Ayurveda and Yoga in Menopause treatment

Menopausal syndrome is a set of symptoms occurring in women during their late 40s and early 50s due to aggravation of the physiological changes that take place as their period of fertility ends. Menopause is a normal consequence of the ageing process, but some women may find the resultant changes more severe and difficult to cope with. This condition is termed as ‘Menopausal Syndrome’.

​At about 45-50 years, the ovaries gradually become less active and reduce their production of the hormones estrogen and progesterone that cause and regulate menstrual cycles in women. As a result, menses stop permanently. A woman is clinically considered to be menopausal if she has not had a menstrual period for one year without any underlying cause. In Ayurveda, the normal age of end of menses is considered 50 years. 
Causes and clinical Features:

1. Less active ovaries -> Reduced production of estrogen and progesterone -> Affected calcium metabolism in the body -> 

  • Osteoporosis
  • joint pains
  • lassitude

    3. Changes in Autonomous Nervous System and Psychological effects -> 

    • Mood swings
    • hot flushs
    • sleeplessness
    • night sweats

    4. Effects on uro-genital system

    • Irregular periods with scanty or excessive bleeding
    • Vaginal dryness and itching
    • stress incontinence 
    • loss of sexual desire etc.

    5. Integumentary effects -> 

    • excessive hair fall
    • wrinkling of skin

    6. Other features -> 

    • Anaemia
    • Oedema.


    Possible Complications 

    1. Cardiovascular problems 
    2. Fractures due to osteoporosis

    Post menpausal bone loss is much higher in women than men, due to the higher impact of estrogen on calcium metabolism.


    Investigations/ Examinations that may be prescribed

    1. Haemogram 
    2. PAP smear 
    3. Serum FSH levels 
    4. Serum estradiol levels 
    5. Serum L.H. levels
    6. Ultrasound abdomen 
    7. Bone mineral densitometry
    8. Mammogram 

          Management approaches 

          (A) Prevention 

          1. Consumption of good quality wheat (rich in Vit.E), unpolished rice (rich in Vit.B1), moong (green gram – for proper proteins), soya (to compensate estrogen deficiency), fresh seasonal fruits (antioxidants), ghee, nuts, milk etc.
          2. Regular medicated oil massage and exposure to mild sun light (for preventing bone loss and osteoporosis).
          3. Practice personal and social good conduct (helps coping with mood swings and psychic impact of menopause).
          4. Maintain healthy body weight (Obesity as well as malnutrition can further aggravate the cardiovascular and bone-loss changes.)
          5. Regular exercises, yoga and meditation.
          6. Control of blood pressure and cholesterol levels.
          7. Use of calcium supplements and diet rich in calcium and antioxidants.
          8. Use of rasayana (anti-ageing) drugs like Chyavanaprasha.
          9. Avoid Guru (difficult to digest) and unwholesome food, excess pungent, salty and sour food items, mustard oil, etc.
          10. Avoid excessive physical exertion.

          (B) Medical management 

          Line of treatment 

          1.Shodhana chikitsa (Detox)

          An appropriate type of Panchakarma detox as determined from the patient’s Dosha Prakriti (constitution) by a qualified practitioner should be the first modality, followed by drug therapy.

          i. External Snehana (Oleation):

          Gentle massage with medicated oils such as : 

          • Mahanarayan taila 
          • Kshirbala taila 
          • Mahamaash taila 
          • Bala taila

            ii. Shirodhara with Yashtimadhu kashaya and milk 45 minutes daily for 15 days.

            iii.Takradhara
            45 minutes daily for 15 days.

            iv. Matra Basti
            with medicated oils daily for 15 days.

            2.Drug therapy

            (a) For debility and hormonal imbalance:

            • Shatavari (Indian Asparagus) 1 -3gm (in Water/ milk)
            • Amalaki (Indian gooseberry) 1 -3 gm (in Water)
            • Madhuyashti (licorice)1-3 gm (in Water) 
            • Ashwagandha (Withania) 3gm (in Milk) 


            (b) For fragile bones:

            • Asthishrinkhala (Cissus quadrangularis) 1-3 gm (in Water)
            • Kukkutanda tvak bhasma 250 mg (in Milk / water) (Note for veggies: This is a calcium supplement made from egg shells).


            (c) For excessive bleeding:

            • Pushyanuga Choorna – the stalwart formulation for women’s health, containing a combination of 40+ herbs, also works great for balancing Doshas in Menopausal syndrome.
            • Chandraprabha vati – alleviates general health problems, specifically good for Pitta involvement that causes irregular menses and hot flushes.
            • Lodhrasava – for correcting anaemia and blood abnormalities caused by menopause.
            • Dadimadi ghrita – A formulation containing pomegranate as main ingredient, that checks blood deficiencies and restores strength after menses.


            (d) For hot flushes / night sweats/ burning sensation:

            • Pravaala pishti and Mukta pishti – Calcium metabolism regulators that are effective alleviators of Pitta Dosha manifesting as hormonal disturbances, which is the prime culprit in these symptoms. However, being made from specific tropical corals and pearls, these may be prohibited in some countries.
            • Chandanasava – An alcohol based liquid formulation containing sandalwood as a main ingredient.
            • Ushirasava – Another alcoholic formulation containing Ushir (Khas), the popular coolant herb.
            • Kamadudha rasa – an effective formulation, but only for those who don’t mind heavy metal compounds in their medicine.

            (e) For insomnia/ mood swings

            • Ashwagandha (Withania) 1-3 gm (with Buffalo Milk)
            • Brahmi vati – a multi-herbal neuro tonic that also helps with insomnia and psychosomatic disorders.


            NOTE
            : This drugs are only indicative recommendations and described here only for patient information. Determining the appropriate drug, dosage and mode/duration of administration should only be done by a qualified practitioner strictly. DO NOT try self medication on the basis of this info.


            Yogic Practices
             
            The following yogic practices are beneficial in menopausal syndrome; however, these should be performed only under the guidance of qualified Yoga therapist. Duration should be decided by the Yoga therapist.

            1. Asanas (Postural exercises)

            • Suryanamaskara
            • Tadasana
            • Katichakrasana
            • Vajrasana
            • Ushtrasana
            • Sarvangasana
            • Setubandhasana
            • Baddhakonasana
            • Pavanmuktasana


            2. Pranayama (breathing exercises)

            • Bhramari
            • Nadishodhana
            • Sitali


            3. Mudras

            • Moolabandha with Ashwini


            4. Yoganidra
            (deep relaxation technique)

            Lifestyle Advice 

            1. Develop positive approach towards menopause 
            2. Take calcium rich diet 
            3. Practice yoga and meditation for stress management 
            4. Check cholesterol levels periodically
            5. Limit tea/coffee consumption
            6.  Avoid sedentary lifestyle
            7. Avoid smoking and alcohol consumption
            8. Maintain genital and sexual hygiene
            9. Take periodic preventive medical check ups. 

            To end with,


            When to switch to surgery / modern medicine:

            1. Heavy bleeding which is not responding to medication
            2. Menopausal syndrome associated with fracture 
            3. Menopausal syndrome associated with other serious systemic illness


            Summary

            Menopausal syndrome is one of the common gynaecological conditions that can very effectively managed using Ayurveda and Yoga. Ayurveda treats Menopausal Syndrome as a Pitta+Vaata ageing disorder, and the therapy focuses mainly on correcting hormonal imbalance, calcium deficiency, anemia and psychological disturbances. A holistic herbal treatment combined with Yogic exercises and lifestyle modifications can be successfully used to minimize the need for biomedical intervention and risk of unwanted side effects from modern synthetic drugs in menopausal syndrome.


            About the Author

            Dr. Harshad Rajandekar is a practising physician based out of Nasik, India. He holds an Ayurvedacharya degree from the prestigious Maharashtra University of Health Sciences, and also does individual research studies in Yoga and other traditional systems of medicine. He can be contacted online here.

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