Dr. (Srnt.) VEENABEN JAVERI

for  the use of only registered medical practitioners 

TREATMENT OF   FUNCTIONAL  UTERINE   BLEEDING

( A Clinical Study with Ayopon ) by

Dr. (Srnt.) VEENABEN JAVERI, M.D., D.G.o.

Consulting Obstetric/ an and Gynaecologist, Baroda

  Introduction 

UTERINE bleeding occurring at unexpected times or in excess of normal menstrual flow, in the absence of organic uterine or systemic disease, is for want of better nomenclature classified as  Functional  Uterine  Bleeding.   It is caused by a disturbance of the physiological mechanism that regulates the normal cycle. Its incidence is high in gynecological practice and its treatment remains far from satisfactory.

The object of this study was to observe the efficacy of certain herbal drugs in established cases of functional uterine bleeding.

Drug

Ayapon  (Alarsin) was tried in this study.

Each  tablet  of  Ayapon  contains :

Ayapan (Eupatorium ayapan) 130 mg.
 Nagkeshar  (Mesua  ferra) 32 mg
 Ashoka (Saraca indica) 130 mg.
 Godanti (Gypsum) 32 mg.

Ayapan : Its constituents ayapin and ayapanin are haemo­ static and are nontoxic.  It is used in uterine and other hemorrhages.

Nagkeshar: It is astringent, hemostatic and stomachic. More effective during bleeding episodes by de­ creasing the amount of bleeding.

Ashoka: Is astringent and uterine sedative.  It acts directly on uterine musculature. It is used in menorrhagia and postpartum hemorrhage.

Godanti:      Is astringent, antacid and cooling. It provides calcium in assimilable form and acts as haemostatic.

Materials  and Method 

Established cases of functional uterine bleeding from our consulting practice were selected for this study. Cases with organic causes were excluded. All cases had previous treat­ment with hormones and / or D & C without benefit.

Dose: 2 tablets Ayapon were given three times a day for 1-3 months.  In those cases which benefited,  1-2 tablets b.  d. or t. d. s., for 7-10 days, starting three days prior to expected menses, were given for the next three cycles.

As supportive treatment haematinics and multivitamins were given where found necessary.

Bed rest was advised during bleeding episodes.

Improvement: Criterion of improvement was based on a reduction in quantity and duration of bleeding and results classified as: 1. Complete, 2. Moderate, 3. Slight, and 4. Not improved.

 

  No. of Cases  Complete  Moderate  Sli8ht Not improved
Menorrhagia 22 17 3 1

1

Metrorrhagia

 15 12           1   2
FUB  of  Puberty 8 7 1    

FUB after  D & C

 6 4 1 1  
FUB  after  delivery 4 3

1

    
  J.B. due to G.B. ring 2

2

      

PUB : Menopausal

 2       1
Total No. of cases 59 46(78%) 7(12%) 2(3%)

4(7%)

In those cases which improved quantity and duration of bleeding were controlled within 3-10 days.  In menorrhagia cases, results were most satisfactory.  In metrorrhagia cases there was a remarkable improvement in the regularity of periods.

Discussion

It should be remembered that uterine bleeding is a symp­ tom and it is bad medicine and worse surgery to treat it as it were the whole disease by drastic drug treatment and surgical measures.

 The diagnosis involves exclusion of organic causes of  ab­ normal uterine bleeding such as a uterine polyp,   myomata, trcinoma  of the cervix,  and  of the endometrium granulosa cell tumor; obstetric causes like abortion, ectopic pregnancy, chorionepithelioma, hydatidiform mole, etc., and systemic causes like hypertension and blood  dyscrasias.

Various theories have been put forward to explain the etiology of functional uterine bleeding, with the presumption of a disturbance with endocrine balance. It may, however, be  mentioned that very little is understood of the exact aetiology or etiological factors responsible for this disorder.

Objectives of the therapy are haemostasis and regulation of bleeding and restoration of ovulatory cycles in an ovulatory type of FUB. Usual measures adopted are dilatation and curettage; hormones and correction of emotional and constitutional factors.

But as mentioned before the treatment of functional uterine bleeding remains unsatisfactory and herein lies the usefulness of Ayapon which is safe, simple to administer and compara­tively cheaper for prolonged use in resistant cases. It is useful even in those cases which require surgical measures, as a sup­portive drug treatment.

Case Reports

  1. FU B of puberty: 15 years old unmarried student – irregular and prolonged periods for 6 months – hormones for 3 cycles with recurrence on discontinuance – PV not done. No pelvic pathology detected. Ayapon 2 b.d. for 15 days. Then 1 t. d. s. for 4 months. It took 3-4 months of Ayapon treatment but gradually the cycles became regular with mode­ rate flow as desired.
  2. Menorrhagia in the underdeveloped uterus: 23 years old housewife -nullipara  -primary  -sterility  -married   5 years – uterine bleeding for 25 days starting as normal period with­ out preceding amenorrhoea. Taken cyclical hormonal treatment for 6 months with recurrence after withdrawal of hormones. Ayapon 2 t.d.s. for 6 weeks, later 1 t.d.s. for 2! months. Menstrual cycles started becoming regular (previous 1-4 months) though flow remained for 8-10 days (as opposed to pretreatment 10-20 days.)
  3. Menorrhagia since menarche: 23 years old housewife, regular profuse period with clots since menarche.    1 FTND lt 1 ½ year back but no change in profuse Ayapon  2 t.d.s.  for lt months,  later  1 t.d.s for  2 months. 3 months after treatment, periods became normal    (5-6/ 30),  regular, moderate and no clots.
  4.  menstrual irregularity in early married Zife : 24 years old housewife – nullipara – uterine bleeding for  15  days after lf months amenorrhoea.   No history of pregnancy symptoms or pro ucts Treated with ergometrine tablet with no benefit . Ayapon 2 t.d.s. for 6 weeks and then  2 b.d. for 3 months.   Cycles became regular and remained so.
  5. Polymenorrhoea with menorrhagia due to B.ring; 25 years old housewife, 2 Ff ND, LD: 6 months back. Irregular profuse bleeding (7-8 / 13-18 days)  after  G.B.  ring  2  months back. Haemostatics had no benefits.  Ayapon  2  t.d.s.  for  1 month, then 2 b.d.,  for  2  months.  The bleeding stopped after 10 days and cycles became gradually normal.
  6. Bleeding fallowing D & C: 25 years old teacher, 1eeding for 25 days since dilatation and Rubin’s test with curettage for primary Ayapon 2  t.d.s.  for  15  days, then 2 b.d. Bleeding stopped after 15 days. Next few cycles were regular though profuse. After 3 months cycles were moderate as usual.
  7. Bleeding following Caesarean section: 30 years old housewife – 2 FTND : 1 CS for APH 21 months back – sterilised. No placental tissue or membrane remained in uterus- no PPH – bleeding not profuse but continuous.  Ayapon 2 t.d.s. for 1 month. Then 2 b.d. for 2 months,  Bleeding stopped after 1 week, then occasional spotting for one month. It completely stopped after one month. (Lactational Amenorr­ hoea.)
  8. Menorrhagia with PID : 32 years old housewife – 3 FTND, LD: 5    Profuse periods.   Treated and improved for PIO but menorrhagia persisted.   Ayapon  2 t.d.s.It months, ‘ ter 2 b.d. for 2 months, Amount of blood loss and duration of bleeding reduced. Cycles normal after 3 months.
  9. Menorrhagia in subinvoluted uterus : 36 years old Irregular bleeding since last delivery 3 months back, almost continuous. No benefit with Methyl ergometrine tablets and calcium inj. Ayapon 2 t.d.s for 1 month, 1t.d.s. for 1 month. Bleeding after 15  days, then cycles became regular.
  10. Menopausal irregular bleeding : 44 years old house· wife – 5 FTND, LD 12 years – vaginal repair with sterili­sation done 9 years back -for last 4 months irregular bleeding PV for 4-6 days  with  2-3 days  dry  interval yellowish  discharge between bleedings pain in lower abdomen no history of amenorrhoea – D & C done 2 years back for present com­ plaints – remained better for 6 months with subsequent re­ Ayapon 2 t.d.s. 1 month – 2 b.d. 3 months. Bleeding controlled after about one month – no recurrence during next 3 months of follow up.

Phadnis (1964) has reported its usefulness in some resis­tant cases of FUB where hysterectomy was avoided.  Mehti’ (1964) also found it efficacious in menorrhagia and metrorrhagia. Pandya Saudamini et al (1963) have reported encouraging results with a combination of two ingredients of Ayapon namely Ashoka Anri Nagkeshar in menorrhagia.

Our observations tend to support the clinical usefulness of Ayapon in functional uterine bleeding of puberty to meno­ pausal age groups before giving drastic drug treatment or resorting to surgical measures and as a supportive treatment after surgical measures in cases where surgery has to be resorted to.

Acknowledgment 

We are thankful to Alarsin Pharmaceutical.  Bombay-1,   for the supply of Ayapon tablets for this study.

References 

  1. Ghosh R: Pharmacology   (1957).   Materia Medica and Therapeutics,  20th     Hilton  & Co., Calcutta.
  2. Mehta   M.:   (1964).   Use of a Eupatorium   Ayapon Combination in Functional  Uterine   Bleeding, Paper before the Scientific Session of 40th All  Judia  Medical Conference at Kakinada.
  3. Pandya    C. et al:           (1963)  Valu•   of indigenous Drugs in Menorrhagia;   The Current Medical Practice 7: 8 543.
  4. Phadnis  H     : (1964) Use of Ayapon Compound in Func­tional Uterine  Haemorrhages;   The Antiseptic, 61: 10,683.
  • From the Indian Practitioner, Bombay-I, Nov. 1965 Vol XVIII No. 11:783-6