Dr. Aarti Kulkarni

What is AMH?

• Anti mullerian hormone (AMH) is a product of granulosa cells of small antral and preantral follicles in woman. AMH is only present in the ovary until menopause.

• AMH envelop each egg and provide them energy.

• Serum AMH is a marker for quantitative aspect of ovarian reserve.

• Ovarian reserve is the term used to determine the capacity of the ovary to provide egg cells that are capable of fertilization and resulting in a healthy and successful pregnancy.

• As women age, the number of follicles or eggs available for reproduction gradually  decline and AMH level also decline with age.

Causes of Low AMH:

Low AMH levels suggests that Ovarian reserve of women is rapidly declining and they must immediately seek infertility treatment; if they are trying to get pregnant.

Causes:

• Hormonal imbalance

• Autoimmune

• Idiopathic

• Environmental causes 

• Genetic factor 

• Age

• Endometriosis

• Stress

High levels of AMH can be seen in PCOD.

How to diagnose low AMH?

Normal levels of Serum AMH:

• Normal 1-3

• Below normal 0.7-0.9

• Low 0.3-0.6

• Very Low <0.3

Low AMH can be diagnosed by doing blood test serum AMH.

Declining levels of AMH are the marker of poor ovarian reserve and premature ovarian failure if occurs in young women. Poor ovarian reserve is a condition of low fertility characterised by low numbers of remaining eggs in ovaries or impaired egg development or recruitment, in short; decreased quality and quantity of eggs in ovaries.

AMH levels in the blood serum can be drawn at any point in menstrual cycle and generally do not vary cycle to cycle.

Other markers to diagnose poor ovarian reserve are:

• High levels of serum FSH done on D2 or D3 of cycle (First day of proper flow is counted as day 1. Spotting is not considered as start of period). High FSH strongly predicts poor response for fertility treatment.

• Antral follicle count (AFC):

Transvaginal sonography can be done to determine AFC. It is measured on Day 2 or Day 3 of period.

                     AFC                         Significance

• • <4                            Poor reserve

  • 4 to 7                      Low count

  • 8 to 12                   Slightly reduced reserve

  • >12                         Normal

The AFC count in Indian Woman is significantly different from western literature. A cut off value of 10 may be used.

Why Low AMH causes infertility?

• Low AMH is not exactly the cause of infertility but an indicator of state of depleted ovarian reserve.

• The woman with advanced age and depleted ovarian reserve responds very poorly to the fertility treatment and even stimulation for IVF treatment. So, in these cases oocytes donation is suggested. As the quality of eggs are also not good; the chances of healthy pregnancy are also lower.

• Ayurvedic treatment gives a new hope in younger women with depleted ovarian reserve.

Ayurvedic management to improve AMH

As Ayurveda has the holistic approach, one has to modify dietary habits and lifestyle to gain maximum result of treatment.

Take healthy diet and modify lifestyle

• Reduce intake of sweetened and processed packaged food

• Avoid salty spicy fried junk food

• Avoid alcohol, tobacco, smoking and caffeine

• Avoid the combination of foods which are incompatible. For example, milk with food, curd with fish, milk with fruits etc.

• Take organic fresh local seasonal fruits and vegetables.

• Eat dry fruits for example black resins with seeds, almonds, walnuts etc.

• Take at least 10 ml desi cow ghee in your diet.

• Keep yourself hydrated.

• Exercise daily to reach a healthy weight.

• Take proper sleep.

• Do Yogasana, pranayama, meditation regularly and avoid stress.

• Follow daily and seasonal regimens explained in Ayurveda according to your body constitution. Know further details about this from nearest Vaidya.

Ayurvedic Medicines:

There are many herbs, bhasmas and medicinal preparation which increase quality and quantity of eggs and also give nutrition to reproductive system when taken under proper guidance. For example, Shatavari, Manjishtha, Amalaki, Guduchi, Gokshur, Yashtimadhu, Vidarikanda, Vacha, Brahmi, Abhrakbhasma, Suvarnamakshik bhasma etc

Panchakarma

• Basti acts on vata predominantly. It increases strength of reproductive organs. Uttarbasti is an intrauterine instillation of sterile medicated oil or ghee. Vamana and Virechana detox the whole body and improve digestive fire for proper nourishment of reproductive hormones and organs and hence, help to increase the quality and quantity of eggs.

• Yoniprakshalana (Irrigation of vulva and vagina with warm decoction) and Pichudharan (Insertion of a sterile tampoon soaked in medicated ghee or oil in posterior fornix of vagina) are also helpful 

• According to Ayurveda; A Cheerful mind forms the basis of pregnancy; so relaxing panchakarma procedures like massage, steam, head massage, Shirodhara are done to reduce stress and its impact on infertility treatments.

Cervical cancer is a malignant neoplasm originating in the cervix uteri. Cervical cancer is one of the most common cause of cancer in women. Lack of screening programs in the developing world means that the disease is not identified until it is too late, resulting in higher mortality.

Symptoms :

• Asymptomatic (without any symptom)

• Vaginal bleeding on touch

• Abnormal vaginal bleeding

• Intermenstrual bleeding

• Bleeding after coitus

• Menstrual bleeding that is longer and Heavier than usual.

• Bleeding even after menopause.

• Moderate pain during sexual intercourse and vaginal discharge in advanced disease, metastases may be present in the abdomen, lungs or elsewhere.

Causes:

(i) The central cause of cervical cancer is HPV - Human Papilloma Virus.

(ii) It is transmitted through sexual contact.

(iii) Low-risk type virus may cause genital warts.

(iv) High-risk type may cause precancer or cancer

(v) Only women with persistent HPV are at risk.

Human papillomavirus (HPV)

HPV is cause of 70% of cervical cancer globally.

Other risk factors: chlamydia infection, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol, and family history of cervical cancer.

HPV vaccines

There are two HPV vaccines (Gardasil and Cervarix) which reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93%.

Treatment:

(i) Surgery (HYSTERECTOMY)(including local excision)

(ii) Chemotherapy in early stages

(iii) Radiotherapy in advanced stages.

Cancer screening: MOST IMPORTANT DIAGNOSTIC TOOL:

• Pap smear can identify precancerous and potentially precancerous changes in cervical cells and tissue. The smear should contain cells from SCJ (squamocolumnar junction), Transformation zone and endocervix. Ayre’s spatula and endocervical brush are used. Cells are spread on slide and fixed immediately. The treatment protocol depends upon the findings of the smear report. Liquid-based cytology can also be performed now.

• Cervical screening programs have reduced the incidence of invasive cervical cancer by 50% or more.

• Colposcopy- a magnified visual inspection of the cervix aided by using a dilute acetic acid (e.g. vinegar), colposcopy guided Biopsy, Endocervical curratage, Pelvic examination are also important tools for screening of cancer.

• The screening intervals are:

Guidelines According to Age and Reproductive Status

• After a woman becomes sexually active, pap smear testing needs to be done after every 2 years.

• After that, if you get 3 consecutive normal pap smears (that is, three normal tests in a row), the doctors may consider spacing this test to every 3 years.

• After 65 years of age, you may stop.

However, doctors may recommend for more frequent testings in any of the following conditions if:

1. You are HIV positive

2. You have inflammation of cervix in previous pap smear screening test.

3. You are nutritionally deficient and weak.

4. Immunocompromised state, like after radiotherapy, chemotherapy, or after a lone term steroid treatment.

5. Your mother was exposed to DES (diethylstilbestrol) while pregnant.

New HOPE for CERVICAL CANCER:

Cervarix and Garsasil are vaccines against certain types of cancer-causing human papillomavirus.

HPV is a virus, usually transmitted sexually, which can cause cervical cancer.

Gardasil, also known as Gardisil or Silgard or recombinant human papillomavirus vaccine [types 6, 11, 16, 18] is a vaccine for use in the prevention of certain strains of human papillomavirus (HPV), specifically HPV types 6, 11, 16 and 18. HPV types 16 and 18 cause an estimated 70% of cervical cancers, and are responsible for most HPV-induced anal, vulvar, vaginal and penile cancer cases. HPV types 6 and 11 cause an estimated 90% of genital warts cases.

Cervarix is designed to prevent infection from HPV types 16 and 18, that cause about 70% of cervical cancer cases.

Administration

Immunization with vaccine consists of 3 doses of 0.5-mL each, by intramuscular injection according to the following schedule: 0, 1, and 6 months.  Vaccine is available in 0.5-mL single-dose vials. You may contact to nearest gynecologist for further information about vaccines.

HOW DOES AYURVEDA HELP?

Ayurveda has definite protective influence over the killing disease. Prana is ultimate force that maintains our vitality. In Ayurveda this is named as Vata. We have to balance our Vata to keep away from killing cancer. Cancer prevention is targeted at creating balance and harmony through AAHARA, VIHARA, DINACHARYA RUTUCHARYA , RUTUSANDHICHARYA, SADVRUTA, PRANAYAMA, RASAYANA SEVAN, PANCHAKARMA AACHAR RASAYANA, AND ANTICANCER HERBS. Research has shown that some ayurvedic herbs has anticancer activity. Curcumin, inhibit tumor-promoting enzymes and interfere with the growth of cancerous tumors. As a powerful antioxidant, curcumin neutralizes free radicals that increase the risk of cancer. So HARIDRA TAILA pichoo (A sterile tampoon soaked in oil kept in vagina) is effective.

• Ginger not only kills cancer cells, it also prevents them building up resistance to cancer tretment.
• Fenugreek seeds were experimentally shown to protect against cancers of the breast, cervix and prostate cancer.
• There are many Ayurvedic herbs that have anti-carcinogenic properties, such as Amla, Ashwagandha, Triphala, Guduchi, Tulsi, Neem, and Brahmi.
• The role of the mind in healing must be emphasized as mental disturbances are a more subtle cause than the physical imbalances in the doshas.
• Spiritual healing is the process of removing or healing our karma, which plays a role in all disease.
• So mental and spiritual both the states are important for curing any disease which is explained only in ayurveda.

It is important to continue looking for effective ways to expand screening for each women for reducing cervical cancer morbidity and mortality worldwide. So here we all should screen, prevent and treat cervical cancer to improve the quality and logitivity of life of women.

The knee is the joint where the bones of the lower and upper legs meet. The largest joint in the body, the knee moves like a hinge, allowing you to sit, squat, walk or jump.

The knee is vulnerable to injury and to the development of osteoarthritis.

The knee consists of three bones:

• femur - the upper leg bone, or thigh bone

• tibia - the bone at the front of the lower leg, or shin bone

• patella - the thick, triangular bone that sits over the other bones at the front of the knee, or kneecap.

The ends of the bones are covered with a layer of cartilage, a slick, elastic material that absorbs shock and allows the bones to glide easily against one another as they move.

Between the tibia and femur bone are two crescent-shaped pads of cartilage that reduce friction and disperse the weight of the body across the joint.

The bones are held together by a joint capsule, which consists of two distinct layers – an outer layer of dense connective tissue and an inner membrane, called the synovium, which secretes a fluid to lubricate the joint. 

The outer layer of the capsule is attached to the ends of the bones and is supported by these ligaments and tendons

Two groups of muscles support the knee.

• Hamstrings - muscles on the back of the thigh, which run from the hip to just below the knee and work to bend the knee.  

• Quadriceps - four muscles on front of the thigh that run from the hip to the knee and straighten the knee from a bent position.

Arthritis of the Knee

Arthritis is inflammation of one or more of your joints. Any joint in the body may be affected by the disease, but it is particularly common in the knee.

Osteoarthritis (OA) is the most common chronic disorder that affects the joints. OA of the knee happens when the cartilage, or cushion, between the knee joints breaks down. This can cause pain, stiffness, and swelling. It is a degenerative,"wear-and-tear" type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people, too.

Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people.

Symptoms

1. A knee joint affected by arthritis may be painful and inflamed.
2. The joint may become stiff and swollen, making it difficult to bend and straighten the knee.
3. Pain and swelling may be worse in the morning, or after sitting or resting.
4. Vigorous activity may cause pain to flare up.
5. The knee may "lock" or "stick" during movement. It may creak, click, snap or make a grinding noise (crepitus).
6. Many people with arthritis note increased joint pain with rainy weather.

In Ayurveda, osteoarthritis is considered a disease of malnutrition that tends to affect vulnerable joints (due to previous injury or infection, congenital reasons etc). When Agni (the ‘digestive fire’ ) is not working properly, wastes or toxins known as Ama are produced instead of useful nutrients for the tissues. These toxins accumulate in the gut and at the same time, Vata (Air/Ether) accumulates in the colon.

Causes of Vata aggravation include: eating excessively cold, dry, rough, bitter, astringent or pungent foods; irregular meal; excessive travelling; constant multitasking and rushing around; high stress; lack of proper sleep; excessively cold or dry environments;  a physically or mentally traumatic event; change or shock; excessive movement.

Aggravated Vata along with Ama (toxins) move from the gut into the channels of circulation, find places in the body that are weak or vulnerable (in this case the joints) and  settle in. Ama can block the channels supplying nutrients to the joints causing further malnutrition. The deterioration and subsequent irritation in the joint causes inflammation, stiffness, swelling and pain.

In both cases of arthritis (Rheumatoid and osteoarthritis) strengthening Agni and removing Ama is the immediate concern.

This is achieved by the following:

Diet :

1. Take regular meals
2. Eat fresh fruits and vegetables
3. Avoid vata aggravating food that is bitter, astringent and spicy.
4. Take desi cow ghee in diet.

Exercise:

Regular exercise under proper guidance can help:

1. With weight loss, which can ease the strain put on your joins
2. Preserve range of motions in the joints
3. Improve muscle strength
4. Reduce joint pain and swelling

Medicines:

The herbs boswellia, turmeric, dashmool,ashwagandha, ginger, triphala, guggulu, and shatavari have all been shown to decrease inflammation by interfering with the production of inflammatory chemicals in the body

Panchakarma: This detoxification treatment eliminate the vitiated Dosha from body and purifies body & mind.

Virechan: Induced loose motions in scientific method for removal of vitiated Pitta, Vata and Kapha.

Basti: Removal of toxins by using medicated oil or herbal decoction enema. It is the best treatment to pacify vitiated vata.

Panchtikta KshirBasti is also helpful in the condition of osteoporosis

ASSOCIATED PROCEDURES

Snehan (Abhyanga): Whole body massage or local massage.
Janubasti: Keeping warm medicated oil on the knee joint. It is helpful in knee joint pain, Arthritis.
Swedan: Steam or fomentation is bringing out sweat by applying heat. Snehan and swedan are also done as pre-treatment before Panchakarma
Pind-sweda: Steam by hot rice mixed with medicinal decoction or milk. It is also helpful in local pain management
Patra-pottali swed : Fomentation by heated bundle of specific fresh herbal leaves warmed with medicated oil. It is very helpful in arthritis.
Nadi-swed: Fomentation with vapours generated out of medicated decoction. Moist heat proves good technique for local pain management e.g. Arthritis and low backache.
Udvartan: Massage with the help of medicinal powders. It is helpful to loose weight.

Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It is more common in older women.

The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.

For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.

Urinary incontinence in females

Major risk factors:

• Pelvic surgery

• Pregnancy

• Childbirth

• Menopause

There are four main types of incontinence:

• Urge incontinence is due to an overactive bladder in which you have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by infection, neurological disorder or diabetes.
• Stress incontinence is due to poor closure of the bladder. Urine leaks when you exert pressure on your bladder by coughing, sneezing, lifting something heavy, laughing, exercising etc.
• Overflow incontinence is due to either poor bladder contraction or blockage of the urethra in which you may experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
• Functional incontinence is due to medications or health problems. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

Causes

The causes and the type of incontinence are closely linked.

Stress incontinence

• Pregnancy and childbirth

• Menopause, as falling estrogen can make the muscles weaker

• Hysterectomy

• Some pelvic surgical procedures

• Age

• Obesity

Urge incontinence

• Cystitis (an inflammation of the lining of the bladder)

• Neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson's disease

• Diabetes

• Urinary tract Infection

Overflow incontinence

• Enlarged prostate gland in males

• Tumor pressing against the bladder

• Urinary stones

• Constipation

Total incontinence

• Anatomical defect from birth

• A spinal cord injury which impairs the nerve signals between the brain and the bladder

• A fistula, when a tube or channel develops between the bladder and a nearby area

Other causes:

Some medications like diuretics, antihypertensive drugs, sleeping tablets, muscle relaxants and alcohol etc.

Management

• Treatment options range from conservative treatment, behavior management, bladder retraining, Exercise, medications and surgery.

• The option of treatment depends on the correct diagnoses.

• Weight loss is recommended in those who are obese.

• Avoiding or limiting consumption of caffeine and alcohol helps a lot.

• Behavioral therapy is not curative for urinary incontinence, but it can improve a person's quality of life.

• Efforts to increase the time between urination, known as bladder training, is recommended in those with urge incontinence.

• Surgery may be used to help stress or overflow incontinence. Common surgical techniques for stress incontinence include slings, tension-free vaginal tape, trans obturator tape (TOT) and bladder suspension among others.

Kegel Exercises

• Exercising the muscles of the pelvis such as with Kegel exercises are a first line treatment for women with stress incontinence.

• To help your concentration and the efficiency of your movements, make sure you breathe in and out as you perform each set of Kegels, instead of holding your breath.

• You can do these exercises either sitting in a chair or lying on the floor.

• Once you know what the movement feels like, do Kegel exercises 3 times a day

• Make sure your bladder is empty, then sit or lie down. Tighten your pelvic floor muscles. Hold tight and count to 8. Relax the muscles and count to 10. Repeat 10 times, 3 times a day (morning, afternoon, and night).

• Pull-in Kegels: To perform a pull-in kegel, think of your pelvic floor muscles as a vacuum. Tense your buttocks and pull your legs up and in. Hold this position for 5 seconds and then release it. Do this 10 times in a row.

• If your back or belly ache a bit after you complete a set of Kegel exercises, then it's an indication that you're not doing them correctly.

Ayurvedic management

• Diet modification
• Exercise
• Yoga especially Mool bandha and Ashwini Mudra

Panchakarma

• Basti (medicated enema): It is done to give strength to pelvic muscles.
• Uttarbasti (intraurethral instillation of sterile oil or ghee): It is recommended in all types of urinary disorders and especially done to strengthen tissues and to pacify vitiated dosha from the tract.
• Pichu application: A sterile tampoon soaked with medicated oil such as yashti tailam/ mooshak tailam is kept in vagina to give strength to muscles.

Medicines

Shilajit, Gokshur, Punarnava, Chandan, Guduchi, Yashtimadhu, Ashwagandha, Shatavari, Ushir, Sariva, etc.

Some medicinal preperations are useful when taken under proper guidance e.g. Varunadi kashay, Chandraprabha vati, Goksuradi guggul, Vishtinduk vati etc.

Hyper acidity (Amlapitta) is also called Acid Dyspepsia, which is one of the most common problem. Hyperacidity is a condition in which stomach secretes excess amount of acid.

Hyperacidity is very closely associated to Amlapitta in Ayurveda which is caused by the imbalance of agni or the digestive fire leading to the vitiation of pitta dosha.

Causes of Hyperacidity:

Hurry’, ‘Worry’, and ‘Curry’ are the three main reasons for the disease.

Diet (Ahara)

• Spicy fried junk food

• Carbonated drinks

• Excessive use of chilly, mustard, garam masala powder (spice mixture), garlic etc. in diet

• Salty and sour foods like chips

• Eating of stale, fermented foods (dosa, uttappa, idli, dhokla etc. bakery food items).

• Excessive intake of fast food

• Excessive intake of Oily foods, pickles

• Excessive intake of tea/coffee.

• Lesser intake of water

• Irregular meal times

• Skipping meals

• Repeated food intake (before the digestion of the previously taken food)

• Incompatible food like taking non-veg with milk, sour fruits with milk, pizza followed by milkshake

• Eating too late at night

Regimens (Vihara)

• Lack of rest

• Fast moving lifestyle.

• Insufficient sleep at night.

• Sleeping immediately after meals.

• Sleeping in daytime

Mental factors

• Stressful lifestyle

• Excessive anxiety

• Anger

Other causes of acidity include:

• Medications: Some anti-inflammatory drugs, when taken for a long period of time can develop chances of hyperacidity.

• Drinking alcohol

• Smoking

• Pregnancy

• Obesity

• Fasting

All the above factors result in an excessive increase of ‘Pitta dosha’ in the body and exhibits symptoms of amlapitta.

The condition of Amlapitta is explained with a simile just as milk is poured into curd pot immediately attains sourness and gets into an inspissated form. In the same way, repeatedly eaten food gets improperly burnt and causes acidity.

Signs and symptoms

• Vomiting

• Loss of proper taste of food

• Loss of interest of food

• Headache

• Heart &chest burn (retrosternal burning)

• Sour or bitter test in mouth and belching.

• Nausea

• Throat burn

• Regurgitation of food or sour substance

• Gaseous distention/ bloating of abdomen

• Pain in abdomen

• Chest pain

• Foul smelling loose motions.

• Burning sensation over feet, hands

• Mouth ulcers

• Fatigue (especially in legs)

• Tiredness

• Fainting

Ayurveda has explained 2 main types of amlapitta:

• Urdhvag Amlapitta: Mainly characterized by vomiting due to upward movement of pitta 

• Adhoga Amlapitta: Mainly characterized by loose motions due to downward movement of pitta.

Investigations

If there is chronic hyperacidity, following investigations are useful:

• Gastroscopy (Upper Gastrointestinal Endoscopy)

• Barium Meal x-ray

• Gastrin levels in blood

• Serology + histology for H. Pylori

• Stool routine examination

Complications 

If not treated at the proper time or if faulty diet, regimen and habits continued, it can complicate as

• Gastric Ulcer
• Chronic Gastritis
• Duodenitis

Prevention

“Prevention is better than cure” it is better to avoid all the causative factors of acid-peptic disorders (amlapitta).

• Avoid excessive salty, oily, sour and spicy foods

• Avoid heavy and untimely food

• Avoid smoking and alcohol intake

• Avoid overcooked, stale and contaminated food

• Avoid fried and junk food items

• Do not skip meals

• Avoid fast

• Do not overeat

• Avoid untimely and irregular food habit

• Avoid foods containing excess amount of garlic, salt, oil, chilies etc. very often.

• Avoid toor dal, horse gram, fenugreek

• Avoid lying down immediately after food

• Avoid, smoking, alcohol, tea, coffee and aspirin type drugs

• Follow the meal times

• Take Light food, Coconut water, articles having cooling properties

• Take vegetables like white pumpkin, cucumber, leafy vegetables except Methi

• Take Wheat, old rice, green gram

• Fruits like gooseberry, dry grapes (black resins), black grapes, pomegranate, fig, dry fig, custard apple.

• Take adequate amount of fluids like pomegranate juice, amla juice, kokam syrup.

• Medicated water with ushir (wala) or coriander-cumin seeds or tulsi seeds (sabja) or laja (puffed rice). 

• Take Warm water.

• Take Moravla (jam made from amla), gulkand (jam made from rose petals) 

• Take One teaspoonful of ghee with warm milk

• Take adequate sleep

• Exercise regularly

• Avoid stress

• Follow mental relaxation techniques like meditation, Yoga and Pranayama

Medical management

As the disease is of Pitta origin, all measures are undertaken to pacify pitta.

Some important drugs useful in Amlapitta

Shatavari, Yashtimadhu, Amalaki, Sunthi, Guduchi, Ushir, chandan shankhabhasma, suvarnamakshik bhasma, pravalpishti, sariva, bhunimb etc

Some important Ayurvedic Medicinal Preparations are helpful when taken under proper guidance

• Kamdudha Rasa 

• Sutashekhar Rasa 

• Prawal Panchamrit 

• Shankh vati

• Bhoonimbadi kwath

• Avipattikar Churna

• Shatavarighrit etc

'Panchakarma procedures' like Vamana (induced vomiting) or Virechana (induced loose motions) whichever is needed as per the symptoms should be administered. In chronic cases, Asthapana basti (medicated enema) is indicated.

UTI is a bacterial infection of the urinary tract. Recurrent UTI or chronic UTI if remain untreated can even lead to an organ failure. UTI is the second most common infection in the body. In reproductive age, there is a 10 fold increase in incidence in women than in men.

Why?

• Short urethra 
• Sexual intercourse
• Close proximity of urethral opening to the areas like vagina and vulva which are contaminated heavily with bacteria
• Recurrent vaginal infection

You may be suffering from UTI if:

1. You feel a pain in pelvis while urinating
2. You feel the need to urinate again and again and despite urgency you manage to pee only little
3. You feel burning while urinating or you have to stop urination in between because of excessive burning
4. Urine appears red or cloudy or bright pink with strong smell.

In severe infection, you may suffer from fever with chills, nausea and vomiting. Bad hygiene, sexual intercourse, recurrent vaginal infections, dehydration, holding urine for too long, pregnancy, catheterization while surgery, hypo-estrogenic state like menopause, having diabetes mellitus are some reasons and predisposing factors behind UTI.

If you feel any of the symptoms of UTI you must visit doctor and get urine microscopic examination done. To get proper result patient should collect midstream urine sample in sterile container after washing the private parts.

In chronic or recurring UTI, more extended investigation protocols like intravenous pyelography, cystoscopy (endoscopy of urinary bladder via urethra) are indicated.

Prevention

• The urge for urination should not be suppressed.
• Drinking water helps dilute your urine and ensures that you'll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
• Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
• Empty your bladder soon after intercourse. 
• Change your birth control method. Diaphragms or unlubricated or spermicide-treated condoms can contribute to bacterial growth.
• Don't use feminine deodorants. These sprays can irritate your genital area and increase your risk of UTI.
• Wear cotton underwear. Cotton fabric allows moisture escape while other fabrics can trap moisture, which creates a potential breeding ground for bacteria. Also, avoid tight-fitting clothing.
• Avoid vaginal dryness
• Get help for recurrent UTI. 
• Avoid intake of hot, oily, spicy, sour, salty, and bitter foods.
• Increase intake of liquids in the form of water, juices, coconut water, and other cooling drinks.
• Increase intake of pitta-pacifying herbs like green cardamom, coriander, licorice root, black resins, gulkand and kokam syrup etc.
• Alcohol and coffee should be forbidden.
• Coriander and cumin seed water: Soak coriander and cumin seeds overnight in 6 times water. Drink 30 to 50 ml water next morning after sieving or filtering. Prepare fresh every day.
• Punarnavashtak kwath, Varunadi kwath, Chandrakala rasa, Chandraprabha vati etc are some of the ayurvedic medicines which are used treat UTI, those should be taken under proper guidance, if you suffer from UTI.

Hello,

I am Dr. Aarti Kulkarni, Ayurveda Gynecologist. Today I will talk about a very common headache disorder that is migraine. It only affects only 1 side of the head. It makes unable to the patient to do their routine work. Its symptom is present aura before the headache. What is aura? Aura is the perception of strange light, volume, confused experiences and thoughts. Migraine is seen with headaches. Its symptoms are headache, nausea, vomiting, loss of appetite, diarrhea, sensitivity to light and sound. Some trigger factors are environmental factors, dietary factors, mental factors. Lifestyle factors are sleep deprivation, oversleep, smoking, meal skipping, menstruation. Mental factors are anger, depression, fear and anxiety.

For prevention, it is better to identify the trigger factor to reduce the intensity of the problem. Proper sleep and meals on time are recommended. Include cow ghee in diet if you are suffering from migraine. Yoga, whole body massage, shirodhara are very helpful. Shirodhara induces the sleep and makes the patient relaxed. Panchakarma is very helpful. Nasya and rakta moksha are very helpful. Medicated oil we put in nasya. To know more contact me through Lybrate.

Thanks!

A woman’s hair is the first most noticeable part of her beauty. It enhances her personality. It is not only true for women but also for men. A bad hair is just a bad day and nowadays bad days are very common because of frequent hair problems.

Common hair problems:

• Excessive hair fall

• Premature Graying

• Dandruff

While in modern life, for achieving their goals and position and even to compete for the basic needs people have to work more stressfully. Due to this, Dinacharya and Ritucharya have taken a back seat, moreover faulty dietary habits and faulty hair care methods with an unending race for chemical cosmetics from fashion industry, exposure to sunlight, water and air pollution etc. lead to greying of hair or fall down at a younger age.

Here are some probable causes:

• Inheritance(heredity)

• Stress

• Hormonal imbalance

• Excessive salty and spicy food

• Lack of sleep

• Lack of nutrition

• Indigestion, stomach infection

• Frequent different hairstyles

• Over combing / overbrushing of hair

• Improper usage of heated hair appliances

• Constant coloring of hair

Nutrition and development of Hair

• According to Ayurveda, from the ingested food, body forms assimilable nutrition fluid. Nutrition fluid gets divided into essential fluid and waste matter.
• The waste matter is responsible for the formation of urine, hair, sweat etc.
• The color of hair is based on one's prakriti (body constitution).
• Vata prakriti: Dry and low-density hair
• Pitta prakriti: Yellowish hair
• Kapha Prakriti: Thick, black and curly hair.

Hair problems:

1. Excessive hair fall:

The vitiated vata dosha and pitta dosha having recourse to the root of hair make hair fall off while vitiated blood and kapha fill up the follicles and thus blocking fresh growth.

2. Premature greying:

Stress, anger, fatigue and sorrow increase agni which vitiates the pitta which having recourse to head make the hair prematurely grey.

3. Dandruff:

It is due to vitiated kapha and vata. They cause hairy parts of the body hard and dry and itchy. So, the skin or scalp gets cracked, hence lead to dandruff.

Ayurvedic Solution

Hair loss problem is of great concern. Various synthetic medicines are available for hair loss treatment which does not treat permanently and also have severe side effects. Turning to Ayurveda is the safer and better option in the long run. Herbal medicines, hair oils, lifestyle and diet regimens, Panchakarma procedures help to prevent premature greying, hair fall, dandruff and promotes hair growth. So, Ayurveda has the holistic approach towards the solution of hair problem.

Diet:

• Avoid packaged food including ready to eat food, tetra pack juices, biscuits, chips etc.

• Avoid salty, spicy and stale food.

• Eat fresh vegetables and fruits

• Keep yourself hydrated.

• Avoid incompatible diet e.g. milkshakes, fruit ice-creams, curd with fish, milk with food etc.

Lifestyle modification

• Do exercise regularly

• Avoid stress

• Take proper sleep

• Follow proper daily and seasonal regimens according to ayurveda

• Avoid heavy hairstyles, use of chemicals on hair, frequent combing etc.

• Wash hair twice a week.

• Do not comb wet hair.

Internal medicines to be taken under proper guidance:

Jatamansi, Guduchi, Musta, Gokshur, Amalaki, Methi, Vidanga, nimba, Shatavari, Ashwagandha etc.

Ayurvedic Iron and calcium supplements.

Local treatments: 

• Shiro-abhyang (head massage):

Massage with ayurvedic hair oils containing maka, neelibhringa, hibiscus, aloe vera, bala, malati, dhatura, gunja, black sesame, tiphala, sariva, yashtimadhu etc according to hair problems.

• Lepa: 

Local application of some herbs like hibiscus, aloe gel, daruharidra, gunja powder etc. Lepa can be used for hair problems under proper guidance.

• Hair Wash using shikekai, ritha etc.

• Shiro basti:

Shirobasti means pooling the liquid medicines, especially herbal oils and or ghee in a chamber or compartment constructed over the head.

• Shirodhara:

Shirodhara is continuous & gentle pouring of medicated oil, liquids or decoction on the forehead. Shirodhara immediately calms, relaxes and has a cleansing effect on mind and nerves.

• Shiro pichu:

The Shiro Pichu Treatment involves keeping a gauze piece or cotton soaked in warm medicated, herbal oil over the affected area. 

• Panchakarma

The procedure and the medicine for panchakarma can be used according to hair problems and their cause.

1. Vaman: Induced vomiting in scientific method for removal of vitiated Kapha and pitta.

2. Virechan: Induced loose motions in scientific method for removal of vitiated Pitta, Vata and Kapha.

3. Basti: Removal of toxins by using medicated oil or herbal decoction enema.

4. Nasya: Removal of toxins from head-neck region by nasal administration of medicated oil or powder. It also facilitates cleansing of sensory organs and endocrine glands.

5. Raktamokshan: Removal of toxins through bloodletting. It is achieved by venesection or by application of leeches.

Hello,

I am Dr. Aarati Kulkarni, practising ayurvedic gynaecologist in Thane. Today we are going to discuss about much talked gynaecological disorder which is PCOD and Endometriosis. So before we know about PCOD and Endometriosis lets know about something about menstrual cycle. So when the woman is menstruating for the first three to four days of her cycle, basically seven to eight follicles, cohort follicles is introduced in the periphery of ovary and after ten to twelve days one dominant follicle gets selected and it ruptures under some influence of hormones. When it gets ruptured, the tube picks up the outside that is female egg, and then if at all there is intercourse happens at that time or if the sperms are present in the cavity, the fertilisation occurs in the fallopian tube and the pregnancy gets attaches to the Endometrium.

If at all there is no pregnancy, then the whole bed, the Endometrium which is prepared for the pregnancy sheds off as a menstrual cycle. So again the cycles happen. Then what happens in PCOD? Basically no dominant follicle is selected and because of unovulation, because of hormonal imbalance, because of irregular ovulation, those follicles attain around 10 to 12mm size and gets collected in the periphery of the ovary and gives the ovary appearance of polycystic. So this is called as polycystic ovary. Then what is polycystic ovary and polycystic ovarian syndrome? So when the PCO hampers the hormones and hampers the metabolic system, it is called as PCOS.

Then what is the syndrome? Irregular periods, obesity, then Hirsutism, weight gain, Acanthosis Nigricans, insulin digestion, infertility and if at all pregnancy happens risk of miscarriage, then acne, scanty or heavy bleeding, these are all the symptom of PCOD. Then this is Hirsutism and Acanthosis Nigricans. So what is the investigation to diagnose about PCOD? Not just sonographic evaluation but it also needs the blood investigation, hormonal as in sugar levels and serum insulin levels. Then this is all about PCOD. Then we will know about the Endometriosis. What is Endometriosis? Basically the inner lining of the uterus is called as Endometrium.

But when this Endometrium grows abnormally outside the Endometrium, it is called as Endometriosis. It can grow on bladder, on tube, on intestine on scar etc. But when it grows in the ovaries in the cystic form, it is called as chocolate cyst or endometrioma or when it grows in the muscular layer of uterus, it is called as adenomyosis which is seen in elderly women. So what are the symptoms? Symptoms are pain while menstruation, pain while intercourse, pelvic pain, adagents and infertility. Say because of abnormal growth of Endometrium on tube or inside the peritoneal cavity, there are androgens formed and because of these androgens tube cannot move properly or its normal movement gets hampered and that’s why it become unable to catch the o site timeline and hence infertility. So how can we diagnose? It can be diagnosed by sonography, by laparoscopy.

Adagents can be diagnosed by laparoscopy and the blood tests CA125. Then what forms the basis of the ayurvedic treatment of PCOD? Basically to correct the hormonal imbalance and maintenance of biological clog of menstruation and if at all if there is any obesity or hirsutism or insulin resistance, the treatment of the same. Then what forms the basis of Endometriosis? That is basically the reduction of pain, the aim of treatment is to reduce the pain while menstruation and to stop the recurrence of Endometriosis. Then ayurvedic treatment consists of what factors is a diet. You should consult the ayurvedic physician or a gynaecologist and get the diet plan according to your constitution and the disease.

Then lifestyle modification and exercise. You should learn the exercise from a proper trainer only and a best way is to avoid exercise during the menstruation because it again can cause Endometriosis. So what are the exercise- suryanamaskar, kapalbhati, gomukhasana, paschimottanasana, vajrasana, sarvangasana, halasana etc. so then ayurvedic treatment. Basically the reproductive system is under the influence of fata and again the subtype of fata is apanvayu. So the best treatment for vested apanvayu is basti. So what is basti? Basti is basically the enima of medicated oil or decoction. So it forms the proper treatment for Endometriosis as well as PCOD. Then ayurvedic medicines for example satyapushpa, satyavari, nirgundi, musta etc can be used than panchakarma. Panchakarma that is vamana that is induced vomiting, virechana that is induced purgession and nasya that is instilation of sterile oil or ghee in the nostrils. So these are the proper treatment or ayurvedic treatment for Endometriosis and PCOD. If you want to know more please contact me through lybrate.

Thanks!

Dysmenorrhoea is the term used to describe painful periods. Normal ovulatory menstruation can be painful, but when it affects one’s routine for example absence in school or office or unable to do day-to-day activities, it has to be investigated and treated. Women of any age can experience painful periods. Some women find periods are no longer painful after pregnancy and childbirth

Symptoms of dysmenorrhoea

• Pain low in the abdomen that can spread to the lower back and legs

• Pain that is gripping or experienced as a constant ache, or a combination of both.

• The pain starts when the period starts, or earlier

• The first 24 hours is the most painful

• Clots are passed in the menstrual blood mostly pain is relieved after the passage of clots.

Dysmenorrhoea can be associated with:

• Nausea and vomiting

• Headache

• Digestive problems

• Fainting

• Premenstrual symptoms, such as tender breasts

Types of Dysmenorrhoea:

• Primary
• Secondary

Causes of Primary dysmenorrhea

Normal menstruation that happens to be painful is known as primary dysmenorrhea. In primary dysmenorrhoea, it is thought that the muscles of the uterus contract harder than normal to excrete the thickened lining (endometrium). These contractions may also reduce blood flow to the uterus which makes the pain worse. The hormone-like compounds that prompt these contractions are prostaglandins. The reason for the increased prostaglandins is not known. This type of dysmenorrhea diminishes with age. It is mostly seen in the adolescent period due to low pain threshold, tension and anxiety.

Causes of secondary dysmenorrhoea

• Endometriosis
• Adenomyosis
• Pelvic inflammatory diseases
• Ovarian cysts
• Fibroids of uterus

Ayurvedic view

According to Ayurveda, there is no pain without vata. Apan vayu is the subtype of vata dosha which is responsible for excretion of waste, cell division and any movement in the body. When there is vitiation of vata, instead of proper direction, apan vayu works in opposite direction. As reproductive organs are under influence of apan vayu, there is colicky pain and the discharge is thrown out with difficulty and becomes frothy. When the position of the uterus is distorted due to faulty positions and excessive coitus, the mouth of the uterus becomes curved and uterus falls back which is responsible for painful intercourse and painful menses. When along with vata, pitta is also vitiated then there are symptoms like chronic backache, painful menses, painful intercourse and periods with excessive bleeding; which can be corelated with PID (Pelvic Inflammatory Disease).

Treatment: Correction of Apana Vata vitiation is the main objective of the treatment. The site of Apana Vata is last part of the intestines. Etiological factors which lead to Apana Vata provocation need to be strictly avoided.

SNEHANA

• Generally, snehana or oleation is done with medicated oil or ghee.
• It may be administered orally (shatavari ghrit) or externally (sesame oil).
• Local massage with sesame oil and hot water bag fomentation or nadi sweda are
• helpful in painful condition.
• Oleation help in pacifying vitiated Apana Vatha.

Virechana-Medicated purgation

• Purgatives or laxatives are useful here for, example gandharva haritaki.

Basti

• As basti is the primary treatment of vitiated apan vata, it is of prime importance during painful episodes as well as to prevent dysmenorrhea.
• Enema with medicated oils is used to pacify Apana Vata.
• Uttarbasti with bala taila, Dashamool ksheer basti and decoction basti, sahchar oil matrabasti are helpful.

Diet:

• Take Fresh fruits and vegetables

• Avoid salty spicy fried junk food

• Take Asafoetida in diet

• Milk medicated with Ashwagandha

• Add Cow ghee in diet

Some useful Medicines:

• Yograj guggul, maharasnadi Kashaya, dashmool kashay, shankhavati, ashokarishta, lodhra, jatamansi, shatavari, ashwagandha, shunthi, hingu, black sesame, haritaki etc.
• Yoga, Pranayama and meditation and exercise
• Stress is the main factor contributing to this disease and hence pranayama and meditative techniques are proved to be effective in relieving the condition and prevent further recurrence.
• Regular exercise is inevitable and part of your lifestyle.

In case you have a concern or query you can always consult an expert & get answers to your questions!