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Non-Surgical Approach Towards Uterine Fibroid and Ovarian Cyst with Yoga Practice

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Non-Surgical Approach Towards Uterine Fibroid and Ovarian Cyst with Yoga Practice IMCR 28 CASE REPORT Non-surgical approach towards uterine fibroid and ovarian cyst with Yoga practice Purnandu Sharma*1, Ranjana Chhabra2, Amit Singh3, Reshma P Jogdand4 1Patanajali Chikitsalya, Raisnghnagar, Rajasthan 2Vinyasa Yoga Studio, Sriganganagar, Rajasthan 3,4S-VYASA University, Jigni, Anekal Taluk, Bengaluru KEY WORDS ABSTRACT Yoga A case of a 43 years old female with uterine fibroid and ovarian cyst was managed by an alter- Uterine fibroid native, Non-surgical approach of yoga intervention. Yoga was practised under supervision daily Ovarian Cyst twice a day for three months showed significant recovery from ovarian Cyst and reduction in Non-Surgical Approach uterine fibroid size. A diagnosis, where surgery was suggested as the only option, yoga has been Complimentary Medicine found to be effective treatment modality in prevention and management. doi: 10.38205/imcr.010228 *Corresponding Author: Purnandu Sharma Patanajali Chikitsalya Raisnghnagar, Rajasthan Contact no: +91-9079806230 E-mail: [email protected] Introduction - high levels of androgen, and the prevalence of polycystic ova ries on pelvic ultrasound exceeds 70% in patients with PCOS- Uterine fibroid referred to as uterine leiomyomata or uterine (11). Yoga is an ancient practice originated in India more than- myomas are commonest benign uterine tumours developing- 5000 years ago as a comprehensive disciplined lifestyle to be in women in reproductive age (1). Most leiomyomas occur in- come aware about one’s body, mind, spirit and their connec the fundus and body of the uterus; only 3% occur in the cer tion to transcend body’s impurities by realising its own true vix. They are most common towards the end of the reproduc Casenature (12).presentation tive years (2). Pathogenesis is not clearly known, though the role of oestrogen and progesterone has been documented in fibroid formation and tumour’s growth (3,4). These tumours - - A 43 years old female non-smoker, non-alcoholic, vegetarian, are rarely reported before menarche (5) and reduce after patient weight-56 kg, height-155 cm, from Sriganga nagar, Ra menopause (6). As per its location relative to uterus layers, tu jasthan reported with diagnosis of uterine fibroid and cysts mours are classified- sub serous, intramural, and sub mucous. in left ovary. Patient was apparently normal when she got her Clinical manifestation of uterine fibroid is abnormal - regular monthly menstrual cycle which usually last 3–4 days uterine bleeding, feeling of pelvic pressure, urine retention, painful micturition. They may be associated with infertility but this time it lasts up to two weeks associated with heavi and miscarriage (7). ness in right side of abdomen and weakness in whole body. Ovarian cysts are the most common abnormality in- She consulted a gynaecologist and suggested ultrasonography women in reproductive age. Polycystic Ovarian Syndrome which revealed fibroid on posterior wall of uterus measuring (PCOS) characterized by multiple small cysts in the ovary, af 15 × 12 mm and cysts in left ovary (Ovary size- 75 × 64 mm)- ter menarche, affects 5–10% of women of reproductive age- (Figure 1). and can be a cause of infertility (8). Studies show that more Later gynaecologist prescribed her medicine and ad than 50% of patients with PCOS develop prediabetes or dia- vised for surgery (Table-1). betes, and there is an increased risk of hypertension, anxiety, Patient decided to go for yoga practices to deal with her myocardial infarction (MI), dyslipidaemia, depression, endo- illness, even her husband was not in favour of trying yoga metrial cancer, and sleep apnoea (9). - practices because of her complaints as he wanted her to get Characteristics of PCOS include increased androgen lev rid of it through surgery. - els, ovulation irregularities, and cysts in ovaries (10). More On the same day patient contacted us, based on patient’s over, alopecia, hirsutism and acne are directly connected with complaints and after evaluation yoga therapeutic interven INTEGRATIVE MEDICINE CASE REPORTS VOLUME 1 NUMBER 2 JULY 2020 www.jimcr.com IMCR CASE REPORT 29 tion was planned. Next day patient started yoga practises with therapist, a brief introduction about yoga and its importance in our life was explained to patient. Lifestyle modification was Methodsuggested by of yoga Therapeutic therapy consultant. intervention and assessment Asanas, pranayama Yoga therapy was designed twice a day morning and evening 55comprising min pranayama and chanting. Each session was of 100 minutes’ session (45 min asanas and relaxation, and chanting. Yoga therapy was started with her comfort zone initially- slowly achieving posture,asana holding, and relieving posture takes ten seconds and slowly reached up to 20 seconds in 15 days where only holding time wasKapal increased, bhati rest were same timing. Each posture was followed by relaxation of one minute. was given at pace of one stroke per Anulomsecond vilomfor 25 minutes with fix force of exhalation within patient’s comfort zone throughout 3 months of Intervention. (alternateantah-kumbhak nostril breathing) was given for period of- 25 minutes where exhalationAgnisar kriya was longer than inhalation with application ofbahya-kumbhak (holding breath after inhala- tion) as per capacity. (flapping of abdomen) was done during (holding breath after exhala tion). Frequency of flapping was kept as per patient’s capacity Table(Table-2 2: and Table-3). Yoga asanas for intervention S. No. Yoga Therapy Practise for 3 months: Asanas Practice Duration of Frequency 1 Practice 1 2 Jogging 72 min 1 Forward–backward & side 3 bending 1 min 1 TwistingSuryanamaskar 15 4 (combination of 60 seconds 5 Tadasana7 postures in series of 10 steps) 3 (Standing straight with 20 seconds feet together and raising arms Trikonasana 3 Fig. 1: - upward direction by side of ears) × 6 (feet apart, bending 20 seconds Showing× the ultrasonography which revealed fibroid on pos on one side, resting hand on same (each side) terior wall of uterus measuring 15 12 mm and cysts in left ovary side of leg, straight up another (Ovary size- 75 64 mm) arm upwards and fix eyes on Naukasanafingers of upward hand) 3 Table 1: - 7 (lying in supine 20 seconds Showing the different medications prescribed by the gynae posture, raise up legs and torso cologistS. No. together around 45-60 degree 8 balancingSetubandhasana body weight on pelvic) 3 1 Medication Duration 2 (lying on 20 seconds Chymoral forte 5 days ground with folded knee joints, Mefenamic acid 250 mg + Tranexamic acid 30 days placing heel on ground, arms 3 500 mg keeping down on ground with - hands placing near heels, raise Ca++ supplements 30 days hips and back up keeping shoul 4 Iron supplements 30 days der on ground) www.jimcr.com INTEGRATIVE MEDICINE CASE REPORTS VOLUME 1 NUMBER 2 JULY 2020 IMCR CASE REPORT 30 Table 4: Comparing the symptoms pre and post Yoga therapy S. No. Yoga Therapy Practise for 3 months: Asanas Practice Duration of Frequency S. SymptomsPre Marktasana Practice 3 No. Post (after Post (after 9 (Lumbar stretch) 20 seconds 1 15 days) 3 months) lying on ground with folded knee (each side) 2 Abnormal Uterine bleeding Present Absent Absent joints together, arms open upside wards on ground, drop down legs Heaviness in right side of Present Absent Absent on each side alternatively and 3 abdomen 10 Bhujangasananeck on opposite direction to legs. 3 Weakness Present Absent Absent (lying prone on 20 seconds Table 5: ground with arms on side of chest, raise torso up with help Comparing the ultrasonography report pre and post Yoga of back muscle with minimum therapy 11 Dhanurasanasupport of hands) 3 S. Pre Ultrasonography (lying prone on 20 seconds No. ground, catch hold feet with After 2 months After hands by folding legs, try to raise (13 Nov 2018) (13 Jan 2019) 3 months 1 15 × 12 mm 15 × 10 mm legs up with help of hands as (1 Feb 2019) 12 Relaxation 5 min 1 much as possible) 2 Uterine fibroid 8 × 7 mm Ovarian cysts 75 × 64 mm Both ovaries Both ovaries Table 3: Pranayama (Left Ovary) are normal are normal Describing the variousPranayama techniques Discussion S. No. - 1 Kapal Bhati - 25 min Practice Duration Patient is teacher by profession, balancing domestic respon (Forcefull exhalation and auto sibilities with professional work engaged her throughout- 2 Agnisaar Kriya 1 min matic inhalation, 1 stroke/sec) the day in different tasks results in stressful events. Stress- (exhale forcefully, hold is a state of emotional or physical arousal occurs as per de 3 breath,Anulom flap Vilom abdominal muscles inside-out) - 25 min mands from various environment factors engaging in multi ple tasks, causing pressure on capacity of individuals to adapt (inhale through left nostril, ex (13). Regulation of stress is controlled by HPA axis. HPA axis hale from right, inhale from right and exhale - fromBhramri left side) comprises hypothalamus, pituitary gland and adrenal glands. Their interaction controls reactions towards stress and reg 4 (Humming sound resemble honey 3 rounds ulates various body functions . Defects in the hypothalamic– 5 beeOm sound)Chanting (2 min) pituitary axis, insulin secretion and its action, and ovarian 3 times function are involved in PCOS . Oestrogen and progesterone- (2 min) hormone levels can fluctuate because of stress that can result in uterine fibroid. Stress can cause activation of the hypotha lamic pituitary adrenal axis and result in release of cortisol, a- Patient was advised allopathic medicine for 30 days, where stress hormone (16). she was regular on medication for first 15 days along with- Improvement in hormonal and biochemical changes re yoga therapy later as she got relief from her complaints and lated to H-P-O and H-P-A axis in polycystic ovarian syndrome she stopped taking medicines and continued yoga therapy. Af has been observed through yoga practice (17). Yoga helps in ter two months of yoga therapy practice, patient was feeling cessation of sympathetic area of the hypothalamus and helps better clinically and got relief from gynaecological complaints.
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