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CASES MATERIA MEDICA GENERAL ARTICLES ABSTRACT MISCELLANEOUS Q & A

Uterine Fibroids: A Clinical Study with USG Follow-up
NATIONAL JOURNAL OF HOMOEOPATHY 2003 May / Jun VOL V NO 3.
Dr Girish Gupta
Dr Naveen Gupta
Dr Vijay Singh
Dr (Mrs) Deepa Bisht

ABSTRACT
A total of two hundred and seventeen (217) cases of Uterine Fibroids (Single and Multiple) were registered and available for proper followup of treatment. Analysis was made to assess the percent response in each case following treatment with Homoeopathic remedies at Gaurang Clinic and Centre for Homoeopathic Research, Lucknow (GCCHR) till December 31, 2002. Timely diagnosis by ultrasonography followed by treatment with Homoeopathy showed excellent response in significant number of cases avoiding surgery which has been the lone option in modern system of medicine. After homoeopathic treatment, seventy four (74) patients were cured, twenty one (21) patients were best improving, showing more than 50 % reduction in the size of fibroid, sixty four (64) patients showed significant improvement, thirty one (31) maintained status quo and twenty one (21) patients did not improve. Status could not be reliably evaluated in four (4) (01.85%) cases due to confusing Ultrasonography reports. Two (2) (00.92 %) cases were of Nabothian Cysts and both of them were cured. The overall results of this study are encouraging and opens new vistas for Homoeopaths to treat patients of Uterine Fibroid with confidence.

INTRODUCTION
Uterine fibromyoma are benign growths in the uterus (subserous, intramural, submucous). Fibroids may occur at any age usually from menarche till menopause but becomes most evident during reproductive and postmenopausal period. The peak age of incidence is during 35 - 45 years of age (Dawn 1990). Novak in 1979 reported it in a young girl of 11 years. After menopause, the tumour may or may not regress spontaneously but never develops a fresh. It also delays menopause. Polymenorrhoea, metrorrhagia, intermenstrual bleeding, gradual swelling of abdomen, dull ache may be the presenting symptoms. However, pressure symptoms such as frequency and retention of urine, oedema of legs may be present but in some cases there may be no symptoms (Dawn 1990).

Although no definite relation is noticed between parity and Uterine fibroids, the patient may be of low parity (either nulliparous or with 1-2 children). The occurrence of uterine fibroid is on the increase in modern living due to increasing intervention in normal reproductive life of a woman. Before advent of different unnatural devices of family planning like contraceptive pills and IUCD, the prevalence of such type of unnatural pelvic growths was very low. Emergence of diagnostic tools like Ultrasonography and CT. scan etc has made the diagnosis easier. Earlier, before advent of these investigative modalities, majority of cases remained undetected.

In modern system of medicine the treatment of Uterine fibroids is chiefly surgical removal of the growth or of the uterus in its entirety depending upon the extent of the lesion and the desire of the woman to retain reproductive ability. Many cases deferred surgery owing to poor general health, advanced age, presence of diabetes and/or hypertension and repeated laparotomy conducted in the past for other surgical conditions. Surgery was the only choice. There are many remedies in the Homoeopathy which cover the signs and symptoms simulating uterine fibroids. There has been sporadic reporting in the Homoeopathic journals about successful treatment of such problems in individual cases. Such cases were neither scrutinized by modern diagnostic gadgets nor reproduced repeatedly to make them acceptable to modern medical scientists.

INCIDENCE
The incidence of uterine fibroid among gynecological patients in England was 3.3 %. Haines in 1975 reported that about one - tenth (1/10th) of all gynaecological patients in England suffer from fibroids. Negroes get fibroids three times more than whites (Dawn 1990).

OBJECTIVE
Homoeopathic physicians all over the world have reported cure by Homoeopathic medicines in the patients of uterine fibroid. There are umpteen number of drugs in Homoeopathic system of medicine which could be prescribed on holistic basis. These claims, however, have neither been scientifically assessed nor published. To prove or disprove such claims a methodical study was undertaken at GCCHR, which is still continued, to critically assess the efficacy of Homoeopathic drugs in patients of uterine fibroid as well as to establish the predisposing and causative factors, age group more prone to this disease.

MATERIALS AND METHODS
1. Patients
: A total of two hundred and seventeen (217) women suffering from Uterine Fibroids (Single or Multiple) were registered and available for proper follow - up at G C C H R till December 31, 2002. These cases were analyzed to assess the percent response of Homoeopathic drugs in cases of Uterine fibroids.

2. Ultrasonography
: Ultrasonography was the main parameter to confirm the diagnosis and to assess the response of treatment. In most cases it was repeated every 3 months. In few cases, ultrasonologist and their machine remained the same and in other cases both were changed just to have cross check and to remove any bias element in their reporting.

3. Repertorisation
: All cases of Uterine Fibroids were repertorised using Hompath.

4. Software
: An indigenous software was developed by Computer Programmer to assess the percent response in the patients of Uterine fibroid after Homoeopathic treatment.

5. Homoeopathic remedies
: The main drugs employed in the present study are mentioned with individual cases in the flow chart.

FEW CASE REPORTS OF MODEL CASES
CASE - 1 : A -9127
A 38 yr, multipara with 2 Caesarian deliveries and 3 spontaneous abortions was having profuse menstrual bleeding with severe dysmenorrhoea with pain and heaviness lower abdomen since 4 - 5 months (LMP - 15/09/2002). Patient had undergone tubectomy 4 years back. Ultrasonography of pelvis dated August 12, 2002 revealed bulky uterus with multiple echogenic focal parenchymal masses in uterine pulp suggestive of Uterine fibroids (Plate -1). The case was repertorised. Symptoms considered for repertorisation were religious dreams, dreams of feasting, of water, of dead relatives, of death of relatives, of dead bodies, of unsuccessful efforts (Magnesia-sulphurica), offended easily, desire for company, fastidious, aversion to conversation, remorse, anxiety about family, sentimental, amelioration from consolation and desire for sweet things. Arsenicum album and Magnesia-sulphurica were selected from various drugs of choice.

FOLLOWUP CASE-1 : A - 9127
Ist prescription
: September 23, 2002: Arsenicum-album 1000 single dose was prescribed followed by Magnesia-sulphurica 30 for eight weeks.

Ist follow -up
: November 22, 2002: Menses appeared on 30/10/2002 but were less profuse, lasted 9 days with reduced pain. Pain lower abdomen also reduced. No dreams except religious dreams, dreams of water and of dead relatives were reported by the patient. Only Magnesia-sulphurica 30 was repeated for six weeks.

IInd follow-up
: January 07, 2003: Menses on 25/12/2002 less profuse, lasted 8 days with no dysmenorrhoea and pain lower abdomen. The patient reported no dreams. Ultrasonography of pelvis dated December 14, 2002 showed normal Uterus with no trace of fibroids (Plate - 1) after four (4) months of treatment.

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