for the use only of a registered medical practitioner or a hospital or a laboratory.
AYAPON IN MENORRHAGIA AND OTHER COMMON MENSTRUAL BLEEDINGS
By
Dr. Vasantben M. Shah, MD., DGO., MRCOG.•.Professor & Head,
Or. Akem M. Desai, MD., DGO.,
Dr. B. Patel, MBBS., Dept. of Obstetrics & Gynaecology,
Govt. Medical College & Civil Hospital, SURAT. Gujarat.
Paper presented at the 5th Gujarat Obst. & Gynaec. Conference, Navsari, 2nd Dec. 1979.
SYNOPSIS
Ayapon was tried in 50 cases of Menorrhagia and other common uterine bleedings. There were 25 cases of menorrhagia. 10 cases of metrorrhagia. 8 cases of pubertal bleeding and 7 cases of bleeding after MTP by suction method. Only in those cases. which showed no pathological condition after necessary investigations were done, were taken up for study. The trial period was of three (menstrual) months.
Relevant data as to menstrual history. past and present. are discussed in detail. Ayapon was given for a period of three months and results were evaluated at the end of the clinical trial.
The results were Excellent in 58°/o, Good in 24°/o. Moderate in 14°/o and Poor in 40/o.The results were Poor in two cases only and they were cases of metrorrhagia aged over 40 years.They were advised hysterectomy.
There were no side effects or any rebound phenomenon when the drug was stopped. On the whole, Ayapon is found to be beneficial in treating cases of menorrhagia and other common menstrual bleedings. It is also found beneficial in controlling bleeding occuring after MTP.
INTRODUCTION
Though the etiology of menorrhagia is varied and may be due to gynecological conditions such as fibromyomata, pelvic endometriosis, hemopoietic disorders, tubercular endometritis, hypertension, and other known factors. In recent years it has been known that in the majority of cases, the etiology is uncertain and bleeding occurs though endometrium is mor pathologically normal. This is termed as ‘Functional Uterine Bleeding’ or ‘Dysfunctional Uterine Bleeding’.
Phadnis (1964) tried Ayapon in ‘ Functional Uterine Haemorrnages’ and found the drug be beneficial, and in some cases, it helped to avoid hysterectomy. Since then many reports have appeared about the usefulness of this herbal drug in dysfunctional uterine bleeding, bleeding due to IUCD, etc. So we undertook the trial of Ayapon at the Civil Hospital, Surat. Cases included were on clinical trial between June 1977 and June 1979.
MATERIALS & METHODS
The study was done during the period of June 1977 to June 1979. Only those 50 cases that were regular and had the full record of in vestigations and follow-up were included in the study. Ayapon was given for three months only and the results were evaluated at the end of three (menstrual) months.
Necessary investigations were done and those with pathological causes were excluded from the study.
AYAPON
Each tablet of Ayapon contains :
Ayapana (Eupatorium ayapana) : 60 mg
Ashok chhal (Saraca indica) : 30 mg
Nagkesar (Mesua ferrea) : 30 mg
Godanti Bhasma (Gypsum) : 30 mg
Kamboji (Breynia patens) : 90 mg.
Jeevanti (Leptadenia reticulate) : 90mg.
‘Ayapon’ is described to be beneficial as a hemostatic in Dysfunctional Uterine Bleeding, Bleeding after the insertion of IUCD, Epistaxis, hemoptysis, bleeding after dental extraction, etc. It is described to have no side effects or re bound phenomenon.
AGE GROUPS
The largest age groups were in the age group of 14-20 Yrs. (24%) and the age group of 36-40 Yrs. (24%). The least affected age groups were:26-30 (6%), 40-50 Yrs. (6%), 21-25 Yrs. (8%) and 31-35 Yrs. (12%). Taking to gether the age groups from 31-45 years, it formed 56% showing that these age groups show a preponderance of cases of dysfunctional uterine bleeding. (Table I)
TABLE 1: AGE GROUPS
|
Age Group |
Menor- rhagia | Metrar- rhagia | Post pubertal
menorrhagia |
MTP
cases |
Total | % |
|
14-20 Yrs. : |
4 | 8 | 12 | 24% | ||
|
21-25 Yrs.: |
4 | 4 | 8% | |||
| 26-30 Yrs.: | 1 | 2 | 3 |
6% |
||
| 31-35 Yrs.: | 5 | 6 |
12% |
|||
| 36-40 Yrs.: | 9 | 2 | 12 |
24% |
||
|
41-45 Yrs.: |
5 | 5 | 10 | 20% | ||
| 46-50 Yrs.: | 2 | 3 |
6% |
|||
|
Total : |
25 | 10 | 8 | 7 | 50 |
100% |
MARITAL STATUS
40 patients (80%) were married and 1O patients (20%) were unmarried. All the unmarried were in the age group of 14-22 Yrs. (Table II)
TABLE II : Marital Status
Martial Status No. %
| Married | 40 | 80% |
| Unmarried | ||
| (14-22 Yrs.) | 10 | 20% |
| Total | 50 | 100% |
AGE OF MENARCHE
34% had menarche at the age of 12 Yrs 22% at 13 Yrs. 24% at 14 years and 2% at 15 yrs. In 18% the if menarche was not known
TABLE Ill: Age of Menarche
Martial Status No. %
| 12 Yrs | 17 | 34% |
| 13 Yrs | 11 | 22% |
| 14 Yrs | 12 | 24% |
| 15 Yrs | 1 | 2% |
| Not Known | 9 | 18% |
| Total | 50 | 100% |
DIAGNOSIS
The majority of cases were of Menorrhagia (50%). There were 10 cases (20%) of Metrorrhagia, 8 cases (16%) of Pubertal Menorrhagia and 7 cases (14%) of MTP with continuous or intermenstrual bleeding. (Table IV)
TABLE IV: Diagnosis
Diagnosis No.of cases %
| Menorrhagia | 17 | 34% |
| Metrorrhagia | 11 | 22% |
| Pubertal menorrhagia | 12 | 24% |
| 15 Yrs | 1 | 2% |
| MTP | 9 | 18% |
| Total | 50 | 100% |
All the 8 cases of puberty or post-pubertal menorrhagia were in the age group of 14-20 Yrs. Menorrhagia had one case in the age group of 26-30, and the maximum number of cases were in the age group of 36-40 with . 9 cases (18%), which was the peak age,after which it came down in the age group of 41-45 Yrs. (5 cases) and one case in the age group of 46-50 Yrs. (See Table I) Metrorrhagia started in the age group of 31-35 years (one case) and the peak age group was of 41-45 years (5 cases out of total of 10 cases), and it came down to 2 cases in the age group of 46-50 years. (See Table I)
There were 7 cases of bleeding due to MTP., and the majority (4 cases) was in the age group of 21-25 years. MTP was done by suction evacuation method. The bleeding was contin ous ranging from 10-15 days after suction in 6 cases. In 1 case, there was intermenstrual uterine bleeding. (See Table I)
MENSTRUAL HISTORY, PAST & PRESENT MENSTRUAL CYCLE IN DAYS
Past menstrual history showed that 42 cases (84% ) had normal cycles. Present menstrual history showed that 32% had short cycles of 15-20 days, 24% had cycles of 20-24 days, and 18% had cycles of 24-26 days. It was normally in 8%. Those 7 cases of MTP had also nor mal cycles before missing the period. The com parison between past and present history of menstrual cycles shows that the menstrual cycles (in days) is generally shortened in cases of dysfunctional uterine bleeding. The details of Past and Present menstrual cycles are given in Table V.
TABLE V: Menstrual Cycle in days, Past & Present
Cycle in days Past History % Present %
| 15-20 days | 2 | 4% | 16 | 32% |
| 20-24 days | 1 | 2% | 12 | 24% |
| 24-26 days | 3 | 6% | 9 | 18% |
| Normal | 42 | 84% | 4 | 8% |
| MTP cases | ||||
| (History of normal cycles before) | ||||
| Puberty menorrhagia (at present) | ||||
| Total | 48 | 96% | 50 | 100% |
QUANTITY OF MENSTRUAL FLOW: PAST HISTORY & PRESENT
There was a past history of normal menstrual flow in 76%, and the flow was Moderate in 20% of cases. The present history showed that the flow was Moderate in 58% and Profuse in 42% (Table VI) .
TABLE VI : Quantity of Menstrual flow, Past History & Present
Flow Past History % Present %
| Moderate | 10 | 20% | 29 | 58% |
| Profuse | 0 | 21 | 42% | |
| Normal | 38 | 76% | 0 | |
| Total | 48 | 96% | 50 | 100% |
DURATION OF MENSTRUAL FLOW (NUMBER OF DAYS): PAST HISTORY & PRESENT :
Past history of the number of days of menstrual flow showed that 30% had the flow for 3-4 days, 50% for 4-5 days, 14% for 5-6 days and 2% for 6-8 days. Present menstrual
history showed that the duration of flow was 6- 1O days in the largest number of patients. (64%)
The details of the number of days of menstrual flow, past history and present are given in Table VII.
TABLE VII : Duration of menstrual flow (In days): Past history and Present
Duration Past History % Present %
| 3-4 days | 15 | 30% | 0 | _ |
| 4-5 days | 25 | 50% | 0 | _ |
| 5-6 days | 7 | 14% | 4 | 8% |
| 6-8 days | 1 | 2% | 12 | 24% |
| 8-10 days | 20 | 40% | ||
| 10-12 days | 5 | 10% | ||
|
Puberty menorrhagia continuous 8-1O days |
2 | 4% | ||
|
MTP: Continuous (After suction) |
6 | 12% | ||
| MTP: intermenstrual | 1 | 2% | ||
| Total | 48 | 96% | 50 | 100% |
DURATION OF PRESENT COMPLAINTS
The largest group of patients (30%) had menorrhagia/metrorrhagia for the duration of 6 months, 6 cases (12%) had menorrhagia since the time of menarche, and the duration of complaints in these ranged from 1 to 4 years. (Table VIII)
TABLE VIII :
Duration of present complaints
Duration No. of cases %
| 8-10 days (Puberty) | 2 | 4% |
| months | 8 | 16% |
| months | 3 | 6% |
| months | 2 | 4% |
| 15 | 30% | |
| 10 months | 4 | 8% |
| 12 months | 3 | 6% |
| Pubery, menorrhagia
(1-4 yrs. Since menarche |
6 | 12% |
|
MTP (Continuous 10-20 days) |
6 | 12% |
| I1ntermenstrual | 1 | 2% |
| Total | 50 | 100% |
ASSOCIATED COMPLAINTS. N = 10
The common complaints among cases of menorrhagia were fatigue and back-ache. Loss of appetite was present among 10 cases.
Table IX
ASSOCIATED COMPLAINTS. N = 10
Complaints No. of cases %
| Fatigue | 22 | 44% |
| Back-ache% | 28 | 56% |
| Loss of appetite | 10 | 20% |
DOSAGE OF AYAPON
Cases of menorrhagia and metrorrhagia were given Ayapon in the dose of 2 tablets three times a day continously for three months (Menstrual months). In 2 cases of puberty with continuous bleeding from the day of puberty (8-1O days), Ayapon 2 tablets, three times a day was immediately given till the bleeding stopped (and it stopped in 8-10 days). Then Ayapon was given continuously, 2 tablets, three times a day for three months. In 6 cases of puberty menorrhagia which was present from the time of menarche, Ayapon was given 2 tablets, three times a day, continuously for three months.
In 7 cases of MTP, in 6 cases there was continuous bleeding from the time of suction evacuation. These were immediately given Ayapon 2 tablets , three times a day till the bleeding stop ped (and it stopped in 8-10 days) . Then they were given Ayapon continuously 2 tabs. three times a day for three months. In one case of in termenstrual bleeding, Ayapon was given, 2 tabs. three times a day for three months
CLASSIFICATION OF RESULTS
The results were classified as Excellent if the amount of and duration of flow were completely normal. It was classified, as Good if the improvement was 75% and over, but not complete. It was classified as Moderate if the improvement was 50-75% . It was classified as poor if the improvement was less than 50% .
RESULTS OF AYAPON TREATMENT: DISCUSSION
7 cases of MTP showed excellent results (100%) with Ayapon . In Pubertal menorrhagia, the Excellent results were 87.5% . In Menorrhagia, 52% showed Excellent results and 28% showed Good Results, and 20% showed Moderate results. In metrorrhagia Excellent results were 20%, Good results were 40% , Moderate Results were 20% and Poor results were 20%. Hysterectomy was advised in two cases of metrorrhagia (aged 42 and 47 years), where the re sponse was Poor. Hysterectomy was also advised in another case aged 43 years where prolapse of the uterus was present. In our opinion, in younger age groups of metrorhagia, Ayapon treatment helped to avoid hysterectomy .
While cases of menorrhagia and other dys functional menstrual bleedings showed improvement , it was also observed that there was excellent relief in the associated symptoms of back-ache and fatigue. There was stress incontinence in one case (38 years) and this condition showed gradual improvement. Patients were followed-up for any rebound phenomenon after stopping Ayapon treatment and none was observed . On the whole, treatment with Ayapon in cases of menorrhagia and other dysfunctional menstrual bleedings has proved beneficial. No side effects were seen.
The results with Ayapon therapy were : Excellent 58% , Good 24% , Moderate 14% and Poor 4 % . (Table X)
TABLE X :Results of Ayapon Treatment
| Results | Menor· rhagia | % | Pubertal menorr. | % | Metror· rhagia | % | MTP | % | Total | % |
| Excellent | 13 | 52.0% | 7 | 87.5% | 2 | 20.0% | 7 | 100.0% | 29 | 58.00% |
| Good | 7 | 28.0% | 12.5% | 4 | 40.0% | 12 | 24.00% | |||
| Moderate | 5 | 20.0% | 2 | 20.0% | 7 | 14.00% | ||||
| Poor | 2 | 20.0% | 2 | 4.00% | ||||||
| Total | 25 | 100.0% | 8 | 100.0% | 10 | 100.0% | 7 | 100.0% | 50 | 100.0% |
SUMMARY
50 cases of dysfunctional uterine bleeding due to menorrhagia (25 cases) , metrorrhagia (1O cases) , pubertal menorrhagia (8 cases) and MTP cases (7) were treated with Ayapon . The results were Exellent in 58% , Good in 24% , Moderate in 14% and Poor in 4% (2 cases) . Both the cases of Poor response were of metrorrhagia aged over 40 years, and were ad vised hysterectomy. In our opinion, hysterectomy could be avoided in the younger age groups of metrorrhagia as they got complete re lief with Ayapon treatment. Ayapon is found to be a beneficial drug in treating menorrhagia, and other common menstrual bleedings.
ACKNOWLEDGEMENT
Our thanks are due to Dr. Niranjan R. Mehta, Dean & Superintendent of Govt. Medical Col lege & Civil Hospital Surat. We are also thankful to Alarsin Pharmaceuticals, Bombay 400 023 , for their cooperation.
REFER ENCES
- Chowdhuri Gouri Rai : A Controlled trial of Ayapon in Copper T (IUCD) in post-insertional Bleeding after MTP in Family Planning : First Asian Congress of Induced Abortion & Voluntary Sterilisation , Bom bay, 4-9 March 1979.
- Jahagirdar, S. R. : Place of lndigeous Drug Ayapon in DUB (Dysfunctional Uterine Bleeding) : XVI Cont. of International College of Surgeons, Hyderabad 2-4 Oct. 1970.
- Jhaveri Veenaben : Treatment of Functional Uterine Bleeding (A Clinical Study with Ayapon) : The Indian Pract. 18 : 11 : 783-6 Nov. 1965.
- Kamat, D. S. & Anjaneyulu, H. : XX All India Obst. & Gynaec. Cont. Gauhati, 3-6 Jan. 1977 & The Indian Pract. Vol. 30 No. 9,383-391, Sept. 1977.
- Karuna, J.: A Clinical Trial of Indigenous Drug ‘Ayapon ‘ in 50 cases of Dysfunctional Uterine Bleeding: Thesis for M.D. submit ted to Andhra University, Waltair, Visakhpatnam, 1974.
- Kodanky Kamal B.: Use of Ayapon in intrauterine Bleeding after l.U.C.D: The Indian Pract. 21: 12 Dec. 1968.
- Lalitha Ananthasubramaniam, Kasturi R. & Jaya Rajendran:Ayapon in Post-lnsertional Bleeding : Mediscope, Vol. XVII, No. IX, Dec. 1975.
- Mehta, A. M. : Use of a Eupatorium Ayapana combination (Ayapon of Alarsin) in Functional Uterine Bleeding : A prelimi nary report: 40th All India Medical Cont. Kakinada, Dec. 1964.
- Misra Anant & Misra Surya Narayan : Studies on the Haemostatic effect of four indigenous drugs & Ayapon : OrissaVety. Jr . 3 : 1965.
1O. Mitra Rama : Value of Herbal Drugs in Functional Uterine Bleeding : Mediscope, 11-2 : 38, May 1968.
- Mukherjee Gouri & Mukherjee Krishna : Ayapon (Alarsin) a safe herbal drug in Dys functional Uterine Bleeding : The Indian Pract. Vol. XXVI, No. 9, 405-408, Sept. 1974.
- Phadnis, H. N. : Use of Ayapon (Eupatorium Ayapana) Compound in Functional Uterine Haemorrhages : The Antiseptic, 61 : 10, Oct. 1964.
- Ramani •Sivaraman : Ayapon in Dysfunc tional Uterine Bleeding : Mediscope, Vol. 18-10, Jan. 1976.
- Ramani Sivaraman : Treatment of Uterine Bleeding after MTP & IUCD with Ayapon and its longterm effect : First Asian Con-. gress of Induced Abortion & Voluntary Sterilisation, Bombay , 4-9 March 1979.
- Rohatgi Pratibha : Functional Uterine Bleeding- treatment with indigenous drug ‘Ayapon’: The Antiseptic, 63:11, 847, Nov. 1966.
- Saxena, S. C. : Use of Ayapon in Functional Uterine Bleeding : Current Med. Pract. Vol. 17, No. 5, 223-28 , May 1973.
- Shah L. M. & Visaria Sarla : Herbal Drug Ayapon (Alarsin) in Dysfunctional Uterine Bleeding (D.U.B.) : 2nd Cont. of the Bom bay Obst., & Gynaec. Society, 16 & 17 Dec. 1972.
- Shelat Ramesh K. : Value of Herbal Drugs in Functional Uterine Bleeding : The Indian Pract. 19 : 10, 697-702, Oct. 1966.
- Ursekar, G. D. (1973) : Ayapon to control Bleeding after IUCD : Maharshtra Med. Jr. \,, Vol. XX, No. 3 June 1973.
- Vijay Gayatri (1976) : Ayapon in Dysfunctional tJterin_e Bleeding : First Rajasthan Obst. & Gynaec. Cont., Jaipur, 25 & 26 April, 1976.