Menopausal Syndrome

Introduction

Menopausal Syndrome includes symptoms associated with the physiological changes that take place in a woman's body as period of fertility ends. Menopause is a normal consequence of the ageing process and is a natural female hormone deficient state that occurs at the age of 45-55 years. In this stage ovaries gradually become less active and reduce their production of sex hormone (estrogen and progesterone). As a result, menses cease permanently.Women are usually considered to be menopausal if she has not had a menstrual period for one year without any underlying cause. Some women experience mild problems or none at all but some women have severe symptoms in this period. It has become an inevitable phenomenon in a women's life and many years are spent in the postmenopausal phase.Similarly in Ayurveda, Acharyas depicted that menses starts at the age of 12 year and stops at the age of 50 and the whole process is a natural phase of life.

Aetiology

1. Reduced production of estrogen and progesterone

2. Less active ovaries

Pathogenesis

It is a natural and normal phenomenon of ageing. Reduced production of sex hormones due

to less active ovaries lead to menopause.

Clinical features

1. Irregular periods with scanty or excessive bleeding

2. Hot flushes

3. Night sweats

4. Vaginal dryness and itching

5. Mood swings

6. Joint pain

7. oedema

8. Sleeplessness

9. lassitude

10. Excessive hair fall

11. Anaemia

12. weakness

13. Stress incontinence

14. Loss of sexual desire

15. Wrinkling of skin etc.

Complications

1. Cardiovascular problems

2. Fractures due to osteoporosis

Investigations/ Examination

1. Haemogram

2. PAP smear

3. Serum FSH levels

4. Serum estrodiol levels

5. Serum L.H. levels

6. Ultrasound abdomen

7. Bone mineral densitometry

8. Mammogram

Management approaches

a. Prevention

1. Consumption of godhuma (wheat), old rice, mudga (green gram), soya, fresh

seasonal fruits, ghee, nuts, milk etc.

2. Regular medicated oil massage and exposure to mild sun light

3. Practice personal and social good conduct

4. Maintain healthy body weight

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 drugs

9. Avoid heavy and unwholesome food, excess pungent, salty and sour food items.

10. Avoid excessive physical exertion

b. Medical management

Line of treatment

1. Shodhana chikitsa (bio-cleansing therapies) / other therapeutic procedures followed by

Shamana chikitsa (palliative therapy) should be advocated.

i. Snehana: Gentle massage with medicated oils such as :

• Mahanarayana taila

• Ksheerabala taila

• Mahamasha taila

• Bala taila

ii. Internal Snehana (internal oleation) with medicated ghrita (Sukumara ghrta, or Mahtriphala ghrita,or Dadimadi ghrita etc) 50 ml with 2-3 gm saindhava lavana(sendha namak) daily for 3-7 days before panchakarma (bio-cleansing procedure)

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

iv. Takra dhara 45 minutes daily for 15 days

v. Matra vasti with Dhanvantara taila / Sukumara ghrta 50 ml daily for 15 days

2. Drug therapy

Simple medicinal plants

Drug	Dosage (per dose)	Vehicle	Duration
For debility
Shatavari tuber(Asparagusracemosus Willd.) churna	1 -3gm	Water/ milk	15 days
Amalaka/Anwala Fruit (Phyllanthusemblica Gartn.) churna	1 -3 gm	Water	15 days
Madhuyashti stem/whole plant(Glycyrrhiza glabra Linn.)churna	1-3 gm	Water	15 days
Ashvagandha stem,Root(Withaniasomnifera Dunal) Churna	3gm	Milk	15 days
For fragile bones
Asthishrinkhala stem/leaf (Cissusquadrangularis Linn.)Churna	1-3 gm	Water	15 days
Kukkutand tvak put bhasma(Incinerated egg cell)	250 mg	Milk / water	15 days

FORMULATIONS

Drug	Dosage (per dose)	Vehicle	Duration
For excessive bleeding
Pushyanuga Churna	1-3 gm	Rice water	15 days
Chandraprabha vati	1.5 gm	Water	15 days
Lodhrasava	10-20 ml	Water	15 days
Ashok!rishta	10-20 ml	Water	15 days
Sukumara ghrita	10-15ml	Warm milk/Warm water	15 days
Dadimadi ghrita	20-30 ml	Warm water	3 - 7 days
Saptasaram Kashayam	10-15 ml	Warm Water empty stomoch	7-15days
For hot flushes / night sweats/ burning sensation
Pravala Pishti	250-500mg	Water/Honey/Milk	15 days
Mukta Pishti	250-500 mg	Water/Honey/milk	15 days
Chandanasava	15-30 ml	Water	15 days
Usheerasava	15-30 ml	Water	15 days
Kamadudha Rasa	125-250 mg	Water/Honey/Milk	15 days
Dhanvantara Taila	Q.S. for matra vasti		15 days
For debility/ anaemia
Ashvagandharishta	15-30 ml	Water	15 days
Shatavari guda	6 gm	Milk	15 days
Lohasava	15-30ml	Water	15 days
Laghu Malinivasant Rasa	125-250mg	Honey/Milk	7days
For insomnia/ mood swings
Manasa mitra Vataka	125 mg	Milk	15days
Brahmi Vati	125-250 mg	Milk	15 days
Brahma Rasayana	10gm thrice daily	Milk	15 days
For fragile bones
Laksha!di Taila	Q.S.For matra vasti		15 days
Dhanvantara Taila	Q.S.For mMtr! vasti		15 days

All bove oral medicines may be used Initially 2 times in a day after meal for 15 days followed by condition of patient and physician's direction.

NOTE: Out of the drugs mentioned above any one of the drug or in the combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy.

c. 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. Suryanamaskara, Tadasana, Katichakrasana, Vajrasana, Ushtrasana, Sarvangasana,

Setubandhasana, Baddhakonasana, Pavanamuktasana, Upavishtakonasana, Merudandasn and chalanasana.

2. Bhramari, Nadi shodhana,Sheetali pranayama.

3. Mulabandha with Ashvini mudra.

4. Deep relaxation technique/ Yoga nidra/ Nadi anusandhana.

Counselling - Advice the patient to

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 life style