Miss PR ATIBH A ROHATGI

 for the use only of registered medical practitioners Reprint*

 FUNCTIONAL UTERINE BLEEDING

TREATMENT WITH AN INDIGENOUS DRUG: “AYAPON”

By

Miss  PR ATIBH A ROHATGI, M.S., D.G.O.

Lecturer in Obst. and  Gynaecology,

G.S V M. Medical  College, Kanpur.

 The term functional uterine bleeding includes all the cases in which bleeding occurs from the uterus  in    the absence of   any discoverable uterine   disease.   Some   authors   prefer    to  cal lit “Dysfunctional  hemorrhage.”   Such cases   are frequently seen   in gynecological   practice. The pathogenesis of   the condition   is not yet fully understood, but   It is believed to  be  due  to  distur­bance   of  the normal  pituitary ovario-uterine relationship ip  which controls   the normal menstrual cycle.   Presenting features   In these cases   may   be   menorrhagia,  polymenorrhcea,   or prolonged bleeding at irregular intervals.  The  treatment of functional  uterine bleeding   is  frequently   a  difficult problem,   and quite  often the usual  medical,  surgical   or  hormone therapy    affords   no  relief. from ancient times, certain indigenous herbal preparations  have been used In    India for treating   uterine   diseases.   The  present trial   was  undertaken  to study the efficacy of  “Ayapon” (Alarsin), a combination of some Ayurvedic drugs, In the treatment of established cases  of  functional uterine bleeding. Each   tablet   of  “Ayapon”  cotains  :- (1)    Aya pan  ( Eupalo- rium ayapana)    130 mg; (2)   Nagkeshar ( M esua ferrea )              32 mg; (3)   Ashoka (Saraca indica)                     130 mg; (4)   Godanti (Gypsum)                            32 mg.

  1. “Ayapan” Is prepared from the dried leaves of  Eupatorium ayapana and contains aya pin (6: 7methylene dioxycoumarin) ayapani n (7-methylene coumarin) and an essential volatile Both , aya pin and aya panin possess hemostatic property when applied locally or taken internally.  Ayapan  has  been  used  to  check internal haemor rhage, haematuria ,  haemoptysls,  etc.  It.  has  also been used as  a  bitter ton le expectorant, diaphoretlc  and  antiperiodic  and   as   an   antidote   to  snake-bites .
  2. Nagkeshar (Mesua ferrea ):- It   is  an   astringent   and stomach lc  and   contains  two   bitter   principles;  it  has   been used In   the   treatment   of   gastrit is  and
  3. Ashoka (Saraca indica) is the bark of the tree of that name possessing strongly astringent and   uterine sedative pro­pe    It acts  on  the muscular fibers of the uterus and exerts a stimulating effect on the endometrium and the ovarian tissue and has  been  used  in  uterine  affections, specially  menorrhagia , also   hemorrholds   and   haemorrhagic   dysentery .
  4. Godantl (gypsum )  is hydrated calcium sup    It is antacid and astringent and has been recommended In Ayurvedic literature for use in   the treatment   of menorrhagia .

All   the   4  drugs   have   been   advocated   for   the   treatment of  menorrhagia  In  Ayurvedic  literature  &  are  generally used… in the   combination,   to   secure better   synergistic   action. SELECTION OF CASES:– One hundred and ten patients between  20 and  48  years   of   age,   with   functional   uterine bleeding   were  selected  for  this  study.    They  were   either  atten­ding the Out-patient Departments  of  Upper  India  Sugar  Ex­change   Maternity   Hospital   and   Dufferin    Hospital    or    were admitted  In  these  hospitals.   A   thorough   preliminary   examination excluded local pathological conditions . Cases with profuse bleeding and   In  a   serious   condition   were   not   included   In the study. ‘Ayapon’  (Alarsin)  was   given   to  the   patients,   in a  dosage of 2 tablets three times a  day for  2  to  3 months.  In some  cases the  drug   was continued   for   about   5   months. The 110  patients,  with functional  uterine  bleeding  (F.U.B.) fell into  7  different  groups   (see  Table  I ). RESULTS  :– The  main  criteria   of improvement were(1 ) Reduction in quantity   of bleeding;  (2)   reduction in  duration ,of bleeding  and   (3)  change In   the irregularity of the   period towards normal Depending upon the  degree  of  relief  obtained  the  results were placed in groups as under ·-( I ) E xcellent showing  complete relief of Symptoms   and   reversal   to   regular    periods ;   (2)  Good  (3)  Slightly  improved and   (4)  no improvement.

TABLE I

Showing  the  results  of  treatment  in  the  110 Cases

 Symptomatology  cases Number of Cases Excellent  Good Slight improvement   No Improvement
Menorrhagia 58 33 16 5 4
F. U. B. after D. and C. 16 11 2 2 1
F. U.B. of puberty 6 4 1 1
F. U B. of menopause 4 2 1 0 1
F. u. B. a fter delivery 14 10 3 0 1
F. U.B. after  caserean  section 8 6 1
\f ctropathia hremorrhagica 4 1
Total    110 66           24 9 11  

 

I .   M ENOR RHAGIA:-lmprovement    was   observed    in    49 or   84.5%  of   cases.   Reduction   in   the   quantity    and    duration of   bleeding   was   observed   with in   8 to  10    days    of    therapy. In 16 cases the periods were irregular; and in 12 of them which showed   improvement,   the   periods    had    become    regular    after 2 or 3 months of  therapy.  In  most  cases  the  treatment  was continued for about 3 months,  while  in  a few cases the drug was continued   for    2    more months.    Twenty   patients    in this   group  were  followed  up  for  8 to  10  months  after  stopping   the drug. Recurrence of bleeding occurred in 4 after 6 to 9 months. They, however, responded to a  second course of Ayapon which was again  continued  for  2 or 3  months.   Fourteen patients  in  this  series  presented  with  profuse bleeding. The bout of bleeding was controlled by hormone therapy in these patients who were then  put  on  Ayapon  therapy  to regulate the cycle. All of the m reported regu lar cycles and moderate   bleeding  after  2 to  3 months  of treatment.

  1. FUNCTION AL UTE RIN E BLE EDING AFTE R DILATA­TION AND CURETTING:-l m provement  was  observed in 1 3 or  81.25%  of the 1 6  cases  and the bleeding  stopped in  all  after

2 or 3 weeks  of  therapy.  Subsequent  periods  had  become normal  i n  6  patie nts  while  profuse  bleeding occurred In eight during subsequent cycles which became moderate after 2 or  3 months   of  therapy.   Ill.    FUNCTIONAL UTE R INE BLEE DI NG OF PU BE RTY:­ lm provement   was  observed   in  5 or 83.3%  of the 6 cases;  and treatment   had  to   be   continued   for  4  to  5   months.    I n   3 of them  the  cycles  were  also  irregular  and  became  regular after   3 or  4   months of therapy.

  1. FUNCTIONAL  UTE RI N E      BLEE DI NG      AFTER DELIVERY:-Fourteen patients had continuous irregular bleeding for 3 to 6 monthsafter  delivery.  Methylergomet rine tablets, Calcium injections , styptoch rome, Clauden we re all of no avail. Reduct ion in quantity was observed in 13 of  the  14 patients after  2 or  3 weeks  of  Ayapon  therapy;  the  cycles  had also become  regular and moderate after 2 or 3 months of therapy
  1. FU NCTI ONAL UTE RI NE BLEEDING OF MENOPAUSE: Improvement was observed in 3 of the 4 Hormonal therapy showed   initial improvement   in   2  of the   4   patients but  later   on  there  was recurrence  in spite    of    treatment.

Aya pon  therapy  b rought  about  an  im provement  withi n 4 to’ 6   weeks, and the treatment was continued for 4 months. I n one patient bleed ingrecured one  month  after  stopping  the drug, bu t was controlled  after 4 weeks  of Ayapon  therapy.

  1. FUNCTIONAL UTERI N E BLEEDING  AFTER CAESAREAN SECTION:-Eight  patients  had  irregular or  continuous  but  not  profuse  bleeding  after  caesa rea n    section   for I to 3 monts Ayapon therapy effected im provement in 7 or 87.5%.’   Bleeding   stopped within    2  to  4  weeks  of   therapy. I n 3 of them bleeding stopped completely  resulting In  l acta­tional ame norrhoea; and the periods became regular  and moderate  after  treatment.
  • M ETROPATHI AH A EM OR R HAG I CA:-Fou r pat ients with metropat h ia hae mor r hagica showed cyst ic hy pe rpl asi a on histopat hological examination of t heir endometrium . Curettage and hor monal therapy h ad  failed  to evoke  any    Con­tinuous  Ayapori  therapy  for  four  months  effected  a  reduction in  the  bleed i ng i n   on ly one pati ent i n  w hom  bleed i ng recu r red af te r  six  mont hs.  Aya pon  was  started  again  and  relief  was obtained   after   two months.

DISCUSSI ON:-l n the absence of  a  precise k nowledge  of the aetiology  of functional  uterine  bleeding,  treat me nt  has  to be  empirical  and  it is not  satisfactory in   most   cases.   The results  of  Ayalon   therapyin 1 1 0   pat ients   with   functional uterine bleeding are very encouragi ng asit  produced satisfactory  response in  81.8%  of  the  patients,  which   included   cases of menorrhagia. function al uterine bleeding after dilatation  and curettage,  of  puberty,  menopause,  after  caesarean  section   and a  few cases  of  Met report hi a  haemorr hagica. Phad n is  (1964)  from  Poona reported  very encou ragi ng resu l ts with Ayapon in some resistant cases of fu nctional uterine bleeding. Pand ya (1963) fou n d a combination of Ashoka and Nagkeshar usefuI in the treat ment of menorrhagia; Mehta ( 1964) also reported good results with  Ayapon  therapy in  menorrh­agia and  metrorrhagl a.  javeri  (1965)  from  Ba rod a  found it to be  effective in  89.8%  of cases off unctional uterine bleeding.   Ayapon therapy  showed  encouraging  results in  81.8%  of the  patients in    our  series,  and   proved   helpful   i n    some  cases i n    avoiding   surgical   or   other   drastic  drug  treatment.   The d r ug was not used on  patie nts  w ho had profuse  bleeding and the general condition the refore,  was  seriou s. I n  a  few casEs where   the   i nitial   bout   of   hemorrhage   was   controlled   by hormone  therapy  in  cases  of  menorrhagia, subsequent Ayapon therapy  helped in regulating  the  menstrual  cycle Relapse was seen in  4  or  20%  of 20 patients with  menorrhagia who were followed up  for  8 to 1 0 months, but  a ll   of  them  responded  to a second course of the same therapy.  No t oxic sym ptoms, we reobserved  even  when  the drug  was Continued for 4 to 5 months. SUMMARY:-•Ayapon ‘ (Alarsin) was triedin  the  treatmen t of 1 1 0 patients with functional uterine bleeding, and found effec­tive in 81 .8% of   them.   They   included  cases  of  menorrhag ia, functional  uterine   bleeding  after  d i l atation  and  cu retti ng, or pu berty, m enopa use, after deli ve ry and caesarea n  section  and met ropat h i a haemor rhagica . Of 4 cases of met ropat h i a haemo­ rrhagi ca treated wit h  the d rug, i m p rove men t  was  observed i n on l y one case an d t h is pat ie nt had a rela pse  after  six  months. No toxic  effects  we re  observed  even   when   the   d r ug  was con­ t i n ued  for 5 months. ACK NOW LE DG E M E NT:-! am than kfu l t o M/s. Ala rsi n Pha rmaceu ticals, Bom bay, for the su pply of Ayapon tablets, used i n  th is  cli n i cal  study. References :

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  3. V. (1965) – Ind. Practitioner , 18 : 783
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  5. Nadkarni , M.  (1954) – Indian  Materia  Medica,  (revised  and enlarged by Nadkarni, A. K. 3rd. Edition.)
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