Uterine Polyp or Cyst Traditional Ayurveda Treatment and Management

Uterine Cyst or Uterine Polyp and Ayurveda

 

Uterine abnormal growths like cysts or polyps are mentioned under the heading Yoni Vyapat in Ayurveda. Yoni Vyapat are the disorders of the reproductive system and 20 different types are explained in Ayurveda. Uterine Polyp can be correlated with Raktayoni mentioned under the Yoni Vyapat. Due to excessive bleeding per vagina which is the main symptom, it is termed as Raktayoni (Rakta – Blood and Yoni – Vagina)

 

रक्तयोन्याख्या सृगति सुतेः । (अ० सं० उ० ३८/४५)

 

 

Active or passive congestion of blood in the vessels of the uterus is the cause of uterine polyps which indicates the predominance of blood tissue or increased amount of blood in the uterine vessels in uterine polyps. Also, Apana Vata, one of the subtypes of Vata Dosha is enveloped by Pitta Dosha and vitiation of Kapha Dosha is also noticed.

 

 

Causative factors

 

 

विंशतिापदो योनेर्जायन्ते दुष्ट भोजनात्। विषमस्थाङ्गशयनभृशमैथुन सेवनैः ।

दुष्टार्तवादपद्रव्यैर्बीजदोषेण दैवतः ।। (अ० सं० उ० २८/३२ एवं अर इ० उ० ३३/२७,२८)

 

Aharaja: Diet factors

Excess intake of dry food items, excess hot or excess cold food and drinks, sweet or sour taste, heavy to digest food, unctuous food items, unwholesome food, over eating, excess intake of alcohol, indigestion are the contributing factors of Raktayoni.

Viharaja: Lifestyle factors

Excess indulgence in sexual intercourse, riding on vehicles or animals for long hours, day sleep, excess physical exercise.

Manasa Nidana: Mental factors

Grief, worries, stress

Anya Nidana: Other factors

Abortions, Injury to the genital organs.

How causative factors lead to the formation of Raktayoni?

• Too much intake of pungent food items, too much anger, fear, anxiety, grief; riding on animals or vehicles excessively increase Vata Dosha.
• Excess sexual intercourse increases pelvic congestion leading to inter menstrual bleeding and heavy bleeding during menstruation. Also, it aggravates Vata Dosha and leads to diminution of tissues.
• Scanty food and non-nourishing food items with poor nutritional quality or indulgence in single taste will not nourish the tissues of the body properly leading to diminution of tissues and increase of Vata Dosha.
• Repeated miscarriage or abortion leads to excess blood loss which in turn weakens the uterus and genital organs and aggravates Apana Vata, a subtype of Vata.
• Trauma causes pressure on uterus to increase immediately leading to congestion of blood vessels, vitiating the blood tissue resulting in heavy menstrual bleeding.
• Whereas excess intake of spicy, sour and salty food increases Pitta Dosha, especially the heating quality of Pitta Dosha increases which in turn vitiates blood tissue causing heavy menstrual bleeding in Raktayoni. Curd and vinegar are hot in potency and it increases Pitta. Also, alcohol and wine vitiate Pitta Dosha.
• Excess intake of heavy to digest food items, meat especially red meat, milk puddings, unctuous and fatty food causes increase of Kapha Dosha because of similar qualities. These are having heavy qualities which are attributed to the Kapha Dosha and heavy substances move in downward direction. Thus, in associated with already aggravated Apana Vata, the vitiated Kapha Dosha increases the flow of menstrual blood by affecting the uterus.
• Over eating, eating before the digestion of previous meals, indulgence in day sleep increases Kapha Dosha. Also, intake of food substances contradictory to one another will cause endotoxin (known as Ama) formation at the digestive level as well as metabolic level thereby afflicting the uterus and reproductive organs.

 

 

Pathogenesis

Like the pathogenesis of any other disease mentioned in Ayurveda, the pathogenesis of uterine polyp is also different from the western medical science. The accumulation and further aggravation of the Doshas initiate the formation of Uterine polyp. Indulging in the above causative factors leads to low digestive fire which in turn affects the metabolic fire leading to formation of unhealthy or under-nourished tissues, especially the first tissue, Rasa Dhatu or lymph is not properly formed. Menstrual blood is a sub-tissue of lymph and hence it gets vitiated too. Also, the second tissue, blood gets vitiated because the lymph is vitiated and blood tissue derives its nutrients from the lymph. These factors collectively affect the vascularity of the uterus and upon reaching the channels of menstruation (that is ovarian and uterine arteries and their branches) leads to congestion and increase in uterine circulation thereby increasing the quantity of menstrual blood immediately.

 

 

As per Ayurveda, all the diseases are caused by the imbalance of Doshas. Doshas have different qualities and in a particular disease, specific qualities of the Dosha get vitiated by indulgence in particular causative factors that aggravate the specific qualities of Doshas. Also, abnormality in specific circulatory channels in particular site of the body is caused by the causative factors. In Raktayoni, the mobility quality of Vata Dosha; flowing and liquid quality of Pitta; thick, stable and unctuous qualities of Kapha are involved in the manifestation of Raktayoni. The thick, stable and unctuous quality of Kapha Dosha leads to the growth of polyp on the lining of the uterus. Mobility quality of Vata is responsible for increased movement and the flowing quality of Pitta is responsible for disturbing the stability quality, also causes depletion of tissues. Liquid quality of Pitta increases the liquid nature of tissues leading to swelling or inflammation of the endometrium causing polyps. Also, as Kapha Dosha is vitiated and causes polyp, it obstructs the Vata Dosha in its normal pathway further leading to increase in Vata Dosha. And the nutrients are not able to reach the destination proper (reproductive tissues) because of this obstruction and hence the reproductive tissues become under nourished.

 

Thus, all these factors lead to increase in quantity and flow of menstrual blood and irregular or intermittent bleeding as well. All the three doshas increase the oestrogen in the body. Vata being the controller sends signals to produce or secrete oestrogen. Pitta Dosha is responsible for various types of excretions in the body including the production of hormones. Kapha Dosha and oestrogen have similar properties hence vitiated Kapha Dosha increases oestrogen. As there is low digestive and metabolic fire, excess oestrogen is not processed nor removed from the body properly thereby leading to increase in circulatory oestrogen. This circulatory oestrogen in turn nourishes the uterine polyps.

 

A woman having uterine polyps suffers from infertility or subfertility because Ayurveda texts say that there are four factors responsible for conception. Just as fertile land, favourable season, good quality seed and proper nutrition to the seed is necessary for germination of a seed, for conception, four factors namely, Ritu (Proper time, that is Ovulation period / Reproductive age), Kshetra (Genital organs, especially healthy uterus), Ambu (Nutrition of the mother to be), Bija (Good quality / Healthy Ovum and Sperm) are necessary. In Uterine polys, the uterus / endometrium (which is the component of Kshetra) is affected by vitiated Doshas, also there is diminution of the reproductive tissues, hence problem of infertility or subfertility.

 

 

Factors involved in pathogenesis are summarized below.

Doshas involved	Vata Pitta Kapha
Tissues affected	Lymph Blood Menstrual fluid
Status of Agni	Low digestive fire
Channels of circulation vitiated	Artavavaha (Channels carrying menstruation) Rasavaha (Lymph carrying channels) Raktavaha (Blood carrying channels) Mamsavaha (Muscle tissue carrying channels)
Type of vitiation of channels of circulation	Atipravritti (Excess flow)
Site of manifestation of the disease	Garbhashaya (Uterus and adnexa) Artavavaha Srotas (Reproductive channels)

 

Symptoms

The vitiated Doshas can produce symptoms locally or of the whole body. The symptoms of Raktayoni mentioned in Ayurveda is summarized below.

1. Menstrual blood flows in abundant quantity
2. Bleeding during menstrual cycle is excess or prolonged.
3. Scanty bleeding during inter menstrual period.
4. Irregular menstrual cycle.
5. There might be associated body aches and pain.
6. Some women might experience burning sensation in the groin, flanks, pelvic region and low back.
7. Severe pain in the uterus.
8. Infertility

 

Classification

It is important to note that all types of Uterine polyps are not the same. In some cases, there is single Dosha dominance and sometimes a combination of Doshas manifest. There are seven types of Uterine polyp based on Dosha predominance namely Vataja, Pittaja, Kaphaja, 3 Samsargaja (Vata-Pittaja, Vata-Kaphaja, Pitta-Kaphaja) and 1 Sannipataja (Combination of Vata, Pitta and Kapha Dosha). The features of different types are explained below.

 

• Vataja Asrigdara: The menstrual blood will be thin, slimy, non-unctuous, blackish or reddish in colour, cold and smells like iron because of the predominance of Vata Dosha. The menstrual flow might be associated with pain, especially in the low back region, flanks, thighs and pelvis. Scanty inter menstrual bleeding may also occur. Menstrual cycles will be irregular and the quantity of flow varies from scanty to normal flow during menstrual cycles.

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• Pittaja Asrigdara: Menstrual blood will have bluish or blackish tinge, resembles water mixed with smoke and has a fishy or musty smell because of the vitiation of Pitta Dosha. Discharge of menstrual blood will be associated with pain and burning sensation. There will be increased thirst, dizziness and weakness. There will be no clots because of the heating quality of Pitta Dosha. Also, there will be profuse bleeding or prolonged menstrual cycles because of the flowing and liquid qualities of Pitta Dosha.

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• Kaphaja Asrigdara: As Kapha Dosha is predominant in this type of Raktayoni, the vitiated menstrual blood will be pale in colour, smells like fat and is unctuous, slimy, sticky, thick and cold. It will be excreted very slowly and clots can be seen resembling the shape of muscle fibres. The menstrual blood will resemble water mixed with red ochre. There may be heaviness of the body, weakness, lack of interest in doing things, nausea, distaste and food cravings experienced during menstrual cycles. Also, the menstrual cycle sometimes becomes prolonged but the flow of blood will be normal to moderate. Heavy flow of menstruation is unlikely when there is Kapha predominance.

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• Samsargaja Asrigdhara: The features resembling the two Doshas which are involved in causing the Uterine polyp will be seen. In Vata Pittaja type, menstrual cycles will be prolonged with moderate to heavy bleeding associated with pain and burning sensation. In Pitta Kaphaja type, there will be thick, slimy discharge of menstrual blood associated with weakness, tiredness and burning sensation. There may or may not be clots. In Vata Kaphaja type, menstrual blood flow will vary from scanty to moderate, cycles will be irregular but short and there could be inter menstrual bleeding. Sometimes there will be pain during menstruation and sometimes no pain.

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• Sannipata Asrigdhara: When all the three Doshas are predominant, the menstrual blood will have properties of all three Doshas. There will be bluish tinge, dirty, slimy and foul-smelling menstrual blood resembling ghee or fat in texture discharged during menstruation. Associated symptoms may be thirst, burning sensation, weakness, pain and anaemia.

 

Ayurveda Treatment Approach of Uterine Polyps and Uterine Cysts

 

Ayurveda treatment approach is considered beneficial for management of disorders of the reproductive system including Uterine polyp. Understanding the Dosha predominance will help in administration of proper and timely treatment. Ayurveda treatment approach involves the use of Shodhana, Shamana and Rasayana therapies for long lasting results.

 

Nidana Parivarjana: Avoidance of causative factor is the first line of treatment as indulgence in causative factor leads to development of the disease.

 

 

Shodhana: Detoxification procedures

 

Detoxification procedures mainly Virechana (Therapeutic purgation) and Basti (Ayurveda herbal enema) are beneficial. Virechana helps to correct the digestive fire and Basti helps to improve the quality of the tissues as it detoxifies and nourishes the reproductive system.

 

Virechana:

Following Abhyanga (Therapeutic massage), Swedana (Steam therapy) and Ghritapana (Oral use of Ayurveda ghee) using Mahatiktaka ghrita or Panchatiktaka ghrita for 5 to 7 days based on one’s status of digestive fire, body strength, body type and imbalance of Doshas, Ayurveda formulations mainly herbal castor oil and herbs like Triphala, Trivrit, Panchasakar are administered for causing purgation. Special diet is suggested during the course of treatment and afterwards for specific period of time for optimum outcome of treatment. Virechana treatment is useful for removing endotoxins and correcting the digestive and metabolic fire. The bitter tasting Ayurveda ghee used for oral administration in the Virechana process is absorbed at the cellular level and repairs the tissues. It also collects the vitiated Doshas and endotoxins and with the help of steam procedures helps to liquify the Doshas and endotoxins brings them to the alimentary canal from where it is eliminated through therapeutic purgation administered in the form of oral Ayurveda formulations.

 

Basti:

Basti is considered as half the treatment in Ayurveda and it has rejuvenating properties too. Vata Dosha increases because of two reasons – diminution of tissues and obstruction to the circulation of Vata Dosha in the circulatory channels. Basti treatment is administered through the anus so it reaches the site of Vata Dosha directly producing faster results. Anuvasana Basti helps to nourish the tissues thereby preventing diminution of tissues and brings equilibrium of Vata Dosha. On the other hand, Niruha Basti prevents obstruction in the channels of circulation thereby regulating or restoring the normal movement of Vata Dosha.

 

Basti is the best treatment to bring equilibrium of Vata Dosha which is the controller of Pitta and Kapha Dosha. Also, as reproductive system is one of the main seats of Vata Dosha and gynaecological diseases do not occur without the involvement of Vata Dosha, Basti is best to pacify and regulate Vata Dosha, hence useful in all gynaecological problems.

 

Anuvasana Basti (Oil enema) using Shatapushpa taila and Niruha Basti (Concoction enema) namely Mustadi Yapana Basti or Lodhradhi Yapana Basti or Rasnadi Niruha Basti are suggested based on the health needs. Yoga Basti course, that is 8 days Basti course starting and ending with Anuvasana Basti is suggested. Anuvasana is administered for 5 days (on first, third, fifth, seventh and eighth day) whereas Niruha Basti is administered for 3 days (on second, fourth and sixth day). Basti is administered following therapeutic massage and steam.

 

Uttara Basti is safe and beneficial for women in their reproductive age and menopause. It is highly beneficial for local aggravation of Doshas in the reproductive system. It is good for detoxification and pacification as well. Unctuous Ayurveda formulation is administered into the uterus during the post menstrual period. As the opening of the uterus will be open during this period, Uttara Basti administration during this time will help in better drug absorption. Uttara Basti is administered for 3 to 4 consecutive days during each menstrual cycle after the bleeding stops. And the procedure is repeated again during next menstrual cycle. Uttara Basti is done after therapeutic massage and hot towel steam or any other steam procedure on the lower abdomen and hips for facilitating better absorption of the drugs and for good outcome of treatment. Uttarabasti has a healing and corrective action in reproductive tract problems, heavy menstrual bleeding, inter menstrual bleeding, uterine pain, fibroid uterus, uterine polyps and it increases the chances of conception.

 

Natural Herbal Treatment and Management for Uterine Polyps

 

 

Shamana: Pacification treatments

 

Various Ayurveda preparations and therapies have been mentioned in Ayurveda texts for treatment of Raktayoni.

 

Therapies like Abhyanga (Ayurvedic massage) and Swedana (Steam procedures) will help to improve circulation, remove any blockage in the circulatory channels, bring equilibrium of the Doshas and enhance immunity. Shirodhara (Third eye treatment) where lukewarm Ayurveda oils are poured on the forehead in a rhythmic manner following a head massage will help in reducing stress and calming the mind. As mental stress is also one of the contributing factors for hormonal imbalances and menstrual irregularities, Shirodhara treatment will be useful.

 

Herbs and Ayurveda formulations having Ruksha (Dry), Laghu (Light), Kashaya (Astringent taste), Ama Pachaka (Digesting or eliminating the endotoxin), Agni vardhaka (Improving digestive fire) and Lekhana (Scarifying) property are used for the management of uterine polyps.

 

• Dry and Light properties will reduce the polys by not nourishing it.
• Eliminating endotoxin and improving digestive fore destroys excess growth of polyps.
• Astringent taste helps in arresting excess bleeding as it has a vasoconstrictive action, also it helps to shrink the size of polys.
• Scarifying property destroys the growth of uterine polyp.
• Different Ayurveda formulations suggested in Raktayoni are mentioned in the below table.

 

Swarasa: Liquid extracts	Udumbara swarasa with honey
Kalka: Herbal paste	Paste of roots of Bala with milk Paste of Bhumiyamalaki with rice water
Churna: Herbal powders	Powder of Machuka and Sharkara with rice water Indrayava churna Pushyanuga churna Avipathikar churna Triphala churna
Kwatha: Herbal decoction	Darvyadi kwath Kwath of Nyagrodhadhi gana Kwath of Dhataki pushpa and Pungi
Siddha Kshira: Ayurveda herbal milk	Milk boiled with bark of Ashoka
Vati: Tablets	Kanchanara guggulu Gokshuradi guggulu Triphala guggulu Chandraprabha vati
Taila: Ayurveda oils	Shatavari taila Shatapushpa taila
Ghrita: Ayurveda ghee	Shatavari ghrita Mahatiktaka ghrita Shalmali ghrita
Avaleha: Herbal Paste/ Jam	Jeerakavaleha Kushmandavaleha
Kalpa: Granules	Lashuna kalpa Shatavari kalpa
Single Herbs	Ashoka (Saraca asoca) Dhataki Pushpa (Woodfordia fruticose) Lodhra (Symplocos racemosa) Nagakesar (Mesua ferrea) Anantamool (Hemidesmus indicus) Gokshur (Tribulus terrestris) Praval Pishti (Coral calcium) Guduchi (Tinospora cordifolia) Varuna (Cretieva nurvula) Guggulu (Commiphora mukul) Kanchanar (Bauhinia vaerigata)

 

These herbs and other Ayurveda formulations have antioxidant, anti-inflammatory and haemostatic properties that bring equilibrium of the three Doshas, improves functioning of the reproductive system and balances hormones.

 

 

Rasayana: Rejuvenation

 

After detoxification and pacification treatments, rejuvenation is planned for to improve the quality of reproductive tissues, maintaining digestive fire, regulating the flow of menstrual blood, helping in conception and preventing the recurrence of uterine polyps. Rasayana in the form of herbs, therapies, diet and lifestyle are suggested.

 

• Rasayana herbs mainly Gokshur, Guduchi and Shatavari are given for a specific period of time.

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• Therapies - Abhyanga (Therapeutic Massage), Pizhichil (Pouring of warm Ayurveda oils on the body), Avagahana (Immersing oneself in lukewarm Ayurveda liquids), Udarabasti (Retention of oil on lower abdomen), Kshiradhara (Pouring of warm herbal milk on the body) are beneficial in balancing all three Doshas. Everyday intake of Ayurveda ghee is suggested. Also, Matra Basti (Oil enema in small quantity for regular or daily use) with Shatavari taila or ghrita is suggested to improve immunity, especially of the reproductive tissues, help in regularizing menstrual cycles and reducing profuse menstrual bleeding.

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Diet for Uterine Polyps

 

Wholesome Diet	Unwholesome Diet
Milk Ghee Green lentil Green leafy vegetables Flaxseed Dry ginger Cardamom	Sour, Salty and Spicy food Curd Vinegar Wine and other alcoholic beverages Meat Sea food Chili, Raw garlic, Fresh ginger

 

• Lifestyle

 

Wholesome Lifestyle	Unwholesome Lifestyle
Rest Proper and timely sleep Simple exercise	Strenuous sports Excess sexual intercourse Physical exertion Staying awake late at night Day sleep Untimely sleep

 

They are uterine tonics, reduces or regulates blood flow to the uterus thereby reducing nourishment of the polyps thus shrinking them, tones up endometrial vascularity thereby reducing excess menstrual bleeding and regulating menstrual cycle.