chapter3.12

for the use of only registered medical practitioners

TREATMENT OF FUNCTIONAL UTERINE BLEEDING

(A Clinical Study with Ayopon)
by
Dr. (Smt.) VEENABEN JAVERI, M.D., D.G.O.
Consulting Obstetrician 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:

Ingredient Quantity
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 haemostatic and are nontoxic. It is used in uterine and other hemorrhages.
Nagkeshar: It is astringent, hemostatic and stomachic. More effective during bleeding episodes by decreasing 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
  4. Not improved
Condition No. of Cases Complete Moderate Slight 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 – – 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 symptom 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 abnormal uterine bleeding such as a uterine polyp, myomata, carcinoma 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. FUB 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 moderate 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 without 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 1½ year back but no change in profuse bleeding.

Ayapon: 2 t.d.s. for 1 month, later 1 t.d.s. for 2 months.
Results: 3 months after treatment, periods became normal (5-6/30), regular, moderate and no clots.
4. Menstrual irregularity in early married life: 24 years old housewife – nullipara – uterine bleeding for 15 days after 4 months amenorrhoea. No history of pregnancy symptoms or products. Treated with ergometrine tablet with no benefit.

Ayapon: 2 t.d.s. for 6 weeks and then 2 b.d. for 3 months.
Results: Cycles became regular and remained so.
5. Polymenorrhoea with menorrhagia due to B. ring: 25 years old housewife, 2 FTND, L.D. 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.
Results: The bleeding stopped after 10 days and cycles became gradually normal.
6. Bleeding following D & C: 25 years old teacher, bleeding for 25 days since dilatation and Rubin’s test with curettage for primary sterility.

Ayapon: 2 t.d.s. for 15 days, then 2 b.d.
Results: 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.
Results: Bleeding stopped after 1 week, then occasional spotting for one month. It completely stopped after one month. (Lactational Amenorrhoea.)
8. Menorrhagia with PID: 32 years old housewife – 3 FTND, L.D. 5 years. Profuse periods. Treated and improved for PID but menorrhagia persisted.

Ayapon: 2 t.d.s. for 1 month, later 2 b.d. for 2 months.
Results: 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, 1 t.d.s. for 1 month.
Results: Bleeding after 15 days, then cycles became regular.
10. Menopausal irregular bleeding: 44 years old housewife – 5 FTND, L.D. 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 complaints – remained better for 6 months with subsequent recurrence.

Ayapon: 2 t.d.s. 1 month – 2 b.d. 3 months.
Results: Bleeding controlled after about one month – no recurrence during next 3 months of follow up.

CONCLUSION / OBSERVATIONS

Phadnis (1964) has reported its usefulness in some resistant cases of FUB where hysterectomy was avoided. Mehta (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 and Nagkeshar in menorrhagia.

Our observations tend to support the clinical usefulness of Ayapon in functional uterine bleeding of puberty to menopausal 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 India Medical Conference at Kakinada.
  3. Pandya C. et al: (1963) Value 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