Ayurveda and Modern Perspective on Rajonivritti w.s.r. to Menopause

[Full title: Ayurveda and Modern Perspective on Rajonivritti w.s.r. to Menopause: Review Based on Literary Study]

Review Article This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 4 (11),109-113, November, 2021 ISSN : 2581-785 X ; https://irjay.com/ DOI: https://doi.org/10.47223/IRJAY.2021.41117 Ayurveda and Modern Perspective on Rajonivritti w.s.r. to Menopause: Review Based on Literary Study Monika Kumari 1 , Mahesh Dixit, 2 Narendra Kumar Meena 3 1 P.G Scholar , Prasuti & Stri Roga Vibhag M.M.M. Govt. Ayurved College, Udaipur 2 Principal, M.M.M. Govt. Ayurved College, Udaipur 3 Associate Professor Prasuti & Stri Roga Vibhag M.M.M. Govt. Ayurved College, Udaipur INTRODUCTION Nirukti The word menopause comes from the Greek words “menos” meaning month and pause meaning “to cease”. So, menopause means the “monthly stops” According of Ayurveda, Rajnoviritti is “ rajah + nivriti ”, where “ rajah” means Artava i.e menstrual blood and “ nivritti ” means cessation. Reference in ayurvedic text In Ayurveda Samhita description of Rajonivritti or Menopause is given and the age of Rajonivritti is mentioned by Acharaya Sushruta as 50 years [1] According to acharya sushruta , menstrual cycle starts at the age of 12 years and cease by the age of 50 years because of ageing phenomenon. Acharya Arundatta opines that the age mentioned above is a probable age not fixed one, there may be some variation in this regard [2] Article Info Article history: Received on:11-10-2021 Accepted on: 17-11-2021 Available online: 30-11-2021 Corresponding author- Monika Kumari, P.G Scholar, Prasuti & Stri Roga Vibhag M.M.M. Govt. Ayurved College, Udaipur Email – mkhardia 96@gmail.com ABSTRACT: Menopause, a phenomenon unique to women, is the ending of a woman’s monthly menstrual period and ovulation. It, alongside, several other changes in the body and mind, brought in due to a decline in the amount of the hormones estrogen and progesterone being produced by the body. Menopause is, occasionally, viewed as an end to youth and sexuality, making it a socially unacceptable occurrence. Menopause, though, one of the important physical and mental milestones in a woman’s life, many women lack information about what is taking place and what are their options. There comes the role of Ayurveda , in Ayurveda literature there is no detailed description of Rajonivritti or menopause except the age of Rajonivritti is given as 50 years. Ayurveda involves a holistic physiological system based on balance, with its cardinal doctrine of human physiology being constituted by “ vata ”, “ pitta ” and “ kapha ”. In modern medicine the only treatment for these symptoms is Hormone replacement therapy (HRT), which is not a long-term therapy to be given as it has side effects on the overall health of the women. In Ayurveda Dhatu kshaya can be treated with Rasayana therapy and other symptoms of hypo-estrogenic conditions can be treated with Phytoestrogens. So, Ayurveda gives a non-hormonal and cost-effective treatment for Rajonivritti or Menopause. Key Words – Menopause, Rajonivritti , HRT, Rasayana therapy.

Monika , et al .: Ayurveda and Modern Perspective on Rajonivritt i w.s.r. To Menopause: Review Based on literary study: 2021; 4 (11):109-113 110 Nidana As Rajonivritti is not described in the ayurveda classics as a separate disease. There is no detailed information available regarding its Nidana, Purvarupa, Rupa, Samprapti etc. So, to understand this condition as a disease, certain basic principles of ayurveda have to be considered. Concentrating on the probable Nidanas (etiological factors) regarding the condition Rajonivritti, few factors can be squeezed out. Some of these factors are mentioned by Acharyas in the context of " Rajah utpatti hetus ", too. These factors can be considered as Rajah nivritti hetus also. Causes of Rajonivritti can be - - Kala – Vata - Karma – Abhighata - Swabhava- Dhatu kshaya Rajonivritti also can be divided into two types – 1.Kalaja Rajonivritti 2. Akalaja Rajonivritti Nidana of akalaja rajonivritti are other than the normal causes mentioned above and they can be ; excessive exercise, fasting, chinta , ruksha (without oil-ghee) little and permissive food, consumption of strong wind and sunlight, fear, mourning, ruksha madyapana , night awakening etc [3] MATERIALS AND METHODS This section includes a chapter dealing with prevention and management of menopausal syndrome in Ayurveda, as well as references to several Ayurvedic classical works, research articles, and journals. AIMS AND OBJECTIVES 1. To Conduct a comprehensive assessment of Ayurvedic and modern literature on menopause. 2. To find out a better alternative of hormone replacement therapy in treating menopause symptoms, according to Ayurveda with Ayurveda herbs and therapies. Samprapti According to Ayurveda Samhita’s Rajonivritti is not a disease it is Jarajanay vikara that means age generated phenomenon in women by the age of 50 years. So, rajonivritti or menopause can be considered as swabhavika vyadhi as are jara(aging), kshudha(hunger), pipasa(thirst), nidra(sleep), mritayu(death) described in samhitas . For understanding the reason behind rajonivritti and what happens because of ageing we have to understand the basic principles of Ayurveda i.e dosha-stithi according to different avastha or kala . In Balya avastha there is dominance of Kapha dosha . In Yuva avastha there is dominance of Pitta dosha . In Praudha avastha there is dominance of Vata dosha . Samprapti for Rajonivritti can be constructed on the basis of swabhavika vyadhi . Considering, Kala, Vayu, Swabhava and Jaravastha as Biological Stimulants, which are common for both Jara and Rajonivritti . These factors will be responsible for generalized dhatukshayka and vice versa to generalised vatavriddhi and kaphakshaya . Both these condition together, will produce particular Rasa - Raktadhatukshaya . The main nourishing Rasadhatu will be decreased both qualitatively and quantitatively and ultimately resulting in its upadhatu Artavakshaya . Due to this factor along with generalized vatavriddhi (increased Laghu, Rksha, Khara Guna ) and kaphakshaya (decreased Gura, Snigdha, Drava Guna); Rukshata And Shosha Of Artavavaha Srotasa take place and all these things will lead to Artavanash and manifest as Rajonivritti . Modern perspective - Menopause is not a disease but a natural aging phenomenon and many women lack information about what is taking place & what are their options regarding a proper diet, nutritional supplements & exercise and simple knowledge & preparation that can enable one to embrace it and move on with grace. The clinical diagnosis is confirmed following stoppage of menstruation for twelve consecutive months without any other pathology [4] Endocrinology of menopausal transition - Few years prior to menopause, along with depletion of the ovarian follicles, the follicles become resistant to pituitary gonadotropins. As a result, there is a significant diminished estradiol production. This decreases the negative feedback effect on hypothalamus-pituitary axis resulting in increase in FSH (Follicle stimulating hormone). The increase in FSH is also due to diminished inhibin. Level of LH (Luteinizing hormone) increases and AMH (Anti- Mullerian hormone) decreases. Due to shortening of follicular phase of the cycle, mean cycle length is shorter. Luteal phase remains constant. there is accelerated rate of follicular depletion so that there are no more follicles available and even if some exist, they are resistant to gonadotropins. Organ changes in menopause – Ovaries shrink in size, wrinkled and white. Fallopian tubes show atrophy, cilia disappear. Uterus becomes smaller, endometrium become thin and atrophic, cervical secretion becomes scanty. Vagina becomes narrow due to loss of elasticity, vaginal pH becomes alkaline due to absence of glycogen and doderlein’s bacillus. Breast fat is reabsorbed and become flat. Bladder and urethra epithelium becomes

Monika , et al .: Ayurveda and Modern Perspective on Rajonivritt i w.s.r. To Menopause: Review Based on literary study: 2021; 4 (11):109-113 111 thin and prone to infections. Visible symptoms : 1 Hot flashes, headache 2 Weight gain 3 depression, fatigue, insomnia, 4 Mood swings, palpitations 5 dementia, anxiety 6 Dyspareunia, low libido, vaginal dryness 7 UTI, urine incontinence 8 Joint pain In Ayurveda we can divide these symptoms according to dosha that is vata, pitta, kapha . • Vata dosha symptoms include anxiety, nervousness, dyspareunia, vaginal dryness, loss of muscle tone, irregular menses, disturbed sleep, bloating and joint pain. • Pitta dosha symptoms include hot temper, anger, irritability, hot flashes, skin rashes, excessive bleeding, UTI. • Kapha dosha symptoms include weight gain, lethargy. Complications – Post-menopausal women run a high risk for fracture of bones due to Osteoporosis and Cardiovascular disease due to deficiency of Estrogen. Estrogen prevents osteoclastic activity and increases absorption of calcium from the gut to prevent osteoporosis. Estrogen increases high density lipoprotein and decreases low density lipoprotein and total cholesterol. Estrogen prevents atherosclerosis by antioxidant property. Treatment General treatment – Counselling plays the most important role in management of menopausal symptoms therefore every woman with menopausal symptoms should be counselled about the physiological and psychological changes. This will clear her mind and will remove her fears and minimize some of the symptoms like anxiety, depression, and disturbed sleep. • Lifestyle modificationthis includes regular physical activities like morning walk and Yogasana, reducing high caffein intake (tea/coffee), stop smoking and alcohol consumption, increasing calcium intake. • Nutritious diet is recommended. • Soy protein is found to be effective in reducing vasomotor symptoms. • Vitamin E reduces hot flash. • Calcium sources for decreasing BMD (bone mineral density). Principal of treatment in Ayurveda – • In modern medicine the only treatment for these symptoms is Hormone replacement therapy, which is not a long-term therapy to be given as it have side effects on the overall health of the women. In Ayurveda Dhatu kshaya can be treated with Rasayana therapy and other symptoms of hypo-estrogenic conditions can be treated with Phytoestrogens. Phytoestrogens have both estrogenic and anti-estrogenic property and action, depending on the target tissue [5] Phytoestrogens exert their effect in a selective estrogen receptor modulator (SERM), through this they affect the endogenous production of estrogen. Other than this we can use drugs with Madhura rasa, Madhura vipaka and sheet veerya are used, they will pacify vata and pitta doshas . Medicated oil can also be used for local application. [6] Specific treatment – 1. Yashtimadhu ,Brahmi – Medhya rasayana and are useful for memory boosting and improving neural functioning 2 Aamlaki churna – act as rasayana . 3. Ashwagandha churna ksheerpaka , Shatavari churna ksheerpaka, Arjuna twak churna ksheerpaka – rasayana therapy. 4. Ashwagandha, Arjuna , cardamom, aloe vera, Shatavari, saffron, sandalwood - vatahara and pittahara herbs 5 Sarwang abhyanga , shiro dhara, shiro vasti,shiro pichu for hot flash and other psychological symptoms. 6 Madhuyashti or shatpushpa tail [7] yoni pichu for dyspareunia. 7. Shankha Bhasma, Praval Bhasma, Kapardika Bhasma,Ashwagandha preparations - for falling Bone Mineral Density (BMD) as they contain calcium

Monika , et al .: Ayurveda and Modern Perspective on Rajonivritt i w.s.r. To Menopause: Review Based on literary study: 2021; 4 (11):109-113 112 8 Lashuna or Garlic based preparations, Navak Gugglu, Shunthi churna, Triphala guggul , etc is also useful [8] These dugs not only help in shedding weight but also reduce harmful lipids in blood which usually rise after menopause. Pathya – Apathya Pathya – 1 Introduce a vata-pitta pacifying diet, that is warm, fresh, nicely cooked food. 2 take regular meals on time 3 consume green leafy vegetables and legumes. 4 Avoid high sugar containing food items. 5 Avoid sour and spicy food items. 6 early bedtime and get up early. 7 oil massage ( abhayanga ) using almond and olive oil and nasal medication ( nasya ). 8 drink coconut water. 9 regular practice of yoga and pranayama, like supta baddha konasana ,setu bandhasana, marjaryasana, seetkari pranayama, bhramari pranayama,anulomaviloma . 10 regular morning walk (at least 30 minutes). Apathya - 1 caffeine and other stimulants 2 refined sugar cold drinks. 3 hot spicy foods, hot drinks, and alcohol 4 eating late at night. DISCUSSION Rajonivritti is not considered to be an illness in Ayurveda. It is thought to be a natural occurrence in every woman who reaches the end of her reproductive life. Almost all Acharyas, without exception, have portrayed Rajonivritti as being around 50 years old. Even in today's world, the average age of menopause is 50. The cause of Rajonivritti at this stage of life is simply a decrease in the amount of Rasa Dhatu available for the sustenance of its Updhatu , or by-product, which in females is Raja. Raja is a by product of Rasadhatu , whose function is better in Taruna Avastha (i.e. Yuvavastha) but diminishes in Praudha Avastha (Late Adulthood), eventually leading to Rajonivritti (menopause) when a woman reaches the age of senescence. . Because Rajonivritti is a normal occurrence in the female body, it can be classified as part of the Swabhavika Vyadhis , which include Jara (ageing), Kshudha (hunger), Pipasa (thirst), Nidra (sleep), and Mrityu (death) as stated in the Vedas. Rajonivritti-janya avastha has many of the same symptoms as Jarawastha in its early stages. As a result, " Gatartava" or "Nishphala" is one of the synonyms for "Old woman." As a result, Rajonivritti can be inferred to be a portion of the ageing process unique to females, and it denotes the onset of geriatric age in women. The Swabhavika Vyadhis are divided into two categories: Kalaja and Akalaja. Rajonivritti is a naturally occurring condition that can be divided into two types: Kalaja rajonivritti (Menopause) and Akalaja rajonivritti (Menopause). The majority of Rajonivritti's Lakshanas are caused by Vata Vriddhi, Kapha Kshaya, and Ashayapakarsha of Pitta caused by aggravated Vata. Rajonivritti is also linked to the vitiation of Manovaha srotas and Dhatukshaya , all of which indicate the onset of old age. Ayurveda has been shown to be effective in the management and prevention of chronic illnesses. Hormone Replacement Therapy (HRT) is more commonly used in modern medicine, although it has major side effects such as an increased risk of reproductive cancers and metabolic problems. This is why it's so important to comprehend menopause conceptually through Ayurveda and come up with safe therapies to prevent morbid symptomatology during this stage. The current study is a genuine attempt to discover an efficient complementary therapy regimen. Modern Concept Menopause is a natural biological process that each woman goes through on her own. Menopausal syndrome is caused by the ovaries' ability to generate oestrogen and progesterone gradually declining, as a result of which the pituitary gland becomes more active (positive feedback) and produces more FSH and LH, resulting in various physical and psychological disorders. Apart from some atrophic alterations in the body, many symptoms of various types, such as Vasomotor, Genitourinary, Gastrointestinal, Locomotor, Psychosexual, and so on. Hormonal imbalance and ageing are to blame for the majority of them. Psychological changes and symptoms vary widely and are mostly determined by an individual's genetic makeup as well as a woman's past attitude toward menopause and its

Monika , et al .: Ayurveda and Modern Perspective on Rajonivritt i w.s.r. To Menopause: Review Based on literary study: 2021; 4 (11):109-113 113 significance, rather than oestrogen insufficiency. CONCLUSION In Ayurveda , Rajonivritti is considered as a natural phenomenon in women’s happening at the end of reproductive life and at the age of 50 years .Menopausal transition and menopause cause imbalance of hormones in the body which further leads to various symptoms that affects the woman’s day to day life. So, to maintain this imbalance of hormones ,doshas and rasa dhatu kshaya a proper balanced diet with regular exercise and yogasana is advised. Ayurveda gives a better approach at understanding rajonivritti along with number of herbal medicines and therapies which are effective with no side effects . Acknowledgment: Nil. Financial Support: Nil. Conflict of Interest: Nil REFERENCES 1 Shastri A.D, Sushruta Samhita, Ayurvedatattav Sandipika commentary Sharir shtan 3/9. Chaukhambha Prakashan; reprint, 2013.pp.988 2 Gupta A, Astanga Hridayam of Vagbhatta; Chaukhambha Prakashan; reprint, 2010.pp.78 3 Sharma P.V Charka- Samhita Agnivesha; English translation; Chapter 17,Shlok no. 76/77 Chaukhambha Orientalia Varanasi; Ninth edition, 2005.pp.76 4 Dutta D.C Menopause chapter 6 th textbook of Gynaecology, 8 th edition, New Delhi, Jaypee Brothers Medical Publishers Ltd.2010 pp.46 5 Sharma H, Vriddha Jivaka, Kashyapa Samhita, Kalpa Sthana, Shatpushpashatavri kalpadhyay, chaukhambha sanskrit samsthan.2009 6 Misra S, Bhavaprakash of Bhavmishra, Chaukhambha Sanskrit Sansthan, Varanasi, Ninth edition, 2004.pp.122. How to cite this article: Kumari M, Dixit M, Meena N.K “ Ayurveda and modern perspective on Rajonivritti w.s.r. to Menopause:Review based on literary study” IRJAY.[online]2021;4(11);109-113. Available from: https://irjay.com DOI: https://doi.org/10.47223/IRJAY.2021.41117

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Ayurveda, Vata, Pitta, Kapha, Yogasana, Dhatukshaya, Vatadosha, Pittadosha, Kaphadosha, Menstrual blood, Rasayana therapy, Ayurveda Samhita, Modern medicine, Herbal medicine, Lifestyle modification, Menstrual cycle, Literary study, Visible symptoms, Classical works, Balanced diet, Hormonal imbalance, Hormone Replacement Therapy, Phytoestrogen, Cardiovascular disease, Ayurvedic text, Menopausal syndrome, Modern perspective, Osteoporosis, Ayurveda herb, Rajonivritti, Menopausal symptoms, Menopause, Menopausal transition, Akalaja Rajonivritti, Estrogen, Swabhavika Vyadhi, Endocrine Changes, Ovarian follicle.