USE OF ALOES IN IRREG ULA R
AND SCANTY MENSTRUATION
P J. DESHPAN DE, M. D. (Born.), D.G O.
Medical Officer, K.B.H .K. Bhabha Hospital Kurla, Bombay-70.
The woman whose periods occur with precise regularity is
Marchen Prinzessin- a princess from a fairy tale. ( Holt J.G.H.)
REPRINT from the A NTISEP TIC, Vol. 59 No.12-Dec. 1962.
introductory
– False notions due to ignorance and superstition regarding menstruation continue to have such a powerful hold O” the imagination of most women that irregularities in the menstrual cycle are looked upon with great fear, suspicion and grave concern. They talk of the accumulation of ‘poisons’ in the system, think of premature onset of menopause, become scared at the prospect of an unwanted pregnancy or shudder at the misfortune of a sterile life and some even get haunted by the nightmare of ‘cancerous disease’. This anxiety aspect of irregular and scanty menstruation assumes practical importance in the clinical management of the condition in general practice, apart from its other physiological, pathological and psychological aspects.
CLASSIFICATION: -It is indeed difficult to classify menstrual disorders as we have to deal with varying symptoms and not with clear cut disease entities. The text-book picture of anyone single disorder is not generally found in clinical practice but more than one of these coexist in one or other of the cycles.
The term irregular and scanty menstruation comprises:-
(1) Oligomenorrhea in which the cycles are lengthened. It is closely related to amenorrhoea, but a precise clear-cut differentiation between the two is often difficult. (2) Polymenorrhoea where menstruation occurs at shorter intervals than the normal average cycle. (3) Hypomenorrhoea where the menstrual discharge is scanty in quantity. It is often found along with oligomenorrhea.
MANAGEMENT:- A complete history-taking and physical examination are always necessary in these cases in order to eliminate any systemic disease, endocrine dysfunctions, local pelvic disorders. Malnutrition, psychic disturbances, and unfavourable living conditions or occupational environments have also to be considered though it is difficult to change the last one for most of the patients.
General measures like diet, and where possible adjustments or changes in living or occupational environments, exercise, and reduction of obesity should be adopted besides the selected line of treatment.
Psychotherapy:- Anxiety being the main feature of these disordcrs, simple psychotherapy may prove helpful if the busy physician can spare the time for it. Patiently listening to the patient’s complaints produces confidence and reassurance to the patient and her tension may be relieved. A clear and sympathetic explanation of the basic mechanism of the menstrual cycle in simple language gives confidence and results In success of the treatment. There are instances where women menstruate at their very first visit to a physician or when a specimen of blood is taken for tests and investigation. ·Serious and chronic mental symptoms should however, be referred to a psychiatrist.
Sex-hormones:–Steroids and gonadotropins have proved some what disappointing in inducing ovulation or restoring or regularizing menstruation. This is perhaps due to the fact that they act as a substitute therapy while the real cause of the disorder remains untreated. And hence their indiscriminate use is to be avoided.
Selection of drug:-Many patients do not however, benefit to any appreciable degree even after one or more of the above measures have been adopted. It was considered, therefore, desirable to investigate the usefulness of aloes, which was used with myrrh and iron for menstrual disorders before the introduction of hormones. In the present study, a compound of aloes (Alarsin) with known pharmacology was selected, as its ingredients appeared to me to be suited to deal with the causes of these disorders to a certain extent.
Pharmacology and chemistry:-1. Aloes indica ( Samsk: Ghrita Kumari. Eng.: Indian aloes. Guz.: Kunvar. Mahr.: Korphad· Tel.: Kalba India . Tamil: Katthalai, Kumari. Can.: Kathaligida. Mal.: Kattavala. Bengali .: Ghrit Kumari). Its active principles are glycosides, aloin, traces of an essential oil resin gum with small quantities of anthraquinone derivatives. It is an appetizer wi a bitter taste; it is digestive, laxative, antiseptic and indirectly emmenagogue. By stimulation of the pelvic circulation, it causes congestion of the uterus and is used in menstrual irregularities.
Balsamodendron myrrh ( Samsk .: Vola, Rasagandha. Eng. Myrrh. Hind .: Bol. Beng : Gandbarash. Can.: Bola. M ahr.: Hir abol. Born .: Bhensa Bol. Td : Bal in trapolurn. Tam.: Vellaippap Olam). It contains essential oil, is bitter to taste and contains resin-myrrh. It is haematinic, appetizer and emmenagogue. When orally administered, it is excreted by the mucous membrane of the genito-urinay tract which it stimulates, disinfects and regulates· It is used in amenorrhrea caused by anremia along with iron and also in painful and scanty menstruation.
Iron (iron in bhasma form):-It is a reputed preparation for anemia and debility. It is considered to be free from the side-effects of iron therapy, like constipation or blackening of teeth. Along with myrrh it has been used in irregular menstrua ion due to anemia.
Rubia cordifolia( Samsk .! Manjista. Eng.: Indian madder . Bom.: Itari. Tel,: Tamravalli. Tamil.: Manjitti. Mal.: Point). It contains a glycoside man Justin. It is sedative and anti-inflammatory, tonic and astringent. It acts on the uterine muscles through the nervous system. Used in scanty menstruation. amenorrhoea, after delivery and in endometritis.
Peganum harmala ( Samsk, and Hindi: Hur mal. Eng.: Syrian rue. Bengal: Isbaod. Guz.: Hurmuro. Mahr.: Harmala. Telugu: Shima1oranti. Tamil: Shimaiazhavana virai.) Its seeds contain three alkaloids harmine, harmaline and harmalol. It is anti-spasmodic, sedative, abortifacient and emmenagogue . Used in amenorrhoea, dysmenorrhoea. Harmal is described in Indian Medicine as alterative, aphrodisiac and lactagogue.
Selection of patients:-Patients were selected at random from the outpatient department of the Hospital. They complained of persistent irregular menstrual periods with prolon1ed inter-menstrual periods of scanty flow. They had been previously treated elsewhere along usual lines. But as their complaints persisted they evinced a great desire or their own accord to have this treatment. Their willin1 co-operation enabled me to collect useful observations. They received the Aloes compound only. About 50 patients were thus treated. The detailed reports on nine typical cases out of these fifty are given below.
Case notes -CASE No. 1:-M.R., aged 35, with complaints of pre-sterility, scanty menses following operation on 3-12-1951; frequent attacks of cold off and on.
(I) lnvestigations:-Chest screening and skiagram revealed nothing abnormal; R. T. tubes blocked; and Eosinophilia:- T 10,672, E. 35%. (2) Obstetric and gynaecological examination:-A ell-built and well-nourished woman with no other disease was operated for Tubo-ovarian masses on both sides on 3-12-1951. Bil. Tubo-ovarian masses of tubercular nature. Tubo 0. masses on the right side removed -salpingostomy on left side done-D and C was done later on 29-6-1959. Very scanty endometrial tissue obtained which was not sufficient for histopathology: pre sterility -married since 15 years-was treated for a long time for hypomenorrhrea with drugs including hormone preparations. Menstrual historp:- 1-2-3/ l i-2-2! months pre-menstrual tensi on syndrome + .Past menstrual history before 10 years 3-4/4-5. Pelvic examination: D and F shifted to lcft-P.S. NAD-AV Mass Rt. Fx. tender (5) Last. M.P.:-Before 10 years. (6) Treatment with aloes compound:-Started on 23-1-1961-2 tablets t.d .s. (7) ObserYation.r:-L.M .P. 15-1 1961: flow for 3 days scanty.L.M.P. 11-2-1961: flow better 3 days. L.M.P. 12-3-1961: flow better than before treatment but less than 11-2-1961. L.M.P. 8-4· 1961: flow better. (8). Remarkst-Satisfactory.
CASE No. l.1 R.I., aged 22, with complaints of irregular mens es, married three years but no issue.
( l ) lnvestigations:- Ova of hookworm + ; R. T. done tubes patent 25-1-1961. Husband’s semen NAD. Urine nil abnormal. Hb.: 85%; R.B.C.: 4.01 mill/cm. (2) General examination: RS/CVS-NAD; Str. Liv. Scanty; Sec, sex well-developed; well built: slight anemia; B.P. ll0/70. (3) Obstetr;c and gynaecological examination:-Pre-sterility. (4) M .History:- 5-6i2-4 months flow scanty-no dysmenorrhrea- 3 years since Menarche since 4 years. (5) Pelvic examination:- CX D and B conical-Ut.: A. V. smaller in size Fx. Rt. Palpable-Lt. Clear. (6) Last M.P.:-20-9·1960 to 27-12-1960. (7) Treatment with aloes Compound:-Started on 27- 12-1960. (8) Observations :-L.M.P. 19-1-1961 : flow 5-6 better . P. 1-3-1961: fl.ow 5 days better. L.M.P. 14-4-1961 ; flow 4-5 days better.(9) Remarks : D and C done on 1-5-61. Endometric : showed normal secretory phase. Had her perir – again on 20-5-1961, but very much less probably due to D and CASE No. 3 :I. J., aged 37 with complaints of scanty irregula r menses for 1 yea r and giddiness, attributed to scanty menses.
lnvestigations :-Urine : normal; Hb 10.9 gms.; R.B.C.3.9 mill/cmm. ‘2) General examination :-Obese; anaemia; no vitamin deficiency signs; RS-CVS : N A O; B,P. 130/80 mm.(3) Obstetric and gynaecologic<e / examination : No dysmenorrhoea; 5 F.T. .D. 13, 11, 9, 8, 7, years ago2 alive; L.D. 7 years 6 ago-breast feeds given for 1!years. (4) M . History :-1-2. 24-26 days scanty since 1 year. 2-3/26-28 days before. (5) Pelvicuamination:-Cx : D and F.; Ut . : R. V. mobile falls back; Fx. : clear. (6) Last M.P.-5-3-1961 scanty for day only. (7) Treatment with A.C. : Started on 11-3-1961-2 t.d.s.
9) Remark s :Patient benefited by treatment.
CASE No. 4.-H.S.; aged 38, with complaints or irregular scanty menses for 2 years and pain in lower abdomen off and on.
(1) General examination :-Well built, obese+ no anaemia; no sign of deficiency; B. P. 110/70; RS/CVS/CNS : NAD; other treatment received : nil.( 2) Obstetric and gynaecological examination : H/pastillness : nil; 4 F.T.N.D. L.D.: 3 years ago; only onechild alive. Not nursing.(3) M . History :-1-2 ys/2-3 months, irregular scanty. No dysmenorrhoea- no other complaint. (4) Pelvic examination:-PV . CXD and F; A.V.N. size, Fx : clear; P S.N.D .(5) Last M.P.: 7-3-1961 Treatme’fl t with A.C. :-Star ted on 13-3-1961, 2 tablets t,d.s.
Observations :-L.M.P. 7-3-1961 : flow scanty-for only a day. L.M.P. 15-4-1961 flow scanty-for 2 days L.MP. 19-5-1961: fl.ow better + + for two days only. (8) Remark s:-Quantity of flow was more and patient was satisfied with flow. She discontinued treatment as she left Bombay; was re-examined after 4 months. Pelvic findings same. Periods were not as regular as before. L.M.P. 27-8-1961 and 3-10-1961 :flow better 1-2 days.
CASE No. 5 :-K.R., aged 35, with complaints of no issue though married 15 years; pre-sterility and irregular scanty menses for last 5 years.
Investigations :-Urine: trace of sugar; otherwise normal referred for fasting blood-sugar. 12.7-’61 124 mg./100 cc. fastil’I” urine :clear; R. T. : tubes blocked. (2) General examination C. good; Obesity : ++ no anaemia; sti : stomatitis; RS/CVS : NAD; B.P. 148/80 mm. Hg. (3) Obstetric and gynaecological examination :-Slight incapacitation caused; dysmenorrhoea a day previous to period and on 1st day; pre-sterility. (4) M . History: -Menarche : does not remember- the age of me. Present M.P. t-2 days/ l-2-3 months irregular scanty since 5 years. Slight dysmenorrhoea. Past M.H. 3-4/26/28 flow + + 5 years ago. Pelvic examination :-CS : D and B; Ut : R.V.N. Size Fx. : clear; PS : NAD Fungus infection of the vulva. (6) Treatment with A.C. r -Started on 1-7-1961 : 2 t.d.s.
6) Observations :-
| Period
20-4-1961 |
Flow
1-2 |
Nature
scanty |
| 24-6-1961 | 1-2 | scanty |
| 21-7-1961 | 2-3 | scanty, slightly better than usual |
| 24-8-1961 | 2-3 | scanty do |
| 23-9-1961 | 2-3 | scanty do |
(8) Remarks :-Throughout her treatment her periods were more or less regular-bleeding increased to some extent. She was relieved of the discomfort she used to feel at the time of her periods.
CASE No. 6 :-H.Y., aged 27, with complaints of secondary stcrility and irregular scanty menses. Investigations:-Endometrial biopsy on 20 days of cycle showed secretory pattern. (2) General examination well built ; slighty emaciated; RS/CVS : N AD; conjunctiva : no anaemia B.P. 110/70 a bald tongue stomatitis. Bowels and mict normal Obstetric and gynaecological history :-Pain, bodyache at the 1le of menses. Married 8 years ago; 1 F.T.N.D. 5 yrs. ago male ild. No other complaint. (4) M. Historyy:- Pre-menses history day/ l-1!months. Flow scanty since 3 yrs. past M. H. 2-3/4-5 weeks; flow normal. Menarche : at the age 14 yrs. L.M.P. 2-7- 1961 after amenorrhoea of two months. (5) Pelvic examination : CX : D. and F-Ex-appeared normal on P.S. Ut : R.V. mobile, N. size brought F. Fx. clear. (6) Last M .P. : 2-7-’61 (7) Treatment with A.C. :-Started on 6-7-‘6 l -2 t.d s .
(9\) Remarks :-This patient showed no improvement in the amount of flow : although the periods were more or less regular oughout the treatment.
CASE No. 7 :-L.J., aged 24, with complaints of pa in i n the lower abdomen; scanty irregular periods for 2! years; pre-sterility; married since childhood.
( l ) Investigations :-R.T. done on 8-8-’61. Tubes patent. Husba nd’s semen was normal. (2) General examination :-Well built, no deficiency symptoms; no anaemia. Secondary sex cha racters well developed; R.S./C.V.S. : NAO; B:P. 125/80 mm. Hg. (3) Obstetric and gynaecological examinations :-Married since childhood; pre-sterility. (4) M . history :-Mena rche at the age of 14 (roughly about 10 years ago). P.M.H. 4-5/ 28-30 for l year before 2!Years. Present M.H. 4-5/11-11-21 since last 2!Years flow scanty. L.M.P. 28-8-Sl no dysmenorrhoea , pain few days before menses, in the abdomen. (5) Pelvic examination : P.V. Ex.: D and F; Ut. : R. V. mobile, normal size; Fx.: Rt. ova ry palpable; Lt. N.A.D. (6) Last M .P. :-28-6-1961. (7) Treatment with A. C. :-Star ted on l1-7-‘6l2 t.d.s. for 3 months.
7) Observations :-
| Obrervations :-Mense | Flow and duration | Quantity |
| 1-8-1961 | 4-5 days | better |
| 7-9-1961 | ____ | better |
| 10-10-1961 | ____ | better |
Remark s :-Patient showed good response during the above treatment and th :: the drug was well tolerated.
CASE No. 8 :- J.K., aged 26 wit h complaints of pain in the abdomen for 2 yea rs; scanty menses; pre-sterility- married 6 years.
(1) lnvestigatio11s:-Urine: N.A. D.; Endo biopsy on 5-3-’61-proliferative phase; R. T. done on 25-7-61 tubes patent. General Examination :-Well built; no obvi ous signs of vitamin deficiency; not anaemic; no history of any illness; second ary sex characters well-developed; R.S. / C.V.S, : N.A.D. Obstetric and 1f n11ecoto1ical examination :-No dysmenorrhoea; lower abdominal discomfort slight at the time of menses- married 6 years; no issue (4) M . Hi1tory :-Presen t M. H. spotting only 2-3 months since 2 y!ars; P.M.H. 2-4/26-30 days flow N. bef 2 years:Menarche at the age of 14, L.M.P. 11-7-’61 (5) Pelvic examination :-P.V. : 15-7-1961 D and B; Ex.; A.V.N. size, a palpable cystic ovary; Right Fx. and left Fx. : N.A.D.; R.S. :N.A. D. (9) Last M .P. :-11-7-1961. (7) Treatmmt with A.C. :-Started from 15-7-’61. 2 t.d.s.
(8) Observations :-
| Periods on | duration | Amount 11-7-1961 Spotting Spotting |
| 22-8-1961 | 1 day | Amount 11-7-1961 Spotting Spotting |
| 27-9-1961 | 1 day | better than last two occasions |
(9) R1marks !-First period afte r amenor rhoea of 2 months ; second period after about 41 days; next period af ter 35 days.
CASE No. 9 :-B.M.; aged 21, with complaints of irregular scanty menses : Married since 6 yea rs but pre-sterility.
(1) General Examination :-Well buil t; slight anaemia, No efficiency symptoms; R.S./C.V.S./C.N.S. : NAO., BP. 125/80 mm. Hg. (2) Obstetric and gynaecological examination :-Pre-sterility : Married since 6 years. (3) M . History :-P.M .H. 2-3 days/2-3 months since last 3 years. (4) Pelvic examination :-CX : D : and B; Ut. : AV. smaller in size; Fx. : clear; P. S. Endo·cervicitis. last M .P . :-1-11-1960. (6) Treatment with A.C. :-Started on 21-1-1961; 2 t,d.s. (7) Observations :-L.M.P. 16-2-1961; flow 4 days improved. L.M.P. 14-3-61; flow 3 days less tha n before but still better. 20-4-61 : flow for 3 days -better; patient was satisfied. 22-5-61 : flow for 3 days scan ty but better than before.
(8) Rmarks :-This Patient was seen again after about 6 months without t rea tmen t. There was again a tendency to irregular menses after 5 to 6 weeks but the flow was better.
Observation :- There was definite improvement as .gards the regularity of menstrual cycles in most cases.. In some of the cases there was even an increase in the quant ity of the menstrual floW.
Summary.- (1) The practical importa nce of management of irregular and scanty menstruation in general practice is stressed; (2) the present day managemen t and the usefulness of a Aloes compound are mentioned.
Acknowledgement. – My grateful thanks are due to Messrs. Alarsin Pharmaceuticals, Bombay 1, for their assistance in this clinical trial.