Menopause is not a disease,just a phase that all women have to go through. Here, Dr. Zankhana Buch, tells us how Ayurveda helps us manage it effectively and efficiently without much hassles.
Ayurveda, a traditional system of medicine has characterized in detail about a woman’s lifecycle. It offers a structured methodology, based on a ‘systems thinking’ approach, to arrive at the precise stage of the pathogenesis/pathophysiology of women’s diseases and natural phases in a women’s life.
This precise disease definition at a holistic level offers a personalized approach that not only helps with a smooth and healthy transition towards menopause but also prevents intensification of conventional hormonal intervention. In addition, it corrects the implications of pre-menopause, menopause and post menopause period and further corrects the deterioration in quality of life parameters often experienced as a sequel.
Ayurveda disease management entails a prescription of personalized diet, lifestyle, predominantly herbal medicines, and systemic cleansing therapies.
Women’s lifecycle – the Ayurveda perspective
Woman’s life cycle is classified into four age groups. The four age groups are – Kanya, Bala, Rajaswala and Vridha.
- Kanya:upto 12 years.
- Bala: 12-16 years
- Rajaswala: 16-50 years
- Vridha: above 50 years
Changes in Reproductive System
As a general rule, the stages of life in a woman is divided into three age groups, childhood, adolescence and adulthood, during which some specific feminine changes occur in a woman. These three phases of life can be taken as-
- Birth to menarche (pre-pubertal)
- After attainment of puberty upto menopause (reproductive age)
- Menopause to death (Post-menopausal age)
In Ayurveda, these age groups can be considered as “balya”, “madhya” and“vriddhavastha”. They have been further divided into some sub-groups.
- In balyavastha a girl up to eight years is called ‘Gauri’
- She is “Rohini” during the ages of 9 and 10
- After 10 years and upto the time of menarche she is known as ‘Kanya’.
- The time when she attains menarche she is called ‘Rajaswala’ and therefore she is taken as ‘Bala’ until she becomes 16 years old or full maturity (Manusmriti).
- ‘Vriddhavasrtha’ is the post-menopausal age. No sub-division is seen in thisage group.
Menopause: Ayurveda Perspective
Menopause/Rajanivritti is one of the Svabhavika Prakriya indicating the change in lifestyle of a woman, due to Jaravastha. This is a natural phenomenon, but, when this stage causes discomfort either to the mind or body, it attains Vyadhisvarupa.
Menopause is not a disease. It is a normal pause to the rhythm of a body function. Hence, the effects of this pause are to be managed naturally.
Well, Ayurveda has acknowledged menopause as a natural transition. And it states that each woman has unique symptoms during this phase owing to the uniqueness in one’s body and mental constitution. Hence, a personalized unique approach is a must to ease the negative effects of menopause.
Ayurveda ensures that menopause can be health promoting, spiritually-transforming and free of signs and symptoms at all the body-mind and spirit level.
Rajonivritti is not described separately as a pathological condition or severe health problem inAyurveda classics. The ancient acharyas termed it as a normal physiology. The term ‘Rajonivritti’ is made up of two different words viz. “Rajah” and “Nivritti”. Rajah – According to Sanskrit language the root word for “Rajah” is given, which means to give color to the substance
1 . The word Rajah is used synonymously for various substances but here it is taken as Artava or Stripushpa (Menstrual blood). Nivritti – Hemchandra have coated the synonyms of the word “Nivritti” like Apravritti, Uparama, Virati, Vyparati and Uparati. In this context, the meaning of Nivritti is understood as end or ceasing. Thus, the term Rajonivritti means end of Artava
Pravritti or cessation of menstruation.
Ideal Age: Menarche and Menopause: 12y and 50y
The period of the initiation of the first menses and its cessation are denoted by the term Rajo Darsana and Rajanivritti in simple terms. In Brihatrayee and Laghutrayee description regarding the same in available and there is no controversy regarding time of the first Artavadarsana and Artavanivritti Kala. Acharyas have mentioned 12 years as the age of first Artavapravrittiand 50 years as the age of Artavanivritti.
Causative factors for Rajonivrutti/Menopause:-
- Vayu (Apan and Vyan)
- Karma or Environment
Artava (menstrual blood) is an Upadhatu (secondary constituent), formed from Rasa Dhatu within a month after proper metabolization of Raktadhatu by its dhatvagni and bhutagni.
The kshaya of Raktadhatu causes Artavakshaya due to utarottardhatukshaya. Kshaya of Updhatu Artava and Shukra, manifest as cessation of menstruation and decreased libido. Further, due to the same reasons, loss of Ojas (body immunity) makes women more susceptible to illness.
Dhatu kshsya leads to Vata Vitiation. With advancing age, progressive vitiation of Vata due to its fundamental properties of Ruksha (Unctuousness), Chala (unstable), Laghu (light), Bahu(talkativeness), Shighra (quick) and Sheeta (cold), further precipitates the Soshana and Kshaya(involution and atrophy) of different Dhatu. This degeneration manifests as Indriya kshaya (loss of this perceptive powers of sensory organs), Bala Kshaya (loss of strength) and Virya Kshaya (loss of reproductive strength). This may explain various symptoms of menopause related to degenerative changes in body such as urogenital atrophy, thinning of the membranes of the vulva, vagina, cervix, and also of the outer urinary tract,shrinking and loss in elasticity of all of the outer and inner genital areas and skin, breast atrophy,decreased libido, difficult to achieve orgasm and dyspareunia or painful intercourse.
Ama, formed due to mandagni (slow/hypo- function of digestive fire) causes strotovarodh(obstruction of channels), which in turn increases Medo-dushti (disorders of fat metabolism) and decreases the nutrient supply to subsequent Dhatus namely Asthi (bone/skeletal system), Majja(bone marrow), and Shukra (sperm/ fertility promoting substance). Increased accumulation of Meda (fat/adipose tissue) and Mamsa (flesh/muscle tissue) Dhatu can cause the weight gain, one of the biggest complaints associated with aging. Body weight increases with age. One of the functions of Dhatu is Shareer Dharan((bear/ supports the bodies frame). Among the dhatu, Asthi dhatu (bones/ skeletal system) is specific for Shareer Dharan. It gives shape to the body and protects the vital organs. According to the principal of Ashraya- aashreyeebhava, asthi dhatu is the seat of Vata Dosha, and asthi and Vata are inversely proportionate to each other. Increase of Vata vitiating factors will cause decrease of Asthi Dhatu. With advancing age vitiating Vata leads to kshaya of Asthi Dhatu (decreased bone density). It can be compared with osteoporosis. Further, vitiated Vata due to kshaya of Rasa Dhatu when gets lodged in Sandhi (joints), causes Sandhigata Vata (osteoarthritis). It is a type of Vatavyadhi (Vata disorder) and Shula Pradhana Vedana (agonizing pain) is the cardinal feature of the disease associated with Sandhis hotha (inflammation of the joints) with Vata Purna Druti Sparsha (lack of movements of the joints or painful movement of the joints),Shula (pain), Shotha (swelling), Stambha(stiffness), Sparsha-asahyata (tenderness), Sphutana (cracking), Akunchana (bending) Prasarana(stretching) etc. at the joints are other features of this problem.This may explain the increased incidence of skeletal ailments like arthralgia, osteopenia, osteoporosis, osteoarthritis and increased predisposition to fractures as seen during menopause.
Although all the three Dosha (Vata, Pitta and Kapha) are always present in body, their relative predominance changes in different conditions and ages. As per fundamental principles of Ayurveda,Kapha is the predominant Dosha during childhood, Pitta during the adulthood and Vata during old age.
The menopause transition represents a period of dynamic change from middle age to old age. This transition from Pitta dominance to Vata dominance causes most of the symptoms of menopause forPitta is more akin to metabolic activities and Vata have an active role in degeneration. Resulting imbalance of Dosha during this transition and Kshaya of Medo Dhatu (fatty tissues) may be the cause for hot flushes, excessive sweating; while Rasa Dhatu Kshaya may cause sleep disturbance,irritability,dryness of the vagina etc. which are commonest symptoms associated with menopause. Prakriti of an individual and Dosha predominance play important role in symptom manifestation. Pitta is basically responsible for the decay and degenerative changes due to its specific properties like ushna (hot), tikshna (sharp), visra (loose), amla (sour), Katu (pungent) etc.
Pittaj prakriti women are susceptible to untimely or premature manifestations of aging and hence may have early menopause. They may experience more exaggerated symptoms also. Kapha is principally responsible for growth and development. Women with Kapha predominance prakriti have a tendency to delayed manifestation of aging and may show delayed menopause and will be less aggrieved by symptoms. If Vata dosha is dominant in Vatik prakriti individual symptoms like sensory motor problems, arthropathies and psychological disturbance like anxiety, irritability,depression and mood swing will be more. In a Pittaj prakriti individual hot flashes will be more pronounced, excessive perspiration and thirst, anger, short temper will be more frequent and in a Kaphaja prakriti weight gain, slow digestion, symptoms related to fluid retention, sleepiness will be more.
Classical Ayurveda Management Of Menopause – Balancing Hormones for Wellness
Major components which need to be addressed in women having problems during menopause are advancing age and allied changes and menopausal symptoms resultant of an impaired metabolism/imbalanced Doshas.
Process Driven, Precision Based Classical Ayurveda Management of Plan of Care which entails a comprehensive approach, tailor made to the various presentations is best approach for its management.
Aging, though considered Nishpratikriya (changes cannot be resisted) has been dealt scientifically in Ayurveda. Emphasizing Ayu (lifespan), its chikitsa (therapeutics) is called as Vaya Sthapana (age stabilizing).
Ayurveda Avatarana (descent of Ayurveda on earth) has been guided by zeal of mankind to have Dirgha Hitakara and SukhakaraAyu (a longer healthy and happy life). It recommends the countering of aging and related changes by use of Vayasthapak drugs (age stabilizers), to rejuvenate the agedbody by Jeevneeya drugs (vitalisers) and for allied aging problems Jarachikitsa i.e. Rasayana Chikitsa(rejuvenating process and formulations).
For menopausal symptoms occurring due to in-equilibrium in Dosha status a wide range of options can be used. This approach should begin with eliciting the potential symptoms at individual level.As related to the concerns of Brain Fog/ Natural Decline in the Menopause, Ayurveda attributes this to the physiological stage of Parihaani (Degeneration) to VATA. Beyond 50 Vata is naturally at its peak, leading to various Vata signs in the body like – anxiety, insomnia (lack of sleep), Diminishing memory,forgetfulness etc.
Ayurveda gives significance to Kala – time in its chikitsa approach in all the diseases. There is always aright time to address the disease. The imbalance of menopause sets in much early in a woman’s life -that is in her mid-30s and 40s. Health problems at menopause represent imbalances in the body that were already growing in the body and are unmasked by the stress of shifting hormones. So to minimize the ill effects of menopause and an easy transition get in charge of your health much early in life.
The natural aggravation of Vata in the upcoming stage of Parihaani (Degeneration) should be addressed right on time with a comprehensive prescription that entails: Diet, Lifestyle, Medicine and Panchakarma effectively balances Vata.
Best foods for menopause
Classical Ayurveda states that one should eat according to one’s own constitution and status of agni, considering the history of other illnesses as well. One size doesn’t fit all. One should have a consultation with an Ayurveda physician to get a plan of food. However, generally going by the principles, one should avoid Vata and Pitta aggravating foods that are dry, very light and gas causing and heat producing in nature.
Herbs for menopause
Classical Ayurveda prescribes herbs and poly-herbal formulation based upon the Dosha involved, the type of dhatu and srotases involved, level of impairment and the state of disease, the strength of the patient and various factors intrinsic and extrinsic. Herbs such as shatavari, amlaki, Guduchi, ashok, kumari are important herbs.
What happens after menopause?
After menopause, the vata is at its peak. There is natural degeneration and decline in there productive functions of the body. The natural level of estrogen and progesterone declines. There is peripheral aromatization as ovaries become nonfunctional. The feminine characters declines, Dueto vata Dosha there is depletion in Rasa dhatu. The level of agni is impaired; Pitta Dosha aggravates and there is reduced moisture content of body. Vata and Pitta aggravation leads to changes in the level of estrogens. Estrogens are known potent neuro-modulators of numerous neuronal circuits throughout the central nervous system. Changing estrogen levels during menopause may impact multiple components involved in maintaining temperature homeostasis, thereby leading to hot flushes, night sweats and other discomforts.
Ayurveda system of medicine advocates the following checklist for all women in all age groups, especially 35 years to 45 years for an easy and comfortable menopause.
- Am I eating the right food that suits my body constitution?
- Am I following the right lifestyle?
- Is my mind and body in harmony with each other or is there a disconnect which needs to be addressed?
- Is my work and life balanced?
- Is my reproductive health optimum? Menarche at the Right Age, Regular Periods, Age at the time of marriage, Uneventful Pregnancies, Uneventful Post-Pregnancy Period, Genital Hygiene, or are there any concerns in above areas which needs a medical supervision?
- What are the Methods of Contraception adopted during the Sexually Active Period- Oral Contraceptives, Intra Uterine Device? Is there a history of overuse of contraceptive methods and what is its impact on menstrual cycle/fertility?
- Am I just beyond disease or do I actually possess the good health with all my vital parameters- Weight, Sleep, Appetite, Motion etc. intact?
- Do I have body complaints that have been continuing for a long time?
If any of the above list poses a risk, address them right on time and one should get in charge of health for a beautiful transition to menopause.
Woman is a creative energy of the universe in almost all of its expressions. Life begins in her womb. It is indeed very important that this unique feature of a woman should be nurtured all throughout her life, from menarche to menopause…
Dr. ZankhanaBuch,MD (Kayachikitsa)
AyurVAID Hospitals, Ramamurthynagar