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CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 157-160

A multi-dimensional approach to endometrial polyp through Ayurvedic intervention – A single-case study


Department of Prasuti Tantra-Streeroga, Dr. BRKR Government Ayurvedic College, Hyderabad, Telangana, India

Date of Submission02-Feb-2022
Date of Decision31-May-2022
Date of Acceptance31-May-2022
Date of Web Publication4-Jul-2022

Correspondence Address:
K M Susdev
Department of Prasuti Tantra-Streeroga, Dr. BRKR Government Ayurvedic College, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_34_22

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  Abstract 


Introduction: Endometrial polyps (EPs) are epithelial proliferation arising from endometrial stroma or glands. They may be responsible for 57%–60% cases of abnormal uterine bleeding. A 36-year-old female patient diagnosed with EP was managed successfully through Ayurveda. In modern science, they are giving oral contraceptive pills or advising for surgery. In this case, we managed with Ayurvedic medication for the span of 3 months and relived completely. Main Clinical Finding: Presented with complaints of intermenstrual bleeding along with heavy menstrual bleeding for the past 1.5 years Diagnosis: The patient was already diagnosed with EP; correlated to Yoni Arshas in Ayurveda classics. Interventions: The patient was treated with internal medicines Kanchanara guggulu, Lodrasava, Jahar mohra pishti, and Panchatikta ghruta guggulu along with Matravasti with Chandana bala lakshadi taila, and Uttaravasti with Kshara taila. Outcome: After 3 months of treatment got complete relief in symptoms with normal USG findings. Conclusion: Ayurvedic treatment regime may be adopted as an alternate to surgical interventions in the management of EP effectively

Keywords: Endometrial polyp, Kshara Taila, Lodrasava, Pancha tikta ghruta guggulu


How to cite this article:
Susdev K M, Joshi S. A multi-dimensional approach to endometrial polyp through Ayurvedic intervention – A single-case study. J Ayurveda 2022;16:157-60

How to cite this URL:
Susdev K M, Joshi S. A multi-dimensional approach to endometrial polyp through Ayurvedic intervention – A single-case study. J Ayurveda [serial online] 2022 [cited 2022 Nov 29];16:157-60. Available from: http://www.journayu.in/text.asp?2022/16/2/157/349769




  Introduction Top


Endometrial polyp (EP) is soft, fleshy intrauterine growths which are composed of endometrial glands, fibrous stroma, and surface epithelium.[1] Peak incidence is between 40 and 49 years and incidence high in patient treated with tamoxifen.[2] They can be single or multiple and range from a few millimeters to several centimeters and associated with abnormal uterine bleeding (AUB). In general, EPs tend to be asymptomatic but may be present in 10%–33% of women with complaints of bleeding, typically in those with heavy menstrual bleeding or intermenstrual bleeding. In Ayurvedic perspective, there is no homologous terminology for it, even though we can correlate with Yoni arshas[3] as an umbrella term and here in this patient, it is Pitta kapha pradhana tridosha vikara with Rakta, Mamsa, and Medas are involved which could be perceived through Dosha dooshya analysis. Hence, treatment modalities were concentrated on Pitta-Kapha samana and Vatanulomana medicines selected accordingly.


  Case Report Top


A 36-year-old married female patient came to the outpatient department of prasuti tantra & stree roga, Dr. BRKR Govt Ayurvedic college, hyderabad on March 15, 2021 with chief complaint of heavy menstrual bleeding along with brownish-colored inter menstrual spotting lasting for 5–10 days, and also painful coitus for the past 1.5 years. She consulted a gynecologist the complete investigation done, which revealed EP on USG at 2020 and took oral contraceptive (OC) pills for the past 1 year. She had previous history of previous EP at 2018 and underwent polypectomy for the same. Even using OC Pills did not get significant result and advised surgery and she was reluctant for that. Thus, she came for Ayurvedic management.

Menstrual history: Menarche at 12 years

LMP: March 7, 2021

M/H: Irregular, 5 Days/26–28 days, Heavy flow, 4–5 pads per day, then followed by intermenstrual spotting from 10th days to 20th no pain, no clots

Obstetrics history: P 2L2A1

Multiparous, Para 2 living 2 with full-term delivery by Lower segment Cesarian section (LSCS) with a history of abortion at 8 weeks of gestation.

  • A1: Spontaneous conception and spontaneous abortion at 8 weeks of GA at 2014
  • L1: Spontaneous conception and full term male baby delivered by LSCS at 2015
  • L2: Spontaneous conception and full term male baby delivered by LSCS at 2017 along with tubectomy.


Last child birth (LCB):5 years back.

  • Contraceptive history: History of OC pills for 1 year
  • Past medical history: No history of DM, hypertension, thyroid abnormalities
  • Past surgical history: The patient had undergone LSCS on 2015, 2017, and polypectomy on 2018
  • Family History: Not significant
  • Personal History: Diet: Nonvegetarian, Appetite: Normal, Sleep: sound, Bowel habits: Clear, Micturition: Clear, Allergy history: Nil, Addiction: None


Examinations

  1. General Physical Examination: Patient was obese and nourished. No pallor, icterus, cyanosis, lymphadenopathy, or edema. Breast and thyroid glands are normal [Table 1]
  2. Systemic examination [Table 2]
  3. Gynecological examination.
Table 1 : Physical examination

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Table 2: Systemic examination

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P/S: Cervix: Healthy, No erosions, No Ulcerations, No discharge present, Vaginal walls: Healthy.

P/V: Uterus: Anteverted anteflexed, Normal in size, Cervix: Downward, Firm, Freely mobile, No tenderness on cervical mobility, All Fornics: Clear and non-tender.

Ashtha vidha pareeksha and Dashavidha pareeksha bhava: Patient had kaphaja pradhana pitta prakruti, vikruti were kapha-pitta pradhana tridosha kopa. Vyayama sakti was alpa. rest of them was normal.

Diagnostic Assessment: Hb 11.2 gm%.

Thyroid profile: Normal range.

USG-TRANSVAGINALSCAN: uterus – 76 × 14 × 47 mm, endometrial thickness - 7 mm.

Hyperechoic lesion measuring 13 × 9 mm noted in upper endometrium.

Right ovary 28 mm × 21 mm × 33 mm, vol-10.6 cc, increase in size, hemorrhagic cyst measuring 25 mm × 21 mm noted.

Left ovary 31 mm × 15 mm × 24 mm, vol-6.3cc, Multiple small follicles F/S/O bilateral PCO morphology.

Diagnosis: Yoni arshas.

Modern correlation: AUB-P (EP).

Therapeutic intervention

Internal medicines:

  1. Kanchanara Guggulu - 2 tablet-bid
  2. Panchatiktaka ghruta guggulu - 5ml twice daily
  3. Lodrasava 15 ml + Jahar mohar pishti 125mg-Bid


Procedures:

  1. . Matravasti with 60 ml of Chandana bala lakshadi taila for the 1st cycle
  2. Uttaravasti with 3 ml of Kshara Taila for the next 2 cycles.


Follow-up and outcomes:

The patient got symptomatic relief from intermenstrual bleeding and HMB by the Chandana bala lakshadi taila Matravasti and Kshara taila Uttaravasti along with 3 months of internal medications and number of pads per day was reduced to 2 pads/day. On USG, there is no EP and it was a normal uterine study. Along with hemorrhagic cyst and PCO features also relieved.


  Discussion Top


On evaluating the disease by dosha vaishamya and amsamsa vidhi, it is Pitta Kapha pradhana Tridoshaja Vyadi and Sthana viseshane, Vata also considered along with Rakta-Mamsa-Medas (blood-muscle-fat) Dhatus are involved. Hence, the drug selection should be according to that and the treatment plan was divided into two. On menstrual phase to reduce the heavy menstrual bleeding; Pitta samana and Stambana, Seeta (cold), Veerya guna medicines were used. In proliferative and secretory phase, Kapha-Vata hara dravyas and those having Ushna (hot), Teekshana (sharp), Chedana (cutting), and Lekhana (scraping) gunas were selected.

In EP patient's risk factors include increasing age, obesity and tamoxifen uses as well as estrogen and progesterone have been implicated in their growth, and higher receptor levels are noted within polyps compared with adjacent normal endometrium. It is evident that here patient's BMI is high which leads to Kapha medo dusti, at reproductive age periods Pitta can easily vitiated by Mithya ahara viharas (improper dietics and lifestyle). Hence, EP is pitta Kapha pradhana Tridosha vyadhi which affects the Rakta (blood), Mamsa (muscle), and Meda (fat). The drugs were selected mainly Pitta-Kapha samana, Vatanulomana and Rakta sudhikara (blood purifying) so the probable mode of actions of drugs are as follows.

Kanchanara guggulu

It is a classical Ayurvedic formulation, Kapha Pitta Samana, having Chedana (cutting), Lekhana (scraping), Deepana, Pachana gunas, and Vrana sodhana ropana karma (wound healing) also used for Kapha accumulations in the tissues results in swollen lymph nodes, cysts or growths.[4] Guggulu breaks down and eliminates Kapha-medas, thus preventing further Kapha meda accumulation, promotes the elimination of inflammatory toxins, anti inflammatory and is administered in uterine fibroid, fibroadenoma, fibrocystic disease, Kanchanara is very useful in extra growth or tumors and helps in reducing bleeding by its Lekhana Chedana gunas (scrapping and cutting).[5]

Panchatiktaka ghruta guggulu

It is Tridosha samana mainly Kapha Vata Samana, have the properties of Rakta prasadaka (blood purifying), Medohara (lipolytic), Balya (strength), Deepana (carminative), Sroto sodhana (cleanse the channels), Lekhana (scraping), Chedana (cutting), Sookshma (subtle), Sroto, pravesaka, Sodhahara, and Kleda hara (mucolytic).[6] By above-said properties, it reduces the size of polyp.

Lodrasava and jaharmohar pishti

The main action of Lodrasava and Jahar mohar pishti is to control the heavy menstrual bleeding and intermenstrual bleeding also, Sara (flowing) and Drava (liquid) Guna of Pitta, Chala (mobile) Guna of Vata causes arthava dusti (menstrual vitiation), and ati pravruti (excessive flow). Hence, the main drug in Lodrasava is lodra; might be acting on the Sara (flowing) and Drava (liquid) Guna of dooshita Pitta with the help of Ruksha (dry), Laghu (light) Guna, and Kashaya Rasa (astringent). Hence, this could be the reason in reducing the amount of bleeding. Laghu (light), Ruksha (dry) Guna having Kapha-Pitta Shamana (pacification) and Shoshana (depletion) property also helps in Arthava Sroto Shodhana[6] and it helps in reducing the size of polyp too. Jahar mohar pishti is pitta samana, Rakta sodhaka, and Balya.

Chandana bala lakshadi taila:

It has the ability to pacify the Pitta and Kaphadoshas in the body and is Ama pachaka, Tridoshahara, shoola prasamana (analgesic).[7] It helps to reduce the inflammation thus preventing the intermenstrual bleeding due to epithelial surface breaking, chronic inflammation, and vascular fragility.

Kshara taila

It is a vata kapha samaka drug by its virtue of Teekshana (sharp), Lekhana (scraping), Chedana (cutting), Sookshma (subtle) guna so it removes chronic inflammation, fibrosis, polypoidal growth. Kshara has well-established corrosive, ulcer healing properties along with tila taila have Garbhasaya sodhana (uterine cleansing), ushna (hot), vikasi, Vyavayi gunas.[8] Hence, it will remove fibrous stroma of endometrium (Rakta-Mamsa-Medo adhishtana) and helps in its rejuvenation by Vrana ropana (wound healing) properties thus restoring normal endometrial lining and function.


  Conclusion Top


EPs are frequently diagnosed in both symptomatic and asymptomatic women. They are growths arising from the endometrial lining of the uterus and may be associated with hyperplasia. Multimodal Ayurveda treatment regime showed encouraging results in managing the case of EP. Moreover, it has no side effects and found to be a better alternative to hormonal therapy. But to establish this fact, further studies on large sample for longer duration is required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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  References Top

1.
Hoffman BL, Schorge JO, Halvorson LM, Hamid CA, Corton MM, Schaffer JI, editors. Williams Gynecology. 4th ed. New York: McGraw Hill; 2020.  Back to cited text no. 1
    
2.
Chou B, Bienstock JL, Satin AJ. The Johns Hopkins Manual of Gynecology and Obstetrics. 6th ed. New York: Wolters Kluwer; 2021.  Back to cited text no. 2
    
3.
Hemalatha K. Comprehensive Treatise on Striroga. 1st ed. Varanasi: Chaukhambha Viswabharati; 2020.  Back to cited text no. 3
    
4.
Brahmanand T. Sarangadhara Samhita by Sarangadharacharya, Dipika Hindi Commentary. 1st ed. Varanasi: Chaukhamba Surbharati Prakashan; 2004.  Back to cited text no. 4
    
5.
Dhiman K. Ayurvedic intervention in the management of uterine fibroids: A case series. Ayu 2014;35:303-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Govinda Vaidyan PM. Ashtangahrudayam of Vagbhada Chikitsa Stana. 1st ed. Kodungalloor: Devi Book Stall; 2014.  Back to cited text no. 6
    
7.
Lakshmipati S. Yogaratnakar, Vidhotani Hindi Tika. Varanasi: Chaukhambha Sanskrit Sthan; 2002.  Back to cited text no. 7
    
8.
Srikantha M. Ashtangahrudayam of Vagbhada Uttarasthanam. 1st ed. Varanasi: Chaukhamba Krishnadas Academy; 2012.  Back to cited text no. 8
    



 
 
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