J.KARUNA

Reprinted from The  Bombay  Hospital  Journal,  Vol. 22,  No.  2,  1980    PP.  36-41

  The usefulness of an Ayurvedic Drug containing Eupatorium Ayapana in 50 cases of Dysfunctional Uterine Bleeding

J.KARUNA

Introduction

Dysfunctional Uterine bleeding is one of the commonest problems faced by Gynae­ colonists in India.  The incidence is reported to vary from 12.6% to 23.1 %. Uterine bleeding occurring at unexpected times or in of normal menstrual flow in the absence of organic or systemic disease is defined as Dysfunctional Uterine Bleeding.

Dysfunctional Uterine bleeding treated with haemostatics and hormones like oestrogen, progesterone, androgens, which on prolonged use, have a number of side effects.  Here lies the  usefuh1ess  of an indigenous drug which is both safe and effective.

COMPOSITION  OF  EACH  TABLET

Ayapana  (Eupatorium  ayapana)   60 mg
Asoka (Saraca indica)   60 mg
Nagakesar (Mesua ferrea)   30 mg
Godanti (Gypsum)   30 mg
Kamboji  (Breynia patens)   90 mg
Jeevanti (Leptadenia  reticulata)  90 mg

Ayapana herb contains an essential vo­ little oil and a neutral crystalline principle; its leaves contain an aromatic vola­ tile oil and the dried;l leaves yield not less than 0.05 % of the alkaloids,  Ayapanin and Ayapin. Asoka bark contains a large amount of tannin and colouring matter haematoxylin catechol.    Godanti, the hydrated calcium sulphate is having astrin­ gent and haemostatic properties. Nagakesar has antibiotic activity.

Material and Methods

The clinical trial was carried out in 50 patients aged 16 to 45 years, with an established history of dysfunctional uterine bleeding. Patients were selected from the Department of Obstetrics and Gynecology,  Government   General   Hospital,   Guntur ( Andhra Pradesh) during the years  1972 and  1973.

Before instituting the treatment,  a thorough general and systemic examination and even dilatation and curettage were done to exclude any pathological condition of the uterus. Most of them had been previously treated on usual lines, i.e.  Dilata­tion and curettage and hormones but with­ out benefit and the bleeding recurred. In each case, endometrial biopsy was taken to study the nature of the response of the endo­metrium at the end of the treatment. As a supportive treatment, haematinics and mul­vitamins were given. Bed rest was ­ advised during bleeding episodes.

DOSAGE

Those suffering from menorrhagia were given 2 tablets 3 times a day for 7 days, prior to the onset of menstruation; 11 cases of polymenorrhagia and 13 cases of metropathia were given one tablet 3 times a day for 30 days. In both the groups the treatment was given for 3 cycles. In 10 cases of continuous and irregular bleeding, they were given 2 tablets, three times a day, for 5 days. If necessary this was followed by the same dosage for another 5 days. The patients were asked to come to follow-up every month when a detailed history regarding the amount and duration of bleeding was noted. They were followed-up for a period of 6 months. If the pa­ tient did not respond to 3 months therapy, the treatment was continued for another three months. Patients who responded to treatment were observed for a further period of 6 months.

Results

The criteria for improvement were :

  1. Reduction in quantity of bleeding.
  2. reduction in duration of bleeding and
  3. change in irregularity of bleeding to­ wards normal.

 

Response

  1. Good : Complete relief of symptoms and reversal to regular periods. The bleed­ ing decreased within 3 days and subse­ quent menstrual rhythm was regularised from the next month. No irregularity was found within  6 months  of  observation.
  2. Fair : When bleeding decreased with­ in one week and ceased completely within 10 days and rhythm was regularised  from third cycle onwards.
  3. Poor : When bleeding  did not stop, in­ spite  of  6  months  course of  therapy.

Obserfations  and Analysis  of Data

TABLE I
Histopatholo’gical findings of endometrium in 50 Patients. Most of the cases ((72%) showed proliferative phase.

TABLE II
Menstrual History: Menorrhagia is the main pre­ senting symptom (32%).

TABLE III
Duration of Bleeding
88% of Cases had the bleeding for more than 6 months.

TABLE IV
Parity Comparison With Other Authors

TABLE V
Distribution of Cases Among Different Reproductive Groups

TABLE VI
Pelvic examination Findings

TABLE VII
Previous treatment

In 26 patients (52%) the response was good. All these patients responded after 3 months of therapy. 19 patients (38%) bad reduced bleeding after 4 months of therapy and got cured  after  6  months  therapy. Only 5 patients did not respond even to 6 months  therapy.    Out of  these  5 patients, 3 were operated – 2 cases were of seed• ling fibroids and one case was of endomet­ rial polypoidosis. Out of the remaining 2 patients, one attained menopause and the other did not come af ter 6 months treat­ ment. On the whole, 45 patients (90%) responded  favourably  to  treatment  and had relief from their symptoms.  (Table VIII).

TABLE VIII

It was noticed that the patients who res­ ponded best were of those suffering from menorrhagia and metropathia. (Table IX).

TABLE IX

TABLE X

The endometrial biopsy was repeated after completion of therapy and it was found to be the same as before the treat­ ment and no change was observed in the endometrium.

Side Effects

Only one patient complained of exces­ sive nausea. No other side effect was no­ ticed.

Discussion

The multiplicity of methods of treatment employed for Dysfunctional Uterine Bleed­ ing evidence difficulties and  disappoint­ ments. Styptics, various combinations of drugs and hormones including ovarian hormones, androgens, gionado1lrophins1, lacto­ gen, thyroid extract, pitressin, vitamins, antimenorrhagic factor of  liver,  raidiothe­ rapy and  operations,  have  all  been  tried with varying claims of success by different workers.

In the  absence  of  exact  knowledge  of the aetiology of dysfunctional  uterine bleeding and  also  the  unsatisfactory  results of treatments, the value of this Ayurvedic preparation with its haemostatic properties, and with assimilable calcium causing coor­ dinated  uterine  contractions  controlling excess of bleeding deserves attention. The present  therapy  showed  encouraging  re­ sults in 90 % of the  patients  in  our  series and proved helpful in some cases in avoid­ ing surgical and drastic drug treatment. Phadnis from Poona (1964), Mehta from Bombay (1964) and Javeri from Baroda (1965) and other authors have reported en­ couraging  results  with  this  therapy.

SUMMARY AND CONCLUSIONS

  1. The present study deals with the use of the combination containing E. Ayapana in the treatment of Dysfunctional  Uterine  Bleed­ ing of  50 cases.
  2. In all these cases, the endometrial pattern was studied by biopsy  before  and  at  the end of the  course and no  change was  found in  the  endometrial
  3. Best results were obtained in cases of me­
  4. There were no side effects with this drug except nausea  in  one
  5. The drug owes its effects to its haemostatic properties and uterine  sedative  action.
  6. The drug is non-hormonal, cheap, effective and
  7. The cure rate in  the  present  series  is  90% 45 patients out of 50 were cured within  one to  6  months  of  therapy,  (The  treatment was given for 6 months only in 19 38%).

ACKNOWLEDGEMENTS :

My grateful acknowledgements to Dr.  N. Subhdra Devi, M.D., FRCOG., Dr. A.  V. Narayana Rao, M.D.,  Dr.  A.  Savitri,  M.D.; Former Professors of Obstetrics  & Gynaecology; Dr. C.  Rani  Hitavachani,  M.D.,  Former  Asst. Prof. of  Obstetrics  &  Gynaecology,  and  Dr. Vani, M.D., student in Obstetrics and Gynaeco­ logy; Guntur Medical College and Gene.ral Hos­ pital,   Guntur.  I  am  thankful   to  Alarsm   Phar-

maceuticals,   Bombay,   for  the  generous   supply of  the  product  containing  Eupatorium  Ayapana.

 

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Abstract  of  Part  II of  the thesis  titled,  “A Clinical  &  Histopathological  study  of  Dysfunctional   Ute­ rine Bleeding (J OO cases) and use of an Ayurvedic  drug  containing  E.  Ayapana  in  Dysfunctional  Ute­ rine  Bleeding  (50  cases)”  submitted  for  M.D.  (Obst.  &  Gynec.)  of  the  Andhra   Un