by Bob Flaws

Recently I was asked to teach a class on gynecology at an American CM school. As a guest lecturer, I asked what the students wanted me to talk about. Many of the students wanted me to talk about uterine myomas (a.k.a. fibroids). This is understandable since 20% of women over 35 and 40% of women over 50 have myomas. In other words, this condition is extremely common in the demographic that makes the most use of CM in the West. So it's totally reasonable practitioners (or soon-to-be practitioners) would want to know how to treat this condition. However, I chose not to lecture on this topic. My reason? It is well known that CM does not treat uterine myomas all that well. While treatments exist in classroom textbooks, I did not want these students to think that they were going to cure all their patients with fibroids. I've been a CM gynecologist for 30 years, and I know this is a "difficult-to-treat" condition.

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On the other hand, it's my experience as a teacher of CM that not many Western practitioners understand this, and this brings me back to evidence-based medicine (EBM)and the practice of Chinese medicine. As a practitioner, I believe we have a professional and an ethical responsibility to our patients to know, based on clinical evidence, what we can treat with what degree of efficacy over what period of time and at what dose or frequency.

There are three main types of uterine fibroids: subserous, intramural, and submucosal. Subserous myomas are on the outside wall of the uterus and may even be connected to the uterus by a stalk (a so-called pedunculated fibroid.) Intramural myomas are within the uterine wall. Thus they are deeper anatomically than subserous myomas. Submucosal myomas are beneath the endometrium and are the deepest of these three types. Having read a number of RCTs on the CM treatment of uterine myomas, I can say that it is common knowledge in China that, the deeper the myoma, the less likely it will respond positively to CM treatment. It is also well known in China that, the large the diameter of the myoma, the less likely it will respond to CM.

So here's some evidence of just these facts. On pages 30-31 of issue #4, 2009 of Xin Zhong Yi (New Chinese Medicine), Li Wen et al. published an article on the treatment of 90 cases of uterine myoma with Chinese herbal medicine for three months. First off, the exclusion criteria included anyone with a myoma larger than six centimeters in diameter. (That's 2.36 inches for us metrically challenged Yanks.) This criterium is based on the fact that anything larger than this is unlikely to respond to CM treatment within three months. Similarly, all women with submucosal myomas were excluded for the same well-established reason. Further, the fact that type of myoma is correlated to treatment efficacy is borne out by the study outcomes. Only 11% of the 70 women in this study with intramural myomas were cured (meaning their myomas disappeared), while 20% of those with subserous myomas were cured.

What this means in clinical practice is that we need to know the type and size of our patient's myoma before we can know the probability of our being able to cure her with CM. This is hugely important information for both ourselves and our patient. In my experience, most women with myomas who come to us do want to be cured. Anything less than complete disappearance of the tumor is usually unacceptable. Further, it is also my experience that few Western women are going to give us more than three months to work our supposed miracles. This study shows us (or at least suggests) what is possible in that time-frame. In fact, there is a relatively large literature on uterine myomas in the Chinese journal literature, all of which basically corroborates this article.

Now for the good news, this study did show that CM was able to improve the symptoms of uterine myomas by 70-85% (depending on the symptom). These symptoms included delayed menstruation, menorrhagia, breast distention and pain, and lower abdominal distention. So, if a woman comes to us hoping to control her excessive bleeding (and therefore get to menopause when the myoma will likely shrink automatically), then we can say "come on down," we have an 85% chance of succeeding in that. Those are odds that I would bet on. This is also my clinical experience. It is relatively easy to control the symptoms of a myoma but considerably harder to actually eliminate the myoma.

If you would like to read more clinical trials on the treatment of uterine myomas with CM, please go to the Blue Poppy TCMinfoline. Type "uterine myoma" into the search box and you will get to translations of several other Chinese studies on this condition. Now your practice is informed by clinical evidence, not just anecdotal stories (or even just your classroom textbook). Now you're practicing EBM. I strongly believe that this will make you a better, more knowledgeable and responsible practitioner, and I think your patients will appreciate and respect this level of competence.

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