Dr. Aarti Kulkarni

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!

Menopause is the stage in a woman’s life when the menstrual cycle stops. When a woman is not menstruating for twelve consecutive months, then she has entered into the phase of menopause. Menses is called as Raja in Ayurveda. For this reason, the stoppage of the menses flow permanently, i.e. menopause is called as Raja Nivrutti, which literally means retirement of menses. According to Ayurveda, this is not a disease; rather it is a natural process in a woman’s life that occurs at the age of 45-55 years. 

With aging, out of three Doshas, Vata dosh increases significantly with considerable decline in pitta and kapha dosha, so menopausal symptoms occurring due to the vitiation of mainly Vata dosha. Every woman is born with definite number of oocytes (ovarian reserve). The natural depletion of the reserve and aging of ovaries cause decrease in feminine hormones and hence menopause occurs.

Premature ovarian Failure:

Premature ovarian failure (POF) is the cessation of the ovarian function before the age of 40 year. It is confirmed by high blood levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH).

Causes of premature ovarian failure

• Unknown cause

• Autoimmune disorders, 

• Thyroid disease

• Women who have a functional disorder affecting the reproductive system (e.g., endometriosis, polycystic ovary syndrome, cancer of the reproductive organs) can go into menopause at a younger age.

• Cigarette smoking

• Higher body mass index

• Racial and ethnic factors

• Illnesses

Surgical Menopause

 Stoppage of menses as a result of removal of the ovaries is called "surgical menopause".

Symptoms of Menopausal Syndrome

Gynaecological

• Mood swings

• Dry skin or mucous membranes (including the vagina)

• Scanty bleeding during perimenopause

• Heavy bleeding during perimenopause

• Irregular bleeding

• Vaginal dryness

• Painful Intercourse

Physical

• Constipation or irritable bowel

• Insomnia

• Bone loss (Osteoporosis)

• Hot flashes

• High blood pressure and heart disease

• Weight gain

• Overweight

• Fluid retention, edema

• High cholesterol or triglycerides

• lack of energy,

• joint soreness stiffness

• back pain

• breast pain

• heart palpitations

• headache

• dizziness

• dry itchy skin

• urinary incontinence, increased urgency

• heavy night sweats

Psychological

• Irritability

• Anxiety. worry, fear

• Reduced libido

• Anger, irritation, jealousy, criticism, competitiveness

• Depression, sadness, greed

• Decreased concentration due to dullness

An Ayurvedic approach for managing Menopause:

Ayurvedic Management consist of mainly Rasayana (rejuvenation) therapy, Specific dietary guidelines, Lifestyle modification, Medicinal supplements, Panchakarma (detoxification) and Yoga.

Rasayana (rejuvenation) therapy: It is an Important therapy for this period which leads to an overall improvement in the formation and maintenance of the living tissues and helps in the prevention of aging, improving resistance against diseases, bodily strength and mental health.

It can be done in 4 ways :

• Achar rasayan (lifestyle modification)

• Ahar Rasayan (Diet Modification)

• Dravya Rasayan (Medicine)

• Panchakarma.

Lifestyle modification (Achar Rasayana): According to Ayurveda, by following Dinacharya, Ritucharya and Ratricharya aging process can be delayed and symptoms related to menopause can be minimized. Exercise should be inevitable part of lifestyle.

Yoga and Pranayama for specific condition like backache/ knee pain/ stress/ obesity should be learned from an experienced teacher and should be followed REGULARLY.

Dietary Guidelines:

Diet can be a crucial tool in menopause management.

If you are prone to Pitta-based problems, such as hot flashes or excessive irritability, follow a Pitta-pacifying diet: avoid foods that are spicy, such as chilies, black mustard seed. Salty foods and sour foods such as ketchup,chips etc.

Favor foods that are bitter, astringent and sweet, as these are cooling to Pitta dosha. Bitter and astringent foods include most vegetables. Sweet foods include rice, milk and Ghee pacify Pitta dosha. Cook with Pitta-reducing spices, such as cinnamon, coriander, cardamom,  and small amounts of cumin seed.

If you experience Vata-related symptoms of menopause such as bloating or vaginal dryness, then eat foods that are sweet, sour and salty as this balances Vata dosha. Avoid Processed sweet food as cakes Pastries, tetrapack juices and processed salty food like chips and biscuits

Apana Vata, which governs the genitourinary tract, elimination, and menstruation, is a key area to attend to when preparing for menopause. Drink plenty of warm water throughout the day. For both Pitta and Vata imbalances Milk and Ghee plays important role.

It is also important to keep your digestion strong and free of ama(Prduct of indigestion). Avoid eating foods that are packaged, processed, frozen, canned or left over. Eat organic foods that are cooked fresh. Your diet should consist of whole grains, fresh fruits and vegetables, and legumes Avoid heavy foods such as meat, cheese and ice cream and curd especially at night.

Medicinal Suppliments:

Shatavari, Ashwagandha, Chandrashur, Shankhkpushpi, Bala, Ardrak, Shatapushpa , Black grams etc can be taken under proper guidance

Panchkarma Therapies:

Basti:

• As menopausal period is under influence of Vata dosha and Mainly Apan Vayu, Basti is the best treatment for vitiated Apan vayu and eventually for disturbed menstrual cycle or heavy bleeding.

• Depending upon body constitution and severity of symptom Vaidya can advise Basti treatment.

• Basti can also be helpful in the gynecological conditions like painful menses and heavy bleeding.

• Intrauterine instillation (Uttarbasti) of sterile medicine (oil or Ghee) is helpful in heavy bleeding.

• Panchtikta KshirBasti is also helpful in the condition of osteoporosis.

• Local Treatments Like Janubasti, Manyabasti and Katibasti (Holding Oil over Knee, neck and back respectively) for Knee, neck and back pain are also helpful.

• Recurrent vaginitis, dryness or inflammatory conditions in Pap’s smear can be treated by local irrigation of lukewarm herbal decoctions (Yoni Prakshalan) and keeping oil soaked tampoon in vagina is also helpful in the conditions of vaginal dryness, cervicitis and first degree uterine prolapse.

Shirodhara:

• Shirodhara is continuous pouring of lukewarm oil or decoction or milk or buttermilk on forehead (in between both eyebrows).

• Medicine to be used can be decided upon the symptoms.

• This procedure helps to reduce stress, sleeplessness, anxiety, irritability, hypertension, hair problems etc.

• It relaxes body and mind as well.

Abhyang:

• Abhyang and Swedan (whole body massage and steam) are one of the traditional measures to relieve stress.

• This procedure helps to get rid of vitiated vata and hence we get pain relief and relaxation.

• According to Ayurveda we should practice Abhyang routinely on head, ear and foot/sole.

• Oletion by medicinal leaves pack (Patra Pind Swedan) is also helpful in knee/back/neck pain.

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

Various Ayurvedic treatment modalities in gynaecology

• Reproductive tract infections are being increasingly recognized as a serious global health problem.
• They can have severe consequences including infertility, ectopic pregnancy, chronic pelvic pain, miscarriage, low birth weight babies etc.
• To treat these disorders, along with ORAL AYURVEDIC treatment, local treatment also plays an important role.

Treatments that can be helpful are 

• Uttarbasti: Uttarbasti is instillation of sterile medicated oil or ghee into uterine cavity at particular period of menstrual cycle. It acts as a purification treatment for uterus & fallopian tubes. Active principles of medicine get absorbed & helps to maintain the health of reproductive organs. It is common treatment for infertility, anovulation, endometriosis, tubal block, heavy bleeding & recurrent abortions.
• Basti: As the reproductive organs are under influence of Apan Vayu and Basti is an important intervention of diseases related to Apan Vayu. Basti is medicated oil, milk or decoction enema. Enema gets absorbed from the micro-channels of intestine & gives the desired effect according to cause and medicine. It is also done in 9 th month of pregnancy to clean the bowels and facilitate the normal labour.
• Basti Chiktsa is very helpful in for irregular menses, painful menses, heavy bleeding, anovultion, Arthritis, Osteoporosis, Backache and Obesity.
• Katibasti: Katibasti is keeping warm medicated oil on the lumbar region for some specific period. It is helpful in sciatica, low backache, lumbar spondylosis, muscular spasm at lumbar region.
• Yoniprakshalan: Yonidhavana is nothing but irrigation of vulva and vagina with warm decoction. Medicines for decoction are used according to the cause. Yonidhavana is helpful in vaginal infections and white discharge.
• Pichudharan: A sterile tampon soaked with medicated oil or ghee is kept in posterior fornix of vagina for 4-5 hours, the procedure is called as pichudharan. It is useful in narrow introitus, vaginismus, cervical erosion, cervicitis, infertility, cystocele, rectocele, 1st degree uterine prolapse etc. Medicines for pichu are used according to the cause. Pichudharan is also done in 9 th month of pregnancy to soothen reproductive tract and facilitate normal delivery.
• Vartidharan: Yonivarti is vaginal suppository or pessary. It is indicated in white discharge, vaginal infections and cervical erosion.
• Dhoopan: It is the process in which fumigation if vulval and vaginal region is done by herbal medicines. Mostly, it is done after delivery to reduce watery secretions, pus and wound discharge.
• KsharPratisaran: It is an application of Kshar (ash obtained by burning herbs) over affected areas, mainly cervical erosion and cervicitis.
• 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. It can help relieve symptoms of anxiety, menopausal stress, stress due to infertility, fatigue & hypertension. Shirodhara has been used to treat vertigo, sleeplessness, disturbed sleep, psoriasis, depression, headache, etc.

Ayurvedic Treatment for Infertility

Obesity is the condition in which body fat is accumulated in excess quantity. It may create negative impact on health. BMI is Body Mass Index. It is calculated as the subject's weight in kilograms divided by square of height in meters. 18.5 to 24.9 is the normal range. Obesity is commonly caused by excessive food intake, wrong habits of eating, Lack of exercise and genetic susceptibility.

Impact of obesity on Reproductive System in females:

Because of the complexity and cyclicity of the female reproductive system, and it's complex relationship with obesity; Obesity is more complicated in women than in men.

Obesity in childhood causes:

• Early onset of puberty.

• Menstrual Irregularities like scanty periods, irregular bleeding, heavy bleeding etc.

• Polycystic Ovarian disease

• Dermatological problems like Acne, Hirsutism

• Increased insulin resistance.

Obesity in Reproductive age:

• Menstrual disturbance, hormonal imbalance.

• PCOS

• Anovulatory cycles

• Infertility

• Poor response to fertility treatments and IUI and IVF

Obesity in Pregnancy:

• Risk of misscarriage

• increased chances of Pregnancy Induced Hypertension

• Gestational Diabetes

• Caesarian section

Obesity in Perimenopausal age:

• Pelvic organ prolapse

• Stress urinary/ Urge Incontinence

• Joint pain, arthritis

• Some kinds of cancer

The influence of female hormones on Obesity:

• Hormonal fluctuations across female lifespan may explain the increased risk for obesity in women. Hormonal changes during menstrual cycle affect calorie and macronutrient intake and 24 hr energy expenditure. Hormaonal medicines have varying impact on body weight and fat distribution.

• Pregnancy is significant factor in developing obesity.

• Menopause is also a high risk time for weight gain in women. There is also hormonally driven shift in body fat distribution from peripheral to abdominal at menopause.

• Abdominal fat is an endocrine organ producing adipokines and inflammatory factors that impact particularly on liver metabolism altering levels of triglycerides and increasing insulin resistance, this may lead to development of metabolic abnormalities, hypertension, insulin resistance, diabetes, increased cholesterol level, abnormal fat distribution, and cardiovascular diseases.

Obesity in Ayurveda

• The Charak Samhita states that Obesity is the most challenging out of eight undesirable physical constitutional elements.

• It is difficult condition to balance because it must be treated with reduction therapies, which become challenging due to increased appetite.

• Our modern diet and lifestyle is showing obesity numbers to rise, ris and rise.

There are 8 particular challenges for Obese persons

• Deficient Longevity

• Slowness in Movements

• Excessive sweating

• May emit bad, fleshy smell

• Excessive hunger

• Excessive thirst 

• Weakness

• Difficulty in sexual intercourse.

Obesity Progression according to Ayurveda

• Excessive intake of sweet, salty, cool food, meat, low quality food, fried food, sedentary lifestyle, lack of exercise, day sleeping, excessive eating etc cause obstruction. This obstruction of kapha dosha blocks movements in digestive system and vata dosha is trapped in abdomen. This results in increased digestive power (Agni), creating more and more hunger.

• Low quality Dhatus (Body elements) and excessive fat that is raw and unprocessed is therefore produced; hence Obesity.

Overview of Ayurvedic Treatment

Restoration, rebuilding and balancing Agni (Digestive Power) with rejuvenation of body and mind form the basis of Ayurvedic Treatment of Obesity.

• Langhan Chikitsa (Reduction Therapy): This is detoxification and removal of Ama (toxins created due to undigested food), which can be done through ayurvedic medicines and Panchkarma. According to severity ayurvedic medicines and Panchkarma can be advised.

• Establishing A Balanced Long Term Diet Plan: A diet plan is given according to indivisual constitution and seasonal variations.

• Medicines: Intake of medicines that are pungent, bitter, and astringent can be helpful. Medicines such as guggulu, cinamon, trikatu, triphala, shilajit, turmeric, garlic, vrikshmla, tulsi, neem, senna, gokshur, chitrak, fennel, gurmar etc. Ayurvedic classical medicines such as Medohar Guggul, chandraprabha vati,  arogyavardhini, mahayograj guggul etc ara helpful when taken under proper guidance.

• Other Therapies: Udvartan, massage, steam, pind/patraswed are helpful when performed under guidance.

• Exercise & Pranayam 

If you wish to discuss about any specific problem, you can consult an Ayurveda.