Treatment of Uterine Fibroids Based on Allopathy and Indian System of Medicine

Uterine fibroids are considered as non-cancerous growth of uterus. According to Ayurveda it is mostly a kapha-accumulation disorder, but often involves pitta and vata displacements also, in which case the patient may be considered as pre-cancerous. Therefore, treatment must be deep-acting to balance the tri-dosha and must be sufficiently sustained over time to eradicatedslow-moving kapha. In this article the causes, complications and treatment options in western system of medicine and Indian system of medicine has been discussed in detail.


Introduction
Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer. Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary-they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size 1 . Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage. As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. In women who have symptoms, the most common symptoms of uterine fibroids include [1]: Heavy menstrual bleeding. • Prolonged menstrual periods -seven days or more of menstrual • bleeding.
Pelvic pressure or pain.

Constipation. •
Backache or leg pains. • Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into surrounding tissue, causing pain and, rarely, fever. Fibroid location, size and number influence signs and symptoms:

Submucosal Fibroids: •
Fibroids that grow into the inner cavity of the uterus (Submucosal Fibroids) are more likely to cause prolonged, heavy menstrual bleeding and are sometimes a problem for women attempting pregnancy.

Sub serosalFibroids: •
Fibroids that project to the outside of the uterus can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing a pressure sensation, or on your spinal nerves, causing backache.

Intramural Fibroids:
• Some fibroids grow within the muscular uterine wall (Intramural Fibroids). If large enough, they can distort the shape of the uterus and cause prolonged, heavy periods, as well as pain and pressure [2].

Causes
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors: Genetic Changes: Many fibroids contain changes in genes that differ from those in normal uterine muscle cells. There's also some evidence that fibroids run in families and that identical twins are more likely to both have fibroids than nonidentical twins.
Hormones: Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

Other Growth Factors: Substances that help the body maintain
tissues, such as insulin-like growth factor, may affect fibroid growth.

Risk Factors
There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors that can have an impact on fibroid development include: Heredity: If your mother or sister had fibroids, you're at increased risk of developing them.
Race: Black women are more likely to have fibroids than women of other racial groups. In addition, black women have fibroids at younger ages, and they're also likely to have more or larger fibroids.
Other factors: Onset of menstruation at an early age, having a diet higher in red meat and lower in green vegetables and fruit, and drinking alcohol, including beer, appear to increase your risk of developing fibroids

Complications
Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss.

Pregnancy and Fibroids [2]
Fibroids usually don't interfere with conception and pregnancy. However, it's possible that fibroids could cause infertility or pregnancy loss. Submucosal fibroids may prevent implantation and growth of an embryo. In such cases, doctors often recommend removing these fibroids before attempting pregnancy or if you've had multiple miscarriages. Rarely, fibroids can distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes.

Other Imaging Tests
If traditional ultrasound doesn't provide enough information, your doctor may order other imaging studies, such as [3]:

Magnetic Resonance Imaging (MRI): This imaging test can
show the size and location of fibroids, identify different types of tumors and help determine appropriate treatment options.
Hysterosonography: Hysterosonographyalso called a saline infusion sonogram, uses sterile saline to expand the uterine cavity, making it easier to get images of the uterine cavity and endometrium. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound.
Hysterosalpingography: Hysterosalpingography (his-tur-osal-ping-GOG-ruh-fee) uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Your doctor may recommend it if infertility is a concern. In addition to revealing fibroids, it can help your doctor determine if your fallopian tubes are open.
Hysteroscopy: For this, your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. Your doctor then injects saline into your uterus, expanding the uterine cavity and allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes.

Treatment of Uterine Fibroids in Western System of Medicine [4]
There's no single best approach to uterine fibroid treatmentmany treatment options exist. If you have symptoms, talk with your doctor about options for symptom relief.

Watchful Waiting
Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that's the case for you, watchful waiting could be the best option. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly-or not at all-and tend to shrink after menopause, when levels of reproductive hormones drop.

Medications
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:

Gonadotropin-Releasing Hormone (Gn-RH) Agonists:
Medications called Gn-RH agonists (Lupron, Synarel, others) treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a Gn-RH agonist to shrink the size of your fibroids before a planned surgery. Many women have significant hot flashes while using Gn-RH agonists. Gn-RH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.

Progestin-releasing Intrauterine Device (IUD): A progestin-
releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn't shrink fibroids or make them disappear.
Other Medications: Your doctor might recommend other medications. For example, oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids. Your doctor also may suggest that you take vitamins and iron if you have heavy menstrual bleeding and anemia.

MRI-guided Focused Ultrasound Surgery (FUS) is:
A noninvasive treatment option for uterine fibroids that preserves your uterus, requires no incision and is done on an outpatient basis.

Performed while you're inside an MRI scanner equipped
with a high-energy ultrasound transducer for treatment. The images give your doctor the precise location of the uterine fibroids.
When the location of the fibroid is targeted, the ultrasound transducerfocuses sound waves (Sonications) into the fibroid to heat and destroy small areas of fibroid tissue.
Newer technology, so researchers are learning more about the long-term safety and effectiveness. But so far data collected show that FUS for uterine fibroids is safe and effective.

Minimally Invasive Procedures
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include: Uterine Artery Embolization: Small particles (Embolic Agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised.

Myolysis:
In this laparoscopic procedure, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids. Myolysis is not used often. Another version of this procedure, radiofrequency ablation, is being studied.

Laparoscopic or Robotic Myomectomy: In a myomectomy,
your surgeon removes the fibroids, leaving the uterus in place. If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments. Robotic myomectomy gives your surgeon a magnified, 3-D view of your uterus, offering more precision, flexibility and dexterity than is possible using some other techniques.
Hysteroscopic Myomectomy: This procedure may be an option if the fibroids are contained inside the uterus (Submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.

Endometrial Ablation and Resection of Submucosal
Fibroids: This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow. Typically, endometrial ablation is effective in stopping abnormal bleeding.

Risk of Developing New Fibroids
For all procedures, except hysterectomy, tiny tumors (Seedlings) that your doctor doesn't detect during surgery could eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence rate. New fibroids, which may or may not require treatment, also can develop.

Treatment of uterine fibroids in Indian system of medicine[6]
According to Ayurveda, a uterine fibroid or raktagulma is caused by over-production of improperly formed kapha and aggravated Apana vata. Due to excessive mental stress, long-term emotional suppression, lack of exercise and the consumption of kapha and vata -exacerbating foods (particularly devitalized junk food, wheat, refined sugar and excess dairy), the digestive are gets vitiated and dushita kapha(or improperly formed, nonviable kapha) is produced.This dushita kapha gets carried by vata into the reproductive system where it is unable to conduct its normal physiological functions. Instead it accumulates, blocks the movement of Apana vata and gets pushed by vitiated vata into the muscle tissue of the uterus. As a result, dysfunction in cellular intelligence (Prana) of the muscle tissue develops, leading to abnormal tissue metabolism and growth, i.e. the formation of one or several deep-seated, expansive and immovable gulmas (Broid Tumours). Uterine fibroids are considered mostly a kapha-accumulation disorder, but often involve pitta and vata displacements also, in which case the patient may be considered as pre-cancerous. Therefore, treatment must be deep-acting to balance the tri-dosha and must be sufficiently sustained over time to eradicated slow-moving kapha.The fibroids can be dissolved by diet, lifestyle changes and Yoga.
Diet: Diet for the patient of uterine fibroids should be kapha-soothing and perhaps also pitta-pacifying, depending upon the bleeding patterns.Bitter, pungent and astringent foods are favored to support the metabolism in reducing its tendency to form fibrotic cellular changes from kapha and ama.Dietary changes should reflect an increase in whole foods and fiber, and a decrease in saturated fats and alcohol consumption.
Lifestyle Changes: Lifestyle should be aimed to reduce kapha, one should be active before sunrise. The earlier the rising time, the quicker kapha can metabolize itself. Self-massage with a minimal quantity of light oil such as sunflower oil can helps to invigorate the body. Exercise, beginning gradually and becoming more vigorous over a few months is advocated.
Yoga: Give emphasis to yoga asanas that focus on the first and second chakras. Poses such as the Cobra, Bow, Boat, Mahamudra and Gentle Spinal Twists are helpful. Postures that focus on the cardio-pulmonary chakra, such as Cow, Lion and Child help remove the psycho-emotional root causes of uterine fibroids in the heart. Sun salutations bring positive activity to all chakras and may be useful if pitta is not elevated. These postures are best learned from an experienced yoga teacher.
Plant like Kumari, Shud Guggulu, Neem, Ashok, Manjistha are useful, Various preparations such as churnas, asavas, arista's, decoctions, etc. can be chosen. Uttara basti (Douche) with a decoction of 2 heaping tsps. each of Ashoka and neem can be cooked for 5 minutes, covered, cooled and strained. To administer, add 1/3 cup aloe gel. Warm castor oil packs applied to the lower abdomen will help to 'melt' the fibroids and retract the kapha via ApanaVayu. Massage Pure, Cold-Pressed Castor Oil daily to lower abdomen around naval area in a circular motion is also helpful.

Withania somnifera(Ashwagandha)
The ancient ayurvedic herb ashwagandha is a multiple benefit herb. It was beneficial effects over the complete human body in a natural way. Ashwagandha helps in cases impotency, stress, constipation, rheumatism and many more chronic ailments. A look at these disorders tells us that they are all related to our life style. The increase in stress and manifold decrease in a healthy diet and lifestyle leads to stress induced disorders including many neurological disorders. People usually complain of stress, fatigue, memory and bodily weakness. Most of us face issues of low stamina and endurance power.
Ashwagandha herb plays a vital role in such cases. It is a great antioxidant and has anti-inflammatory properties. It helps to promote overall well-being of the body and nourishes it with strength and immunity. Apart from these, the ayurvedic herbal supplement for work out has potential powers to nourish the brain to make the functioning of the brain quicker and sharper. It has dynamic results on the male sexual system as it facilitates quicker and longer lasting erections.

Curcuma longa(Curcumin)
Owing to its rich medicinal properties, curcumin is a widely used herb in case of cancer. Many malignant cancers have found their management in curcumin. Anti-oxidants present in the herb reduce the free-radicals from the body thereby improving the health and immunity. Curcumin herb has rich anti-diabetic properties that make it a wonderful herb to use for diabetic patients. It is a famous Chinese medicine to relieve digestive and liver related diseases. Its anti-inflammatory properties make it a strong herb for various allergies, infections and inflammations. The herb has the power to fight against toxins and infections owing to its rich antibiotic properties. It is used in many cosmetics dues to its beneficial actions on the skin. We use curcuma longa to prepare curcumin capsules.

Commiphora mukul(Guggul)
Guggul has highly potent rejuvenating properties. It revitalizes cells and therefore rejuvenates them. Its purifying properties as well as lipid-regulating properties make it a wonderful herb for many health tonics. It is useful for people who have low hemoglobin and are anemic. It is useful in many heath conditions as it has proved its versatility in several conditions. The effect it has on cholesterol and triglyceride levels indirectly protects the heart from atherosclerosis. This property of the Guggul ayurvedic herb helps to prevent the oxidization of cholesterol and therefore control the subsequent hardening of the arteries. The herb is beneficial for hypothyroidism related disorders. The herb promotes the metabolism and therefore aids in weight loss. Guggul is used in the preparation of kachnaar guggul.

Asparagus racemosus(Shatavari)
The botanical name of shatavari is Asparagus racemosus. The herb has been used for its multiple health benefits over centuries. Its medicinal properties have worked well for nervous and gastric disorders. Ayurvedic physicians have used its beneficial effects for improving female health and female sexual system since centuries. Its main sphere of action is on the female sexual system where it helps to increase the libido thereby helping improve confidence and self-esteem. The usual symptoms seen in women are irritation over petty issues, stress from work or due to other emotional factors, decreased interest and desire for sexuality and low energy complains in performing daily activities. They usually complain of feeling tired all day or the lack of stamina. Shatavari herb helps improve stamina and energy levels in women. It shows wonderful action on the female libido and enduring power that increases self-respect and confidence. Shatavari is used in the preparation of Naari kalyan churna.

Bacopa monneiri(Brahmi)
The brahmi herb is famous for its magnificent properties.
A few of its astonishing effects have been proved on conditions like Parkinson's and Alzheimer's. It is used by physicians for stress, post-natal depression, anxiety, add and epilepsy. It is a major product of many a memory tonic. Stress, anxiety, menstrual disturbances, hair loss and fatigue are a few conditions where the herb has shown positive effects. These anti-oxidants remove the toxins from the body nourishes the blood cells. Another wonderful action of the herb is on the nervous system wherein it works to increase the coordination between the nervous system components thereby increasing the brain functioning. It is therefore used as a brain tonic. For its action on controlling the anxiety of the nervous system the ayurvedic herb is used as a tranquilizer. The actions of the Brahmi herb over the brain area make it a wonderful tonic to help enhance the mental capabilities of the individual. It affects both the short and the long-term memory. It promotes a relaxed state of mind and nerves, spreading calmness. Brahmi is used in naari kaliyan churna.
There are certain natural remedies for uterine fibroid using Aloe vera.

Ingredients
Aloe vera • gel / pulp -30 g Cumin seeds powder -3 pinches • Turmeric powder -3 pinches • Sugar candy powder -as needed • Preparation Put all the above in a glass, add half cup of water, and mix well to make juice.

Usage
Drink it. It will cure the diseases of uterus.
By mixing 2 -3 tea spoons of turmeric powder and 5 handful neem leaves in water, it results in a paste form. By Appling this paste thickly in the pelvic region for half an hour will help removing fibroids.

Treatment of Uterine Fibroid in Homeopathy
Calcarea carbonica is an excellent homeopathic cure for fibroids. This medicine can be used by women in whom the menses last for too long a duration and the flow is profuse. The excessive flow of menses may result in infertility. The women requiring this medicine feel an extreme chill and their feet remain excessively cold during the bleeding from uterus.It is also suited for women who are overweight.
Thlaspibursa-pastorisis yet another natural homeopathic medicine for treating fibroid uterus. This medicine can be pre-scribed in the cases wherein the menses appear very frequently, and at short intervals. In most cases, the patient has not yet recovered from one period and the next period starts. The severe cramping pain in uterus and back during menses can also be treated with this medicine.
Trillium pendulum is used in homeopathic treatment of those cases of fibroid where the excessive bleeding from uterus is accompanied by fainting spells. The characteristic color of menstrual blood is bright red and this is a major criterion for this medicine to be used in fibroid cases.
Fraxinusamericana is a natural homeopathic medicine for treating fibroid where excessive bearing down sensations accompany the menstrual flow. This medicine is also effective if cramps in feet accompany the menstrual bleeding.
Homeopathic remedy Calcareafluorica works effectively for treating the fibroids that are very hard and large in size.

Homeopathic medicines for treating Menorrhagia (Excessive/prolonged bleeding from uterus) in fibroid uterus cases: 7
Ferrummetallicum is a wonderful homeopathic medicine to control excessive bleeding from uterus due to fibroid. This medicine gives excellent results in cases where excessive blood of pale and watery character flows from uterus. Ipecacuanha is yet another natural Homeopathic medicine for treating menorrhagia in fibroid cases. For this medicine to be used in menorrhagia, the main criterion is a profuse flow of bright red blood from uterus along with a persistent nauseating feeling. The homeopathic remedy Kali Carbonicum can provide relief in cases where bleeding from the uterus continues to take place for too long a period and the blood is corroding / acrid in nature. This medicine can also relieve the extreme backache during bleeding from the uterus, which gets better by sitting or pressure. Another effective natural homeopathic medicine for controlling menorrhagia that needs to be mentioned here is Ammonium carbonicum. This medicine suits those cases of menorrhagia where the menstrual blood is black, clotted and extremely profuse. The severe pain in thighs with a feeling of extreme fatigue during menorrhagia can also be treated with this medicine.

Homeopathic medicines for treating Metrorrhagia (Bleeding in between menses) in fibroid uterus cases:
Homeopathic remedy Sabina is a well indicated medicine for treating metrorrhagia in fibroid patients where bleeding from uterus of partly fluid and partly clotted nature occurs on least motion and a sexual excitement accompanies it. Another medicine, Hamamelisvirginica, is a natural homeopathic medicine used in treatment of metrorrhagia in fibroid where slight straining or over exertion brings on the bleeding from uterus. The blood from uterus is dark colored and flows without any pain in patients who require this medicine. Ustilagomaydis is also a natural homeopathic remedy for treating inter-menstrual bleeding in fibroid uterus wherein a slight provocation brings on the flow. The characteristic of blood indicating a requirement of this medicine is that the blood is dark and clotted, and forms long black strings. Homeopathic remedy Cyclamen europaeum also gives good results in cases where migraine symptoms accompany the bleeding of black clotted blood from fibroid uterus in between periods.

Magnesium Phosphoricum and Pulsatilla-Homeopathic Medicine for Uterine Fibroids -for treating Dysmenorrhea (Pain during menses).
Magnesium Phosphoricum is an excellent homeopathic remedy to relieve the cramping pains in uterus during menses in fibroid cases. The patients who require this medicine feel better by applying warmth or pressure on the uterine region during menses. The medicine Pulsatilla Pratensis is a natural homeopathic medicine that works well in cases where the pain in the uterus is so severe that it compels the affected woman to cry out; the pain is accompanied by nausea and chilliness.

Homeopathic medicines for treating pressure symptoms on urinary bladder and rectum in fibroid cases:
Erigeron is a very well regarded natural homeopathic remedy for treating pressure symptoms in fibroid cases where violent irritation of bladder and rectum accompanies excessive bright red bleeding from uterus. Homeopathic medicines Bryonia Alba and Nux Vomica are both equally effective medicines for treating constipation due to pressure on rectum by the fibroid. Bryonia Alba can be given to those patients who suffer from a condition in which the stool is very hard, dry and is passed with great difficulty. Nux Vomica can be prescribed in those cases where the patient complains of constant desire to pass stool due to pressure of fibroid on rectum, but is able to pass out only a little at time. Homeopathic medicines Sepia Officinalis and Thuja Occidentalis are very useful medicines in treating pressure symptoms on urinary bladder due to fibroid. Sepia Officinalis works well I cases where the patient complains of frequent urination due to constant pressure on the bladder. The patient requiring this medicine has to hasten to urinate and has bearing down pains in uterus; also, the urine is very offensive. Thuja Occidentlis is a natural homeopathic remedy for patients of fibroid who mainly complain of difficulty in emptying the whole bladder at one time and have to urinate five to six times for attaining a satisfactorily empty bladder.

Homeopathic medicines Cinchona officinalis and Ferrumphosphoricum for treating Anemia in fibroid patients:
Both Cinchona Officinalis and Ferrum Phoshphoricum are excellent natural Homeopathic medicines that help in improving the Hemoglobin count in patients of fibroid who have become excessively anemic due to extreme blood loss during menses.

Uterine Fibroids Homeopathic Treatment
Fibroids are not in any way associated with an increased risk of uterine cancer, and tend to shrink after the menopausal period sets in in a woman. This is due to a drop in the reproductive hormone level in the woman at this stage. Homeopathic remedies are natural and completely safe, with no side effects. They work by balancing the hormone level in the body and shrinking the fibroids. The length of treatment varies from woman to woman and essentially depends on the size and number of fibroids. Homeopathy, being a holistic treatment method, not only aids the treatment of the discomforts caused by uterine fibroids but also has a positive effect on the overall health of the woman.

Conclusions
Uterine fibroids are benign tumor growths that originate from the muscle layers of the uterus, and are almost always non-cancerous. Depending on the symptoms the treatment has to be taken. All the time surgery is not required. It should be given last preference in the treatment of uterine fibroid. In this article, various alternative approaches and therapies were discussed in detail to eliminate the problems associated with fibroid.