a Roma taste is an enzyme that turns androgens into estrogens.
[SPEAKER_00]: The fibroid is essentially making its own estrogen.
[SPEAKER_00]: And if you listen to the adenomyosis podcast, that's the same thing that's happening inside of adenomyosis affected cells and tissues.
[SPEAKER_00]: It has more estrogen.
[SPEAKER_00]: It's a localized environment.
[SPEAKER_00]: So just like fibroids, identifyosis, this is the one thing they have in common of many things they have in common, is that it's a localized estrogen problem, not systemic.
[SPEAKER_00]: And there's also oxidative stress.
[SPEAKER_00]: I'm just going to explain oxidative stress really quickly to you.
[SPEAKER_00]: When we metabolize energy in our mitochondria, we create reactive oxygen species as like almost a waste product of that.
[SPEAKER_00]: chemical reactions.
[SPEAKER_00]: So we're always creating these reactive oxygen species aka rose and they are an incomplete molecule and they have like one or two electrons missing and they are just going to rip apart the environment around them just really searching for these electrons and these constituents they need to balance themselves and that's why
[SPEAKER_00]: we have antioxidants because they balance them and they make sure that it's taken care of and that's why oxidative stress is associated with aging and oxidative stress is also associated with DNA fragmentation because these reactive oxygen species, if they get into the cell, or close to a nucleus,
[SPEAKER_00]: and into the DNA, it can really fuck up our DNA and create mutations.
[SPEAKER_00]: Reactive oxygen species are also generated during normal cyclical hormonal fluctuations, and they can cause DNA damage.
[SPEAKER_00]: Our marker of this damage that we know of is 80 HDG, which accumulates in fibroid tissue.
[SPEAKER_00]: And this DNA damage environment appears to be the major driver of
[SPEAKER_00]: high frequency mid 12 mutations that then trigger fibroids in the first place.
[SPEAKER_00]: And once that fibroid exists, the hormonal signaling continues to generate reactive oxygen species.
[SPEAKER_00]: So it's making its own estrogen and it's creating more oxidative stress.
[SPEAKER_00]: So it's creating this localised environment that's really, really, really oxidatively stressed out and there's lots and lots of lots of estrogen that then makes it more sensitive to progesterone.
[SPEAKER_00]: I want you to also understand it's extracellular matrix, so the matrix on the outside of the fibroid.
[SPEAKER_00]: A fibroid is not just proliferation of cells, it's proliferating cells embedded in a dense collagen scaffold that's being upregulated by astrodial.
[SPEAKER_00]: Transforming growth factor beta 3 is highly expressed in fibroids and it drives fibroblasts to produce collagen types 1 and 3.
[SPEAKER_00]: And then this matrix is then chronically remodeled, but really resistant to breakdown, which is why even when you shut off the hormonal drive.
[SPEAKER_00]: So some women are suggested to take a G&I H agonist, which turns off your brain from making the precursors L-H NFSH for Estrodial and Progestin, so we're shutting down the cycle, and then that shuts down the fibroids from growing.
[SPEAKER_00]: Right, the fibroid doesn't necessarily disappear entirely because the matrix, the collagen matrix remains.
[SPEAKER_00]: So the cells can shrink inside of the matrix, but the matrix is still there.
[SPEAKER_00]: It's almost like it's external skeleton.
[SPEAKER_00]: This is also why fibroids feel really, really firm on examination.
[SPEAKER_00]: So if you're palpating a densely collagenized mass,
[SPEAKER_00]: It's not just an enlarged muscle, it feels a lot harder.
[SPEAKER_00]: So let's put that pathophysiology all together in a sequence, right?
[SPEAKER_00]: So oxidative stress and normal cyclical hormone or signaling, they create DNA damage, in a myometriopsel inside of the myometrium.
[SPEAKER_00]: That damage creates a mid-12 or a HMGA2 mutation in that cell.
[SPEAKER_00]: And then we start to make more cells and make more protein that is mutated.
[SPEAKER_00]: The mutation requires the cells response to hormones, particularly progesterine, so it's really sensitive to progesterine.
[SPEAKER_00]: And that single mutated cell begins to proliferate in response to normal cyclical progesterine generating more and more and more monoclonal expansion.
[SPEAKER_00]: So it's creating more and more and more cells that are clones of itself.
[SPEAKER_00]: The mutated cells then recruit surrounding fibroblasts are like, hey, come over here.
[SPEAKER_00]: We're making our own ecosystem.
[SPEAKER_00]: Wanna join?
[SPEAKER_00]: And together, they establish this local aromatics.
[SPEAKER_00]: And they're like, cool.
[SPEAKER_00]: So let's not depend on her estradiol.
[SPEAKER_00]: Let's make our own.
[SPEAKER_00]: Right.
[SPEAKER_00]: Let's take all of our testosterone and turn it into estradiol.
[SPEAKER_00]: And then we can become more and more more sensitive to progesterine.
[SPEAKER_00]: Those fibroblasts that are then sensitive to more and more and more of that localized estradiol from Abramatease, is now going to lay down the extracellular collagen scaffolding.
[SPEAKER_00]: And then the fibroid grows, vascular abnormalities develop and symptoms start to appear.
[SPEAKER_00]: Right, so nowhere in this sequence did I say estrogen donuts, okay?
[SPEAKER_00]: It's not required, it's not accurate.
[SPEAKER_00]: The system is not over-supplied with estrogen.
[SPEAKER_00]: It's misunderstanding to normal signals because of an underlying somatic mutation and a chronic oxidative stress environment.
[SPEAKER_00]: All right, so what are some risk factors that are modifiable and non-monifiable?
[SPEAKER_00]: So non-modifiable, these are the ones you cannot change.
[SPEAKER_00]: Age, race, ethnicity, family history, early menarck, a delayed first pregnancy as well, so let's get
[SPEAKER_00]: age, incidents rises steadily through the reproductive years, peaks in the 40s and then drops post-minute pause.
[SPEAKER_00]: We can't change that.
[SPEAKER_00]: Race and ethnicity.
[SPEAKER_00]: So black women bear the highest burden, Asian, then Hispanic, and then white women follow after that.
[SPEAKER_00]: So this isn't a simple genetic explanation.
[SPEAKER_00]: The disparity is being driven by intersecting environmental dietary and structural factors and racism.
[SPEAKER_00]: Okay?
[SPEAKER_00]: family history.
[SPEAKER_00]: First degree relatives of women with fibroids have roughly 2.5 the risk of women who don't.
[SPEAKER_00]: There is a familial pattern, although most fibroids are still sporadic, so remember there is somatic mutation, they're not inherited.
[SPEAKER_00]: Early men arc.
[SPEAKER_00]: So if you have an earlier period, that means you've been exposed to estradiol and persistent for longer periods of time, and therefore you have an association.
[SPEAKER_00]: of a higher lifetime risk.
[SPEAKER_00]: Also delayed pregnancy, because when we're pregnant there are changes to our immune cells, there are changes to our myometrium, and we're also exposed to cycling hormones less.
[SPEAKER_00]: Even though we have more estrogen, and the land scape changes, and it actually does become a little bit more protective against fibroids.
[SPEAKER_00]: Those are the things we can't change.
[SPEAKER_00]: We can't change any of those, modifyable ones.
[SPEAKER_00]: These are the actual things that you can work on.
[SPEAKER_00]: So metabolic health and addaposti.
[SPEAKER_00]: So this is being higher BMI, particularly if you've gained weight in your adulthood, that's strongly associated with fibroids in most studies.
[SPEAKER_00]: And there are many mechanisms behind this, but I think the main one,
[SPEAKER_00]: is add a post tissue, fat tissue, produces estrogen, and then a romanticization of antigenes as well.
[SPEAKER_00]: So we often think of fat tissue as inert, but it is metabolically and hormonally active, and it can turn antigenes via a rubber taste into estrogen.
[SPEAKER_00]: Secondly, is vitamin D deficiency.
[SPEAKER_00]: So this is one of the most consistent findings in fibroid epidemiology, multiple studies show that serum 25 hydroxy vitamin D is significantly lower in women with fibroids than those without.
[SPEAKER_00]: The mechanism is really plausible.
[SPEAKER_00]: So vitamin D binds to the vitamin D receptor.
[SPEAKER_00]: It inhibits smooth muscle proliferation and it also downregulates
[SPEAKER_00]: progesterone, and it also reduces extracellular matrix deposition.
[SPEAKER_00]: So it actually negatively impacts the structure and the foundation of how a fibroid forms, and it's also an antioxidant.
[SPEAKER_00]: So remember those reactive oxygen species I was talking before, it's going to get rid of them.
[SPEAKER_00]: The disparity in black women partially reflects both dietary intake.
[SPEAKER_00]: and reduce synthesis at higher melanin concentrations.
[SPEAKER_00]: So, if you're a black woman in your living in Minnesota, for example, actually, I don't know how sunny Minnesota is salivating in Canada.
[SPEAKER_00]: Nice living Canada.
[SPEAKER_00]: You have far less access to sun.
[SPEAKER_00]: It's cold there.
[SPEAKER_00]: You're going to be covered up a lot.
[SPEAKER_00]: And unless you are eating vitamin D-rich foods, which tend to be a little bit more expensive, and you're not taking a supplement, then you're going to have low vitamin D, you're going to have more reactive oxygen species and a higher risk of
[SPEAKER_00]: There is randomized control trial evidence for vitamin D supplementation, promising for growth prevention, mixed for actual shrinkage, so we know that it can prevent growth, so if we say a fiber it has grown to five centimeters, if we start taking vitamin D, it stops at five centimeters and it can decrease the time it takes for it to get to six or seven.
[SPEAKER_00]: It's mixed for actual shrinkage, so in some studies they've shown that vitamin D supplementation can shrink it in some women in some studies and not in others.
[SPEAKER_00]: Hypotension.
[SPEAKER_00]: So this is an independent risk factor and it appears in most large cohort analyses of women and fibroids.
[SPEAKER_00]: So the mechanism really likely relates to vascular smooth muscle proliferation signals shared between hypotensive
[SPEAKER_00]: So it's reason enough to have your blood pressure checked and treated if it's elevated and to cry and disrupting chemical exposure, we'll talk about that a lot in the next section.
[SPEAKER_00]: So if you have higher exposure to endocrine disrupting chemicals like cosmetics in your diet, your hair products, plastics, food packaging, you have a higher risk of developing fibroids, alcohol, multiple studies associate alcohol intake with higher fibroid risk.
[SPEAKER_00]: That's also highlighted a lot.
[SPEAKER_00]: in the black women's health study found a dose dependent relationships.
[SPEAKER_00]: So we know if you have 10 glasses of wine, you have a high high risk of developing fibroids, but if you don't have one glass of wine a week, your risk is lower.
[SPEAKER_00]: So it's a dose dependent relationship here.
[SPEAKER_00]: Physical activity, it's consistently protective again that's a finding from the black women's health study.
[SPEAKER_00]: they found that women who engaged in at least seven hours per week of physical activity had a 40% lower risk of fibroids, why?
[SPEAKER_00]: Because exercise is anti-inflammatory and decreases reactive oxygen species.
[SPEAKER_00]: Another reason why is weight management?
[SPEAKER_00]: Improved insulin sensitivity, reduced inflammation, and possibly altered hormone metabolism as well.
[SPEAKER_00]: Also, reproductive history, like I said before, multiple pregnancies and extended lactation are protective.
[SPEAKER_00]: It's not something that you can plan for, right?
[SPEAKER_00]: You're not going to have a baby and commit to two years of breastfeeding because you're thinking, oh, this is going to decrease my fibroid risk, right?
[SPEAKER_00]: And once thinking like that, nor do I want you to, or is this a shame for women who don't want to have children, that's something like that.
[SPEAKER_00]: It's just saying that because of the hormonal impact that lactation and pregnancy has, it does lower the risk of fibroids.
[SPEAKER_00]: Let's get to endocrine disruption chemicals.
[SPEAKER_00]: I have a full podcast on EDCs.
[SPEAKER_00]: If you want to go deeper into that, but let's do a little bit here.
[SPEAKER_00]: So let's start with diet before we go into endocrine disruption.
[SPEAKER_00]: So fruit and vegetable intake, particularly in the black women's health study is inversely associated with fibroid risk.
[SPEAKER_00]: I know it's boring.
[SPEAKER_00]: It's so boring to eat that zucchini and eat a banana.
[SPEAKER_00]: But it's protective against fibroids.
[SPEAKER_00]: Because carrots and oils, the pigments in red, orange and green produce a PS specifically protective.
[SPEAKER_00]: Dairy, this one surprises a lot of people.
[SPEAKER_00]: There's a lot of anti-dairy propaganda online happening at the moment, you could never get me, you would never get me, you would never be able to take away my cheese and full cream marchers and coffees, okay?
[SPEAKER_00]: You can tear it out of my cold hand hands, okay?
[SPEAKER_00]: But in the black women's health study, higher dairy intake was associated with reduced fire-broid risk and that was control for other factors.
[SPEAKER_00]: So how?
[SPEAKER_00]: The proposed mechanisms include calcium,
[SPEAKER_00]: and buturic acid inhibiting smooth muscle proliferation.
[SPEAKER_00]: Note the population here as well.
[SPEAKER_00]: So this isn't necessarily blanket dietary advice, but the anti-dairy dogma in wellness needs a lot of pushback because it's not evidence based.
[SPEAKER_00]: Also adequate vitamin D. So from...
[SPEAKER_00]: food exposure, supplementation, sun exposure, a dietary pattern that's also high in fiber, because if we're excreting Estrodial in our poo, yes, we poo out, 16 oh, H, Estrodial, which is kind of a nasty metabolite over the Estrodial that can be recirculated if we are pooing her out, then she can't recirculate and attach to smooth muscle, myometriol, fibroids and say you need to be really really sensitive to progesterine.
[SPEAKER_00]: What increases the pattern in diet, red meat and processed meat?
[SPEAKER_00]: So one study found that women eating more than one serving of red meat per day had a 70% greater risk of fibres than those eating no meat at all.
[SPEAKER_00]: ham and process meat also shows similar signals here as well, high glycemic load, so high sugar and refined carbohydrate intake is also associated with the increase risk of the black women's health study.
[SPEAKER_00]: So plausibly, via insulin resistance and also inflammation and oxidative stress as well, alcohol, food, additives and highly processed foods.
[SPEAKER_00]: They're all associated with an increase in the risk of development of fibroids.
[SPEAKER_00]: What about fish?
[SPEAKER_00]: So, this is a bit mixed.
[SPEAKER_00]: Italian case control data suggests that it's protective, but when there's a U.S. Great Lakes cohort, they found increased risk.
[SPEAKER_00]: The plausibility and explanation here might be PCB and Mercury contamination and from specific fisheries.
[SPEAKER_00]: So, the bottom line is eat fish, because omega-3s are anti-inflammatory and anti-oxidative stress.
[SPEAKER_00]: And clean up those reactive oxygen species, but you just want to make sure you're eating kind of smaller fish
[SPEAKER_00]: and your mercury exposure.
[SPEAKER_00]: And if you don't want to eat fish, you can have a omega-3 supplement go.
[SPEAKER_00]: I have my never single day.
[SPEAKER_00]: Soy.
[SPEAKER_00]: So despite persisting claims that soy causes or worsens fibroids, most studies do not support this.
[SPEAKER_00]: I really need to do a singular podcast about this or an article or something because the soy hate out there.
[SPEAKER_00]: I don't really understand it.
[SPEAKER_00]: It's not evidence-based as well.
[SPEAKER_00]: Soy is a flavone.
[SPEAKER_00]: They bind weekly at estrogen receptors.
[SPEAKER_00]: and appear to have no consistent effect on fibride risk.
[SPEAKER_00]: I'm going to say that again, soy iso flavones, bind weekly at a estrogen receptors, and appear to have no consistent effect on fibride risk, write it down, write it down, pen and paper, pen and paper.
[SPEAKER_00]: One exception here, though, is that frequent soybean milk consumption in some Asian populations shows a very small positive association.
[SPEAKER_00]: But this is possibly a mark of other dietary or lifestyle factors.
[SPEAKER_00]: coffee and caffeine, the signal is inconsistent and small, so don't worry about it.
[SPEAKER_00]: What about endocrine distracting chemicals?
[SPEAKER_00]: Okay, so this is the big story that's happening with the black women's health study in America at the moment.
[SPEAKER_00]: So endocrine distracting chemicals are compounds that interfere with hormone signaling.
[SPEAKER_00]: By binding to the hormone receptors, altering hormone synthesis or metabolism or changing hormone receptor expressions.
[SPEAKER_00]: So they're all different and there's a long list.
[SPEAKER_00]: VALO, it's BPA, it's replacements of BPA as well, parabens, vannals, organophosphates, flame retardates, PFAs, DDT, other pesticides, DS, nantorial, historical case with DS is one to look up as well.
[SPEAKER_00]: So what's the evidence for fibroids specifically?
[SPEAKER_00]: D-E-H-P is the most studied and most implicated.
[SPEAKER_00]: So there's a metaanalysis of case control studies that has shown a statistically
[SPEAKER_00]: between urinary DEHP metabolites and higher development of fibroid risk.
[SPEAKER_00]: There's also higher urinary phallic concentrations that correlate larger with correlate with larger uterine volume in women undergoing fibroid surgery.
[SPEAKER_00]: BPA has also been shown in cell culture to directly stimulate fibroid growth and organophosphate esters which are flame retardants in furniture and electronics.
[SPEAKER_00]: They also show positive association with fibroid risk and in a mixture of analysis.
[SPEAKER_00]: So where do they come from?
[SPEAKER_00]: So fragrance, personal hair, care products, so anything with fragrance or perfume, chuck it out, don't use it.
[SPEAKER_00]: Soft plaques sticks, especially if you're heating in soft plastics.
[SPEAKER_00]: So food packaging, cling wrap, some water bottles as well.
[SPEAKER_00]: cosmetics and beauty products, nail polish, hairspray, moisturizers, perfume, cash register receipts as well.
[SPEAKER_00]: I know this is really popular, everyone was talking about it online and I was always cringing at it, but unfortunately they were right about that, canned food lining as well, so mostly a BPA free now, but they're also being replaced with BPS, which has similar activity.
[SPEAKER_00]: They're just replacing one poison with another.
[SPEAKER_00]: The vinyl fluorine shower curtains and some children's toys as well.
[SPEAKER_00]: Let's talk about the hair product story.
[SPEAKER_00]: So this is really critically important, especially for black women.
[SPEAKER_00]: So the Boston University Louran Wise Laboratory has been publishing landmark work on this specific trend.
[SPEAKER_00]: The 2012 study established that chemical hair relaxes are associated with increased fibroid risk in black women.
[SPEAKER_00]: A 2025 study extended this to include temporary hair dyes and keratin treatments all associated with increased fibroid risk.
[SPEAKER_00]: So the chemicals specifically of concern here that we usually see in all of these products.
[SPEAKER_00]: are fallates, parabens, fennels, for maldehyde, which is specifically in keratin treatments and Brazilian blowouts and metals.
[SPEAKER_00]: So for maldehyde is a known human-castinogen and an endocrine disruptor.
[SPEAKER_00]: Temporary relaxes in keratin treatments.
[SPEAKER_00]: often contain femaldehyde and femaldehyde releasing compounds that vaporize when heat is applied.
[SPEAKER_00]: So this is a real and specific exposure that disproportionately affects black women.
[SPEAKER_00]: And at six along side, not instead of the systematic and structural factors that drive racial disparity in the development of fibroids.
[SPEAKER_00]: So how can you practically reduce your harm?
[SPEAKER_00]: So avoid fragrance and perfume in personal care.
[SPEAKER_00]: I make my own perfume.
[SPEAKER_00]: I use like a local perfume maker.
[SPEAKER_00]: And she uses amazing hydrosoles.
[SPEAKER_00]: And they all smell incredible.
[SPEAKER_00]: Don't heat food in plastic.
[SPEAKER_00]: Not in a microwave, not in a dishwasher.
[SPEAKER_00]: Okay.
[SPEAKER_00]: Refuse receives when possible or take digital.
[SPEAKER_00]: Fill to your drinking water if you can.
[SPEAKER_00]: Make sure when you use hair chemical treatments minimise the frequency and look for the maldehyde free formulations and ensure your salon is ventilated as well.
[SPEAKER_00]: You don't want to be sitting in a nail salon or a hair salon that just has heaps of chemicals that you're constantly breathing in.
[SPEAKER_00]: You can't eliminate or EDC exposure in modern life, okay?
[SPEAKER_00]: Pick which ones are important to you and stick to them and avoid all the other ones, okay?
[SPEAKER_00]: I like to have my nails done.
[SPEAKER_00]: I know I'm going to copy a bit of black for that, but that's the only thing I do.
[SPEAKER_00]: I don't do anything else, okay?
[SPEAKER_00]: Finally, can you shrink them?
[SPEAKER_00]: Next let's talk about the question that is on every once mine.
[SPEAKER_00]: Can you shrink them?
[SPEAKER_00]: Let's look at some medical surgical and natural options.
[SPEAKER_00]: The short answer here is yes under specific circumstances with specific tools.
[SPEAKER_00]: Let's talk about it.
[SPEAKER_00]: So let's talk about natural spontaneous shrinkage.
[SPEAKER_00]: So fibroids naturally shrink after menopause because there's less estrogen and progesterone around.
[SPEAKER_00]: We also have spontaneous regression during reproductive years that can happen.
[SPEAKER_00]: But it's really uncommon.
[SPEAKER_00]: So some MRI studies of fibroid growth show a mean rate of about 9% per six months in reduction of spontaneous production, but it's really variable.
[SPEAKER_00]: And some grow rapidly, some grow slowly, some regrets.
[SPEAKER_00]: So everyone is different.
[SPEAKER_00]: What about medical shrinkage?
[SPEAKER_00]: Let's talk about G&R H Agnes.
[SPEAKER_00]: So going back to the cascade of events hormonally in your body.
[SPEAKER_00]: So what happens first?
[SPEAKER_00]: G&R H is released from your hyperthalamus and it goes next door to your petuitary and it releases FSH.
[SPEAKER_00]: Then we see an increases as an extra dial.
[SPEAKER_00]: And then that signals to the pituitary.
[SPEAKER_00]: Hey, we have a dominant follicle here with a really good ovum.
[SPEAKER_00]: We're ready to go.
[SPEAKER_00]: And then your hypothalamus will release G and I H again.
[SPEAKER_00]: To the pituitary gland and that will release LH.
[SPEAKER_00]: And then that'll cause ovulation and then we release progesterone.
[SPEAKER_00]: Okay, if we shut down G and I H, we are stopping FSH and LH, so we don't make Estrodial and Progestion.
[SPEAKER_00]: So when we do that, and we use G and I H agonists, so we decrease the ovulation rate in a woman.
[SPEAKER_00]: We generally see fibroid shrink and bleeding can stop.
[SPEAKER_00]: The side effects, though, are induced menopause.
[SPEAKER_00]: So hot flashes, night sweats, mood changes, vaginal dryness, and critically bone density loss with prolonged use because estradiol works with our osteoblast, which make our bone.
[SPEAKER_00]: And if we don't have estradiol around, we have less bone density.
[SPEAKER_00]: So understandably, this is not a long term solution.
[SPEAKER_00]: it's usually used pre-operatively to shrink your fibroids so you have an easier surgery.
[SPEAKER_00]: Alongside that, G&R H medication when you stop that, fibroids can be grow to original size within three to six months.
[SPEAKER_00]: So that's why we're always going to use G&R H Agnes before surgery to remove them so we can stop that from happening.
[SPEAKER_00]: What about combined oral contraceptives, pregestin ID, like the Kylina or the Marina?
[SPEAKER_00]: What about trans-asamic acid and non-steroidal anti-inflammatories?
[SPEAKER_00]: So none of these shrink fibroids, they can all manage symptoms though, so you can bind oral contraceptives, they can manage bleeding through endometrule suppression, then might slightly reduce fibroid growth over time, but it's not going to stop them from being there at all, it's not going to shrink them.
[SPEAKER_00]: your live-energestoral-based marina or kylina that's going to dramatically reduce your bleeding, but again, it's not going to decrease the fibroid size.
[SPEAKER_00]: Transnismic acid is something that we use when we want a woman to stop bleeding so heavily.
[SPEAKER_00]: Again, that's not going to decrease the size of the fibroid, but it's a symptomatic manager.
[SPEAKER_00]: And insates, they reduce your prostate gland and synthesis, and they decrease bleeding modestly.
[SPEAKER_00]: and they can help with period pain, but again, they're not going to decrease the size of fibroids.
[SPEAKER_00]: So there's options for surgical shrinkage and that's usually what's going to be offered to women as you can see from this podcast and here from this podcast.
[SPEAKER_00]: There is a milieu of different options that are going to be given to a women with fibroid that needs to be taken out in generally.
[SPEAKER_00]: The aim is to shrink it before we remove it.
[SPEAKER_00]: So surgical removal of fibroids with uterine prevention is kind of what most women want if they're still in their cycling years and they still haven't had a baby and they want to.
[SPEAKER_00]: So hystereoscopic, so that's going through your cervix, it's day surgery, it's minimal recovery and no external scars so we're just cutting it out.
[SPEAKER_00]: laparoscopic or robotic, that's faster recovery than open surgery, but you know, it's you're going to have incisions in your stomach.
[SPEAKER_00]: Open, so that's for very large fibroid, that's a quite intense surgery, and then if you want to preserve your fertility,
[SPEAKER_00]: Your recurrence rate is around 15 to 30 percent of five years.
[SPEAKER_00]: So generally, once you recover from that surgery and your surgeon gives you the go ahead to have sex, you're going to be encouraged to have a baby.
[SPEAKER_00]: Within five years, because that's, you know, myometric is the considered fatility, sparing gold standard by most guidelines, including Ranskog in Australia.
[SPEAKER_00]: But because of the fibroid, it's kind of impossible to get rid of every single one of those mutated cells, right?
[SPEAKER_00]: Surgeons are amazing, but you know, that's really difficult to absolutely ensure you've removed every single cell.
[SPEAKER_00]: And so that's why recurrence rates are about 15 to 30 percent because there is a risk it can come back.
[SPEAKER_00]: There's also uterine artery embolism, so that's an interventional radiology procedure.
[SPEAKER_00]: So the volume reduction is usually around 40 to 60%.
[SPEAKER_00]: And so that is when there's a catheter placed through the femoral artery to the uterine arteries.
[SPEAKER_00]: and tiny particles are injected into the fibroid to acclude the fibroid blood supply.
[SPEAKER_00]: So that is basically saying to the fibroid, we're going to take away the supply that's fueling this and it causes the fibroid's tuna crows and shrink.
[SPEAKER_00]: And the recovery is much quicker than surgery, post embolism syndrome does exist though.
[SPEAKER_00]: So pain, low-grade fever, fatigue for several days is actually expected as a part of the treatment.
[SPEAKER_00]: And the reintervention rate is 20 to 30% at five years as well.
[SPEAKER_00]: So again, we're still seeing some women coming back with fibroids even after this treatment.
[SPEAKER_00]: MRI guided focused ultrasound is also an option.
[SPEAKER_00]: So that's non-invasive and it's basically, it's very cool.
[SPEAKER_00]: It's high intensity focused ultrasound waves that converge on the fibroid under MRI guidance and that causes thermal collagulation.
[SPEAKER_00]: So that's not a surgery.
[SPEAKER_00]: There's no incisions.
[SPEAKER_00]: There's no anesthesia.
[SPEAKER_00]: beyond mild sedation, it's a day procedure, so you walk out of there, but it's not suitable for all fibres.
[SPEAKER_00]: So it really depends on calcification, number, size, where it is in the body, how easily it's accessible.
[SPEAKER_00]: but that is FDA approved women desiring future fertility.
[SPEAKER_00]: I will say though, with this, the evidence base seems to be a lot smaller than for the other options there are.
[SPEAKER_00]: And finally, we have history rectomy.
[SPEAKER_00]: This is a definitive treatment, no fibroid, no reoccurrence.
[SPEAKER_00]: So I would like to say this is left women who have tried all the other options and there's at high reoccurrence rate.
[SPEAKER_00]: And she's recurred after every single treatment.
[SPEAKER_00]: But unfortunately, this isn't the case, unfortunately, this is offered as first line treatment to women, which I don't think is appropriate.
[SPEAKER_00]: I think it is appropriate if you don't want to reproduce.
[SPEAKER_00]: And it's been offered to you with the ovaries staying intact in your pelvis because there's a huge negative outcome associated with the removal of your ovaries.
[SPEAKER_00]: It puts you in an immediate state of menopause, which is concerning and does have health risk, especially if you're quite young.
[SPEAKER_00]: It should not be the automatic first offer.
[SPEAKER_00]: to a woman with fibroids, but it's really offered quite quickly, especially to older women, and especially for black women as well.
[SPEAKER_00]: So if you are going for a hysterectomy, that's fine.
[SPEAKER_00]: If you're making that choice, just always make sure that they always live in your ovaries.
[SPEAKER_00]: So what are some natural options that do have some evidence?
[SPEAKER_00]: So Ig, CG, green tea.
[SPEAKER_00]: So this is the most exciting, nutraceutical.
[SPEAKER_00]: I think this is everything that Tumorik is trying to be, personally, in a small randomized control pilot trial, 800 milligrams per day of green tea extract.
[SPEAKER_00]: with 45% EEG CG for four months significantly reduced fibroid volume and compared with placebo.
[SPEAKER_00]: Symptons severity also improved as well.
[SPEAKER_00]: That's pretty cool.
[SPEAKER_00]: Cell structure and animal studies also show that EEG CG induces apoptosis of fibroid cells.
[SPEAKER_00]: It also inhibits proliferation and also reduces extracellular and matrix desposition.
[SPEAKER_00]: So that's really cool as well.
[SPEAKER_00]: We're also currently waiting on the friend trial.
[SPEAKER_00]: So this is a multi-center NI-C HD-funded randomized placebo control trial across John Hopkins, Yale, University of Chicago, and other U.S. centers.
[SPEAKER_00]: They are investigating E.G.C.G for fibroids and unexplained for infertility.
[SPEAKER_00]: So this is the largest and best-described fibroid and E.G.C.G trial today.
[SPEAKER_00]: We're still waiting for those results and I think that's going to be very exciting when it comes out.
[SPEAKER_00]: Vitamin D repletion, so we talked about this earlier, right?
[SPEAKER_00]: So our CT evidence supports growth prevention and reduced recurrence as well.
[SPEAKER_00]: So the reasonable target is your vitamin D above, you know, 30 nanograms is what they say if we can get it higher than that, that's probably going to be more optimal, but the dose depends on the baseline, right?
[SPEAKER_00]: So if you have high vitamin D, it's not going to give you that much more of a benefit if you already had optimal vitamin D. But the benefit is going to be a lot if you had low vitamin D. If you know what I mean dietary optimization, eat your veggies, eat your fruit, eat your fiber, eat less red and processed meat, don't drink alcohol, moderate dairy.
[SPEAKER_00]: Okay, it's pretty simple.
[SPEAKER_00]: It's pretty boring.
[SPEAKER_00]: But if you can keep to an 80, 20 diet, you're going to be in the good books.
[SPEAKER_00]: exercise.
[SPEAKER_00]: So the black women's health study again, they found that a 40% reduction with seven hours per week of activity is really impressive.
[SPEAKER_00]: I might be thinking, going to the gym for seven hours a week is crazy, Sarah.
[SPEAKER_00]: You're telling me I've got to go to the gym and lift weights for seven hours a week.
[SPEAKER_00]: No, I'm not saying that, girl.
[SPEAKER_00]: I'm saying, after lunch and dinner, you should go for a 15 minute walk.
[SPEAKER_00]: That's half an hour.
[SPEAKER_00]: And then lift weights for half an hour.
[SPEAKER_00]: I'm saying go with your girlfriends and do a half an hour of vinyasa class on a Sunday.
[SPEAKER_00]: I'm saying go to the beach with your partner and go for a walk with your dog.
[SPEAKER_00]: I'm saying have sex for a couple hours.
[SPEAKER_00]: Okay?
[SPEAKER_00]: There's lots of different things that can be physical activity.
[SPEAKER_00]: Let's finish up with an audit of wellness guarantees, right?
[SPEAKER_00]: So let's go through A to F of what natural things are out there, what supplements and food compounds actually work on fibroids.
[SPEAKER_00]: For grade A, we don't have anything.
[SPEAKER_00]: Okay, so we don't have any significant findings from metronolysis, any systematic reviews that even shows lightly.
[SPEAKER_00]: that it shrinks or can treat vibrates, okay?
[SPEAKER_00]: So there's nothing in grade B.
[SPEAKER_00]: We do have something and it's green tea extracts.
[SPEAKER_00]: So EG, CG, positive pilot R, R, C, T. When that friend's trial comes out and we do find significant findings if it is a finding, it'll move green tea into grade A.
[SPEAKER_00]: Okay?
[SPEAKER_00]: So that large trial is still pending.
[SPEAKER_00]: Currently the most promising natural intervention we have is
[SPEAKER_00]: Then fruit and vegetable rich low red meat dietary patterns, and then also reducing endocrine disrupting chemicals and physical activity, reducing weight is all in B.
[SPEAKER_00]: We've spoken about all of those.
[SPEAKER_00]: What about grade C?
[SPEAKER_00]: So this is a mechanistic plus week clinical evidence.
[SPEAKER_00]: So traditional Chinese medicine, so several Chinese language RCT suggests benefit for symptom management and possibly volume reduction as well.
[SPEAKER_00]: but the methodological quality is really mixed, and you know, so it could benefit, it could also not benefit.
[SPEAKER_00]: I'd also say that traditional Chinese medicine is really amazing, but it's probably giving benefit on the symptomology of fibroids, not treating the fibroids.
[SPEAKER_00]: And the same goes for acupuncture, so small trials suggest some benefit.
[SPEAKER_00]: for fibroid related bleeding and pain, which is really cool.
[SPEAKER_00]: And so if you have fibroids and you're symptomatic and you're waiting for surgery or your treatment, then acupuncture can be really great, but it's not a treatment.
[SPEAKER_00]: NAC as well, it's an antioxidant, so it's small trials and endometriosis are suggesting benefit, but there's extremely limited direct fiber at evidence that we have, but NAC is plausible as a mechanism given the oxidative stress role.
[SPEAKER_00]: Grade D, so mechanistic only and then no meaningful trials have been found to show.
[SPEAKER_00]: any impact at all, Cuckuman also turmeric.
[SPEAKER_00]: So what I've said before, turmeric is really trying to be green tea.
[SPEAKER_00]: Everyone's really obsessed with turmeric, and I was for a while, and now recently I read that in 2002, most of the studies that we really put out that put Cuckuman and turmeric on the map were now being found to be fraudulent in 2026.
[SPEAKER_00]: So more on that, maybe I'll do a little article on that and see what findings are true and what are not.
[SPEAKER_00]: It's really
[SPEAKER_00]: causing quite a fuss in wellness and in academic circles as well, being found for fraud, you know, 10 years, 20 years after you've published these findings and have created an industry is
[SPEAKER_00]: quite concerning, but Cuckuman, it's anti-fibrodic and anti-proliferative in cell culture and animal models, but no human RCT for fibroids has been found.
[SPEAKER_00]: It's safe as an anti-inflammatory, but again, because these studies have been found to be fraudulent, now everything is up in the air.
[SPEAKER_00]: You know, Cuckuman five months ago, if you asked me, it would have been in grade B.
[SPEAKER_00]: But now, it's kind of come down to great date because of everything that's happening and all of that research is now under question.
[SPEAKER_00]: Artigress.
[SPEAKER_00]: Let's move on to by-text.
[SPEAKER_00]: So there's no good evidence for fibroids specifically.
[SPEAKER_00]: Sometimes it's promoted for reducing prolactin or increasing progesterine.
[SPEAKER_00]: The lighter mechanism if real would be theoretically promote fibroid growth, okay?
[SPEAKER_00]: So, ViTeX does increase progesterone.
[SPEAKER_00]: We do have some research to show that post ovulation.
[SPEAKER_00]: It can also increase LH before ovulation, so it's not great.
[SPEAKER_00]: If you're a woman with p-moss and you already have high LH, it's not necessarily going to make you ovulate at all.
[SPEAKER_00]: If you take it after ovulation, it can increase your corpusulidium output of progesterone and support progesterone production.
[SPEAKER_00]: but how would that actually help fibroids?
[SPEAKER_00]: Wouldn't that make fibroids bigger?
[SPEAKER_00]: Because that promotes more progesterone and that's going to increase the size and the rate of growth of a fibroid.
[SPEAKER_00]: So, Vitix, I don't think, is a fibroid intervention at all.
[SPEAKER_00]: Although there is some modest evidence for it being effective for PMS and it can also be effective for your luteal length and also decreasing the length and the severity of bleeding as well.
[SPEAKER_00]: So that's why it's in great detail.
[SPEAKER_00]: DIM, so this is a compound from cruciferous vegetables,
[SPEAKER_00]: Cell-culture data suggests it shifts metabolism estrogen from the 16 alpha hydroxy pathway, which is proliferative, towards the two hydroxy pathway, which is not.
[SPEAKER_00]: So there's no clinical fibroid data.
[SPEAKER_00]: It's really marketed heavily as like an estrogen decreaser, which is true.
[SPEAKER_00]: It is true.
[SPEAKER_00]: It can help your liver get rid of excess estrogen, but again, estrogen isn't normally the culprit in fibroids.
[SPEAKER_00]: Next, we have revisitrol.
[SPEAKER_00]: So just putting this here because everyone talks about it all the time, but there's no cell culture data, there's no human fiber at trials.
[SPEAKER_00]: I can't understand loosely how it could work because it's an anti-inflammatory and it does have some antioxidant impacts as well.
[SPEAKER_00]: They're a better anti-oxidance.
[SPEAKER_00]: Next, let's talk about grade F and it's really interesting because all of the ones that have no supporting evidence and they're often country-indicated by biology are the ones that are most popular.
[SPEAKER_00]: So cast oil packs, they're really heavily promoted, but there's no clinical evidence to show that they shrink fibroids nor affect them at all.
[SPEAKER_00]: So, rickanolyic acid, which is in the cast oil, it does not penetrate skin, it doesn't do anything to your subcutaneous fat,
[SPEAKER_00]: The heat and the pressure is really beautiful for symptomatic pain relief, and it's contraindicated in pregnancy, because cast oil is a urine stimulant, and it can increase your heavy bleeding.
[SPEAKER_00]: So cast oil packs, four fibroids, probably one of the worst things you could do.
[SPEAKER_00]: Seats cycling, they claim that
[SPEAKER_00]: Flax and pumpkin seeds in the follicular phase, and that's some flour and sesame in the luteal phase to balance your hormones.
[SPEAKER_00]: Look, seeds are absolutely nutritionally excellent.
[SPEAKER_00]: And that's the beginning and end of that story, basically.
[SPEAKER_00]: Five word teas.
[SPEAKER_00]: These usually contain like black, strapped molasses, dandelion, red bars, relief, and other marketed blends.
[SPEAKER_00]: Those teas are amazing.
[SPEAKER_00]: They can absolutely help with this symptomology of fibroids.
[SPEAKER_00]: Are they going to decrease your fibroids size or shrink them?
[SPEAKER_00]: Absolutely not.
[SPEAKER_00]: Yoni steaming is that going to help the symptoms?
[SPEAKER_00]: Yes it can.
[SPEAKER_00]: Is it going to shrink your fibroids?
[SPEAKER_00]: Absolutely not.
[SPEAKER_00]: What about enzymes, claim to dissolve fibroids by breaking down the protein?
[SPEAKER_00]: Absolutely no clinical evidence, and the mechanism proposed here also makes no sense at all.
[SPEAKER_00]: If we take an enzyme, taken locally, it does not just seek out your urine fibroids and dissolve them.
[SPEAKER_00]: It does not work that way.
[SPEAKER_00]: And finally, cleanses and elimination diets for fibroids.
[SPEAKER_00]: The evidence base for this is there's no evidence base.
[SPEAKER_00]: Unless what you mean by a cleans is eating less red meat process meat and not drinking and eating more fruits and vegetables.
[SPEAKER_00]: If that's your cleans, then yeah, that's evidence base.
[SPEAKER_00]: If not, then no.
[SPEAKER_00]: What about fibroids and pregnancy?
[SPEAKER_00]: So most pregnancies with fibroids are uncomplicated.
[SPEAKER_00]: How are you sharing to here?
[SPEAKER_00]: So the narrative that any fibroid means high risk pregnancy isn't necessarily accurate.
[SPEAKER_00]: So the literature does show slightly increased risk of complications, but many women deliver healthy babies with fibroids present whether they know about them or not.
[SPEAKER_00]: That being said, miscarriage risk is elevated by about 14%.
[SPEAKER_00]: In women with fibroids compared to 7.6% with those without, in some datasets.
[SPEAKER_00]: So, again, it's heavily influenced by size, number, location.
[SPEAKER_00]: There's a two to threefold risk of increased fetal, mal-presentation, placenta previa, pre-term birth, and placenta abruption, and cesarean delivery.
[SPEAKER_00]: So, from baseline, larger fibroids, over five centimeters, multiple fibroids, sub-mucosal location, and lower uterine segment location,
[SPEAKER_00]: and postpartum hemorrhage is also really riskier here as well.
[SPEAKER_00]: So that's something that you need to know going into a pregnancy with a fibroid.
[SPEAKER_00]: Those things can be taken care of.
[SPEAKER_00]: There is medical management for all of that to decrease your risk and make sure your care team is on top of it.
[SPEAKER_00]: You might be thinking, well, during pregnancy, estrogen and progesterone are at their highest points.
[SPEAKER_00]: You might be thinking that's going to increase your fibroid size.
[SPEAKER_00]: Well, despite that enormous rise, most fibroids actually don't grow significantly.
[SPEAKER_00]: So this is a real persistent misconception.
[SPEAKER_00]: Some fibroids, so they tend to grow in that first trimester, but then they stabilize in the second.
[SPEAKER_00]: and a minority undergo regeneration.
[SPEAKER_00]: So growing out growing their blood supply and causing significant pain around 20 to 22 weeks, if that's treated conservatively, that can be taken care of as well.
[SPEAKER_00]: So there is risk, I'm not going to say there isn't risk, but it can be managed medically.
[SPEAKER_00]: Okay, but I have a fibroid and I want to fall pregnant.
[SPEAKER_00]: So here a few things that you might want to consider
[SPEAKER_00]: intervention-wise, pre-pregnancy.
[SPEAKER_00]: So if you have a sub-mucosal fibroid that's just stored in your internal cavity, you might want to remove that because that's going to decrease your fertility rate and it can increase your miscarriage rate as well and it can increase that.
[SPEAKER_00]: All those are the risks in pregnancy that I just spoke about before.
[SPEAKER_00]: If you have large intermural fibroids that distort the cavity as well, all of those risks still apply.
[SPEAKER_00]: A fibroids that don't distort the cavity, just leave them alone, usually they're fine.
[SPEAKER_00]: So that's the Ranscog position on all of those different fibroids.
[SPEAKER_00]: But of course, go to your healthcare provider and look at your fibroid and figure out what the best healthcare plan for you is.
[SPEAKER_00]: So hopefully you enjoyed this podcast.
[SPEAKER_00]: Hopefully you had just spelled quite a lot of myths around fibroids.
[SPEAKER_00]: Normalized my fibroids were certain degree and made them a little bit less scary.
[SPEAKER_00]: And you know, the boring things that you do every single day give you the best prevention on fibroids.
[SPEAKER_00]: Thank you so much for taking the time out of your busy day to listen to this episode.
[SPEAKER_00]: If you loved it, please remember to like, subscribe and send to a loved one.
[SPEAKER_00]: If you want to learn more from our quorum and please check out the website at arquorum.com.au where you can find a pothora of offerings like charts, masterclasses, courses and organic clothing.
[SPEAKER_00]: You can also head over to patreon.com slash archwomen or substack.com slash archwomen to join the community.
[SPEAKER_00]: I hope you have a really beautiful morning, afternoon or evening wherever you are in the world and I will see you on the next episode.