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

7. Avoid smoking and consumption of alcohol

In addition, adequate counselling regarding cleanliness of genital organs, sexual behavior and for regular medical check up should be given.

Indications for referral

1. Heavy bleeding which is not responding to medication

2. Menopausal syndrome associated with fracture

3. Menopausal syndrome associated with other serious systemic illness

Reference

AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS Department of AYUSH

Ministry of Health and Family Welfare, Government of IndiaCentral Council for Research in Ayurveda and Siddha, New Delhi 201

  • PUBLISHED DATE : Jun 24, 2016
  • PUBLISHED BY : Zahid
  • CREATED / VALIDATED BY : Janardan Panday
  • LAST UPDATED ON : Jun 24, 2016

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