Uterine fibroids are the most common benign tumors in female reproductive organs. According to Chinese medicine, the disease is caused by dysfunction of internal organs, qi stagnation, blood stasis, cold condensation, phlegm blockage, dampness and heat, and deficiency of positive energy. It is most common in women aged 30-50 years old, most common in women aged 40-50 years old, less common in women under 20 years old, and about 20% of women over 35 years old have uterine fibroids. Uterine fibroids are usually found in women of reproductive age. After menopause, the fibroids stop growing or even shrink and disappear, and the occurrence of fibroids is mostly thought to be related to female hormones.
I. Uterine fibroids in the eyes of Chinese medicine
The clinical manifestations of uterine fibroids are relatively light and the signs are not very obvious, as the onset of uterine fibroids is mostly due to qi stagnation and blood stasis, as the evil is not yet strong and the positive is not yet decayed. With the development of the disease, it may enter the typical stage of the disease, and the symptoms and signs may change, such as shortened menstrual cycle, increased menstrual volume, prolonged menstrual period, irregular vaginal bleeding due to the increase of uterine cavity and endometrial area, poor contraction or excessive endometrial hyperplasia, etc. Once the submucosal myoma is necrotic and infected, there will be continuous or irregular vaginal bleeding or purulent blood discharge, etc. This is the period when the evil is strong but the positive is not yet decayed. In the middle and late stages of the disease, there may be weakness, anemia and other symptoms of the gradual decline of the righteousness. Of course, the symptoms of the onset of the disease may vary from person to person, so it is necessary to make a diagnosis after examination and clarification.
Clinical symptoms of uterine fibroids
The most common clinical symptoms are uterine bleeding, abdominal mass, lumbar and abdominal pain, increased leucorrhea, frequent and urgent urination, irregular bowel movement, infertility, anemia, etc. However, there are also patients who do not have any symptoms and are found through gynecological screening.
1.Changes in menstruation: increased menstrual flow, shortened cycles, prolonged periods, irregular vaginal bleeding, etc.
2, abdominal mass: a mass is found in the middle of the lower abdomen, which is more easily palpable by pushing the uterus upward when the bladder is full, with a hard texture and irregular shape.
3.Increased leucorrhea: Increased secretion of endometrial glands, accompanied by pelvic congestion, resulting in increased leucorrhea. The submucosal myoma hanging in the vagina is prone to infection and necrosis on its surface, producing a large amount of pus and blood discharge and flesh-like tissue discharge, accompanied by odor.
4, abdominal pain, lumbago, lower abdominal cramps: usually abdominal pain is not obvious, cramps and lumbago are often seen and aggravated during menstruation. Acute abdominal pain occurs in case of subplasmalemmal myoma twisting; in case of red degeneration of pregnant uterine fibroid, abdominal pain is severe and accompanied by fever.
5, compression symptoms: compression of the bladder, urinary frequency, urinary disorder, urinary retention, compression of the ureter, hydronephrosis; compression of the rectum, defecation difficulties.
6. Infertility: 25-40% of the cases. It may distort the fallopian tube by compression or deform the uterine cavity, affecting the fertilization of the egg.
7. Secondary anemia: dizziness, weakness and loss of appetite.
During gynecological examination, the uterus is found to be enlarged, with irregular surface, single or multiple nodular protrusions, hard texture, and submucosal fibroid uterus is mostly uniformly enlarged, sometimes located in the uterine orifice or prolapsing out of the vagina, red, parenchymal, smooth surface, covered with exudate or ulcer formation on the surface when accompanied by infection, with foul odor.
Three, the two-way treatment of uterine fibroids
The treatment of fibroids depends on the patient’s age, fertility status, clinical symptoms, the location, size, growth rate and number of fibroids, etc. If the fibroids are small, have no obvious symptoms, and have little impact on health, especially in perimenopausal patients, the natural shrinkage of fibroids after ovarian dysfunction can be considered. Such patients are followed up regularly and surgery is not required for the time being. The general rule is to invigorate blood circulation, resolve blood stasis, soften hardness and disperse nodules, and at the same time, to nourish the spleen and kidneys to support positive energy. Combined with modern medical research, the mechanism of efficacy of the above mentioned drugs is to improve microcirculation, anti-inflammation, inhibit connective tissue proliferation and immune regulation to achieve the purpose of treating uterine fibroids.
1. Qi stagnation and blood stasis type
The main manifestations are irregular menstruation, relatively normal menstrual flow, slightly excessive menstrual flow, prolonged menstrual period, difficult to clean, abdominal distension and pain, breast distension, thin white moss or purple gas, and astringent pulse. On examination, the patient’s uterus was found to be slightly large, medium or hard in quality, and the B-ultrasound showed a small tumor. The treatment emphasizes draining the liver and Qi, activating blood circulation and removing blood stasis.
2. Blood stasis and accumulation type
The main manifestations are heavy menstrual flow like gush, purple color with blood clots, stabbing pain in the lower abdomen that cannot be pressed, some people have long duration of menstruation, difficult to clean, purple tongue with petechiae, and sunken and astringent pulse. On examination, the uterus is found to be evenly or asymmetrically enlarged, hard in texture, single or multiple protrusions can be palpated, and the tumor is large or numerous under B-ultrasound. Treatment can be done by activating blood circulation, removing blood stasis and softening hardness. For those with damp-heat, clear heat and dampness, activate blood circulation and remove blood stasis; for those with cold, warm the menstruation and disperse cold, activate blood circulation and remove blood stasis.
3.Spleen deficiency and blood stasis
The main manifestations are heavy menstrual flow like injection, light purple color of menstruation, painful cramping in the abdomen, dizziness and weakness, loss of appetite, less colorful face, some people also have diarrhea, fat tongue with purple color, thin white or greasy moss, thin and astringent pulse. The treatment is to strengthen the spleen, benefit the qi and activate the blood to remove blood stasis.
4.Kidney deficiency and blood stasis type
Heavy menstruation with dripping and difficult to clean, purple and dull with lumps, hidden pain in the abdomen, lumbosacral soreness, dizziness and tinnitus, pale purple tongue with tooth marks or petechiae, sunken and astringent pulse, easily causing infertility or abortion, slippery fetus, which should be taken seriously. The treatment is supplemented by tonifying kidney qi and activating blood circulation to remove blood stasis. In cases of partial Kidney-Yin deficiency, accompanied by irritable heat in the five hearts, insomnia and night sweating, red tongue with little coating, treatment should focus on nourishing the Kidney and nourishing Yin.
In particular, in addition to the treatment of uterine fibroids according to the above-mentioned subtypes, it is also necessary to treat them differently according to the different periods of the menstrual cycle. According to the progress of the disease, at the early stage of the disease, we should regulate the Qi and activate the Blood, at the middle stage, we should remove the stasis and disperse the nodules, and at the later stage, we should attack and nourish both, and we should protect the vital energy.
IV. Surgical treatment
Surgery is generally recommended when the uterus is larger than the size of a 2.5 month gestation uterus, or when clinical symptoms are obvious, secondary anemia, or when the fibroid grows rapidly within a short period of time and has the possibility of degeneration. In some patients, surgery should also be considered if the fibroids do not shrink but increase in size after menopause.
(1) Myomectomy: for unmarried or unmarried patients under 35 years old who wish to preserve their reproductive function. Transabdominal or laparoscopic resection of fibroids, protruding from the uterus or vagina or submucosal fibroids are removed vaginally or via hysteroscopy.
(2) Hysterectomy: for those with large fibroids, obvious symptoms, ineffective medication, no need to preserve reproductive function or suspected malignant change, subtotal or total hysterectomy is performed; those under 50 years of age with normal ovarian appearance can have their ovaries preserved.