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Homœopathy in treatment of patients with fibromyoma of the uterus
British Horn~eopathic Journal O c t o b e r 1992, Vol. 81, pp. 164-167
Homoeopathy in treatment of patients with fibromyoma of the uterus Dr A. V. P O P O V
Abstract The efficacy of homoeopathic treatment of patients with fibromyoma of the uterus has been studied. Eighty-four patients with various clinical manifestations of the disease were under our observation. All patients received homoeopathic therapy only. Besides pelvic examination, real-time ultrasonic scanning was used for evaluation of turnout volume. The period of observation varied from one to three years. In our opinion homceopathy used alone is an effective method of treatment of patients with fibromyoma of the uterus. It is possible to stop the growth of a tumour and even to reduce its size, as well as to control pain and abnormal endometrial bleeding. In the course of investigation certain patterns of response to treatment were found. These require further investigation.
KEY WORDS : Fibromyoma of the uterus; Case series; Homoeopathy; Ultrasound imaging; Ukraine.
Introduction Therapy of fibromyoma of the uterus remains one of the main problems of modern gynaecology. This neoplasm is found in 20-25% of women of reproductive age 1'2 and is one of the most common human tumours. In 30-50% of the cases fibromyoma of the uterus is accompanied by abnormal endometrial bleeding, pain and disturbance of function of adiacent 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 systems of the organism. The treatment of anaemia, 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 fibromyoma. Homceopathy may be such a method. But in the Centre of Homoeopathy of the Ministry of Health of the Ukraine, Kiev.
literature available to us, there is no clinical analysis of the efficacy in homeeopathic treatment of fibromyoma. Many of the problems concerning practical treatment of such patients have not been solved. Materials and methods 84 women with fibromyoma of the uterus were under our observation. The majority were of reproductive age (see Fig. 1). A family history of various tumours was present in 30 patients (35.7%). Of these 19 (22.6%) had fibromyoma of the uterus, 6 cases (7.1%) had other tumours of the genitals and in 5 cases (5.9%) tumours 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%)--deliveries were accompanied with obstetric problems. Development of the fibromyoma in 75 women (89.3%) was accompanied by disturbance of various other organs and systems. In 8 women (9.5%) drug allergies were recorded in the history.
164
Volume 81, Number 4, October 1992
165
b~gure /.'Age distribution of patients in this series. A--<35 years; B--35 39 years; C~40-44 years; D ~ 5 M 9 years; E-->50 years. All patients were given only h o m t e o p a t h i c t r e a t m e n t . The period of o b s e r v a t i o n varied from one to t h r e e years. Besides pelvic examination (every 3 m o n t h s ) ultrasonic scanning was carried out (every 6 m o n t h s ) . In the course o f these investigations structure and volume of the tumour, size and localization of the f i b r o m a t o u s n o d e s and state o f the e n d o m e t r i u m w e r e defined. A simplified formula for the volume of an ellipsoid was used to calculate the t u m o u r volume: V = 4/3 A/2 B/2 C/2; where V is volume, A is the length, B is the width and C is the thickness o f the uterus. Pain and menstrual b l e e d i n g were e s t i m a t e d by a q u e s t i o n n a i r e c o m p l e t e d by the patient: a 3-point scale ( w o r s e / s a m e / b e t t e r ) for pain and bleeding. In case of a b n o r m a l e n d o m e t r i a l bleeding characteristics of the blood w e r e determined. Diagnostic curettage o f the uterus and
Figure 2: The most frequentlyused medicinesfor treatment of patients with myoma of the uterus. e n d o m e t r i a l biopsy were carried out where indicated. S t a n d a r d statistical m e t h o d s , in particular the S t u d e n t ' s t-test and n o n p a r a m e t r i c tests, were used to analyse the data obtained.
Results B e f o r e t r e a t m e n t , pain was r e p o r t e d by 38 patients; this i m p r o v e d with t r e a t m e n t in 30 (78.9%) ( p < 0 . 0 1 ) . Abnormal endometrial bleeding was o b s e r v e d in 40 w o m e n ; this i m p r o v e d with treatm e n t in 30 patients (75.0%) (p<0.01). The m e a n level of h a e m o g l o b i n in capillary b l o o d before commencing treatment was
TABLE i. Uterine myoma in various clinical groups before and after treatment Clinical groups (myoma size) <400 cm3 401- 550 cm3 661- 780 cm3 781-1000 cm3 1001 1200 cm3 1201-1500 cm3 > 1500 cm3
Mean volume of tumour M _+m before treatment 350.3 +_ 9.1 468.4 + 9.3 607.4 _+ 11.2 928.8 + 15.9 1392.0 _+60.4
after treatment 344.9-+ 415.4_+ 677.8 _+ 893.8 -
19.8 14.7 39.6 66.4
1305.0 _ 109.6
>0.05 <0.01 >0.1 >0.5 >0.5
166
British Homoeopathic Journal
A Clinical effect
?/mprovmnt Before treatment
After treatment
Change of Medicines
Absence of effect
Term of observation .........................................................................
-~
Figure 3." Schematic presentation of 'drug deafness'.
10.2 + 2.8 G/L; the m e a n n u m b e r of erythrocytes was 2.88 + 0.08 x 10 ~2. A f t e r treatment these values were 11.4 + 4.4G/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 e n d o m e t r i u m in 6 patients. In 2 patients the presence of submucous myomas was detected. Malignant changes in the uterus were not found in any case. D e p e n d i n g on the volume of the fibromyoma, patients were divided into the following clinical groups: < 4 0 0 c m 3 (6-week pregnancy) 401-550 cm 3 (up to 7 weeks) 551-660 cm 3 (7-8 weeks) 661-780 cm 3 (8-9 weeks) 7 8 1 - 1 0 0 0 c m 3 (9-10 weeks) 1001-1200 cm 3 (10-11 weeks) 1201-1500 cm 3 (11-12 weeks) >1500 cm 3 (more than 12 weeks).
Volume of the t u m o u r in the clinical groups before and after treatment is shown in Table 1. R e d u c t i o n of the tumour volume (by m o r e than
50 c m 3) w a s observed in 24 (28.6%) patients. A n increase in volume (by m o r e than 50 cm 3) was observed in 16 (19.0%) patients. The tumour volume was considered stable if it changed by not more than 50 cm 3. The n u m b e r of such cases was 44 (52.4%). Sixty homeeopathic medicines were used. The most frequently used medicines are given in Fig. 2. The n u m b e r of the medicines prescribed per patient varied from 1 to 4.
Drug deafness A m o n g the patients who had abnormal endometrial bleeding was a group in w h o m a positive effect was observed at the beginning of treatment, but subsequently ceased. We call this p h e n o m e n o n 'drug deafness'. D r u g 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 p h e n o m e n o n started 3-5 months after beginning hom~eopathy. All these patients were prescribed other homeeopathic preparations which achieved an effect in 4 patients, no i m p r o v e m e n t in 5 patients
Volume 81, Number 4, October 1992
a n d in 6 w o m e n the result was n o t clear because of the s h o r t t e r m of o b s e r v a t i o n . T h e p h e n o m e n o n of ' d r u g d e a f n e s s ' is s h o w n in diagrammatic f o r m in Fig. 3. T h e s e c o n d p a t t e r n o b s e r v e d by us c o n c e r n e d the patients who had abnormal endometrial bleeding. In 18 patients, while m e n o r r h a g i a i m p r o v e d , f u r t h e r g r o w t h of the t u m o u r was o b s e r v e d . O n the o t h e r h a n d , 9 w o m e n s h o w e d a d e c r e a s e in m y o m a v o l u m e whilst e n d o m e t r i a l b l e e d i n g did n o t i m p r o v e . So, in w o m e n who h a d f i b r o m y o m a t a with a b n o r m a l e n d o m e t r i a l bleeding, a n inverse r e l a t i o n s h i p was n o t e d between turnout size and degree of menorrhagia. Conclusion
In o u r o p i n i o n h o m 0 e o p a t h y a l o n e c a n b e a sufficiently effective m e t h o d of t h e r a p y for p a t i e n t s with f i b r o m y o m a of the uterus. It is possible to slow d o w n t h e growth of t h e t u m o u r a n d even r e d u c e its size, also to arrest pain a n d a b n o r m a l e n d o m e t r i a l bleeding. T h e o p t i m u m effects are a c h i e v e d with small t u m o u r s ( < 1 0 weeks gestation). We c o n s i d e r t h a t a search for 'specific' drugs in f i b r o m y o m a of the uterus is n o t very promising. T h e f r e q u e n c y of use of various m e d i c a t i o n s m a y d e p e n d mainly o n p e r s o n a l peculiarities and the skill of the h o m c e o p a t h . T h e only c o n d i t i o n of
Address for correspondence:
Dr A. V. Popov 22/9 Kominterna Street 252032 Kiev Ukraine
167 successful t r e a t m e n t is following the principle of similarity. If drug deafness occurs (e.g. r e c u r r e n c e of m e n o r r h a g i a after successful initial t r e a t m e n t ) , we r e c o m m e n d c h a n g i n g t h e prescription, t a k i n g account of m i a s m a t i c factors. If o n e is sure of the c o r r e c t n e s s of the prescriptions, in o u r o p i n i o n the p o t e n c y and/or f r e q u e n c y of the m e d i c i n e should b e c h a n g e d . Besides, it should b e k e p t in m i n d t h a t d u r i n g t r e a t m e n t a n inverse relationship between uterine bleeding and m y o m a size are possible. References 1 Current Obstetric Gynecologic Diagnosis and Treatment. Ed.
by Martin E. Pernol! and Ralph C. Benson. Sixth ed. 1987. p. 657. 2 Demidov V], Zykin BI. Ultrasound diagnostic in the gynaecological practice. Moscow 1990. P. 60 (in Russian). 3 Bodjazhina VI, Vasilevskaja LN, Pobedinsky NM, Strugatsky VM. Diagnosis and treatment in gynaecologicalpractice. Moscow 1980. E 166 (in Russian). 4 Practice of gynaecology. Ed. by L. V. Tymoshenko. Kiev 198(}. Pp. 241-42 (in Russian). 5 Vihljaeva EM, Vasilevskaja LN. Myoma of the uterus. Moscow 1981. Pp 30-46; 128-29 (in Russian). 6Smith TA. Woman's Guide to Homceopathic Medicine. Thorsons Publishers Inc. NY 1984. E 135-37. 7 Dictionnaire homeopathique L. Pommier Maloine S. A. Editeur 1985. Pp. 240-241. 8 louanny I, Grapanne IB, Dancer H, Masson IL. Therapeutique Homeopathique Tome II. Pp. 238-41.
Homoeopathy in treatment of patients with fibromyoma of the uterus Dr A. V. P O P O V
Abstract The efficacy of homoeopathic treatment of patients with fibromyoma of the uterus has been studied. Eighty-four patients with various clinical manifestations of the disease were under our observation. All patients received homoeopathic therapy only. Besides pelvic examination, real-time ultrasonic scanning was used for evaluation of turnout volume. The period of observation varied from one to three years. In our opinion homceopathy used alone is an effective method of treatment of patients with fibromyoma of the uterus. It is possible to stop the growth of a tumour and even to reduce its size, as well as to control pain and abnormal endometrial bleeding. In the course of investigation certain patterns of response to treatment were found. These require further investigation.
KEY WORDS : Fibromyoma of the uterus; Case series; Homoeopathy; Ultrasound imaging; Ukraine.
Introduction Therapy of fibromyoma of the uterus remains one of the main problems of modern gynaecology. This neoplasm is found in 20-25% of women of reproductive age 1'2 and is one of the most common human tumours. In 30-50% of the cases fibromyoma of the uterus is accompanied by abnormal endometrial bleeding, pain and disturbance of function of adiacent 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 systems of the organism. The treatment of anaemia, 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 fibromyoma. Homceopathy may be such a method. But in the Centre of Homoeopathy of the Ministry of Health of the Ukraine, Kiev.
literature available to us, there is no clinical analysis of the efficacy in homeeopathic treatment of fibromyoma. Many of the problems concerning practical treatment of such patients have not been solved. Materials and methods 84 women with fibromyoma of the uterus were under our observation. The majority were of reproductive age (see Fig. 1). A family history of various tumours was present in 30 patients (35.7%). Of these 19 (22.6%) had fibromyoma of the uterus, 6 cases (7.1%) had other tumours of the genitals and in 5 cases (5.9%) tumours 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%)--deliveries were accompanied with obstetric problems. Development of the fibromyoma in 75 women (89.3%) was accompanied by disturbance of various other organs and systems. In 8 women (9.5%) drug allergies were recorded in the history.
164
Volume 81, Number 4, October 1992
165
b~gure /.'Age distribution of patients in this series. A--<35 years; B--35 39 years; C~40-44 years; D ~ 5 M 9 years; E-->50 years. All patients were given only h o m t e o p a t h i c t r e a t m e n t . The period of o b s e r v a t i o n varied from one to t h r e e years. Besides pelvic examination (every 3 m o n t h s ) ultrasonic scanning was carried out (every 6 m o n t h s ) . In the course o f these investigations structure and volume of the tumour, size and localization of the f i b r o m a t o u s n o d e s and state o f the e n d o m e t r i u m w e r e defined. A simplified formula for the volume of an ellipsoid was used to calculate the t u m o u r volume: V = 4/3 A/2 B/2 C/2; where V is volume, A is the length, B is the width and C is the thickness o f the uterus. Pain and menstrual b l e e d i n g were e s t i m a t e d by a q u e s t i o n n a i r e c o m p l e t e d by the patient: a 3-point scale ( w o r s e / s a m e / b e t t e r ) for pain and bleeding. In case of a b n o r m a l e n d o m e t r i a l bleeding characteristics of the blood w e r e determined. Diagnostic curettage o f the uterus and
Figure 2: The most frequentlyused medicinesfor treatment of patients with myoma of the uterus. e n d o m e t r i a l biopsy were carried out where indicated. S t a n d a r d statistical m e t h o d s , in particular the S t u d e n t ' s t-test and n o n p a r a m e t r i c tests, were used to analyse the data obtained.
Results B e f o r e t r e a t m e n t , pain was r e p o r t e d by 38 patients; this i m p r o v e d with t r e a t m e n t in 30 (78.9%) ( p < 0 . 0 1 ) . Abnormal endometrial bleeding was o b s e r v e d in 40 w o m e n ; this i m p r o v e d with treatm e n t in 30 patients (75.0%) (p<0.01). The m e a n level of h a e m o g l o b i n in capillary b l o o d before commencing treatment was
TABLE i. Uterine myoma in various clinical groups before and after treatment Clinical groups (myoma size) <400 cm3 401- 550 cm3 661- 780 cm3 781-1000 cm3 1001 1200 cm3 1201-1500 cm3 > 1500 cm3
Mean volume of tumour M _+m before treatment 350.3 +_ 9.1 468.4 + 9.3 607.4 _+ 11.2 928.8 + 15.9 1392.0 _+60.4
after treatment 344.9-+ 415.4_+ 677.8 _+ 893.8 -
19.8 14.7 39.6 66.4
1305.0 _ 109.6
>0.05 <0.01 >0.1 >0.5 >0.5
166
British Homoeopathic Journal
A Clinical effect
?/mprovmnt Before treatment
After treatment
Change of Medicines
Absence of effect
Term of observation .........................................................................
-~
Figure 3." Schematic presentation of 'drug deafness'.
10.2 + 2.8 G/L; the m e a n n u m b e r of erythrocytes was 2.88 + 0.08 x 10 ~2. A f t e r treatment these values were 11.4 + 4.4G/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 e n d o m e t r i u m in 6 patients. In 2 patients the presence of submucous myomas was detected. Malignant changes in the uterus were not found in any case. D e p e n d i n g on the volume of the fibromyoma, patients were divided into the following clinical groups: < 4 0 0 c m 3 (6-week pregnancy) 401-550 cm 3 (up to 7 weeks) 551-660 cm 3 (7-8 weeks) 661-780 cm 3 (8-9 weeks) 7 8 1 - 1 0 0 0 c m 3 (9-10 weeks) 1001-1200 cm 3 (10-11 weeks) 1201-1500 cm 3 (11-12 weeks) >1500 cm 3 (more than 12 weeks).
Volume of the t u m o u r in the clinical groups before and after treatment is shown in Table 1. R e d u c t i o n of the tumour volume (by m o r e than
50 c m 3) w a s observed in 24 (28.6%) patients. A n increase in volume (by m o r e than 50 cm 3) was observed in 16 (19.0%) patients. The tumour volume was considered stable if it changed by not more than 50 cm 3. The n u m b e r of such cases was 44 (52.4%). Sixty homeeopathic medicines were used. The most frequently used medicines are given in Fig. 2. The n u m b e r of the medicines prescribed per patient varied from 1 to 4.
Drug deafness A m o n g the patients who had abnormal endometrial bleeding was a group in w h o m a positive effect was observed at the beginning of treatment, but subsequently ceased. We call this p h e n o m e n o n 'drug deafness'. D r u g 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 p h e n o m e n o n started 3-5 months after beginning hom~eopathy. All these patients were prescribed other homeeopathic preparations which achieved an effect in 4 patients, no i m p r o v e m e n t in 5 patients
Volume 81, Number 4, October 1992
a n d in 6 w o m e n the result was n o t clear because of the s h o r t t e r m of o b s e r v a t i o n . T h e p h e n o m e n o n of ' d r u g d e a f n e s s ' is s h o w n in diagrammatic f o r m in Fig. 3. T h e s e c o n d p a t t e r n o b s e r v e d by us c o n c e r n e d the patients who had abnormal endometrial bleeding. In 18 patients, while m e n o r r h a g i a i m p r o v e d , f u r t h e r g r o w t h of the t u m o u r was o b s e r v e d . O n the o t h e r h a n d , 9 w o m e n s h o w e d a d e c r e a s e in m y o m a v o l u m e whilst e n d o m e t r i a l b l e e d i n g did n o t i m p r o v e . So, in w o m e n who h a d f i b r o m y o m a t a with a b n o r m a l e n d o m e t r i a l bleeding, a n inverse r e l a t i o n s h i p was n o t e d between turnout size and degree of menorrhagia. Conclusion
In o u r o p i n i o n h o m 0 e o p a t h y a l o n e c a n b e a sufficiently effective m e t h o d of t h e r a p y for p a t i e n t s with f i b r o m y o m a of the uterus. It is possible to slow d o w n t h e growth of t h e t u m o u r a n d even r e d u c e its size, also to arrest pain a n d a b n o r m a l e n d o m e t r i a l bleeding. T h e o p t i m u m effects are a c h i e v e d with small t u m o u r s ( < 1 0 weeks gestation). We c o n s i d e r t h a t a search for 'specific' drugs in f i b r o m y o m a of the uterus is n o t very promising. T h e f r e q u e n c y of use of various m e d i c a t i o n s m a y d e p e n d mainly o n p e r s o n a l peculiarities and the skill of the h o m c e o p a t h . T h e only c o n d i t i o n of
Address for correspondence:
Dr A. V. Popov 22/9 Kominterna Street 252032 Kiev Ukraine
167 successful t r e a t m e n t is following the principle of similarity. If drug deafness occurs (e.g. r e c u r r e n c e of m e n o r r h a g i a after successful initial t r e a t m e n t ) , we r e c o m m e n d c h a n g i n g t h e prescription, t a k i n g account of m i a s m a t i c factors. If o n e is sure of the c o r r e c t n e s s of the prescriptions, in o u r o p i n i o n the p o t e n c y and/or f r e q u e n c y of the m e d i c i n e should b e c h a n g e d . Besides, it should b e k e p t in m i n d t h a t d u r i n g t r e a t m e n t a n inverse relationship between uterine bleeding and m y o m a size are possible. References 1 Current Obstetric Gynecologic Diagnosis and Treatment. Ed.
by Martin E. Pernol! and Ralph C. Benson. Sixth ed. 1987. p. 657. 2 Demidov V], Zykin BI. Ultrasound diagnostic in the gynaecological practice. Moscow 1990. P. 60 (in Russian). 3 Bodjazhina VI, Vasilevskaja LN, Pobedinsky NM, Strugatsky VM. Diagnosis and treatment in gynaecologicalpractice. Moscow 1980. E 166 (in Russian). 4 Practice of gynaecology. Ed. by L. V. Tymoshenko. Kiev 198(}. Pp. 241-42 (in Russian). 5 Vihljaeva EM, Vasilevskaja LN. Myoma of the uterus. Moscow 1981. Pp 30-46; 128-29 (in Russian). 6Smith TA. Woman's Guide to Homceopathic Medicine. Thorsons Publishers Inc. NY 1984. E 135-37. 7 Dictionnaire homeopathique L. Pommier Maloine S. A. Editeur 1985. Pp. 240-241. 8 louanny I, Grapanne IB, Dancer H, Masson IL. Therapeutique Homeopathique Tome II. Pp. 238-41.