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