A Survey on Menopausal Symptoms in relation to Prakruti

[Find the meaning and references behind the names: Sreenath, June, Long, Anjali, Amrita, Divya]

ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 65 A Survey on Menopausal Symptoms in relation to Prakruti Dr. Divya Sreenath J, 1 Dr. Henavathi SK, 2 Dr. Anjali M. V, 3 Dr. A. Nalinakshan 4 1 Research Fellow, Project on Diminishing Ovarian Reserve, Govt. Women and Child Hospital, Poojapura, Thiruvananthapuram, Kerala. 2 Professor and HOD, 3 Assistant Professor, Department of Prasūtitantra and Strīroga, Amrita School of Ayurveda, Kollam, Kerala, 4 Pro-Vice Chancellor, Kerala University of Health Sciences, Kerala, INDIA. I NTRODUCTION Menopause is an integral part of aging process in women’s life. World Health Organization (WHO) defines menopause as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Natural menopause is recognized as 12 consecutive months of amenorrhea for which there is no other obvious pathological cause. As the Address for correspondence: Dr. Divya Sreenath J Research Fellow, Project on Diminishing Ovarian Reserve, Govt. Women and Child Hospital, Poojapura, Thiruvananthapuram, Kerala.India. E-mail: divyasreenath 07@gmail.com Submission Date : 24/05/2018 Accepted Date: 18/06/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 3 i 3.12877 life of expectancy of women is increasing world wide, women are expected to spend 1/3 rd of their life in the post-menopausal period. Women are having a more complex and stressful aging process, resulting from hormonal changes that occurs during the transition period. Menopause brings psychological and biological changes that effect women’s health and degrade her quality of life. According to World Health Organisation (WHO) in the year 1990 there were 467 million women aged 50 years and above globally. (40% of them lived in the developed countries, where as 60% were in the developing countries). The global figure is expected to hit 1200 million by the year 2030. Significantly, as the proportion of post menopausal women living in the developed region is expected to decline by over 16%, it in turn causes an alarming situation for the developing countries [1] This read along with the statistical data put forward by IMS (Indian Menopause Society) research, that there are about 65 million Indian women above the age of 45 makes the Indian scenario crucial by demanding A B S T R A C T Menopause is a universal phenomenon and an unavoidable physiological transition process in a women’s life, which marks the end of women’s reproductive capacity. It is caused by the depletion of ovarian function followed by the cessation of menstruation. In Ayurveda literature, the term Rajoniv ṛ tti (menopause) is used for menopause and it considered as a sign of aging or Jarā . As a result of change in hormones after menopause certain psychological and biological changes affect women’s health and degrade her quality of life. Ācāryā Vāgbha ṭ a had mentioned that in Kaphaprak ṛ ti (body type ) individual, and women who are having a habit of taking ghee ( Vātapitta Prasamana - pacify Vata Pitta humors) and milk ( Jeevaniya ), and who are having a pleasant mind in those subjects the Ārtava (menstruation) retains long . The aim of the study was to assess the menopausal symptoms that is mentioned in the menopausal rating scale (MRS) in relation to Prakruti of an individual. For that a survey study is conducted in 250 menopausal women in Sakthikulangara village (Kollam district) who satisfy the inclusion and exclusion criteria. It was observed that out of the 11 menopausal symptoms 9 symptoms shows statistically significant association with Vātapittaprak ṛ ti . Key words: Menopause, MRS, Prakruti, Menopausal Symptoms, Hot Flushes.

[Find the meaning and references behind the names: Main, Heart, Good]

Dr. Divya Sreenath J. et.al. A Survey on Menopausal Symptoms in relation to Prakruti ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 66 utmost priority to menopausal health. In India, it is worth while to note that the number of studies in this field are scarce. Some scattered studies have focused only on estimating the menopausal age and symptoms. Few describe the symptoms in terms of both frequency and severity. Only very limited research data was available regarding menopausal symptoms experienced by women in Kerala. In India there is considerably lack of awareness regarding menopausal symptoms among the public. The side effects including risk of malignancy in hormone replacement therapy which stays as the main line of management in modern medicine stands incognizant to the Indian mob. HRT is the main line of management of the menopausal symptoms and most of women are less aware regarding the side effects including the risk of malignancies. In classics also only a few reference regarding the menopause ( Rajoniv ṛ tti) . For a better understanding of this condition, an earnest attempt is made to assess the Prak ṛ ti of a menopausal women coupled with the occurrence of menopausal symptoms and to find out whether there is any relation between the occurrences of symptoms and her own Prak ṛ ti . The relevance being the fact that, diet and life style modification can be advised even to the premenopausal women according to her Prak ṛ ti in order to reduce the occurrence or severity of symptoms and thus improve the quality of life. M ATERIALS AND M ETHODS A cross sectional survey study was done in Sakthikulangara village ward no: 2 ( Kollam district) with an aim to observe menopausal symptoms in relation to Prak ṛ ti and also to determine the frequency and intensity of menopausal symptoms. For that 250 menopausal women who satisfy the inclusion and exclusion criteria were selected. Data is collected by face to face interview method, with the aid of a self-administered questionnaire which consisting of 3 parts. Part-1 consist of sociodemographic data and reproductive profile, Part-2 consist of menopausal rating scale [MRS], for assessing the menopausal symptoms. Which composed of 11 items assessing menopausal symptoms divided into three subscales: a) Somatic b) Psychological c) Urogenital and Part-3 consist of Prakruti assessment questionnaire for determining Prakruti’ Assessment is done for each of the 11 menopausal symptoms with Prak ṛ ti. Statistical analysis is done using Pearson's chi square test or the chi square test of association is used for evaluation, using Software - SPSS version 20. R ESULTS Menopause is an important health issue around the world, ultimately affecting all women. The prevalence of menopausal symptoms varies widely in individuals of the same population and in different population groups. The variation in the frequencies of symptoms are influenced by socio-demographic / socio-cultural factors, economic stress, general health status, individual perception of menopause, genetic, racial differences and reproductive parameters like parity [2] etc. In Āyurveda classics also we may find references like exposure to precipitating factors like, Avara Satva , Mithyaāhāra and Vihārā , Mānasika Do ṣ ā etc. that further accelerate the gravity of various distressing symptoms. In the present study, a total of 250 subjects between the age group of 40-60 years are selected. Out of them a good majority that is 41.5% falls within the age group of 50-54 years. The mean age of women selected for the study was 51.89 years and the mean age at which they attained menopause is 46.56 years. Each of the 11 menopausal symptoms with was assessed with the 3 Dvido ṣ aja Prak ṛ ti (combination of humors) (Vātapitta, Vātakapha and Pittakapha) and the result are as follows.( chart 1) SN Menopausal Symptoms p Significance with Prakriti 1 Hot Flushes 0.0001 < 0.05 H.S. in Vātapitta Prak ṛ ti 2 Heart Discomfort 0.0001 < 0.05 H.S. in Vātapitta Prak ṛ ti

[Find the meaning and references behind the names: Aya, Hum]

Dr. Divya Sreenath J. et.al. ISSN: 2456-3110 Journal of Ayurveda and Integra 3 Sleep Problems 0.0001 < 0.05 H.S. Prak 4 Depressive Mood 0.003 < 0.05 S. in Prak 5 Irritability 0.001 < 0.05 S. in Prak 6 Anxity 0.0001 < 0.05 H.S. Prak 7 Physical and Mental Exhaution 0.036 < 0.05 S. in Prak 8 Sexual Problems 0.257 > 0.05 N.S. the 3 Prak 9 Bladder Problems 0.041 < 0.05 S. in Prak 10 Dryness of Vagina 0.014 < 0.05 S. in Prak 11 Joint Problems 0.78 > 0.05 N.S. the Dvid H.S. - highly significant, S - Significant, N.S. - N DISCUSSION As there are only a few references re menopausal symptoms in Āyurved menopausal symptoms is a repres symptoms in the Parihani stage (transit midperiod between Yuvāvasthā (you V ṛ ddhāvasthā (old age) but by analysin predominance in each menopausal symp classify these symptoms under Vāta Lak ṣ a ṇ a’s (signs specific Vata hum Pradhāna Lak ṣ a ṇ a and Kapha K ṣ aya La Vāta is the Pradhāna Do ṣ a during the la and Pitta Do ṣ a is the Pradhāna Do ṣ Madhyamavaya (middle age). As there the Pitta dominant stage to a Vāta dom during the perimenopausal period the .al. A Survey on Menopausal Symptoms in relatio ORIGINAL ARTI egrated Medical Sciences | May - June 2018 | Vol. 3 H.S. in Vātapitta Prak ṛ ti S. in Vātapitta Prak ṛ ti S. in Vātapitta Prak ṛ ti H.S. in Vātapitta Prak ṛ ti S. in Vātapitta Prak ṛ ti N.S. with any of the 3 Dvido ṣ aja Prak ṛ ti S. in Vātapitta Prak ṛ ti S. in Vātapitta Prak ṛ ti N.S. with any of the Dvido ṣ ajaprak ṛ ti Non significant s regarding the rvedic classics, presentation of nsition stage) (a young age) and lysing the Do ṣ ā ymptoms we can Vāta Pradhāna humors), Pitta a Lak ṣ a ṇ a’s . As e late age of life ṣ a during the ere is shift from dominant stage the women may experience symptoms of Vā V ṛ ddhi and Kapha K ṣ aya La certain signs and symptom under the different menopa under MRS. Ācāryā Vāgbh Kapha Prakriti individual, a a habbit of taking Ghrita Kshreera ( Jeevaniya ), and mind in those subjects the other Prakriti’s it is sa Anyathā’ [it can also be in the present study that in had more severe men Vātakapha and Pittakaph study it is observed that, Hot flushes - The sympto considered under the Pitta O ṣ a ṃ , Dhūmaka etc. It cle Do ṣ a in occurrence of hot result it is seems that individuals had hot flushes Chala Gu ṇ a of Vāta whic U ṣṇ a Gu ṇ ā of Pitta which high statistical significance hot flushes. 0 10 20 30 40 50 60 70 80 90 100 38 49 58 68 70 37 23 27 36 41 75 83 80 84 Menopausal Sym VK lation to Prakruti RTICLE May-June 2018 ol. 3 | Issue 3 67 Vāta V ṛ ddhi , along with Pitta a Lak ṣ a ṇ a . And which produce ptoms which we can correlate nopausal symptoms mentioned gbha ṭ a had mentioned that in al, and women who are having ita ( Vātapitta Prasamana ) and nd who are having a pleasant the Arthava retains long and in s said that ‘Viparītāsthatho e interpreted with the base of in Vātapitta Prakriti individual menopausal symptoms than apha Prakriti . In the present ptoms of hot flushes can be Pitta Nanatmaja Vikāra’s like t clearly states the role of Pitta hot flushes. On analysing the that 76% Vātapitta Prak ṛ ti shes, it may be because of the hich increases the Dāha and ich may be the reason for the ance of Vātapitta Prak ṛ ti and 70 73 62 58 54 38 74 41 40 34 37 37 25 51 90 93 76 71 71 59 88 l Symptoms & Prakriti PK VP

[Find the meaning and references behind the names: Buddhi, Har, Sara, Ash, Manas, Rajo, Shana, Yam, Rasak, Sana]

Dr. Divya Sreenath J. et.al. A Survey on Menopausal Symptoms in relation to Prakruti ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 68 Heart discomfort (palpitation) - The symptom of palpitation can be considered Ash ṛ ddrava which is mentioned in Nanatmajavāta Vikāra, Vātika H ṛ droga, in Rasak ṣ aya and also in Kapha K ṣ aya. From these it is clear that Vāta Do ṣ a has a role in palpitation. In 84% of Vātapitta Prak ṛ ti individuals had palpitation, it may be because of the Chala Gu ṇ ā of Vāta and Sara Gu ṇ ā of Pitta may contribute to this increased incidence. Sleep problems - Nidrānasa is multifactorial, it can occurs due to so many factors like Vāta V ṛ ddhi ( when Vāta increases Rajo Gu ṇ a also increases causing reduction in Tamo Gu ṇ a), Pitta V ṛ ddhi (Pitta V ṛ ddhi Vikāra like hot flushes), Manastāpa (Psychological symptoms) Dhātu K ṣ aya and Kapha K ṣ aya (as age advances there is Kapha K ṣ aya ) may affects the Svābhāvika Nidrā . In the present study also it is evident that the association of Vāta and Pitta had an effect in Nidrānasa as 81% of Vātapitta Prak ṛ ti individuals suffer from Nidrānasa. Psychological symptoms - As Ācāryā has mentioned that Prā ṇ a Vāyu is responsible for the normal functioning of Buddhi, Indriya and Manas . Manovikaras like Vi ṣ ādā (depression ), Udvega (anxiety), etc. may occur when there is disturbance of Vāta Do ṣ a (as Vāta Prak ṛ ti individuals are more prone to Vāta V ṛ ddhi Vikāra’s ) and also it may be due to the Śīghragu ṇ ā of the Vāta Do ṣ ā those Prak ṛ ti persons are more subjected to getting irritated easily especially during the late period of life. From the present study it is evident that, among Vātapitta Prak ṛ ti individuals 91.8% suffered fromthe symptoms of irritability. In Nanatmaja Vāta Vyādhi Ācāryā had mentioned Vi ṣ ādā as a psychological symptom due to the predominance of Vāta. As it may be the reason why 87.5% Vātapitta Prak ṛ ti individual shown the incidence of the symptom. The Tamogu ṇ a may also contribute to the development of depression in the subjects it may be the reason why Vātakapha and Pitta Kapha subjects were also observed a higher rate of incidence. ( Vātakapha - 72%) Anxiety or Udvega is seen in 94% of Vātapitta Prak ṛ ti subjects Physical and mental exhaustion - Nanatmaja Vāta Vikara, Glān i and Klama is seen more in Vātapitta Prak ṛ ti almost 77% of subject’s symptom which is comparatively more according to the remaining Prak ṛ ti . Sexual problems - As Śukra Dhātu is responsible for Har ṣ a ṇ a . As there is Dhātuk ṣ aya of Uttara Dhātu’s which may lead to k ṣ ayam of even Śukra Dhātu and certain other factors like psychological disturbances, vaginal dryness may also contribute to the change in sexual desire and it is evident from certain studies. In 72% of subjects of Vātapitta Prak ṛ ti , 63% of Pitta Kapha Prak ṛ ti subjects and 61% of Vātakapha Prak ṛ ti subjects have sexual discomfort but none of the Prak ṛ ti shoes statistical significance with the sexual problems of the subjects. Bladder problems - Vāta Do ṣ a is having major role in Sandhānakara of Śārīra. As a result of aging process due to K ṣ aya of Dhātu’s . Mā ṃ sa Dhātu also get K ṣ aya and affects the Peśī and Snāyu which may cause laxity and stress incontinence. Also leads to Śaithilyam and Sra ṃ sana which leads to the Chuthaavastha of Vasthi along with anterior vaginal wall and cause increased frequency of micturition. In this present study 68% of subjects with Vātapitta Prak ṛ ti has the symptoms. 57.4% of Vātakapha Prak ṛ ti had the symptoms of bladder problems. As we can see here the subjects with Vāta Prak ṛ ti had an increased frequency of symptom compared to Pitta Kapha Prak ṛ ti subjects. Dryness of Vagina - (along with burning sensation and dyspareunia) In Nanatmaja Vāta Vikāra’s Ācāryā has mentioned Rauk ṣ yam and Pāru ṣ yam are due to increased Vāta Do ṣ a . And also while explaining Śu ṣ ka Yoni Vyāpat, Ācāryā had mentioned Yoni Shosham as a result of increased Vāta Do ṣ a. Due to this dryness there is increased burning sensation and most of the patients have dyspareunia and lack of interest in sexual activity due to the pain and burning sensation and it may be due to the association of Rūk ṣ a Pitta there is further increase of Vāta which may contribute to the burning sensation which may be the reason why 60% of subjects with Vātapitta had the symptom

[Find the meaning and references behind the names: Priya, Anurag, Nil, Med, Chaudhary]

Dr. Divya Sreenath J. et.al. A Survey on Menopausal Symptoms in relation to Prakruti ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 69 and due to the association of Snigdha Gu ṇ a of Kapha only 40% of Vātakapha subject had the symptom. One of the limitation of my study that I couldn’t collect the data from the 250 subjects regarding this parameters because 13.2% of subjects present in the study are widowed. Joint and muscular discomfort - As there is Āsraya - Āsrayi relation between Asthi and Vāta. When the Vāta Do ṣ a increases as age advances there is K ṣ aya of Asthi Dhātu . Which result in pain in the joints as 85% of subjects have this joint and muscular discomfort. 89% of Vātapitta Prak ṛ ti subjects, 87% of Pitta Kapha subjects and 78% of Vātakapha subjects suffer from this symptoms. And none of the Prak ṛ ti shows a significant relation with this symptom. As from the above facts it is clear that most of the menopausal women suffer from the joint and muscular discomforts rather than a particular group of subject. CONCLUSION This study showed that out of the 11 menopausal symptoms 9 symptoms shows statistically significant association with the Vātapitta Prak ṛ ti of subjects, hence it can be concluded that Vata Pitta Prak ṛ ti subjects are more prone to menopausal symptoms REFERENCES 1 World Health Organization (1996). Research on menopause in the 1990’s. Report of WHO Scientific Group Geneva, (WHO Technical Report Series, No. 866). 2 Priya Bansal, Anurag Chaudhary, Menopausal problems among rural middle aged women of Punjab, International Journal of Research in Health Sciences. Oct–Dec 2013 Volume-1, Issue-3 ******************************* How to cite this article: Dr. Divya Sreenath J, Dr. Hinavath, Dr. Anjali M. V, Dr. A. Nalinakshan. A Survey on Menopausal Symptoms in relation to Prakruti . J Ayurveda Integr Med Sci 2018;3:65-69. http://dx.doi.org/10.21760/jaims.v 3 i 3.12877 Source of Support: Nil, Conflict of Interest: None declared.

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Mrish, Anxiety, Prakruti, Indian women, Statistical analysis, Quality of life, Original article, Health science, Developing countries, World Health Organization, Hormone Replacement Therapy, Post-menopausal women, Sleep problem, Hot flushes, Psychological symptoms, Life style modification, Menopausal symptoms, Irritability, Ayurveda literature, Menopause, Joint problems, Menopausal age, Hormonal change, Menopausal rating scale, Menopausal Health, Sexual problem, Middle-aged women, Bladder Problems.