Management of Adenomyosis and improvement in fertility through Ayurveda - A Case Study

Pooja Shindhe; H.V. Rachana

Management of Adenomyosis and improvement in fertility through Ayurveda - A Case Study

Shindhe P.^1*, Rachana H.²

DOI:

^1* Pooja Shindhe, Post Graduate Scholar, Department of Prasooti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

² H.V. Rachana, Professor, Department of Prasooti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

Adenomyosis is an important clinical challenge in gynaecology and healthcare economics. Moreover, Adenomyosis and leiomyomas commonly coexist in the same uterus and differentiating the symptoms for each pathological process can be problematic. Most of these leads to gynaecological symptoms like, AUB, dysmenorrhoea, infertility etc. The treatment explained in the modern science like endometrial ablation/resection, uterine artery ligation, have many complications. In Ayurveda this can be managed based on Dosha, Dhatu involvement in the Roga and Rogi. In this case patient came to OPD with complaints of anxious to conceive since 2 years and also complaints of severe abdominal pain and increased amount of bleeding during menstruation. We managed the case with Ayurvedic line of management by Panchakarma and oral Ayurvedic medicines successfully. After that she conceived and delivered to a healthy baby by LSCS without any complications during pregnancy and delivery.

Keywords: Adenomyosis, Yoga Basti, Vataja Yoni Vyapad, Virechana

Corresponding Author	How to Cite this Article	To Browse
Pooja Shindhe, Post Graduate Scholar, Department of Prasooti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India. Email:	Pooja Shindhe, H.V. Rachana, Management of Adenomyosis and improvement in fertility through Ayurveda - A Case Study. J Ayu Int Med Sci. 2022;7(11):261-265. Available From https://jaims.in/jaims/article/view/2187

Introduction

Adenomyosis is characterized by the presence of endometrial glands and stroma within the myometrium, surrounded by smooth muscle hyperplasia. In about one-third, it remains asymptomatic being discovered on histological examination. There is diffuse symmetrical enlargement of the uterus; the posterior wall is often more thickened than the anterior one.^[1]

Adenomyosis appears to have an adverse impact on the risk of other health outcomes, including obstetrical outcomes.

Studies using imaging to diagnose adenomyosis have reported an association between adenomyosis and an increased risk of preterm birth, small for gestational age, and pre-eclampsia among pregnant women who conceive spontaneously.^[2]

Women with adenomyosis have a higher incidence of infertility and miscarriage, due to abnormal function of the subendometrial myometrium, interference in sperm transport and blastocyst implantation, abnormal endometrial immune response and nitric oxide level.^[3]

Ayurvedic treatment relieves the symptoms and is very helpful in improving overall health of patient. Based on symptoms of severe pain, flow and menstrual blood colour it may be correlated with Artavaha Srotodushti, Vatika Yoni Vyapad and Atya Artava.

Case Report

A 29 years female Patient with marital life of 4 years, came to OPD of Prasuti tantra and Streeroga, S.S.C.A.S.R.&H.

Bengaluru with the complaints of anxious to conceive since 2 years. Also, complaints of increased lower abdominal pain with increased amount of bleeding during menstruation since 1 year.

Personal History

Diet: Vegetarian (Packet foods, pickles, lemon)

Sleep: 6-7 hours of sound sleep

Appetite: Normal – 3 times a day

Bowel: Once per day, normal

Habits: Nil

Micturition: 5-6 times per day, no burning sensation.

Obstetric history

G0P0A0L0D0

Menstrual history

Age of Menarche: 12 years

LMP: 1/3/2021

Flow: Regular

D1 & D2 - 3 pads : 100 % soakage

D3 - 3 pad : 80 % soakage

D4 & D5 - 2 pad : 80 % soakage

D6 - 1 Pad.

Interval - 32-35 days

Anubandhi Vedana

Clots - Present

Pain - Present +++

Color - Dark red

Samsthanika Pareeksha / Sroto Pareeksha (systemic examination)

R/S - Nvbs heard, no added sound
CVS – S1 S2 heard, no murmur sound heard
CNS – Well oriented to time, place, person
P/A - Soft. Non tenderness present.

No scar marks

Investigations

USG - Dated 24/07/2021

Bulky Uterus - With Subserosal (1.8 X 1.3 X 2.3 Cm) & Intramural Fibroid
Adenomyosis, B/L Polycystic Morphology

Thyroid profile on - Dated 21/1/2022

T3 - 1.16 ng/ml

T4 - 7.80 mcg/dl

TSH - 3.09 miu

Diagnosis

Adenomyosis

Treatment

Classical Virechana Planned

Poorvakarma	Medicine	Days
Deepana Pachana	Agnitundi Vati 2 BD, Before food. Avipattikara Churna - 2tsp bed time with hot water Anupana.	3 Days
Snehapana	Guggulu Tiktaka Ghrita - 40ml, 80ml, 120ml	3 Days
Sarvanga Abhyanga and Baspa Sweda	Sahacharadi Taila	3 Days

On the 3^rd day of Sarvanga Abhyanga and Baspa Sweda, Virechana With 60gm Trivrit Lehya + 100 ml Triphala Kashaya given.

Observation: 14 Vegas occurred (Madhyama Shuddhi)

After 3 days of Vishrama Kala Yoga Basti planned.

Anuvasana Basti - Dhanwantaram Taila - 30 ml + Sahacharadi Taila - 30 ml

Niruha Basti - Dashamoola Kashaya Basti

Dashamoola Kashaya - 450ml

Dhanwantaram Taila - 60ml

Shatapushpa Kalka - 20gm

Gomutra - 60ml

Madhu - 80ml

Saindhava - 5gm

Internal medicines given

Pushpadhanwa Rasa 1-0-1 After Food
Tab Shatavari 1-1-1 After Food
Sukumara Kashaya 2tsp-0-2tsp With Equal Water Before Food
Aloes Compound 2-0-2 After Food
Kanchanara Guggulu 1-0-1 After Food
Usheerasava + Chandanasava – 3tsp-0-3tsp with Half Glass of Water X 1 month given

Follow Up: After 2 cycles she came to our OPD with the complaints of previous complaint of pain during menstruation and heavy bleeding has reduced during last cycle. After that cycle she stopped the all medicines and tried for conception and she missed her periods in next month. She came to our hospital with amenorrhea of 1 month 10 days.

Investigation: UPT Positive

USG of abdomen and pelvis

A Single Live Intrauterine Gestation of 6 Weeks 4 Days

Ovaries - Enlarged in size and multiple sized peripherally arranged follicles.
Uterus - Anteverted, Mild Bulky Measuring 7.9 X 4.3 X 5.7 Cm

Subserosal Fibroid with Left Lateral Ant. Wall Measuring 1.8 X 1.3 X 2.3 Cm. No Adenomyosis seen.

Advice: Madiphala Rasayana 2tsp-0-2tsp before Food

Tab. Shatavari 1-0-1 after Food

Outcomes: Patient was comfortable and has reduced the dysmenorrhoea and heavy menstrual bleeding in next cycle of treatment. Adenomyosis completely resolved after 2 months of treatment. After two months of treatment patient came to hospital with complaint of amenorrhea of 1 month 10 days. Investigations done with biochemical (UPT test) and biophysical test (Early pregnancy scan). Resulted as A Single Live Intrauterine Gestation of 6 Weeks 4 Days. She was regular to her ANC check-up in our hospital till her term, she delivered by LSCS in our hospital without any complications in pregnancy, delivery and puerperium.

Discussion

As patient was having the heavy menstrual bleeding one of the symptom of adenomyosis, so first managed with the classical Virechana. Guggulu Tiktaka Ghrita is having the ingredients of Tridoshashamaka, helps by reducing the inflammatory changes occurring in uterus and body. Ghrita is having Vata-Pitta Shamaka property helps in Asrigdara. Guggulu has been used for various disorders specially related to Vata Dosha. In this patient was having the severe pain during menstruation due to adenomyosis changes in uterus can be reduced by Guggulu Tiktaka Ghrita orally. Sahacharadi Taila used for Abhyanga which is having the property of Vatashamaka helps in normalise of vitiated Dosha. In Astanga Hrudaya has been explained as Sahacharadi Taila helps in all Yoni Rogas.

Trivritlehyam is having Tikta Rasa, Tikta Rasa has the property of Deepana, Pachana, Raktaprasadana, Dahaprashamana, Shoshana of Mala, Mutra, Pitta, Kapha. Apanavritta Pitta is one of the main causes leading to Asrigdara and Virechana helps to pacify the Apana Vayu.^[4]

Vata Dosha is the most important among Tridosha which is responsible to control all type of movement. Apana Vayu is located in Pakvadhana and traversed though Sroni (pelvis), Basti (urinary bladder), Medhra (external genital apparatus of each sex) and Uru (thighs). It helps in elimination Samirana (flatus), Sakrit (faeces), Mutra (urine), Sukra (semen), Garbha (fetus), Artava (menstrual fluid). If any derangements in the Apana Vata function leads to different Artava Dusti and Yoni Rogas.

As in adenomyosis due to vitiated Vata and Pitta Doshas, Virechana will helps to remove the Pitta accumulated in Garbhashaya. It has being proven that Dashamoola has anti-inflammatory, analgesic, and antipyretic actions.^[5]

Basti is basically due to its Shodhana property that starts from the Pakvashaya. It is multidrug formulation that is given per rectum and reaches up to ileocaecal junction.

Basti Chikitsa makes the vitiated Apanavata to move in a downward direction and cures the adenomyosis, Granthi by action of medicines given in the form of Basti also cures the dysmenorrhea.^[6]

Sukumar Kashaya has been given orally which is having the Ingredients like Dashamoola, Satavari, Tranapanchamoola etc. are of Vatashamaka, Granthihara, and cures Artava Vikara. As in adenomyosis uterus will become inflamed and little bulky Kanchanara Guggulu having the property of Granthihara, Shothahara helps in reduction of Shotha in body.

Conclusion

As the management of adenomyosis in modern is having limited methods with more side effects, but in Ayurveda based on Doshas and Dhatu involved in Roga manage each disease.

In this case due to adenomyosis patient was having the menstrual problems and also infertility problems cured successfully by Ayurvedic line of treatment.

USG report before treatment

USG report after treatment

Reference

1. Dutta D C. Textbook of Gynaecology. Edition 6. New Delhi: Jaypee Brothers; 2013. p.314.

2. Upson K, Missmer SA. Epidemiology of Adenomyosis. Semin Reprod Med. 2020 May;38(2-03):89-107. doi: 10.1055/s-0040-1718920. Epub 2020 Oct 26. PMID: 33105509; PMCID: PMC7927213.

3. Dutta D C. Textbook of Gynaecology. Edition 6. New Delhi: Jaypee Brothers; 2013. p.315.

4. Khushboo Jha, Subhadra, K. Bharathi, Sonu. Management of Asrigdara Through Virechana Karma. International Journal of Ayurveda and Pharma Research. 2020;8(12): 82-86.

5. Gupta RA. International Conference on Traditional Medicine, Madras. 1986 Jan 23-25; [Google Scholar]

6. Shalinee, Pravesh tomar. Role of Basti in Udavrtta Yonivyapada w.s.r to Dysmenorrhea: A Review. International Journal of Ayurveda and Pharma Research. 2019; 7(4): 53-56.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-10-29	2022-11-01	2022-11-08	2022-11-15	2022-11-22
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Adenomyosis

Journal of Ayurveda and Integrated Medical Sciences