1 / 51

Fibroid uterus- a deep insight

Fibroid uterus- a deep insight. Presented by: Vishnu.r.nair, 4 th year pharm.d, National college of pharmacy, Kerala university of health sciences(kuhs), kerala state. INDEX/ CONTENTS OF THIS PPT :. GENERAL ACKNOWLEDGEMENT GENERAL INTRODUCTION  EPIDEMIOLOGICAL STATISTICS 

hisa
Download Presentation

Fibroid uterus- a deep insight

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Fibroid uterus- a deep insight Presented by: Vishnu.r.nair, 4th year pharm.d, National college of pharmacy, Kerala university of health sciences(kuhs), kerala state

  2. INDEX/ CONTENTS OF THIS PPT : • GENERAL ACKNOWLEDGEMENT • GENERAL INTRODUCTION  • EPIDEMIOLOGICAL STATISTICS  • TYPES OF FIBROIDS  • ETIOLOGY/ CAUSES OF FIBROIDS  • PATHOPHYSIOLOGY  • CLINICAL MANIFESTATIONS  • RISK FACTORS FOR FIBROIDS  • COMPLICATIONS OF FIBROIDS  • DIAGNOSTIC PRINCIPLES FOR FIBROIDS  • MANAGEMENT STRATEGIES FOR FIBROIDS  • BIBLIOGRAPHY/ REFERENCE 

  3.  GENERAL ACKNOWLEDGEMENT  : HELLO READERS…………………. Its my 21st ppt…………………………… As far as making this ppt is concerned, I wish to thank the almighty, my ever-loving parents, dear teachers of 4th year, my friends, pharm.d group members and everyone, near and dear, for ur support, care & guidance in my initiatives n works…….. with a note of thanks, I surely hope that this ppt will prove worthy for anyone who go through it Do send me ur reviews n comments!!! @rxvichu-alwz4uh!   

  4.  General introduction  : • UTERINE FIBROIDS are defined as “NON-CANCEROUS GROWTHS of UTERUS, that usually appear during CHILDBEARING YEARS” • Also known as “ UTERINE LEIOMYOMAS”/ simply “MYOMAS” • Not associated (in most cases) , with UTERINE CANCER • FIBROID SIZE varies from SEEDLINGS(undetectable by human eye), to BULKY MASSES, that can DISTORT/ENLARGE the UTERUS • Fibroid may be SINGLE in OCCURRENCE/ MULTIPLE in number • Many women have UTERINE FIBROIDS at sometime in their lives • Most women do not know that they have fibroids, since they often are ASYMPTOMATIC……………………………

  5.  EPIDEMIOLOGICAL STATISTICS  : • According to NATIONAL INSTITUTE OF HEALTH, about 70-80% of women experience FIBROIDS by age 50 • About 77% specimens of HYSTERECTOMY(Conducted in US), were found to have FIBROIDS, in VARIABLE NUMBERS, SIZES & SITES • According to SONOGRAPHICSURVEY in 35-49 years aged AFRO-AMERICAN WOMEN  60% FIBROIDS were reported in them • WHITE WOMEN have LOWER PREVALENCE : 40% at age 35, and almost 70% by age 50……………………….

  6.  TYPES OF FIBROIDS  : FIBROIDS are classified as: • INTRAMURAL FIBROIDS: • MOST COMMON type of fibroid • Appears within UTERUS LINING(ENDOMETRIUM) • May grow larger & cause WOMB SWELLING 2. SUB-SEROSAL FIBROIDS: • Form on OUTSIDE of UTERUS(SEROSA) • May grow large enough to make WOMB appear BIGGER ON ONE SIDE

  7. 3. PEDUNCULATED FIBROIDS: • When SUBSEROSAL TUMORS develop a STEM(SLENDER BASE, that supports the TUMOR)  PEDUNCULATED TUMORS are formed 4. SUBMUCOSAL FIBROIDS : • Develop in INNER LINING (MYOMETRIUM) of UTERUS • Not as common as other types • Cause HEAVY MENSTRUAL BLEEDING & TROUBLE in CONCEIVING…………………….

  8.  ETIOLOGY/ CAUSES OF FIBROIDS  : CAUSES OF FIBROIDS INCLUDE: • GENETIC CAUSES: - Fibroidsare usually MONOCLONAL • 40% include CHROMOSOMAL ABNORMALITIES • 60% include UNDETECTED MUTATIONS • CHROMOSOMAL ABNORMALITIES include: • TRANSLOCATIONS between CHROMOSOMES 12 & 14 • DELETION of CHROMOSOME 7 • TRISOMY of CHROMOSOME 12 (in LARGE TUMORS)

  9. 2. HORMONES: • ESTROGEN & PROGESTERONE (Hormones, that stimulate DEVELOPMENT of UTERINE LINING, during each MENSTRUAL CYCLE , in preparation for PREGNANCY) Promotes fibroid growth • Fibroids contain more ESTROGEN & PROGESTERONE RECEPTORS than NORMAL UTERINE MUSCLE CELLS do • ESTROGEN  induces INCREASED EXPRESSION of PROGESTERONE RECEPTORS  Promotes ONCOGENIC EFFECTS of PROGESTERONE • This explains why: • Fibroids tend to SHRINK after MENOPAUSE • Fibroids tend to occur during HRT(ERT)

  10. 3. GROWTH FACTORS: • GROWTH FACTORS  PROTEIN POLYPEPTIDES , produced LOCALLY by SMOOTH MUSCLE CELLS & FIBROBLASTS • GROWTH FACTORS  increase EXTRACELLULAR MATRIX  promote FIBROID GROWTH • GROWTH FACTORS include: • TUMOR-GROWTH FACTOR(BETA) • BASIC FIBROBLAST GROWTH FACTOR • EPIDERMAL GROWTH FACTOR(EGF) • PLATELET DERIVED GROWTH FACTOR (PDGF) • VASCULAR ENDOTHELIAL FACTOR (VEF) • INSULIN- LIKE GROWTH FACTOR

  11. 4. MISCELLANEOUS CAUSES: INCLUDE: • OBESITY • ERT • ENDOMETRIOSIS • ENDOMETRIAL CANCER • OVULATORY INFERTILITY • EARLY MENARCHE • PREGNANCY………………………………………………….

  12.  PATHOPHYSIOLOGY OF FIBROIDS  : - There are 2 types of FACTORS, that cause FIBROID UTERUS: • PRE-DISPOSING FACTORS: INCLUDE: • Age g. Use of ORAL CONTRACEPTIVES • Gender h. High fat diet • Race i. Obesity • Lifestyle j. Family history • Early menarche k. Anxiety • Nulliparity

  13. 2. PRECIPITATING FACTORS: INCLUDE: • Hormone replacement therapy (hrt) • Luteal insufficiency • Anovulation • Both PRE-DISPOSING & PRECIPITATING FACTORS  Cause ESTROGEN DOMINANCE  If ESTROGEN DOMINANCE is not treated  PROLIFERATION of CELLS in UTERUS occurs  OVERGROWTH of ENDOMETRIAL LINING occurs  UTERINE FIBROID develops  FIBROIDS interferes with VASCULAR SUPPLY  Causes DEGENERATION in INTERIOR PART of FIBROID  causes HYPERMENORRHOEA, and OTHER SYMPTOMS………………………

  14. - ESTROGEN DOMINANCE is associated with: • SWELLING OF BREASTS • DEPRESSION • LOSS OF SEXUAL DRIVE • DYSMENORRHOEA………………………………

  15.  CLINICAL MANIFESTATIONS  : • HEAVY MENSTRUAL BLEEDING • MENSTRUAL PERIODS, LASTING MORE THAN 1 WEEK • PELVIC PRESSURE/ PAIN • DIFFICULTY IN EMPTYING THE BLADDER • CONSTIPATION • BACKACHE • LEG PAINS • ACUTE ABDOMINAL PAIN • FREQUENT URINATION

  16. 10. DYSPAREUNIA 11. ANOREXIA 12. SWELLING/ ENLARGEMENT OF ABDOMEN…………………………..

  17.  RISK FACTORS FOR FIBROIDS  : INCLUDE: • AGE: • Incidence increases with AGE, till ONSET of MENOPAUSE 2. ENDOGENOUS HORMONAL FACTORS: INCLUDE: • EARLY MENARCHE • LATE MENOPAUSE • HYPER-ESTROGENIC STATES • INCREASED RESPONSIVENESS & EXPRESSION OF PROGESTERONE RECEPTORS ‘A’ & ‘B’

  18. 3. FAMILY HISTORY : • FIRST DEGREE RELATIVES  have 3.5 TIMES more risk of DEVELOPING FIBROIDS 4. ETHNICITY : • BLACK WOMEN  develop FIBROIDS 2.9 TIMES more than WHITE WOMEN 5. BODY WEIGHT: • Risk of FIBROIDS increases by 21% , with each 10 KG increase in BODY WEIGHT 6. DIET : • Diet , rich in RED MEAT, HAM, BEEF  Increases FIBROID RISK 7. EXERCISE: - Women doing REGULAR EXERCISE (at least 7 hrs./ week)  have LOW RISK , than those who DON’T EXERCISE

  19. 8. ESTROGEN REPLACEMENT THERAPY: • Increased INCIDENCE observed when PROGESTERONE is added 9. PREGNANCY: • PREGNANCY increases production of ESTROGEN & PROGESTERONE  Encourages RAPID DEVELOPMENT of FIBROIDS 10. TISSUE INJURY: - Increases LOCAL PRODUCTION of TISSUE GROWTH FACTORS…………………………

  20.  Complications of fibroids  : INCLUDE: • ANEMIA (DUE TO HEAVY BLOOD LOSS) • INFERTILITY • PLACENTAL ABRUPTION • FETAL GROWTH RESTRICTION • PRE-TERM DELIVERY • CHF………………………………….

  21.  DIAGNOSTIC PRINCIPLES FOR FIBROIDS  INCLUDE: • ULTRASOUND: • ULTRASOUND  uses SOUND WAVES  obtains PICTURE of UTERUS  confirms diagnosis , and also helps to MEASURE FIBROIDS • DOCTOR/ TECHNICIAN  Moves the ULTRASOUND DEVICE (TRANSDUCER) over ABDOMEN (TRANS-ABDOMINAL) / places it inside VAGINA (TRANS-VAGINAL) , to get images of UTERUS 2. BLOOD TESTS: - If ABNORMAL MENSTRUATION is observed  doctor may order other tests to investigate POTENTIAL CAUSES

  22. - TESTSinclude: • CBC (COMPLETE BLOOD COUNT) : To see if ANEMIA has occurred , due to CHRONIC BLOOD LOSS • OTHER TESTS : To rule out OTHER BLEEDING DISORDERS/ THYROID PROBLEMS 3. MRI-SCAN : - Usedfor the following purposes: • To show SIZE & LOCATION of FIBROIDS • To identify DIFFERENT TUMOR TYPES • To determine APPROPRIATE TREATMENT OPTIONS

  23. 4. HYSTEROSONOGRAPHY: • Also known as “SALINE INFUSION SONOGRAM” • Here  STERILE SALINE is used  EXPANDS UTERINE CAVITY  Makes easier to get images of SUBMUCOSAL FIBROIDS & ENDOMETRIUM 5. HYSTEROSALPINGOGRAPHY: • Here  DYE is used  HIGHLIGHTS UTERINE CAVITY & FALLOPIAN TUBES on X-RAY IMAGES • Helps in: • Revealing fibroids • To determine if FALLOPIAN TUBES are OPEN

  24. 6. HYSTEROSCOPY: - In this procedure  doctor inserts a HYSTEROSCOPE (Small, lighted TELESCOPE) through CERVIX into UTERUS  then SALINE is injected into UTERUS  expands UTERINE CAVITY  Allows doctor to examine walls of UTERUS & OPENINGS of FALLOPIAN TUBES……………………………..

  25.  MANAGEMENT STRATEGIES FOR FIBROIDS  : INCLUDES: • GOALS OF THERAPY • PHARMACOTHERAPY • NON-PHARMACOTHERAPY

  26. A. GOALS OF THERAPY : • To relieve pain & discomfort • To avoid progression into complications • To assess need of therapy & its proper planning • To improve hrqol (health-related quality of life) • To ensure patient convalescence as much as possible…………………….

  27. B. PHARMACOTHERAPY : • Gnrh (gonadotropin-releasing hormone) agonists: • Temporary treatment for PRE-MENOPAUSAL WOMEN, with HEAVY MENORRHAGIA • Actions include: • DRUG BLOCKS PRODUCTION of ESTROGEN & PROGESTERONE  Puts patient in a TEMPORARY MENOPAUSAL STATE  MENSTRUATION STOPS  FIBROIDS SHRINK  ANEMIA IMPROVES • DRUG  REDUCES UTERINE VOLUME by 35% • DRUG  REDUCES FIBROID VOLUME by 30% • DRUG  REDUCES BLEEDING

  28. SYMPTOMS RETURN , when MEDICATION IS STOPPED • Usually given for 3-6 MONTHS • DRUGS used include: • TRIPTORELIN (TRELSTAR): • MOA : DRUG  REDUCES ‘FSH’ LEVELS  SUPPRESSES STEROIDOGENESIS  REDUCES ESTROGEN levels • ADRs: • HOT FLUSHES (82%) • BONE PAIN (17%) • IMPOTENCE (10%) - INTERACTION : DRUG + AMIODARONE  Increases TOXICITY OF LATTER  High risk of TDP(TORSADES DE POINTES)

  29. DOSE : 3.75 mg DEPOT (i.m) MONTHLY…………… II. LEUPROLIDE ACETATE(LUPRON) : • MOA : DRUG  INHIBITS GONADOTROPIN SECRETION  SUPPRESSES OVARIAN STEROIDOGENESIS  REDUCES FSH LEVELS • AGONIST ANALOGUE of luteinizing hormone-releasing hormone(lhrh) • ADRs: • HOT FLUSHES (57%) • ISCHEMIA (19%) • FATIGUE (18%) • INTERACTION : DRUG + AMIODARONE  increased risk of TDP • DOSE : 3.75 mg DEPOT (i.m) MONTHLY……………………………….

  30. III. GOSERELIN(ZOLADEX): • LHRH ANALOGUE • Same MOA as that of LEUPROLIDE • ADRs: • FLUSHING (46-96%) • VAGINITIS (5-75%) • BREAST ATROPHY (33%) • DEPRESSION IN WOMEN (54%) • REDUCED LIBIDO (47-61%) • INTERACTION : DRUG + AMIODARONE  Increased risk of TDP • DOSE : 3.6 mg DEPOT (s.c) MONTHLY………………………………

  31. 4. Nafarelin (synarel): • Synthetic decapeptide • Moa : drug  desensitizes response to ENDOGENOUS GnRH  REDUCES FSH SECRETION  REDUCES OVARIAN PRODUCTION • ADRs: • ACNE (10%) • BREAST ENLARGEMENT (8%) • VAGINAL BLEEDING (8%) • DOSE : 200 mg , taken TWICE DAILY, INTRANASALLY ( ONE SPRAY into 1 NOSTRIL in MORNING, & 1 SPRAY into OTHER NOSTRIL at EVENING)

  32. 2. PROGESTIN-RELEASING INTRAUTERINE DEVICE: • REASONABLE TREATMENT for selected women of CHILD-BEARING AGE , with FIBROIDASSOCIATED MENORRHAGIA, andinterested to have CONCEPTION • Reduces HEAVY BLEEDING caused by FIBROIDS • Provides only SYMPTOMATIC RELIEF • Doesn’t SHRINK FIBROIDS/ make them DISAPPEAR • PREVENTS PREGNANCY • 85% of such women returned to their normal bleeding in 3 months • 40% developed REVERSIBLE AMENORRHEA at the end of 1.5-2 YEARS • Example : MIRENA-LEVONORGESTREL RELEASING IUCD……………………………….

  33. 3. TRANSEXAMIC ACID (LYSTEDA): • NON-HORMONAL MEDICATION • EASES HEAVY MENSTRUAL PERIODS • Taken only on HEAVY BLEEDING DAYS • DOSE : 10mg/kg i.v (over 30 mins)………………………. 4. ORAL CONTRACEPTIVES/ PROGESTINS: • CONTROL MENSTRUAL BLEEDING • Don’t reduce fibroid size

  34. 5. NSAIDs: - Relieve pain associated with FIBROIDS • Don’t reduce BLEEDING caused by FIBROIDS 6. VITAMIN & IRON SUPPLEMENTS: - Used to control HEAVY MENORRHAGIA & ANEMIA…………………………………..

  35. B. NON-PHARMACOTHERAPY : INCLUDES: • NON-INVASIVE PROCEDURES • MINIMALLY INVASIVE PROCEDURES • TRADITIONAL SURGICAL PROCEDURES • HOME REMEDIES FOR FIBROID UTERUS • PATIENT COUNSELLING TIPS(DO’S FOR FIBROIDS) • PATIENT COUNSELLING TIPS(DON’T’S FOR FIBROIDS)

  36. 1. NON – INVASIVE PROCEDURES : INCLUDES: • FOCUSED ULTRASOUND SURGERY (FUS): • Helps in UTERUS PREPARATION • Requires NO INCISION • Done on OUT-PATIENT BASIS • Performed in presence of MRI-SCANNER, that is equipped with a HIGH-ENERGY ULTRASOUND TRANSDUCER • IMAGE PROVIDED by TRANSDUCER Provides PRECISE LOCATION of UTERINE FIBROIDS  When LOCATION of the FIBROID is TARGETED  ULTRASOUND TRANSDUCER FOCUSSES SOUND WAVES(SONICATIONS) into FIBROID  HEATS & DESTROYS small areas of FIBROID TISSUE…………..

  37. 2. MINIMALLY INVASIVE PROCEDURES: INCLUDE: • UTERINE ARTERY EMBOLIZATION: • In this process  SMALL PARTICLES (EMBOLIC AGENTS)  INJECTED into ARTERIES supplying the UTERUS  CUTS OFF BLOOD SUPPLY to FIBROIDS  Cause them to SHRINK & DIE • Complications may occur if the BLOOD SUPPLY to the OVARIES/ other ORGANS is COMPROMISED…………………….. II. MYOLYSIS: - LAPAROSCOPIC PROCEDURE

  38. Here  RADIOFREQUENCY ENERGY, ELECTRIC CURRENT / LASER is used  DESTROYS FIBROIDS  SHRINKS BLOOD VESSELS that feed them • CRYOMYOLYSIS : Involves FREEZING of FIBROIDS III. LAPAROSCOPIC/ ROBOTIC MYOMECTOMY: • During MYOMECTOMY  SURGEON removes FIBROIDS, keeping UTERUS in its place • LAPAROSCOPIC method is used if FIBROIDS are FEW & SMALL in NUMBER • Here  SLENDER INSTRUMENTS are INSERTED through SMALL INCISIONS in the ABDOMEN  FIBROIDS are broken into SMALLER PIECES (A process, known as MORCELLATION) • ROBOTIC MYOMECTOMY gives surgeon a MAGNIFIED, 3-D IMAGE OF UTERUS Provides MORE PRECISION,DEXTERITY & FLEXIBILITY…………………….

  39. IV. HYSTEROSCOPIC MYOMECTOMY: • Applicable for SUB-MUCOSAL FIBROIDS • Here  SURGEON removes FIBROIDS, using INSTRUMENTS, inserted through VAGINA & CERVIX into the UTERUS V. ENDOMETRIAL ABLATION: - Here  a SPECIALIZED INSTRUMENT is inserted into UTERUS  Uses HEAT, MICROWAVE ENERGY, HOT WATER/ ELECTRIC CURRENT  Destroys UTERINE LINING  Ends MENSTRUATION/ REDUCES MENSTRUAL FLOW…………………………

  40. 3. TRADITIONAL SURGICAL PROCEDURES: INCLUDES: • ABDOMINAL MYOMECTOMY: • Applicable for MULTIPLE FIBROIDS, VERY LARGE/ DEEP FIBROIDS • OPEN ABDOMINAL SURGICAL PROCEDURE • DEMERIT : SCARRING after surgery  can affect future FERTILITY II. HYSTERECTOMY: • Only proven PERMANENT SOLUTION for UTERINE FIBROIDS • Ends ABILITY TO HAVE CHILDREN, since the procedure involves REMOVAL OF UTERUS as such……….

  41. 4. Home remedies for fibroid uterus : INCLUDE: • CASTOR OIL PACK: • CASTOR OIL PACK  Appliedon ABDOMEN  Stimulates LYMPHATIC & CIRCULATORY SYSTEM  Increases LYMPHOCYTES (Disease- fighting cells)  Eliminates TOXINS from body • CASTOR OIL  Contains RICINOLEIC ACID  has ANTI-INFLAMMATORY ACTION  SHRINKS FIBROIDS  Relives PAIN • SATURATE a piece of WOOL FLANNEL in CASTOR OIL  Place it on your ABDOMEN  Cover it with a PLASTIC WRAP  Place HEATING PAD/ HOT WATER BOTTLE on it  cover it with an OLD TOWEL  Leave it on for about 1 HOUR  REMOVE IT  REPEAT 3-4 times a week, (for 1 month), unless SYMPTOMS RESOLVE • NEVER USE THIS REMEDY during MENSTRUATION/ if you are trying to CONCEIVE…………

  42. II. CHASTEBERRY: • Also known as “VITEX AGNUS-CASTUS” • Found in SOUTHERN EUROPE & MEDITERRANEAN AREAS • Good HERBAL SOLUTION to maintain HORMONAL BALANCE, REDUCE ESTROGEN LEVELS, & REDUCE INFLAMMATION • Take 25-30 drops of CHASTEBERRY TINCTURE TWICE/ FOUR TIMES DAILY • CHASTEBERRY may REDUCE EFFECTIVENESS of BIRTH CONTROL PILLS………………….. III. MILK THISTLE: • METABOLIZES & gets RID of EXCESS ESTROGEN • Take 15-20 drops of its TINCTURE (THRICE DAILY) for 3-4 months……………………

  43. IV. DANDELION: • According to HERBALISTS POOR LIVER FUNCTION  Causes POOR ELIMINATION of EXCESS HORMONES  results in FIBROIDS • DANDELION has 2 actions: • Aids in LIVER DETOXIFICATION • Clears EXCESS ESTROGEN from the body • BOIL 3 tbsp. of DANDELION ROOT in 3.5 cup water  let it SIMMER for 15 minutes  turn off heat  allow to steep for 15 minutes  STRAIN it  Drink this tea thrice daily for 3 months………

  44. V. GREEN TEA: • According to STUDIES  GREEN TEA contains a compound called “EPIGALLOCATECHIN GALLATE(EGCG)”  INHIBITS GROWTH of FIBROID CELLS  Increases its DEATH RATE • EGCG  Has ANTI-INFLAMMATORY, ANTI-PROLIFERATIVE & ANTI-OXIDANT effects • According to RESEARCHERS  Along with reducing FIBROID SIZE  GREEN TEA also reduces SEVERITY of FIBROID SYMPTOMS • Drink 2-3 cups of GREEN TEA daily for several months……………………… VI. MILK: - According to a study published in AMERICAN JOURNAL OF EPIDEMIOLOGY in 2009 RESEARCHERS at BOSTON UNIVERSITY SCHOOL OF MEDICINE found that BLACK WOMEN, who consumed 4/ more DAIRY SERVINGS a day, had 30% REDUCED RISK of UTERINE FIBROIDS, compared to those with <1 serving/day

  45. CALCIUMfound in milk  reduces CELL PROLIFERATION • Combine MILK with BLACKSTRAP MOLASSES(rich in IRON)  Helps to FIGHT ANEMIA , resulting from HEAVY BLEEDING due to FIBROIDS • Mix 1-2 tbsp. BLACKSTRAP MOLASSES in a cup of WARM MILK  Drink it OD/ BID, for few months…………………………….. VII. BURDOCK ROOT TEA: • Improves LIVER’S ABILITY to METABOLIZE ESTROGEN  Reduces FIBROIDS • BURDOCK ROOT  Contains LIGNAN “ARCTIGENIN”  Reduces FIBROID SIZE  Prevents NEW TUMOR GROWTH • Add 1 tsp. of DRIED BURDOCK ROOT to a cup of HOT WATER  STEEP for 10-15 minutes  STRAIN it  Drink it TID, for 3-4 months…………………………………….

  46. VIII. APPLE CIDER VINEGAR: - APPLE CIDER VINEGAR  REMOVES TOXINS & PROMOTES FAT LOSS  helps to REDUCEFIBROID SYMPTOMS • Add 1 tsp of APPLE CIDER VINEGAR to a glass of water  add NATURAL SWEETENER to taste  drink it daily on a regular basis ……….. IX. GARLIC: • NATURAL ANTI-OXIDANT & ANTI-INFLAMMATORY AGENT • Reduces GROWTH of TUMORS & UTERINE FIBROIDS • Eat 3-4 GARLIC CLOVES a day, along with a glass of milk………..

  47. x. Indian gooseberry(amla): - Amla potent anti-oxidant & immunomodulator  Reduces fibroids & their SYMPTOMS - Mix 1 tsp of AMLA POWDER & HONEY  CONSUME it in MORNING, for few months…………………………

  48. 5. PATIENT COUNSELLING TIPS (DO’S FOR FIBROIDS) : • EXERCISE REGULARLY • DRINK PLENTY OF WATER A DAY • CONSUME WHOLE GRAINS, LIKE OATS, BROWN RICE, ETC • EAT BEANS, NUTS, SEEDS • EAT PLENTY OF GREEN VEGETABLES • EAT PLENTY OF FIBER RICH FOODS • COMBAT OBESITY, BY PROPER MEDITATION & FOCUSSING ON JUSTIFIABLE FOOD CHOICES………………………………….

  49. 6. PATIENT COUNSELLING TIPS(DON’T’S FOR FIBROIDS): • AVOID JUNK FOODS • AVOID FRIED FOODS AS MUCH AS POSSIBLE • AVOID RED MEAT & HAM • AVOID STRESS AS FAR AS POSSIBLE • AVOID ALCOHOL CONSUMPTION • AVOID HIGHLY SUGARY PRODUCTS………………………………..

  50.  BIBLIOGRAPHY/ REFERENCE  : • www.sciencedaily.com/releases/2009/12/091204.html • www.top10homeremedies.com/home-remedies-fibroids.html/3 • www.mayoclinic.org • www.healthline.com • Thomason.P; Lin.C.Eugene; “UTERINE LEIOMYOMA(FIBROID) IMAGING”; emedicine.medscape.com………………………

More Related