A CASE STUDY- ABNORMAL UTERINE BLEEDING AND MANAGEMENT BY AYURVEDIC REMEDIES

ABSTRACT

Abnormal uterine bleeding (AUB) is very common in the world. Even though it is a rare cause of mortality but it is a common cause of morbidity in the reproductive age group women. Most of the cases are treated well with modern medicine but some patients fail to respond to the known medicines. This is a case which was not responding to all the known treatments but successfully treated by Ayurvedic treatments.

INTRODUCTION

It is the abnormal bleeding from the uterus which is longer or heavier than usual or does not occur at the regular menstrual time. Heavy bleeding, Inter-menstrual bleeding, Spotting, Contact bleeding etc. can be included under this heading.

DYSFUNCTIONAL UTERINE BLEEDING

When there is abnormal bleeding from the uterus without any demonstrable structural or organic disease, it is called Dysfunctional Uterine Bleeding (DUB). The main cause of DUB is an imbalance in the sex hormones. In extremes of the age (either teen-age or pre-menopausal) it is very common. Girls experiencing puberty and women entering menopause can have imbalanced hormone levels for months or even years. This causes sporadic bleeding, heavy bleeding, and/or spotting.

Absence of progesterone from anovulation and subsequent endometrial hypertrophy is the main pathology occurring in 90% of DUB. Ovulatory DUB is rare (10%). Irregular ripening or shedding of the endometrium causes a spectrum of vaginal bleeding presentations. It can be in the form of spotting, moderate or heavy bleeding. Apart from progesterone, other hormones like estrogens, FSH etc. and factors like prostaglandins and certain enzymes are involved in the pathology of AUB.

ASRIGDARA

Ayurveda considers AUB as Asrigdara ( Asrig= blood, Daranam= to flow). Asrigdara is a gynecological problem presenting with excessive or prolonged uterine bleeding during menstruation or intermenstrual period, back ache, pain in lower abdomen and weakness. It can be compared to Dysfunctional Uterine Bleeding. Causes such as excessive use of pungent food vitiates vata dosha; Salt and sour food vitiates mainly Pitta dosha, & these together vitiates Rakta( blood). Then Rakta and Pitha agitates Vata leading to Asrigdara. Here, by Chala guna (mobility) of Vata and sara guna(fluidic nature) and dravaguna ( liquefying nature) of Pitta disturbs HPO axis. Aggravated Vata disturbs the normal function of hypothalamus which in turn effects the initiation of menstruation; aggravated Pitta cause more FSH release, in turn excessive secretion of estrogen causing hyperplasia of endometrium, where menstruation starts by the withdrawal of estrogen results into excessive bleeding.

Case study

This moderately built female patient Raveena (19 years/female/unmarried) was suffering from abnormal menstrual bleeding which was varying in amount but mostly continuous throughout a month varying in amount from spotting to heavy for the last two years. Tiredness, fatigue and occasional fainting for last 6 months were also present. Her complete blood count revealed anemia (Hb-7.4gm/dL). Other relevant tests like serum. Prolactin, thyroid stimulating hormone were normal. USG was normal for pelvic organs. She tried Modern medicine, homoeopathy and Ayurveda but didn’t get any relief. So she consulted in our clinic.

TREATMENTS GIVEN

First week

  • Juice of Vasa(Adathoda vasica), Apamarga(Achyranthes aspera), Musali (Curculigo orchioide), satavari( asparagus racemosus) 4 ml each were given with honey (10 ml) in empty stomach-(traditional medicine)
  • Ashoka bark milk decoction 60n ml in the evening.
  • Fresh Cow butter 1 teaspoon at bedtime.
  • Thakradhara for head- 45 minutes, 7 days

Second week

  • Musalikhadiradi kashayam- 60 ml in the morning
  • Dusparsakadi kashayam – 60 ml in the evening
  • Chandraprabha gulika 1-0-1
  • Annabhedi sindoora capsule 1-0-1
  • Shirodhara with ksheerabala taila- 1 hour

Third week

  • Asoka gritha 10ml in the morning
  • Lohasindoora capsule 1-0-1
  • Dusparsakadi kashayam 60ml before lunch
  • Abhyanga with ksheerabala and Avagaha (sitz bath) in Nalpamara kashayam for 30 minutes, 7 days.

Fourth week

  • Milk decoction prepared with laksha(Laccifer lacca) 60 ml in the morning
  • Lohasindoora capsule 1-0-1
  • Sukumara gritha 10 ml bedtime.
  • Abhyanga with balaguluchyadi taila
  • Panchakarma Nasya with Anutaila

Fifth week

  • Abhyanga with balaguluchyadi taila
  • Panchakarma Nasya with Dhanwanthara taila 101 avarthi
  • Yoga vasti( 3 kashayavasti and 4 snehavasti)
  • The same internal medicines were continued for next three weeks.

 

OUTCOME OF THE STUDY

The heavy bleeding reduced in the first week itself. The number of pads used per day reduced from 8-10/day to 2-4/day.Her fatigue and lassitude were decreased significantly. By second week, bleeding stopped completely after a long period of two years. But on the third week spotting was noted again with a slight abdominal pain, no medicines were changed, it’s corrected normally within two days.

A follow up was maintained for a period of three months after the treatment. In the second month there was no bleeding. In the third month she got her menstruation (exactly after 68th day of the commencement of the treatment. It was a normal one with 6 day duration, normal bleeding and mild lower abdominal pain. Her complete blood count was taken after the menstruation in which anemia was shown to be corrected, Hb ( 12.4gm/dL). An ultrasound was also performed on 16th day of menstruation; it showed a follicle of size 18mm in the left ovary and an endometrial thickness of 9mm. A repeat scan was taken on 18th day which showed a ruptured follicle in the left ovary, fluid in the POD and endometrial thickness of 10mm (suggestive signs of ovulation).

In the fourth month, also she got menses exactly after 34th days of previous menses, which lasted 5 days, with normal bleeding and minimal lower abdominal pain. Her life became normal with the correction of abnormal vaginal bleeding.

CONCLUSION

The disease was identified as AUB (Asrigdara) as there was no demonstrable structural or organic disease. As the disease was chronic in nature, a long-term treatment is planned, initially to stop the vaginal bleeding and then to correct the disturbed HPO axis along with correction of anemia. Bleeding was arrested successfully and anemia is corrected by the given medicines. HPO axis is normalized which is evident by the ovulation.so we could state that with Ayurvedic treatment we can successfully AUB.

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