FIBROID UTERUS

• Fibroids are benign hormone-sensitive uterine neoplasms and the most common cause of hysterectomy 
• Peak incidence during the reproductive age; between 35 – 45 years
• It is predominantly an oestrogen dependent tumor and does not occur before menarche and the fibroid regress after menopause
• Increased growth of fibroid can be seen in pregnancy and can cause several complications

Types of fibroids

• Intramural / Interstitial - lie within the myometrial wall of the uterus. Subsequently, they grow outwards or inwards
• Subserous - localized in the outer uterine wall and grows outward towards the peritoneal cavity and is covered by peritoneum
• Submucous - localized directly below the endometrial layer ( uterine mucosa)
• Cervical fibroids
• Broad ligament fibroids

• Nulliparity
• Early menarche
• Obesity
• PCOS
• Family history
• High-fat diet 
• Genetic alterations
• Oral contraceptives

• Most of the fibroids are asymptomatic and diagnosed accidentally during USG, laparoscopy, etc.
• Menstrual irregularities – Menorrhagia, Metrorrhagia (more common with subserous fibroids)
• Dysmenorrhoea
• Infertility
• Pressure symptoms – constipation, dysuria, retention of urine, increased frequency of micturition, etc.
• Dyspareunia
• Reproductive abnormalities (miscarriage, preterm labour, IUGR, recurrent pregnancy loss)
• Lower abdominal or pelvic pain
• Abdominal enlargement

• USG - Abdominal, transvaginal or pelvic USG
• Laparoscopy
• Hysteroscopy – to access submucosal fibroids
• Endometrial biopsy
• Hysterosalpingography 
• MRI – to evaluate uterus and ovaries for potentially complicated surgical cases and visually differentiate between leiomyomas, adenomyomas, and adenomyosis

For symptomatic fibroids 

• Medication to control symptoms
• Medication aimed at shrinking tumours
• Ultrasound fibroid destruction
• Surgically aided methods to reduce blood supply of fibroids
• Myomectomy or radiofrequency ablation
• Hysterectomy
• Treatment for infection and anemia

 Medications-

• Oral contraceptive pills

• GnRH agonists
• Anti-hormonal drugs (mifepristone)
• Antifibrinolytics
• Non-steroidal anti-inflammatory agents
• Progesterone receptor modulator 

Surgery 

• Myomectomy
• Hysterectomy
• Uterine artery embolization
• Uterine artery ligation
• Radiofrequency ablation
• Endometrial ablation

Ayurvedic Treatment

Internal Medicines

• Bleeding phase- give haemostatic treatment initially

Later

• Varanadi Kashaya
• Chitraka grandyadi Kashaya
• Munditaka Kashaya
• Saptasara kashaya
• Trayantyadi Kashaya – in bleeding fibroids
• Decoction of Varuna twak + shigru
• Kumaryasava
• Abhayarishta
• Asokarishta
• Kanchanara Guggulu
• Chandraprabha vati
• Gomutra Hareetaki
• Dashamoola Hareetaki

Procedures

• Snehana - Varanadi Ghrita, Pippalyadi Anuvasana Taila, Tila Taila, Dashamoola Taila 
• In bleeding fibroids- Guggulu Thiktaka Gritha, Maha Thiktaka Gritha 
• Vamana
• Virechana - in bleeding fibroids
• Vasti - Erandamoola Kashaya, Dashamoola Kashaya, Punarnavaashtaka Kashaya, Varuna Shigru Kashaya, Lekhana Mahakashya 
• Uttara Vasti – above said Sneha preparations and Lekhana Mahakashya sidha Taila