Udumbara (Ficus racemosa Willd.): A challenging drug in the management of Heavy Menstrual Bleeding

Women of reproductive age frequently have heavy menstrual bleeding (HMB), a common gynecological disease. It is characterized by excessive or prolonged menstrual bleeding that can interfere with a woman’s daily activities and physical, emotional, social, and psychological quality of life. It is defined as cyclic bleeding at normal intervals, the bleeding is either excessive in amount (>80ml) or duration (> 7 days), or both. In India reported prevalence of AUB is around 17.9%. HMB can have various impacts on a woman’s health. In Ayurveda, it may be explained in terms of asrigdara. In traditional drug practices, distinct parts (leaves, stem, root, fruit, seeds, latex, or even entire plant) of Ficus racemosa Willd. are used to manage HMB. Its Sanskrit name is Udumbara. Ficus racemosa Willd. has confirmed various pharmacological actions like hypoglycemic, hypolipidemic, anti-carcinogenic, antidiuretic, hepatoprotective, anti-ulcer, and antifungal. β-sitosterol and glauanol acetate are the phytoconstituent found. In the present review management of HMB with Udumbara as ekal dravya (single drug) with the expected mode of action has been explained. Most of the drug reviews have not explained the mode of action for managing HMB. Understanding the mode of action of Udumbara at different stages of shadkriyakala (stages of disease manifestation and management) of asrigdara will help better administration of the herb and also prevent complications.