Efficacy of Hijama Bila Shart and Tukhm Bartang versus Tranexamic Acid in Women with Kathrat-i-Hayd.

Heavy menstrual bleeding (HMB) is diagnosed as excessive or prolonged uterine bleeding per menstruation of more than 80 ml or for 7 days in a normal cycle. According to the traditional Unani texts, excessive menstrual blood loss (MBL) with regular cycles and excessive bleeding, either in volume or length, are the characteristics of heavy menstrual bleeding (HMB).  An alternative semiquantitative technique for evaluating MBL makes use of a pictorial blood loss assessment chart (PBLAC). Menorrhagia can be effectively treated using a variety of herbs and regimental therapy, such as dry cupping, which is part of the Unani medical system. Plantago major, commonly known as great plantain or Tukhm Bartang in Unani medicine, belongs to the Plantaginaceae family. Tukhm Bartang has been chosen as a study drug among the various medications accessible for HMB. It possesses Syptic, detergent, Musakkin, and others.  It contains several active compounds, i.e. phenolic acids, flavonoids, tannins, polysaccharides, terpenoids, lipids, iridoid glycosides, and caffeic acid derivatives. Application of dry cupping below the breast is also useful to control heavy menstrual bleeding. The hypothesis of the study will be dry cupping and Tukhm Bartang versus tranexamic acid in HMB will be effective at post-intervention. The objective of the study is to determine and compare the efficacy of dry cupping and Tukhm Bartangversus tranexamic acid in HMB.  Diagnosed cases of HMB fulfilling the inclusion criteria will be randomly selected. Written informed consent will be obtained from patients. The drug will be given either to the test or control group. In the test group, 5g of Tukhm Bartang will be given in three divided doses for five days and dry cupping for 3 days from the first day of menstruation for 3 consecutive months. Patient global assessment of tolerability to therapy will be assessed for safety and tolerability to therapy at the end of the treatment.  PBLAC, and Samanta questionnaire will be assessed at baseline and each follow-up. MIQ (Menorrhagia Impact Questionnaire) and Haemoglobin percentage will be assessed at baseline and at the end of the intervention. The total sample will be 62 patients (31 in each group).  The Primary outcome will be assesdPBLAC (Pictorial Blood Loss Assessment Chart). The secondary outcome will be Samanta questionnaire, MIQ (Menorrhagia Impact Questionnaire), and Haemoglobin percentage. The appropriate tests will be applied to analyse the data. Descriptive statistical analysis will be used in the study. Results on continuous measurements will be presented in mean (SD) and results on the categorical measurements will be presented in number (percentage) with a 5 percent  level of significance and 95 percent confidence interval.