ABSTRACT : Uterine fibroids are benign tumor of uterus and clinically apparent in a large part of reproductive aged women. Clinically, they present with a variety of symptoms. Homoeopathy is very usefull in treating cases of fibroid. Use of repertory helps in easy selection of medicine. Among them one of the important is Murphy repertory which has different rubric and medicine. In this article an attempt made to differentiate the 1st grade medicine for fibroid in Murphy repertory.
INTRODUCTION
Uterine fibroids (UFs), also known as uterine leiomyomas, are benign smooth muscle neoplasms of the uterus that affect women of reproductive age.1
Incidence
It has been estimated that at least 20 percent of women at the age of 30 have got fibroid in their wombs. Fortunately, most of them (50%) remain asymptomatic.2
The incidence of symptomatic fibroid in hospital outpatient is about 3 percent.
A high incidence of 10 percent prevails in England.
It is predominantly an estrogen-dependent tumor. Estrogen and progesterone is incriminated as the cause. Estrogen dependency is evidenced by: a) Growth potentiality is limited during childbearing period. b) Increased growth during pregnancy. c)They do not occur before menarche. d)Following menopause, there is cessation of growth and there is no new growth at all. e) It seems to contain more estrogen receptors than the adjacent myometrium. f) Frequent association of anovulation.
Risk factor for fibroid2
Increased risk
Nulliparity
Obesity
Hyperestrogenic state
Black women
Reduced risk
Multiparity
Smoking
Types:
• Body
• Cervical
Body is divided into Interstitial or intramural, Subperitoneal or subserous, Submucous.
The fibroids are mostly located in the body of the uterus and are usually multiple. Cervical fibroid is rare
Pathology
Naked eye appearance
The uterus is enlarged; the shape is distorted by multiple nodular growth of varying sizes.
Occasionally, there may be uniform enlargement of the uterus by a single fibroid.
The feel is firm. Cut surface of the tumor is smooth and whitish. The cut section, in the absence of degenerative changes, shows features of whorled appearance and trabeculation. These are due to the intermingling of fibrous tissues with the muscle bundles.
Microscopic appearance
The tumor consists of smooth muscles and fibrous connective tissues of varying proportion.
Originally, it consists of only muscle element but later on, fibrous tissues intermingle with the muscle bundles.
CLINICAL FEATURES2
The majority of fibroids remain asymptomatic (75%). They are accidentally discovered by the physician during routine examination or at laparotomy or laparoscopy.
Symptoms
Menorrhagia
Metrorrhagia
Dysmenorrhea
Infertility
Abdominal swellings (lump)
Pressure symptoms
Signs
General examination reveals varying degrees of pallor depending upon the magnitude and duration of menstrual loss.
Abdominal examination
The tumor may not be sufficiently enlarged to be felt per abdomen. But if enlarged to 14 weeks or more, the following features are noted.
Palpation
Feel is firm, more toward hard; may be cystic in cystic degeneration.
Margins are well-defined except the lower pole which cannot be reached suggestive of pelvic in origin.
Surface is nodular; may be uniformly enlarged in a single fibroid.
Mobility is restricted from above downwards but can be moved from side to side.
Percussion
The swelling is dull on percussion.
Pelvic examination
Bimanual examination reveals the uterus irregularly enlarged by the swelling felt per abdomen
COMPLICATIONS
Hyaline degeneration
Cystic degeneration
Fatty degeneration
Calcific degeneration
Red degeneration
Atrophy
Necrosis
Infection
INVESTIGATIONS2
Although, the majority of uterine fibroids can be diagnosed from the history and pelvic examination but at times pose problems in diagnosis.
Ultrasound is an useful diagnostic tool to confirm the diagnosis of fibroid.
Transvaginal ultrasound can accurately assess the myoma location, dimensions volume and also any adnexal pathology. Hydroureter or hydronephrotic changes can be diagnosed.
Three-dimensional ultrasonography can locate fibroids accurately.
Magnetic resonance imaging (MRI)
It is more accurate compared to ultrasound.
It helps to differentiate adenomyosis from fibroids.
MRI is not used routinely for the diagnosis. It is expensive and not widely available
Laparoscopy
Laparoscopy is helpful, if the uterine size is less than 12 weeks and associated with pelvic pain and infertility. Associated pelvic endometriosis and tubal pathology can be revealed.
It can also differentiate a pedunculated fibroid from ovarian tumor, not revealed by clinical examination and ultrasound
Hysteroscopy
Hysteroscopy is of help to detect submucous fibroid in unexplained infertility and repeated pregnancy wastage.
The presence and site of submucous fibroid can be diagnosed by direct visualization during hysteroscopy
MANAGEMENT
The drugs are used either as a temporary palliation or may be used in rare cases, as an alternative to surgery
The 1st grade medicine for the rubric fibroid in Murphy repertory3
AURUM MURIATICUM NATRONATUM
CALCAREA CARBONICA
CALCAREA FLUORICA
FRAXINUS AMERICANA
PHOSPHORUS
SEPIA
THYROIDINUM
USTILAGO MAYDIS
AURUM MURIATICUM NATRONATUM
Pronounced effect on the female organs.
Has more power over uterine tumors than any other remedy (Burnett)4
Ossified uterus4,5
Uterus fill up whole pelvis4,5
Ulceration of neck of womb and vagina
Leucorrhoea with spasmodic contraction of vagina
Induration of some parts of uterus, ulcers of uterus and of vaginal walls6
Chronic metritis and prolapse4,5
Miscarriage from uterine induration5.
CALCAREA CARBONICA
It is indicated for person of scrofulous type, who take cold easily, with increased mucous secretion, children who grow fat, are large bellied, with large head4.
Great sensitiveness to cold.
Cutting pain in uterus during menstruation4,5
Menses too early too profuse, too long, with vertigo, toothache and cold, damp feet5.
Uterus is easly displaced4.
Leucorrhoea before menses
Leucorrhoea milky
Uterine polyps5
Sterility with copious menses
CALCAREA FLUORICA
Powerful remedy for hard, stony glands
Mentally the person has great depression, fear of financial ruin5.
Hard knots in female breast
Fibroid hard and stony4
FRAXINUS AMERICANA
Enlargement of the uterus4
Uterine tonic for nervous females5.
Fibrous growth, subinvolution and prolapse of uterus
Cramps in feet
Cold creeping and hot flashes
watery unirritating leucorrhoea
Tenderness in left inguinal region, bearing down pain, extending down thigh
Fibroid with bearing down sensation5, cramping in feet worse in afternoon and night4
Indicated for tall slender persons, narrow chested, with thin transparent skin, weakened by loss of animal fluids, with great nervous debility4.
Great susceptibility to external impression, to light, sound, odour, touch, thunder-storms4.
Menses too early and scanty not profuse, but last too long5
Endometritis, prolapsus with weak sinking feeling in Abdomen6
Uterine pain running upward, stitches from vagina into pelvis6
Slight haemorrhage from uterus between the periods
Weeps before menses5
Frequent and profuse or short uterine bleeding in between the periods in nursing woman5
Leucorrhoea profuse, smarting , corrosive, instead of menses5
Cancer of uterus
Amenorrhoea, with vicarious menstruation5
Suppuration of mammae, burning, watery, offensive discharge
Uterine polyps
SEPIA
Indicated for weakness, yellow complexion, bearing down sensation especially in woman
Mentally person is indifferent to loved ones, irritable, easily offended, dreads to be alone4
It is suited to young persons of both sexes of nervous and delicate constitution
Aversion to family to those loved best5
Weak uterus or dragging or bearing down sensation as if everything would escape through the vagina5
Menses too late and scanty, irregular; early and profuse; sharp pains
Violent stitches upward in the vagina, from uterus to umbilicus
Leucorrhoea yellow, greenish with much itching
Prolapse of uterus and vagina
Bearing down sensation as if something would escape through vulva; must cross limbs to prevent protrusion
THYROIDIUM
Mentally the person irritable, worse least opposition, goes into a rage over trifles.
Concentration difficult
Depression on waking5
Indicated for uterine fibroid
Amenorrhoea
Gnawing in uterus4
Puerperal convulsions, insanity
USTILAGO MAYDIS
Indicated for person with great despondency and mental irritability
Very sad, exceedingly, sleep restless, could not bear to see or talk with any one5
Flabby condition of uterus
Vicarious menstruation
Bearing down as if everything would come through6
Profuse menses after miscarriage
Discharge of blood from slightest provocation, bright red partly clotted
Oozing of dark blood, clotted, forming long strings.
Uterus hypertrophied
CONCLUSION
The available literature shows the scope of Homoeopathic medicine in the treatment of fibroid. In the Murphy repertory under the rubric fibroid 1st grade medicines are mentioned. On the basis of characteristic symptom and mental generals along with physical generals we can differentiate these medicines and select proper Similimum according to the case. On the basis of this data further clinical studies can be plan to explore the effectiveness of these medicine in the treatment of fibroid.
REFERENCE
1 Stewart EA, Cookson CL, Gandolfo RA, Schulze‐Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Sep;124(10):1501-12.
2 Konar H. D.C Dutta’s textbook of Gynaecology. 6th ed. Kolkata, India: JAYPEE Publishers; 2013.
3 Murphy R. Homoeopathic Medical Repertory. 3rd ed. New Delhi: B. Jain; 1998
4 Boericke W. New manual of Homoeopathic Materia Medica and Repertory. 9th ed. New Delhi: B. Jain Publishers; 2003.
5 Murphy R. Lotus materia medica. 3rd ed. Noida: B Jain Publishers Pvt Ltd; 2021.
6 Samuel L. Homoeopathic therapeutics. B. Jain publishers Pvt Ltd New Delhi. 2001
About Author:
DR ARUN K JOHN
MD PART 1
Department of case taking and repertory
Under the guidance of DR MUNIR AHMED R
Government Homoeopathic Medical College and Hospital Bengaluru
