FIBROID UTERUS

• The most common benign tumor of uterus
• The most common cause of hysterectomy now days.
• Peak incidence during the reproductive age; between 35 – 45 years
• Predominantly an oestrogen dependent tumor.
• They do not occur before menarche.
• After menopause, the fibroid regress
• Increases growth of fibroid can be seen in pregnancy & causes several complications.

Types of fibroids

• Intramural / Interstitial
• Subserous
• Submucous
• Cervical fibroids
• Broad ligament fibroids
• Intramural fibroids lie within the myometrial wall of the uterus. Subsequently, they grow outwards or inwards.
• Subserous fibroid – the intramural fibroid grows outward towards the peritoneal cavity and is covered by peritoneum.
• Submucous fibroid – the intramural fibroid grows into the uterine cavity and is covered by the endometrium. They produce maximum menstrual problems

• Nulliparity
• 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)
• Dysmenorrhea
• Infertility
• Pressure symptoms – constipation, dysuria, retention of urine, increased frequency of micturition etc.
• Dyspareunia
• Pregnancy-related problems (miscarriage, preterm labour, IUGR, recurrent pregnancy loss)
• Lower abdominal or pelvic pain
• Abdominal enlargement

• USG - An abdominal, transvaginal or pelvic USG
• Laparoscopy
• Hysteroscopy
• An endometrial biopsy
• Hysterosalpingography

• 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 radio frequency ablation
• Hysterectomy
• Treatment for infection and anemia
• Medications
• Oral contraceptive pills
• GnRH agonists
• Anti-hormonal drugs (mifepristone)
• Anti-fibrinolytics
• Non-steroidal anti-inflammatory agents
• Progesterone receptor modulator
• Surgery
• Myomectomy
• Hysterectomy
• Uterine artery embolization
• Uterine artery ligation
• Radio frequency ablation
• Endometrial ablation

Ayurvedic Management

• Can be correlated with Garbhashya granthi / arbuda
• So basically the treatment principles should be Vata Kapha Samana drugs which are having specific action on Mamsa & Meda and having Lekhana property.
• If heavy bleeding is associated, Pitta also should be considered
• But in all cases, Raktha shodhaka should be considered, as Raktha is directly involved in the pathogenesis.

Internal Medicines

• Varanadi Kashaya
• Chitraka grandyadi Kashaya
• Munditaka Kashaya
• Decoction of Varuna twak & shigru
• Kanchanara Guggulu
• Shigru Guggulu
• Medohara Guggulu
• Gomutra Hareetaki
• Dasamoola Hareetaki
• Trayantyadi Kashaya – if bleeding fibroids
• If patients is in bleeding phase, we have to give hemostatic treatment first
• After stoppage of bleeding, we can give the above said medicines, according to the condition of patient

External Procedures

• Virechana can be done, especially in bleeding fibroids
• Vamana
• Vasti is better option – can try Yoga Vasti, Kala Vasti & Karma Vasti
• For Vasti, Kashayas having Vata kapha hara properties, Lekhana properties, Sothohara properties can be used
• Erandamoola Kashaya, Dasamoola Kashaya, Punarnava Ashtaka Kashaya, Varuna Shigru Kashaya, Lekhana Mahakashya etc can be used
• For Sneha, Varanadi Ghrita, Pippalyadi Anuvasana Taila, Tila Taila, Dasamoola Taila etc can be used
• In bleeding fibroids, Guggulu Thiktaka Ghritam, Maha Thiktaka Ghrita etc. can be used
• For Uttara Vasti also the above said Sneha preperations and Lekhana Mahakashya siddha Taila can be used.