Therapy of uterine fibroid remains one of the main problems of modern gynecology. This neoplasm is found in 20-25% of women of reproductive age [1;2] and is one of the most common human tumors. In 30-50% of the cases uterine fibroid is accompanied by abnormal endometrial bleeding, pain and disturbances of function of adjacent organs [3]. The main method of treatment continues to be hysterectomy. Besides perioperative complications, the shortcomings of this method include loss of reproductive and menstrual function, as well as sexual and psychic disturbances. The inhibition of ovarian function with hormonal preparations has unphysiological effects and can cause serious disturbances of various system of the organism. The treatment of anemia, use of analgesics, spasmolytic and uterotonic preparations can be considered purely symptomatic, as they do not remove the cause of the disease.

So, the necessity exists to seek new methods in the management of uterine fibroid. Homeopathy may be such a method. But in the literature available to us, there is no clinical analysis of the efficacy in homeopathic treatment of uterine fibroid. Many of the problems concerning practical treatment of such patients have not been solved.

A family history of various tumors was present in 30 patients (35.7%). Of these 18 women (22.6%) had uterine fibroid, 6 cases (7.1%) had other tumors of the genitals and in 5 cases (5.9%) tumors of other organs were noted. 28 (33.3%) women suffered from chronic pelvic inflammatory disease. 11 patients (13.1%) had had surgery to the uterine appendages. 26 (31,0%) women suffered from disorders of the uterine cervix. The majority of the patients were parous – 73 (86.9%). In a significant number of these patients – 21 (28.8%) – delivers were accompanied with obstetric complications. Development of the uterine fibroid in 75 women (89.3%) was accompanied by disturbances of various other organs and systems. In 8 women (9.5%) drug allergies were recorded in the life history.

All patients were given only homeopathic treatment. The period of observation varied from one to three years. Besides pelvic examination (every 3 months) ultrasonic scanning was carried out (every 6 months). In the course of these investigation structure and volume of the tumor, size and localization of the fibroid nodes and state of the endometrium were defined.

A simplified formula for the volume of an ellipsoid was used to calculate the tumor volume: V = 4/3 A/2 B/2 C2; where V is volume, A is the length, B is the width and C is thickness of the uterus.

Pain and menstrual bleeding were estimated by a questionnaire completed by the patient: a 3-point scale (worse – same – better) for pain and bleeding. In case of abnormal endometrial bleeding characteristics of the blood were determined. Diagnostic curettage of the uterus and endometrial biopsy were carried out where indicated. Standard statistical methods, in particular the Student’s t-test and nonparametric tests, were used to analyze the data obtained.

RESULTS

Before treatment, pain was reported by 38 patients, this improved with treatment in 30 (78.9%, p<0.01). Abnormal endometrial bleeding was observed in 40 women, this improved with treatment in 30 patients (75.0% p<0.01). The mean level of hemoglobin in capillary blood before commencing treatment was 10.2±2.8 G/L; the mean number of erythrocytes was 2.88±0.08 x 10¹². After treatment these values were 11.4±4.4 G/L and 3.24±0.11 (p<0.05) respectively.

Diagnostic endometrial curettage was carried out in 24 (28.6%) women. Hyperplasia was found in 15, chronic endometritis in 3 and normal endometrium in 6 patients. In 2 patients the presence of submucous uterine fibroid was detected. Malignant changes in the uterus were not found in any case.

Depending on the volume of the uterine fibroid, patients were divided into the following clinical groups:

• < 400cm³ (6-weeks pregnancy)
• 401-550cm³ (up 7-weeks pregnancy)
• 551-660cm³ (7-8-weeks pregnancy)
• 661-780cm³ (8-9-weeks pregnancy)
• 781-1000cm³ (9-10-weeks pregnancy)
• 1001-1200cm³ (10-11-weeks pregnancy)
• 1201-1500cm³ (11-12-weeks pregnancy)
• >1500cm³ (more than 12-weeks pregnancy)

Volume of the tumor in the clinical groups before and after treatment is shown in Table 1.

Table 1. Uterine fibroid in various clinical groups before and after treatment

Reduction of the tumor volume (more than 50cm³) was observed in 24 (28.6%) patients. An increase in volume (more than 50cm³) was observed in 16 (19.0%) patients. The tumor volume was considerable stable if it changed by not more than 50cm³. The number of such cases was 44 (52.4%).

Sixty homeopathic remedies were used. The most frequently used medicines are given below. The number of the drugs prescribed per patient varied from 1 to 4.

Pulsatilla nigricans (27)

Conium maculatum (26)

Calcium fluoricum (25)

Sepia (24)

Iodum (23)

Sabina juniperus (21)

Argentum nitricum (21)

China regia (20)

Ignatia amara (18)

Silicea (18)

Calcium carbonicum (17)

Cimicifuga racemosa (16)

Apis mellifica (15)

Calium iodatum (14)

Lycopodium (13)

Nux vomica (10)

Sulphur (10)

DRUG DEAFNESS

Among the patients who had abnormal endometrial bleeding was a group in which a positive effect was observed at the beginning of treatment, but subsequently ceased. We call this phenomenon “drug deafness”. Drug deafness was observed in 15 women i.e. in 48.4% of the patients who had abnormal bleeding and in whom a positive effect was observed at the start of the treatment. Most often this phenomenon started 3-5 months after beginning homeopathy. All these patients were prescribed other homeopathic preparations which achieved an effect in 4 patients, no improvement in 5 patients and in 6 women the result was not clear because of the short term of observation. The phenomenon of “drug deafness” is shown in diagrammatic form in Fig. 2.

The second pattern observed by us concerned the patients who had abnormal endometrial bleeding. In 18 patients, while menorrhagia improved, further growth of the tumor was observed. On the other hand, 9 women showed a decrease in fibroid volume whilst endometrial bleeding, an inverse relationship was noted between tumor size and degree of menorrhagia.

CONCLUSION

In our opinion homeopathy alone can be a sufficiently effective method of therapy for patients with uterine fibroid. It is possible to slow down the growth of the tumor and even reduce its size, also to arrest pain and abnormal endometrial bleeding. The optimum effects are achieved with small tumors (

We consider that a search for “specific” drugs in uterine fibroid is not very promising. The frequency of use of various medications may depend mainly on personal peculiarities and the skill of the homeopath. The only condition of successful treatment is following the principle of similarity.

If drug deafness occurs (e.g. recurrence of menorrhagia after successful initial treatment), we recommend changing the prescription, taking account of miasmatic factors. If one is sure of the correctness of the prescriptions, in our opinion the potency and/or frequency of the medicine should be changed. Besides, it should be kept in mind that during treatment an inverse relationship between uterine bleeding and fibroid size are possible.

REFERENCES:

1. Current Obstetric Gynecologic Diagnosis and Treatment. Ed. by Martin L. Pernoll and Ralph C. Benson. Sixth ed. 1987, p.657.
2. Demidov V.I., Zykin B.I. Ultrasound diagnostic in the gynecological practice. Moskow, 1990. 60p.
3. Bodjazhina V.I., Vasilevskaja L.N., Pobedinsky N.M., Strugatsky V.M. Diagnosis and treatment in gynecological practice. Moscow, 1980, p.166.
4. Smith T.A. Woman’s Guide to Homeopathic Medicine. Thorsons Publishers Inc. NY, 1984, p.135-37.
5. Iouanny, Grapanne I.B., Dancer H., Masson I.L. Therapeutique Homeopathique. Tome II, p.238-41.