chapter3.11

for the use only of registered medical practitioners, or a hospital or a Laboratory.

AYAPON IN DYSFUNCTIONAL UTERINE BLEEDING

Use of AYAPON (Eupatorium Ayapana) Compound
In Functional Uterine Haemorrhages
by
Dr H. N. PHADNIS, M.D., F.C.P.S. (Born)
Consulting Obstetrician and Gynaecologist, and Honorary Obstetrician & Gynaecologist,
Sassoon Hospital and 8. J . Medical College, Poona.
REPRINT: The Antiseptic, October 1964

INTRODUCTION

The fact that “functional uterine haemorrhage” is being seriously discussed at national and international Obstetric and Gynaecological Conferences shows that there is no satisfactory treatment for this very common symptom and that the physiological and pathological aspects of this problem are not yet fully understood.

Functional uterine haemorrhage is a major gynaecological problem in general and consulting practice and also in the out patients’ departments of teaching and other hospitals. These cases are first treated by family physicians on the usual conventional lines and when no relief is observed, they are referred to the gynaecologist. Inspite of the expert diagnostic facilities now available and the vast clinical experience that has accumulated, there are a number of cases in which the cause cannot be detected and the usual surgical and/or hormone treatments do not help.

In patients complaining of vaginal bleeding, it is essential to confirm the site of bleeding. Pathological lesions of the vagina, cervix and vulva must be excluded before thinking of any menstrual irregularity. Pregnancy complications (abortions, post-abortal and puerperal bleedings) must also be ruled out. Profuse and/or irregular bleeding due to various causes may occur.

Tumours and infections in and around the uterus including genital tuberculosis can be excluded or diagnosed by thorough history-taking and physical examination, if necessary under sodium pentothal anaesthesia.

There are however many cases where no local pathological lesion is detected and the only abnormality in the pelvic is evidence of congestion, congested cervix and vagina with clear mucoid discharge from the cervix which may be often excessive. Displacements of the uterus may also cause this type of congestion, when no cause can be found, uterine haemorrhage is usually attributed to dysfunctional bleeding.

The object of this study was to observe the usefulness of certain Ayurvedic drugs in functional uterine bleeding where no pathological or other causes can be detected.

PHARMACOLOGY AND THERAPEUTICS OF THE DRUG

“Ayapon” (Alarsin) was selected for this study. Ayapon is a combination of Ayapan (Eupatorium ayapana) 130 mg; Nagkeshar (Mesua ferrea) – 32 mg; Godanti (Gypsum) – 32 mg; and Ashoka (Saraca indica) – 130 mg.

Ayapan: Its constituents – ayapin and ayapanin are blood coagulant haemostatics and are non-toxic, it is used in uterine and other haemorrhages.
Nagkeshar: Is astringent, haemostatic, stomachic; acts better during bleeding episodes, by decreasing the amount of bleeding.
Ashoka: Is a well-known astringent and uterine sedative. It contracts the uterus and its effect is believed to be directly on the uterine musculature. It is used in menorrhagia and post-partum haemorrhages.
Godanti: Is astringent, antacid and cooling, It provides calcium in an assimilable form and is therefore a haemostatic.

MATERIAL AND METHODS

Patients for this study were selected from our consulting practice. In most cases the usual hormone or surgical treatment did not help and no pathological or other cause could be detected.

The normal dose adopted was: 2 tablets of Ayapon t.d.s. for 1 to 2 months and then 1 tablet t.d.s. for 1 to 2 months.

The cases included functional uterine haemorrhages of puberty and menopause; menorrhagia and metrorrhrgia; persisting and irregular haemorrhages after delivery, abortion or miscarriage; also haemorrhages persisting after dilatation and curetting.

RESULTS

Fifty patients were treated with Ayapon, which checked the quantity of flow in most cases and afforded remarkable relief. And where the treatment was continued in proper dosage complete relief was recorded in most of the cases.

  • In cases of irregular and profuse bleeding there was control of bleeding and the monthly period also improved in
  • Even in menorrhagia of longstanding treated with hormones and where dilatation and curettage was done, Ayapon helped to avoid hysterectomy; the same result was obtained in a few cases which had proved resistant to extensive hormone treatment and surgical management (like D & C).
  • Where the local pathology e.g. cervicitis was treated surgically but bleeding persisted, Ayapon proved effective.

Ayapon helped in avoiding hysterectomy.

The drug should be continued for at least 3 months to derive its full benefit. It is cheaper than hormonal therapy and does not require the close observation, dosage and time adjustments like hormone therapy, Further there are no side-effects.

CASE REPORTS

1. Patient, aged 21 complained of irregular and profuse bleeding p.v. after caesarean section. Curettage was done to remove retained pieces of membrane. Subsequently there was irregular and profuse menses (Pelvic findings normal).

Ayapon: 2 tablets t.d.s. were given for 2 months with haematinics.
Results: The haemorrhage was controlled and the menses became regular.
2. Patient, aged 24 years, irregular and profuse menses since menarche, weakness. Previously metropathia haemorrhagica treated with D and C with only temporary relief.

Ayapon: 2 t.d.s. for 2 months.
Results: Good - m.c. regular.
3. Patient, aged 30, irregular and profuse menses. Had this complaint since menarche though there had been two normal pregnancies and deliveries.

Ayapon: 2 t.d.s. for 2 months, then 1 t.d.s. for 2 months.
Results: Good.
4. Patient, aged 26 years, regular but profuse menses, no dysmenorrhoea, was treated previously for sterility with D and C. She then had two normal pregnancies and deliveries. But menorrhagia persisted, pelvic findings normal; D and C done with temporary relief.

Ayapon: 2 t.d.s. for 1 month; then 1 t.d.s. for 2 months.
Results: Good.
5. Patient, aged 28 years, regular but profuse menses, weakness. D and C gave only temporary relief. Pelvic findings normal.

Ayapon: 2 t.d.s. for 2 months; then 1 t.d.s. for 1 month.
Results: Good.
6. Patient, aged 38 years, irregular and profuse menses and leucorrhoea – treated by diathermy cauterization for cervicitis; leucorrhoea was controlled but menorrhagia persisted.

Ayapon: 2 t.d.s. for 2 months.
Results: Menorrhagia controlled and hysterectomy was avoided.
7. Patient, aged 25 years, irregular and profuse menses following a caesarean section; D and C done with temporary relief; mild pelvic sepsis treated but no Ayapon.

Ayapon: 2 t.d.s. for 2 months; 1 t.d.s. for 1 month.
Results: Haemorrhage was controlled; Ayapon proved effective after local treatment had failed.
8. Patient, aged 32 years, irregular and profuse menses with leucorrhoea, cervicitis treated with cauterization; relief of leucorrhoea but bleeding not well controlled. Pelvic findings normal.

Ayapon: 2 t.d.s. for 1 month; then 1 t.d.s. for 3 months.
Results: Good.
9. Patient, aged 36 years, unmarried, irregular and profuse menses of long standing. D and C gave only temporary relief. No pathological condition noted.

Ayapon: 2 t.d.s. for 2 months; then 1 t.d.s. for 2 months.
Results: Bleeding less and was within limits.
10. Patient, aged 37 years, irregular and profuse bleeding at menses, treated extensively with hormone etc, D and C also done with temporary relief only. Pelvic findings normal.

Ayapon: 2 t.d.s. for 1 month; then 1 t.d.s. for 2 month.
Results: Good - hysterectomy avoided.

SUMMARY

  1. Ayapon (Ayapan, Nagkeshar, Ashoka, Godanti) was tried with very satisfactory results in functional uterine bleeding not due to pathological or other causes.
  2. In some resistant cases it also avoided hysterectomy.
  3. Ayapon treatment must be continued for 3 months to obtain full benefit.
  4. The dosage is safe and economical.

ACKNOWLEDGEMENT

We are thankful to Manthan, Research Division of Alarsin Pharmaceuticals, Bombay-1, for their assistance in the study.