Hello friends............................... This is my FIRST PPT OUTSIDE PHARM.D SYLLABUS!!!! This ppt is REGARDING FIBROID UTERUS, with a therapeutical & pathophysiological approach!! Do go through....will surely be useful for students posted in OBG departments! Regards, @rxvichu-alwz4uh! :)

1. FIBROID UTERUS- A
DEEP INSIGHT
PRESENTED BY:
VISHNU.R.NAIR,
4TH YEAR PHARM.D,
NATIONAL COLLEGE OF PHARMACY,
KERALA UNIVERSITY OF HEALTH

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

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

6.  TYPES OF FIBROIDS  :
FIBROIDS ARE CLASSIFIED AS:
1. 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:
1. GENETIC CAUSES:
- FIBROIDS are usually MONOCLONAL
- 40% include CHROMOSOMAL ABNORMALITIES
- 60% include UNDETECTED MUTATIONS
- CHROMOSOMAL ABNORMALITIES include:
a. TRANSLOCATIONS between CHROMOSOMES 12 & 14
b. DELETION of CHROMOSOME 7
c. 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:
a. Fibroids tend to SHRINK after MENOPAUSE
b. 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:
a. TUMOR-GROWTH FACTOR(BETA)
b. BASIC FIBROBLAST GROWTH FACTOR
c. EPIDERMAL GROWTH FACTOR(EGF)
d. PLATELET DERIVED GROWTH FACTOR (PDGF)
e. VASCULAR ENDOTHELIAL FACTOR (VEF)
f. INSULIN- LIKE GROWTH FACTOR

11. 4. MISCELLANEOUS CAUSES:
INCLUDE:
a. OBESITY
b. ERT
c. ENDOMETRIOSIS
d. ENDOMETRIAL CANCER
e. OVULATORY INFERTILITY
f. EARLY MENARCHE
g. PREGNANCY………………………………………………….

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

13. 2. PRECIPITATING FACTORS:
INCLUDE:
a. HORMONE REPLACEMENT THERAPY (HRT)
b. LUTEAL INSUFFICIENCY
c. 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:
a. SWELLING OF BREASTS
b. DEPRESSION
c. LOSS OF SEXUAL DRIVE
d. DYSMENORRHOEA………………………………

15.  CLINICAL MANIFESTATIONS  :
1. HEAVY MENSTRUAL BLEEDING
2. MENSTRUAL PERIODS, LASTING MORE THAN 1 WEEK
3. PELVIC PRESSURE/ PAIN
4. DIFFICULTY IN EMPTYING THE BLADDER
5. CONSTIPATION
6. BACKACHE
7. LEG PAINS
8. ACUTE ABDOMINAL PAIN
9. FREQUENT URINATION

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

17.  RISK FACTORS FOR FIBROIDS  :
INCLUDE:
1. AGE:
- Incidence increases with AGE, till ONSET of MENOPAUSE
2. ENDOGENOUS HORMONAL FACTORS:
INCLUDE:
a. EARLY MENARCHE
b. LATE MENOPAUSE
c. HYPER-ESTROGENIC STATES
d. INCREASED RESPONSIVENESS & EXPRESSION OF PROGESTERONE RECEPTORS

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 ,

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:
1. ANEMIA (DUE TO HEAVY BLOOD LOSS)
2. INFERTILITY
3. PLACENTAL ABRUPTION
4. FETAL GROWTH RESTRICTION
5. PRE-TERM DELIVERY
6. CHF………………………………….

21.  DIAGNOSTIC PRINCIPLES FOR
FIBROIDS 
INCLUDE:
1. 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. - TESTS include:
a. CBC (COMPLETE BLOOD COUNT) : To see if ANEMIA has occurred , due to
CHRONIC BLOOD LOSS
b. OTHER TESTS : TO RULE OUT OTHER BLEEDING DISORDERS/ THYROID
PROBLEMS
3. MRI-SCAN :
- Used for the following purposes:
a. To show SIZE & LOCATION of FIBROIDS
b. To identify DIFFERENT TUMOR TYPES
c. 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:
a. Revealing fibroids
b. 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:
A. GOALS OF THERAPY
B. PHARMACOTHERAPY
C. NON-PHARMACOTHERAPY

26. A. GOALS OF THERAPY :
1. TO RELIEVE PAIN & DISCOMFORT
2. TO AVOID PROGRESSION INTO COMPLICATIONS
3. TO ASSESS NEED OF THERAPY & ITS PROPER PLANNING
4. TO IMPROVE HRQOL (HEALTH-RELATED QUALITY OF LIFE)
5. TO ENSURE PATIENT CONVALESCENCE AS MUCH AS
POSSIBLE…………………….

27. B. PHARMACOTHERAPY :
1. GNRH (GONADOTROPIN-RELEASING HORMONE) AGONISTS:
- TEMPORARY TREATMENT for PRE-MENOPAUSAL WOMEN, with HEAVY
MENORRHAGIA
- Actions include:
a. DRUG  BLOCKS PRODUCTION of ESTROGEN & PROGESTERONE  Puts
patient in a TEMPORARY MENOPAUSAL STATE  MENSTRUATION STOPS 
FIBROIDS SHRINK  ANEMIA IMPROVES
b. DRUG  REDUCES UTERINE VOLUME by 35%
c. DRUG  REDUCES FIBROID VOLUME by 30%
d. DRUG  REDUCES BLEEDING

28. - SYMPTOMS RETURN , when MEDICATION IS STOPPED
- Usually given for 3-6 MONTHS
- DRUGS used include:
I. 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
FIBROID ASSOCIATED MENORRHAGIA, and interested 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:
1. NON-INVASIVE PROCEDURES
2. MINIMALLY INVASIVE PROCEDURES
3. TRADITIONAL SURGICAL PROCEDURES
4. HOME REMEDIES FOR FIBROID UTERUS
5. PATIENT COUNSELLING TIPS(DO’S FOR FIBROIDS)
6. PATIENT COUNSELLING TIPS(DON’T’S FOR FIBROIDS)

36. 1. NON – INVASIVE PROCEDURES :
INCLUDES:
I. 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:
I. 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:
I. 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:
I. CASTOR OIL PACK:
- CASTOR OIL PACK  Applied on 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

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:
a. Aids in LIVER DETOXIFICATION
b. 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%

45. - CALCIUM found 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 REDUCE FIBROID 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)
:
1. EXERCISE REGULARLY
2. DRINK PLENTY OF WATER A DAY
3. CONSUME WHOLE GRAINS, LIKE OATS, BROWN RICE, ETC
4. EAT BEANS, NUTS, SEEDS
5. EAT PLENTY OF GREEN VEGETABLES
6. EAT PLENTY OF FIBER RICH FOODS
7. COMBAT OBESITY, BY PROPER MEDITATION & FOCUSSING ON JUSTIFIABLE
FOOD CHOICES………………………………….

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

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

51. THANK YOU !!!!!
@RXVICHU-ALWZ4UH!
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