Uterus myoma is a clinical common disease in gynecology. The incidence of uterine fibroids is between 20% and 30% among women of childbearing age. In the early stage of the disease, there are no obvious symptoms, but in the middle and late period, symptoms such as prolonged menstrual period, abdominal pain, increased leucorrhea and irregular vaginal bleeding may be occurred, which have a great impact on the life of the patients (Wang, 2018). The effect of surgical treatment on patients with uterine fibroids is positive. However, because of a high postoperative recurrence rate, most of the patients without surgical indications are treated conservatively, mainly oral administration of mifepristone, but there is still a higher recurrence rate and more adverse reactions (Yu, 2018). In order to explore and analyze the efficacy of mifepristone + cinnamon twig and poria ecoction in patients with uterine fibroids, a total of 100 patients with uterine fibroids treated in our hospital from March 2017 to October 2018 were enrolled in the study. The study is detailed below:

1 Material and methods

1.1 General information

A total of 100 patients with uterine fibroids treated in our hospital from March 2017 to October 2018 were enrolled in this study and randomly divided into two groups: control group (n=50) and treatment group (n=50). The patients were between 25 and 46 years old (median 34.12 ±2.58 years old); and the course of disease was between 7 months and 34 months (median 18.22 ±3.58 months). Of 19 patients suffered from submucous myoma, 32 patients with subserous myoma, 49 patients with intramural myoma, 38 patients with multiple myoma and 62 patients with single myoma. The sizes of uterine fibroids were ranged from 12 cm³ to36 cm³ (median 22.15 ±4.25 cm³). The difference was not statistically significant between the two groups (P＞0.05), with comparability.

1.2 Methods

Mifepristone + cinnamon twig and poria decoction in the treatment group: Take 25mg mifepristone before bedtime once a day. Cinnamon twig and poria decoction consist of 15g of tree peony bark, 15g of cassia twig, 12g of poria cocos, 10g of radix paeoniae rubra, 12g of peach kernel and 12g of cortex moutan. Modification according to symptom: Add in 10 g of yerbadetajo herb, 10 g of donkey-hide gelatin and 15 g of root of rehmannia in patients with more blood loss; 10g of folium artemisiae argyi, 12g of ligusticum wallichii, 15g of rehmannia glutinosa in those with abnormal menstruation; and 15g of rhizoma corydalis in those with abdominal bearing-down pain. These herbs were decocted in water for oral administration, once a day, taken warm in the morning or evening. Mifepristone in the control group: The dosage and administration of mifepristone were the same as the treatment group. The study lasted for two months in both groups.

1.3 Observational indexes

The levels of sex hormone [progesterone (P), follicle stimulating hormone (FSH), estrogen (E₂), luteinizing hormone (LH) and the sizes of uterine fibroids were recorded in the two groups.

1.4 Evaluation criteria

Ineffective: The volume of uterine myoma is reduced by less than 25% or even enlarged. Effective: All the symptoms disappear basically and the reduction of uterine myoma volume is between 25% and 50%. Remarkably effective: All the symptoms disappear. The size of uterus is normal and the volume of uterine myoma was reduced by more than 50% (Zhang, 2018).

1.5 Statistical analysis

The data are analyzed by SPSS20.0 software. mean ± standard deviation represents the sex hormone levels and uterine myoma volume. t test is conducted and the treatment outcome is indicated by (%). x² test is carried out. If P＜0.05, the difference is statistically significant between the two groups.

2 Results

2.1 Comparison of sex hormone levels

Progesterone level in the treatment group was lower than that in the control group. The difference was statistically significant (t=4.973，P=0.000). The level of follicle stimulating hormone in the treatment group was lower than in the control group. The difference was statistically significant (t=5.146, P=0.000). The estradiol level in the treatment group was lower than that in the control group. The difference was statistically significant (t=3.733, P=0.000). The level of luteinizing hormone in the treatment group was lower than that in the control group. The difference was statistically significant (t=3.318, P=0.001). Please see table 1 for details.

Table 1 Comparison of sex hormone levels (mean ± standard deviation)

2.2 Comparison of efficacy

The total response rate of the treatment group was higher than that of the control group, and the difference was statistically significant (x²=5.005，P=0.025). Please see table 2 for details.

Table 2 Comparison of efficacy [n (%)]

2.3 Comparison of uterine myoma volume

The sizes of uterine fibroids in the treatment group were significantly smaller than those in the control group (t = 10.143, P=0.000). See table 3 for details.

Table 3 Comparison of uterine myoma volume (mean ± standard deviation)

3 Conclusions

Uterine myoma is also known as uterine fibroids and fibromyoma clinically, which is more commonly seen in women aged between 30 and 50 years. The occurrence of fibroids is related to normal myocyte mutation, local growth factors and sex hormone, etc. Majority of patients have no obvious symptoms and are accidentally found in ultrasound or pelvic examinations, often accompanied by high level of estrogen, therefore, they are often treated by estrogen antagonists. Some scholars also believe that it is associated with progesterone, so progesterone receptor antagonists have been applied in the treatment (Liu et al., 2018).

Mifepristone is the first choice for conservative treatment in patients with uterine fibroids. This drug can reduce the level of progesterone significantly by competing with progesterone receptors, and contribute to the regression of ovarian corpus luteum, thereby reducing the level of estrogen further. The tumor is reduced by lowering hormone levels. Moreover, the drug can inhibit the growth of myoma cells and induce vascular degeneration of the tumor, thereby managing uterine fibroids (He, 2017). However, mifepristone alone may change the menstrual blood volume which may be increased after the patients stop taking it. Some patients' fibroids are gradually increasing; thus, the long-term effect of the drug is uncertain. In traditional Chinese medicine, uterine myoma belongs to the category of abdominal mass. The pathogenesis of uterine myoma includes the emptiness of uterine vessels during the menstrual and postpartum periods, Chong-Ren disharmony, the cold of the uterine body, blood stasis and mass formation due to stagnant movement of qi and blood. Eventually, masses are formed, leading to dysmenorrhea, abnormal menstruation and excessive menstrual volume. Therefore, the treatment is mainly eliminating disease and removing mass; warning meridians and dredging collaterals; and promoting circulation and removing stasis. In the formula of cinnamon twig and poria decoction, cassia twig can remove the stasis and guide the stagnation, warm and smooth blood vessels; and poria will dissolve the phlegm and promote the urination, invigorate the spleen and supplement qi, thereby helping eliminating stasis. Compatibility with cortex moutan will clear away heat and cool blood, promote the blood circulation and dissipate the blood stasis; compatibility with peach kernel will invigorate the circulation of blood and remove the stasis, and improve the effect of removing blood stasis of cassia twig; compatibility with paeonia lactiflora can remove the heat and pain, cool the blood and remove the blood stasis. A combination of the above medicine can warm up the blood vessels; promote the blood circulation and remove the blood stasis; and eliminate the masses and remove the stasis (Zhang et al., 2018).

To sum up, mifepristone in combination with cinnamon twig and poria decoction has a high response rate in patients with uterine fibroids; can significantly improve the sex hormone levels of patients; and significantly reduce the sizes of uterine fibroids.

Authors’ contributions

Fu Yingjie and Wang He designed this study. Wang He collected data. Fu Yingjie wrote this manuscript. Fu Yingjie and Wang He revised the manuscript. All authors read and approved the final manuscript.

Acknowledgments

We would like to extend our sincere gratitude to our departmental chair for their support. Additionally, we would like to give many thanks to our physicians, engineers, and nurses as well as the other staff of the department.

References

He Z.C., 2017, Treatment outcome of mifepristone in combination with cinnamon twig and poria decoction in patients with uterine myoma, Heilongjiang Medicine Journal, 30(6): 1295-1297

Liu X.Z., Zhang W., and Xue C.Q., 2018, Clinical observation of cinnamon twig and poria decoction in combination with mifepristone in the treatment of uterine fibroids, Journal of Yunnan University of Traditional Chinese Medicine, (1): 68-70

Wang W.J., 2018, Clinical observation of modified cinnamon twig and poria decoction in combination with mifepristone in the treatment of uterine fibroids, Health Care Guide, 23(44): 80

Yu X.J., 2018, Clinical effect of cinnamon twig and poria decoction in combination with mifepristone on uterine fibroids, Med. J. People Health, 30(20): 94-96

Zhang L., 2018, Clinical evaluation of modified cinnamon twig and poria decoction in combination with mifepristone in the treatment of uterine fibroids, Special Health,

Zhang L.X., Qiao F., and Yuan L., 2018, Clinical observation of cinnamon twig and poria decoction in combination with mifepristone in the treatment of uterine fibroids, World Journal of Integrated Chinese and Western Medicine, 13(9): 1259-1262