Therapeutic Impact of Virechana Followed by Shamana Chikitsa in the Management of Endometrial Hyperplasia – A Single Case Study

Introduction: Endometrial hyperplasia is a uterine pathology characterised by increased endometrial thickness with abnormal uterine bleeding and represents a precursor to the endometrial cancer. Premenopausal women are more susceptible to it. Premenopausal women with abnormal uterine bleeding are around 20% and Postmenopausal women up to 15%. Primary factor here is the unopposed estrogen. Medical management with correction of hormone imbalance is the first line of treatment. In ayurveda it can be corelated to Lohitakshara Yonivyapada1. Chikitsa of Lohitakshara Yonivyapada include Sthambaka, Shothahara and Tridosha Shamaka Karma. Aims and Objectives: To evaluate the efficacy of virechana followed by shamana chikitsa in the management of Dysfunctional Uterine Bleeding (DUB)2 due to Endometrial Hyperplasia. Methodology: A 44-year-old married woman presented to the OPD of Prasooti and Stree Roga, TGAMC, Ballari, with complaints of irregular menstruation associated with prolonged heavy bleeding for the past one year. The bleeding persisted for 15–20 days per cycle, requiring the use of approximately 10–12 sanitary pads per day. Initially, Sthambhana Chikitsa was adopted using Pushyanuga Churna, Tab. Styplon, and Pradarantaka Loha. This was followed by Virechana Karma using Trivruth Lehya. Thereafter, Shamana Chikitsa was administered for a duration of 15 days. Results: Following the above-mentioned treatment, ultrasonography revealed a reduction in endometrial thickness from 17 mm to 4 mm, with no evidence of a bulky uterus. Clinically, the patient showed marked improvement, with menstrual bleeding reduced to 3–4 pads per day and restoration of a regular 28–30-day menstrual cycle. Conclusion: Sthambhana is considered the first line of management in bleeding phase therefore, Sthambhana yogas with hemostatic and anti-inflammatory actions are employed. Virechana Karma acts as Beejam bhavati karmukata and promotes Vatanulomana, thereby correcting Pitta-avruta Apana Vayu. Subsequently, Shamana yogas such as Ashokarishta and Lodrasava help control heavy menstrual bleeding and regulate irregular menstrual cycles.