for the use only of registered medical practitioners
USE OF ‘ AYAPON ‘
IN UTERINE BLEEDING AFTER IUCD*
By :
(M RS.) KAM AL 8. KODKANY
M. D .. F .C .P.S ,. D .G .0,.
Honorary Medical OffiGer, Family Planning Department,District Hospital, Belgaum.
SINCE the Government of India accepted family planning as a national policy, newer and newer contraceptives are becoming popular. The most important advantage of IUC D aa contraceptive is that the couple need to make only the decision to have it fitted in. Thereafter, so long as the device remains in place, no further contraception action is necessary. Therefore, this fo1m of contra· ception became very popular and is still favoured by the majority because of the high level of protection it offers easy insertion and removal, minimum of medical supervision and also as it is least ex· pensive. With the device being used now for over a period of four years in our country, more and more side-effects of the same are being reported in the literature and many are worried about the uterme bleeding which occurs after their use which is irregular and sometimes profuse, not only causing anaemia in the patient but also irritating the woman since she feels that she is in period always!
In the District Hospital at Belgaum which is attached to the J. N. Medical College, a well equipped Family Planning Centre is being conducted by the hospital. The IUCD was introd uced since July, 1965 at t his Centre and till the end of the year 1966, totally 978 women were fitted in with this device. Out of thee, 978 cases 254 women attended the hospital for bleeding after its insertion, statistically giving a figure of 25.9%. The following table gives the details.
Table I
| Total number of loops introduced cases | 978 | |
| Total num r of bleeding cases | 254 | 25.9 % |
| (i) Severe bleeding cases | 68 | 0 % |
| (ii) Moderate but prolonged bleeding cases | 99 | 77.0 ‘% |
| (iii) Mild bleeding cases | 87 |
All these cases were routinely administered calcium and vit. C tablets and also Sulpha group of drugs for 7 days and in spite of these, the bleeding occurring in about 25 per cent cases needed att ention. There were 9 cases who actually required admission and treatment. Robert Wilson also found an incidence of 27.6 per cent intermenstrual bleeding. 3.8 per cent with menorrhagia and 4 per cent with a persistent increase in flow or prolongation of flow S. Rozine et al studied endometrial histology and clinical sympto ms. They found that endometrial pattern was normal in 40 of 61 women whose presenting complaint was abnormal bleeding. They also found that endometrium showed no recognizable tissue react· ion to the presence of IUCD even after many years. This indicates that the uterine bleeding is in the form of functional haemorrhage rather than due to any palpable pathology. It is known as well, that the functional uterine haemorrhage has a spontaneous cure rate of almost 40%. The remedy lay in either removal of the device, or ad ministering hormones like the progestational agents. The former was too drastic a method and the latter would be rather expensive. At this stage, the use of ‘Ayapon’ (Alarsin Pharmaceuticals) came to our mind, as it is cheap and has been used by many in functional uterine haemorrhages with good effect.
Pharmacodynamics of ‘Ayapon’:
‘Ayapon’ is a combination of Ayurvedic herbal consist units :
- Ayapon 130 containing ayapon and ayaprn in. Both are hac most attics and enhance coagulation. They are non-toxic.
- Nagkeshar (Mesua ferrea) 32 It i,; an astringent, haemostatic and stomachic. Reduces the amount of bleeding.
- Ashoka (area-l n:lica) 130 It is a powerful ut !rine sedative and astringent as well.
- Godanti (Gypsum) 32 It is astringent, antacid, and cooling. lt provides calcium in an assimilable form.
Material and Methods: Cases who were having Lippe’s loop and came with the complaints of menstrual disturbances between May, 1967 and April 30th 1968 at the Family Planning Centre at District Hospital, Belgaum, were selected for this study. These menstrual disturbances were in the form of (i) intermenstrual bleeding, (II) excessive flow during periods, (Ill) increased the duration of the menstrual flow, etc.
These patients were given ‘Ayapon’. A total of 30 tablets were considered a 1 course. Instructions were given to take two tablets three times a day for 5 days. At the end of this period, patients had to report personally and take another course of 30 tablets if symptoms were not relieved. A maximum of 3 courses was given to any patient at the end of which if bleeding was not controlled they were considered as failures.
There were 50 cases treated in this study between 13th May, 67 and 30th December 1967. During this period there were 50 cases who presented with history of irregular menstrual bleeding on the introduction of the IUCO viz., Lippe’s loop.
All were given 30 tablets as the first course and It was satisfy ing to note that 32 had stopped bleeding at the end of the first course. One patient required only 2 days’ treatment. Among these, 12 patients who had the main complaint as menorrhagia required the treatment during their next period as well. 5 of them required repetition for 3 cycles. There was no more complaint of menorr Hagia after the third cycle.
There were 13 patients in the irregular bleeding group who required 2 courses of treatment for the stoppage of the bleeding. 5 patients who had to be given 3 courses of treatment did not respond at all. They were considered as failures. All the patients who bad responded to treatment were given a maintenance dose of 1 tab, thrice daily for 1 month.
From this record, we find that ‘Ayapon’ is a drug which controls irregular bleeding or intermenstrual bleeding to the extent 64 % with only 5 days therapy or a course of 30 tablets. About 26% required the drug for over 10 days or 60 tablets. 10% of the cases did not respond to the treatment. Those cases who have menorrhagia or cyclic excessive bleeding may require the drug to be repeated in their next few cycles. Maintenance dose of 3 tablets daily can be given in these cases as the drug has no harmful effect and is also economical.
In conclusion, we feel that ‘Ayapon’ is a drug which is safe and effective in controlling the various menstrual irregularities after IUCD is introduced. We do not claim that the drug gives a dramatic curebut feel that the woman has a chance to keep the loop I n place and not ask for its removal due to the presence of bleeding which has a tendency of spontaneous cure after 3-4 months. The ‘Loop programme’, therefore, has a good chance of success with these drugs. Surely most of the cases of loop ask for removal with I n the first 4 months or so. The drug being least expensive aad also least toxic, it can be given a further trial on a mass sea with proper controlled study.
Acknowledgement : w wish to record our thank s to the District Surgeon, Dr N. Y. Anegund i , who has allowed us to try the drug and also report the results. Our sincere tha·1k s are ::lue to Dr B. S. J I rge, Dean, J. N. Medical College, for allowing us to put bl i ;h t his and to Dr. B. S. Kodkany, Head of the Dept. of Obstetrics & Gynaecology, for his valuable guidance in recording our results.