E-ISSN:2456-3110

Case Report

Adenomyosis

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 11 December
Publisherwww.maharshicharaka.in

A Case Report on Ayurvedic management in Adenomyosis

Sharma R.1*
DOI:

1* Rashmi Sharma, Associate Professor and Ph.D. Scholar, P.G. Department of Prasuti Tantra Evam Stri Roga UPGIAS&R, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University, Jodhpur, Rajasthan, India.

Adenomyosis is a medical complication involving into the myometrium of the uterus. It is a condition where endometrial tissue proliferates in the myometrium and these ectopic endometrial tissue in the myometrium starts proliferating as a result thickening of the uterus occurs. Treating adenomyosis is a challenge and hysterectomy has been the only way to treat the condition. But by using Ayurvedic formulation with properties like Raktastambhan, Raktavardhak, Vatashamak, Balya, Lekhana etc. properties patient got significant relief from pain and excessive bleeding along with the improved quality of life.

Keywords: Adenomyosis, Asrgdhara, Dyspareunia, Raktastambhana

Corresponding Author How to Cite this Article To Browse
Rashmi Sharma, Associate Professor and Ph.D. Scholar, P.G. Department of Prasuti Tantra Evam Stri Roga UPGIAS&R, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University, Jodhpur, Rajasthan, India.
Email: 		Rashmi Sharma, A Case Report on Ayurvedic management in Adenomyosis. J Ayu Int Med Sci. 2022;7(11):191-194.
Available From
https://jaims.in/jaims/article/view/2097

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-01 2022-11-02 2022-11-09 2022-11-16 2022-11-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Rashmi Sharmaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(11)191
Sharma R: A Case Report on Ayurvedic management in Adenomyosis

Introduction

Adenomyosis is a Gynaecological condition characterized by ectopic endometrial tissue within the uterine myometrium. Deep endometriosis (DE) occurs in 15-30% of patients with endometriosis and is associated with concomitant adenomyosis in around 25-50% of cases.[1,2] In India the prevalence of Adenomyosis is 23.5% in which 80% were seen in the age group of 31-50yrs. Patient complaints of severe menorrhagia 50%, dysmenorrhea 30% and Metrorrhagia 20% and dyspareunia and chronic pelvic pain are less common.[3,4] The treatment of symptomatic adenomyosis in women over 40 who have completed their families is hysterectomy. Conservative treatment which includes NSAIDs, hormonal therapy, menstrual suppression with progestin’s, GnRH analogues etc. Ayurvedic treatment relieves the symptoms and is very helpful in improving overall health of patient. There is no any direct correlation of adenomyosis but based on the symptoms like Theevra Vedana, Shyava Aruna Varna Artava, Kati Vedana, it can be correlate to Vataja Asrgdhara.[5] Treatment approach should be Raktastambhan, Raktavardhak and Vata Shamak.

Case Study

A 46 years old married female patient, housewife by occupation with the complaints of heavy and prolonged menstrual bleeding per vaginum, severe pain in lower abdomen before the onset of menstruation and during menstruation since last six menstrual cycles associated with low back pain and general weakness. She was unable to perform day-to-day activities during menstrual cycle like household works due to heavy bleeding and severe lower abdominal pain. She visited nearby clinic and was prescribed with tablets Tranexamic acid 500mg BD and analgesic for the pain. She had taken those tablets for last 2 months only during menstrual cycle. Even after taking these medicines the patient did not find any relief. She revisited the clinic for the same complaints and was advised for USG- Abdomen & pelvis finding adenomyosis changes in myometrium. Patient was advised for hysterectomy. As she was not willing for hysterectomy so approach to Dr. S.R. Rajasthan Ayurved University hospital on 14/03/2022 (OPD no.-4288) for Ayurvedic treatment.

Past history of endometrial biopsy done on 26/07/2021, reported proliferative endometrium no evidence of malignancy.

Personal history

Appetite: Reduced.

Bowel: Sometimes regular sometimes constipated.

Micturition: 3-4 times a day 1-2 times in night.

Sleep: 5 hours in night and 1/2 to 1 hour afternoon (Diva Sayan)

Menstrual history

Menarche - 12 years of age

Menstrual cycle - Nature - Irregular, Duration - 60-90 days, bleeding phase - 15-20 days

No. of pads used /day – 7-8 pads/day on 1st 4 days, 3-4 pads/day on 5th day, 1-2 pads/day rest of the days

Blood clots - Present

Marital history

Got married in the age of 19 years.

Obstetrical history

P3 A0 L3 - FTND at hospital, L3- female child age 17 years

No any contraceptive history

Clinical Findings

Per Abdomen

Inspection - No any surgical scar present

Palpation - Soft, Tenderness in supra pubic and right iliac fossa, No organomegaly observed

Percussion - Tympanic

Auscultation - Normal Bowel sounds heard

Gynaecological Examination

Pelvic Examination

Examination of Vulva


  • Inspection: Pubic Hair - Normal
  • Clitoris - Normal
  • Labia - Normal



Journal of Ayurveda and Integrated Medical Sciences 2022;7(11)192
Sharma R: A Case Report on Ayurvedic management in Adenomyosis

Per Vaginal Examination

  • Cervix - Soft, Mobile, Movement - Painful
  • Lateral Fornices - Free, Non tender
  • Posterior Fornix - Tenderness +

Uterus (Bimanual Examination)

  • Position - Anteverted & Anteflexed, Size - Bulky Uterus
  • Tenderness - Present

Per speculum Examination

Cx healthy, no abnormal discharge

Investigation (before treatment)

USG (Abdomen +pelvis) - 19/02/2022 - Bulky uterus (94 x 73 x 59 mm) with heterogeneous echotexture of myometrium likely adenomyosis changes. ET measures 6.7 mm.

Hb - 10.20 gm. %

Treatment

The treatment is carried out with the following medicine for 6 month. During this period the patient was advised to take Pathya Ahara (nutritive diet) and avoid Amla & Lavana Aahara.

Name of medicine Dose
Chandrakala Rasa 250mg BD
Pradrantak Loha 250mg BD
Praval Pishti 250mg BD
Dashmool Kashaya 15ml BD
Lodhrasava 15ml BD

Observation and Result

The patient had followed the Aahar and drug restriction strictly. After six months of treatment, patient was comfortable and pain was very much reduced and bleeding was reduced and clots were absent. The Ultrasonography was done after 6 months of treatment.

Laboratory finding

USG (Abdomen +pelvis) - 13 september2022

Uterus: Anteverted (87 x 53 x 42 mm). Endometrial thickness: 9-10 mm.

No gross adnexal pathology seen.

Hb-11.20 gm. %

jaims_2097_01.JPGBefore treatment

jaims_2097_02.JPGAfter treatment


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Sharma R: A Case Report on Ayurvedic management in Adenomyosis

Discussion

Chandrakala Rasa contains Kajjali, Tamra Bhasma, and herbal Dravyas like Kutaki, Guduchi, and Ushira etc.

The drug contains ingredients having properties of Raktaprasadana, Raktavarodhak Balya, Raktapittahara, Dahashamana, etc. By these properties it relief the symptoms of patient heavy menstrual bleeding.

Praval Pishti, a powdered formulation of coral is hallowed with Madhura, Amla and Kashaya Rasa and shows Laghu and Snigdha Guna. Its properties like Shita Virya, Kashaya Rasa and Madhura Vipaka act as Raktaastambhak. It pacifies all the three Doshas, Kapha, Pitta and the Vata Doshas.

Pradrantak Loha content Lauh Bhasma, Tamra Bhasma, Shankh Bhasma, Vang Bhasma, Abhrak Bhasma, Trikatu, Triphala, etc. It is indicted in Pradar Roga due to properties like Kashaya Rasa which act as Sthambhana. Loha Bhasma that induces the formation of haemoglobin and RBCs. Sankha Bhasma and Abhrak Bhasma stimulate appetite and improve digestion. Trikatu and Triphala having Lekhana properties which reduce the growth of endometrium in myometrium.

In Lodhrasava, Lodhra is the main ingredient. Lodhra, the main ingredient possesses Kashaya Rasa, Seetha Veerya, Pittaghna, Sthambhana and Grahi properties. It is also highly effective astringent, and this astringent action can be attributed to an alkaloid present in Lodhra bark called loturodine. It is suggested that Lodhra might have influenced the endometrial prostaglandin apparatus, thereby acting effectively in the control of abnormal uterine bleeding.

Dashamoola Kwatha contains Bilva, Agnimantha, Shyonaka, Patala, Gambhari, Bruhati Kantakari, Shaliparni, Prisniparni, Gokshura.

Most of the drugs in Dashamooal are having Madhura & Kashaya Rasa, Laghu Ruksha Guna, Ushna Veerya, Madhura Vipaka, which mainly act on Vata Vikriti. Madhura rasa, Laghu Guna and Madhura Vipaka helps to pacify vitiated Vata. The actions of Dashamoola are Vatahara, Shulahara, Shothahar, Balya etc. It has being also proven that Dashamoola has anti-inflammatory and analgesic properties.

Conclusion

Ayurveda is a holistic science in which root cause of disease is treated. In the present study, Chandrakala Rasa, Pradrantak Loha, Praval Pishti Lodhrasava, Dashamoola Kashaya and have been used for the treatment of adenomyosis, which is found to be very effective. The treatment given was very effective for heavy menstrual bleeding management and treating the adenomyosis and improved patient’s general health.

Consent: Consent of the patient is taken. Proper advice and counselling also done during treatment.

Reference

1. Chapron, C. et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum. Reprod. 32(7), 1393–1401 (2017)

2. Lazzeri, L. et al. Preoperative and postoperative clinical and transvaginal ultrasound findings of adenomyosis in patients with deep infiltrating endometriosis. Reprod. Sci. 21(8), 1027–1033 (2014).

3. Ferenczy. A. Pathophysilogy Of Adenomyosis. Hum. Reprod. Update 4(4), 312-322(1998). Google Scholar /Medline /ISI

4. Bergeron C. A. Pathology and Physiology Of Adenomyosis. Best Pract. Res. Clin. Obstet.Gynecol.20(4).511-521(2006).

5. Striroga by Prof. (Km.) Premavati tewari, chaukhambha Orientalia, Varanasi, 2nd edition, Reprint – 2012, Pg-185, Pp-636.


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