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TITLE OF CASE:

Standalone Ayurvedic management of Dysfunctional Uterine Bleeding - A case report

Dr Prajeesh Nath

ABSTRACT

A 41-year-old female patient, a teacher by profession, presented with prolonged vaginal bleeding with occasional clots for two months associated with low Hemoglobin count and having a feeling of generalized body swelling. She had taken some unknown Ayurvedic medications for two months. The patient did not respond well to the treatments, and the condition was found to be progressing. She opted for a second Ayurvedic consultation. Her blood loss was 60 ml/day, which could be measured as she was using a menstrual cup, and in the blood routine examination, the Hemoglobin level was 8gm/dl. The condition was provisionally diagnosed as Dysfunctional Uterine Bleeding and treated the condition as Asrgdara. Rakta shodhana and rakta prasadana were the line of treatments administered. After four days of Ayurvedic treatment, the blood loss reduced to 15ml/day, and after six days, the bleeding completely stopped. In the monthly follow-ups done for the next three months, the patient had a healthy menstrual cycle with menstrual flow lasting for four days with no blood clots. Hemoglobin checked after four months of treatment was 11.6gm/dl. So, Ayurveda can be adopted as an alternate way of managing complex dysfunctional uterine bleeding.

KEYWORDS

Dysfunctional uterine bleeding, Asrgdara, Case report, Ayurveda, Standalone

INTRODUCTION

Dysfunctional uterine bleeding or Abnormal uterine bleeding is a broad term that describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy. Up to one-third of women will experience abnormal uterine bleeding in their life, with irregularities most commonly occurring at menarche and perimenopause. A normal menstrual cycle has a frequency of 24 to 38 days and lasts 2 to 7, with 5 to 80 milliliters of blood loss. Variations in any of these 4 parameters constitute abnormal uterine bleeding.

PATIENT INFORMATION

41year old female patient, a teacher by profession, complained of prolonged vaginal bleeding with occasional clots since 2 months associated with low Hb and a feeling of having a generalized body swelling.

Medical history: The onset of symptoms started about 2 months ago. The patient had missed periods on February 2021, and on 12th March, bleeding started, which was very scanty. Later from 18th March 2021, she experienced heavy bleeding with occasional clots. The patient did not have any other co-morbidities or any previous history of menstrual irregularity apart from a simple ovarian cyst in the right ovary. The quantity of vaginal bleeding was increasing day by day. The blood loss at the time of consultation was approximately 60 ml/day. The patient was not willing to take up the modern line of management. She previously consulted an Ayurvedic doctor, who advised her some oral medications, the details she doesn't remember. She took them for a short while but did not get much relief. So, she approached for a second Ayurvedic consultation.

CLINICAL FINDINGS

1. Not done as the patient had consulted online. Body weight recorded by the patient - 74kg

TIMELINE

Image 1. Attached

DIAGNOSTIC ASSESSMENT

Modern Diagnosis: Based on the presenting symptoms and medical history, the condition was diagnosed as Dysfunctional Uterine Bleeding.

Image 2. Blood investigation report before treatment

Ayurvedic diagnosis: Asrigdara was the diagnosis confirmed by the physician

Differential diagnosis: The differential diagnosis for genital tract bleeding based on anatomic location or system:

• Vulva: Benign growths or malignancy

• Vagina: Benign growths, sexually transmitted infections, vaginitis, malignancy, trauma, foreign bodies

• Cervix: Benign growths, sexually transmitted infections, malignancy

• Fallopian tubes and ovaries: Pelvic inflammatory disease, malignancy.

These were ruled out by the physician, based on the clinical examination and the investigations done.

Prognosis: In the conventional line of management, non-steroidal anti-inflammatory drugs (NSAIDs) or ant prostaglandins are used but with side effects like headaches, and gastrointestinal symptoms such as nausea, vomiting, diarrhoea and dyspepsia. In this case, the patient opted for Ayurvedic treatment. With standalone Ayurvedic treatment, prolonged vaginal bleeding for 2 months, completely stopped with 6 days of treatment and the Hb level has almost reached the normal range after 5 months of treatment.

THERAPEUTIC INTERVENTION

See Tab ‘Treatment Details’

FOLLOW-UP AND OUTCOMES

First follow-up (8/5/21)- Bleeding reduced and the blood loss become 15 ml/day.

Second 10/5/21- Bleeding completely stopped

4/6/2021- Next menstrual flow - after 26 days with occasional clots and flow last for 10days

In further follow ups done for next 3 months, the patient had normal menstrual cycle with menstrual flow lasting for four days with no blood clots

14/10/21- Hb - 11.6 gm/dl

Clinician-based assessment: The patient had prolonged vaginal bleeding for 2 months soaking 7-8 pads / 4 cups per day (blood loss - 60 ml/day) associated with low Hb count. 4 days after the initiation of treatment the bleeding reduced, and the blood loss become 15 ml/day. After 6 days of treatment, the bleeding completely stopped. Hb count before the treatment was 8gm/dl which has become 11.6gm/dl after 4 months of treatment.

Image 3. Blood investigation report after treatment

Body weight recorded by the patient before treatment- 74kg, which becomes 68kg after treatment.

Patient assessed: Not relevant

Intervention adherence and tolerability: The patient adhered to the prescribed treatments and tolerated the treatments well.

Method of assessment- By monitoring the patient.

Adverse and unanticipated events: None reported

DISCUSSION

Excessive flow and prolonged duration of menses during menstrual cycle or inter-menstrual bleeding known as Asrigdara. Acharya Charaka has described four types of Asrigdara i.e., Vataja, Pittaja, Kaphaja and Sannipataja Asrigdara. Acharya Sushruta has mentioned all types of Asrigdara along with general clinical features of Asrigdara but has not described any classification. Different types of Samprapti, Dosanubandha and Anubandhita Lakshana are seen in every patient of Asrgdara. So, the treatment depends based on doshanubandha and Samprapti Vighatana. In this case, the clinician treated the condition as Asrigdara and followed rakta prasadana and rakta sodhana line of management. Guluchyadi Kashayam was advised for Rakta prasadana and Rakta Sthambana . Punarnavadi was given, focussing on sarvanga sopha with Pandu and also as Rakta prasadana. Avipathi Churnam was advised for samana and sodhana of Pitta. Chandraprabha Vati was given to reduce the Sarvanga Sopha. It also acts as Granthi vilayana, vatanaulomana, and srotosodhana. Lodhradi kashayami is Yoni dosha hara. Drakshadi has Brihmana, Rakta prasadana

PATIENT’S PERSPECTIVE:

Not available

LEARNING POINTS:

A case of prolonged vaginal bleeding could be successfully managed with standalone Ayurvedic treatment within few days. Also, the persisting low Hb count of the patient for several years has reached to normal range after 5 months of Ayurvedic medications. So, Ayurveda can be opted as an alternative treatment dysfunctional uterine bleeding.

INFORMED CONSENT

Written consent was obtained from the patient.

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared

FUNDING

None

REFERENCE

1. Davis E, Sparzak PB. Abnormal Uterine Bleeding. [Updated 2022 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532913/
2. Acharya Priyavrat Sharma(ed), Sushruta Samhita with Dalhana virachita Nibandha Sangraha vyakhya, published by Chaukhamba samskrita Samsthana, Varanasi, 8th edition 2005, Sharira Sthana 2/18

Image 1. Timeline

Image 2. Blood investigation report before treatment

Image 3. Blood investigation reports after treatment