Therapeutic Efficacy and Safety of Multi-Modal Ayurvedic Protocols in the Management of Garbhashayagata Arbuda (Uterine Fibroid): A Systematic Review

Background: Uterine fibroids are the most common benign tumors of the female reproductive system and are associated with heavy menstrual bleeding, pelvic pain, dysmenorrhea, infertility, and reduced quality of life. Ayurveda offers a conservative approach to management through Shodhana and Shamana therapies; however, the available clinical evidence requires systematic evaluation. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, AYUSH Research Portal, DHARA, and Google Scholar. Clinical studies evaluating Ayurvedic interventions for uterine fibroids were screened according to predefined eligibility criteria. Data on study characteristics, interventions, outcomes, safety, and risk of bias were extracted and qualitatively synthesized. Risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Results: Seven clinical studies published between 2014 and 2026 were included. The interventions comprised Panchakarma procedures (Vamana, Virechana, and Uttara Basti) and classical Ayurvedic formulations. Most studies demonstrated significant reductions in fibroid size, menstrual bleeding, pelvic pain, and symptom severity. Combined Shodhana and Shamana therapies generally produced superior outcomes compared with oral therapy alone. No serious adverse drug reactions were reported. The overall risk of bias ranged from some concerns to moderate. Conclusion: Ayurvedic interventions appear to be safe and beneficial in reducing fibroid size and improving clinical symptoms. However, larger, well-designed randomized controlled trials with standardized treatment protocols and longer follow-up are required to strengthen the current evidence.