Menopausal Syndrome - Ayurvedic Review

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REVIEW ARTICLE August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 190 Menopausal Syndrome - Ayurvedic Review Jyoti Kanwar Solanki 1 , Sushmita Rajpurohit 2 , Sanoor Bano 3 1,2,3 Post Graduate Scholar, Department of Prasuti Tantra evam Stri Roga, Dr. Sarvapalli Radha Krishnan Rajasthan Ayurveda University, Jodhpur, Rajasthan, India. I NTRODUCTION The propagation of the species is a basic aim of nature. In the multiplication of humans, “woman has a pivotal role to play.” Right from the moment that she entered the world, or when she steps in adolescence which makes her capable to be prepared to experience motherhood, or finally the transition to menopause. Menopause is generally defined as the cessation of menses for period of 12 months or a period equivalent to three previous cycles or the time of cessation of Address for correspondence: Dr. Jyoti Kanwar Solanki Post Graduate Scholar, Department of Prasuti Tantra evam Stri Roga, Dr. Sarvapalli Radha Krishnan Rajasthan Ayurveda University, Jodhpur, Rajasthan, India. E-mail: jyotikanwarsolanki 123456@gmail.com Submission Date: 00/06/2023 Accepted Date: 00/07/2023 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.8.8.29 ovarian function resulting in permanent amenorrhea [1] Menopause is a natural phenomenon occurs at the age of 45-55 years. Various hormonal changes take place in the body during this phase of life; which results in development of several signs and symptoms that may disturb the routine activities. During reproductive years, women are protected by female hormones, i.e., estrogen and progesterone. With menopause, women enter an estrogen deficient phase in their lives, which accelerates the ageing process resulting into greater vulnerability to psychosomatic problems. These diminished hormonal levels lead to the various symptoms seen in menopausal phase which includes vasomotor symptoms like hot flushes, night sweats, headache, insomnia, dizziness, etc. Psychological symptoms include mood swings, anxiety, depression, irritability, etc. Other symptoms include loss of libido, dyspareunia, osteoporotic changes as well as cardiovascular changes. Incidence and prevalence rate of postmenopausal syndrome is 78% of population, but only 19.5% of the symptomatic women take treatment [2] Currently, the number of menopausal women is about 43 million and projected figures in A B S T R A C T Each phase of a women’s life is beautiful and should be considered as gracious. Right from the moment that she entered the world, or when she steps in adolescence which makes her capable to be prepared to experience motherhood, or finally the transition to menopause. The word ‘Menopause’ comes from the Greek word ‘Menos’ (month) & ‘Pausis’ (cessation). Menopause is a gradual and natural transitional phase of adjustment between the active and ina ctive ovarian function and occupies several years of a women’s life and involves biological and psychological changes adjustments. During the period of menopause, the women enter an oestrogen deficient phase which leads to the various symptoms. In Ayurveda the context of menopause is depicted as “ Jarapakwa Avastha ” of body and Rajonivrutti . Rajonivrutti Janya Laksana is a group of symptoms produced by degenerative changes in the body. Degenerative changes are explained in Ayurveda as Dhatukshaya Lakshana. Vata Dosha dominance is seen in the later stage of life. In Ayurveda , Menopausal symptom are regarded as imbalance of the Dosha [ Vata, Pitta, Kapha ] and Dhatukshya which occurs as a natural & gradual consequence of aging. Ayurveda has excellent solution for a safe & happy transition into menopause. Ayurveda , the science of life, advocates a holistic treatment of Menopausal syndrome by modification of diet & life style, utilizing various herbs and minerals and offers a reliable option to the convention treatment. Ayurvedic treatment for menopause involves correcting hormonal imbalance with appropriate diet, Samshamana therapy, internal detoxification ( Panchakarma therapy), Rasayan therapy and Yoga therapy. Key words: Menopausal syndrome, Menopause, Rajonivrutti, Rasayan, Panchakarma, Yoga therapy.

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Jyoti Kanwar Solanki et al. Menopausal Syndrome - Ayurvedic Review ISSN: 2456-3110 REVIEW ARTICLE August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 191 2026 have estimated to be 103 million [3] So, menopausal health demands even higher priority in Indian scenario. In Ayurveda , the context of Menopause is depicted as “ Jara Pakva Avastha” of body and Rajonivrutti . Though, Rajonivritti as a diseased condition is not described separately in the classical Ayurveda texts, Rajonivritti Kala are mentioned by almost all Acharyas without any controversy. According to Acharya Sushruta and various other references, 50 years is mentioned as the age of Rajonivrutti [4] Menopause is linked with Vata Dosha dominated stage of life. Therefore, symptoms in menopausal phase like insomnia, anxiety, urinary symptoms, osteoporotic changes are due to dominance of Vata Dosha . Along with those Pitta Dosha symptoms like hot flushes, irritability, etc. are seen, during this phase. Rajonivrutti Janya Lakshan is a group of symptoms produced by degenerative process of body. Degenerative changes are explained in Ayurveda as Dhatukshaya Lakshana. Modern Aspect of Menopause Menopause is defined as permanent cessation of ovarian function resulting in permanent amenorrhoea, it occurring between ages of 45-50 years of average is 47 years. Climacteric is a phase of declining in ovarian function. Therefore, no corpus luteum and hence no progesterone is secreted by the ovary leading to anovulatory cycle and thus irregular menstruation occurs. Later graafian follicle formation also stops, oestrogen activity and atrophy of endometrium leads to amenorrhoea. Therefore, there is a fall in oestrogen level and rebound increase in FSH and LH by anterior pituitary gland [5] Cause of Menopause Menopause is a natural process that occurs as the ovaries age and produce less reproductive hormones. The body begins to undergo several changes in response to lower levels of: ▪ Oestrogen ▪ Progesterone ▪ Testosterone ▪ Follicle-stimulating hormone (fsh) ▪ Luteinizing hormone (LH) In some cases, menopause is induced, or caused by injury or surgical removal of the ovaries and related pelvic structures. Common causes of induced menopause include: ▪ Bilateral oophorectomy, or surgical removal of the ovaries ▪ Ovarian ablation, or the shutdown of ovary function, which may be done by hormone therapy, surgery, or radiotherapy techniques in women with oestrogen receptor-positive tumours ▪ Pelvic radiation. ▪ Pelvic injuries that severely damage or destroy the ovaries. Menopausal Symptoms Hot flushes Insomnia Mood changes Vaginal dryness Atrophic vaginitis Cystitis Drying out and thinning out of skin Palpitations Loss of libido Osteoporosis Anxiety/Depression Diagnosis of Menopause 1 Cessation of menstruation for consecutive 12 month during climacteric. 2 Appearance of menopausal symptoms “hot flush “and “night sweat”. 3 Vaginal cytology - showing maturation index of at least 10/85 /5 (feature of low oestrogen) 4 Serum oestradiol; 40 mIU/ ml (three values at weeks interval required)

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Jyoti Kanwar Solanki et al. Menopausal Syndrome - Ayurvedic Review ISSN: 2456-3110 REVIEW ARTICLE August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 192 Management 1 Counselling 2 Antioxidants and multivitamins 3 HRT (hormonal replacement therapy) HRT has wider range of secondary health complications like vaginal bleeding, breast cancer, endometrial cancer etc. There is increased incidence of malignancy and thromboembolic disease. Ayurveda aspect of Menopause In Ayurveda, Menopausal symptoms are regarded as “imbalance of the Dosha (Vata, Pitta, Kapha) which occurs as a natural and gradual consequence of aging. Nidana of Rajonivrutti The specific reasons for Rajonivrutti are not described in the Ayurvedic texts. But the most probable reasons for it to occur are [6] 1 Swabhava 2 Jarapakvasharira due to Kala 3 Dhatukshaya 4 Effect of Dosha 5 Vayu 6. Abhighata Types of Rajonivrutti In some manners, Rajonivrutti is a naturally occurring condition in every woman as that of Jaravastha etc. Swabhavika Vyadhies . So Rajonivrutti also can be divided into two types: 1) Kalaja Rajonivrutti 2 ) AkalajaRajonivrutti Lakshanas of Rajonivritti As there is no direct reference available regarding Lakshanas of Rajonivritti in the Ayurvedic classics, the clinical symptoms manifested by the patients of Rajonivritti are the manifestations of Dhatukshayaja Lakshanas along with vitiated Doshas . Samprapti of Rajonivritti (Menopausal syndrome) Vataja Lakshana Shirahshoola (Headache), Hrid Spandana (Palpitation), Hasta Pada Suti (Numbness), Shabda Asahishnuta (Noise- Intolerance), Bala-Kshaya (Weakness ), Adhmana (Distension of abdomen), Vibandha (Constipation), Anidra/Alpanidra (Sleepnessness), Bhrama (Vertigo), Anavasthita Chitatvam (Mood swing), Vaichitya (Loss of concentration), Vishaada (Depression), Chinta ( Anxiety), Smritimandhya (Decreased memory), Krichchhra Vyavayata (Loss of libido), Maithunaasahishnuta (Dyspareunia ), Vak Sang (Change in voice), Vali (Wrinkling of skin), Asthivedana (Pain in bones), Katishool (Low backache), Sandhi Vedana (Joint pain), Vamanatvam (Loss of ht.), Angamarda (Body ache), Yoni Vedana (Pain in vagina), Yoni Shushakta (Vaginal dryness), Prabhutamutrata (Frequency), Urge incontinence , Mutrakrichhrata (Pain in micturition). Pittaja Lakshana Osha (Hot flushes), Atisveda (Sweating ), Amarsha (Irritability), Yoni Daha (Burning sensation), Yoni Daurgandhya (Foul smelling), Mutradaha (Burning sensation in Urine). Kaphaja Lakshana Atisthaulaya (Weight gain), Yoni Kandu (Itching), Yoni Srava (Vaginal discharge).

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Jyoti Kanwar Solanki et al. Menopausal Syndrome - Ayurvedic Review ISSN: 2456-3110 REVIEW ARTICLE August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 193 Management From the above theory we can conclude that various Ayurvedic drugs having properties of Rasayana , Vata Shaman and Kapha Vardhan can be helpful in the management of menopausal syndrome. In the early pre‐menopause stage it is better to balance the aggravated or underplaying factors, so that the intensity of the menopause symptoms will be far less or even can be negligible. Ayurveda has excellent solution for a safe and happy transition into menopause Ayurvedic Treatment for Menopausal Symptoms involves correcting Dosha imbalance with appropriate diet, Samshamana therapy, internal detoxification ( Panchakarma therapy/Samshodhan therapy), Sattvavjaya Chikitsa , Yoga therapy , Rasayan therapy . Vata dominant menopause Diet - Increase warm food and drinks, regular meals, and use spices such as fennel and cumin. Decrease caffeine and other stimulants, refined sugar, cold drinks, salads. Lifestyle - Early bedtime, oil massage using almond and olive oil, meditation, yoga, Regular exercise like walking Herbs - Ashwagandha ( Withania somnifera ), Arjuna ( Terminalia arjuna ), Cardamom ( Elettaria cardomam ), Garlic ( Allium sativum ), Guggulu ( Commiphora mukul ), Sandalwood ( Santalum alba ) and Zizphus ( Ziziphus jujube ). Pitta dominant menopause Diet - Increase cooling foods, water intake, sweet juicy fruits (grapes, pears, plums, mango, melons, apples, zucchini, yellow squash, cucumber, organic foods. Use spices such as cinnamon, cardamom and fennel. Avoid hot spicy foods, hot drinks and alcohol. Lifestyle - Oil massage using coconut and sesame oil. Use Meditation and other techniques to reduce anger, hatred and resentment. Exercise and exposure to the sun are limited. Herbs - Aloevera, Arjuna ( Terminalia arjuna ), Amla ( Emblica officinalis ), Saffron ( Crocus sativus ), Sandalwood and Use spices such as cinnamon, cardamom and fennel. Kapha dominant menopause Diet - Prefer light, dry and warm food, Consume fruits, whole grains, legumes, and vegetables. Use spices such as black pepper, turmeric and ginger. Avoid meat, cheese, sugar, cold foods and drinks. Weekly fasting is helpful. Most or all of the daily food should be consumed before 6 p.m. Lifestyle - Get up early. Mustard oil and linseed oil are often recommended for massage. Herbs - Cinnamon, Guggulu ( Commiphora mukul ), Mustard ( Brasscia nigra ), Haritaki ( Terminalia chebula ), Nagarmotha ( Cyperus rotundus ). Panchakarma ▪ Snehan - (Appling medicated oil all over the body) Bala oil, Mahanarayan oil. ▪ Swedan - (taking steam) using Dashmul decoction, Pottali pind sweda. ▪ Shirodhara - Shirodhara found to be effective in the management of disturbed psychological symptoms. Shirodhara with Shatavari oil, Takra dhara, Dashmool kwath can be helpful [7] ▪ Nasya - (instillation of oil through nasal opening) Panchendriya vardhan oil, Anu tail. ▪ Uttarbasti - (medicated oil is instillation through the vaginal or urethral opening) Yastimadhu tail. ▪ Pichu - (medicated tampons kept in the vagina) Shatavari Tail , Shatdhaut Ghrita. ▪ Basti - specially Anuvasan Basti (oil based medicated enema). Yoga therapy - Yoga is an original & ancient holistic art of living that include physical, mental, moral, spiritual spheres. The Sanskrit word Yoga means to “join or union” and the practice of Yoga beings this union to all levels of one’s self. The eight limbs of Yoga - Yama, Niyam, Aasana, Pranayama , Pratyahar, Dharana, Dhyana, Samadhi . The most commonly performed Yoga practices are postures ( Aasana ), controlling breathing ( Pranayama ) & Meditation ( Dhyana ) Asana -

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Jyoti Kanwar Solanki et al. Menopausal Syndrome - Ayurvedic Review ISSN: 2456-3110 REVIEW ARTICLE August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 194 Savasana, Padhmasana , Varjasana Pranayama - Sheetali Pranayama, Ujjayi Pranayama. Yoga Therapy is a useful adjunctive complementary & integrative for menopausal women. Current evidence indicates that women will benefit from Yoga therapy during menopausal transition in term of decrease risk of cardiovascular disease, insulin resistance & loss of bone mineral density as well as improved psychological wellbeing, sleep patterns & emotional modulation. Rasayana Therapy Rasayana therapy is not only preventing the aging changes, but it brings in youth fullness to a person. It increases life span, memory, & intelligence health; improve color & complexion, Strength & performance of the organs of cognition & conation. Rasayana drugs act by strengthening all seven Dhatus. According to Aacharya Charaka , Rasayana produces long life lasting memory, talent, healthy physique, youth, lustre bright complexion, good voice, strength of body and senses, truthfulness, respect, and glowing body [8] Aacharya Charaka has described “ Rasayana” as a means to promote vigour and health which is mainly virilific and promotive of vitality [8] Maharsi Susruta has defined ‘Rasayana’ as the method which retards the aging process, increases longevity, talent, vitality and makes the body fit to overcome the factors causing ailments [9] Many drugs act as Rasayana properity: Triphala Triphala consisting of Haritaki ( Terminalia chebula ), Vibhitaki ( Termanalia belerica ), Amalaki ( Embelica officianalis) , pacify all the three Doshas & also is an excellent Vayasthapana (anti-aging agent) Ashwagandha ( Withana somnifera ) ▪ It is a powerful antioxidant & immune modulator. ▪ It is one that improves strength, muscle mass, relieves stress. ▪ In Menopause patient, it controls effectively the vasomotor symptoms (Hot flushes, night sweats, palpitation) Yasthimadhu ( Glycerrhiza glabra ) ▪ It is another Rasayana drug which is prescribed for Menopause. ▪ It is an excellent antioxidant, Immuno modulator & anti-depressant, memory enhancer. ▪ It is described as a promoting agent for life, voice, hair, complexion, strength & libido. ▪ Classical anti-aging Formulation e.g., Chyavan Prasha & Brahm Rasayan. Medhya Rasayana The Ayurvedic texts describe certain Rasayana drugs which specially influence the Medha and promote mental competence. Such Rasayan are called as Medhya Rasayana . Aacharya Charak has described four Medhya Rasayanas namely Sankhpushpi, Mandukaparni, Guduchi and Yastimadhu. [10] Such Medhya Rasayana drugs have been scientifically studied in recent years and they have been reported to possess varying degree of Anxiolytic and psychotropic activity besides restoration of intelligence and memory. CONCLUSION Each phase of a woman’s life is beautiful and should be considered as gracious Nowadays, symptoms related to menopause are becoming a major problem; for which a safe and effective line of treatment is necessary. The basic concept of Ayurvedic medicine is “ Swasthsya Swastya Rakshanam and Aturasya Vikara Prasamanam ” prevention is better than cure. Ayurveda have different way to overcome the menopausal symptoms. The ways are like; Diet, Samshana Chikitsa, Panchkarma, Rasayana, Yoga, Pranayama etc. Menopausal symptoms generally occur due to disturbed Vata Dosha . Dhatukshay is responsible for Vata Vruddhi and vitiated Vata Dosha affects various systems in women’s body. From the above theory we can conclude that various Ayurvedic drugs having properties of Rasayana , Vata Shaman and Kapha Vardhan along with Panchakarma , Sadvrutaa, balanced diet, Yoga , meditation can be helpful for the management of menopausal syndrome. REFERENCES 1 ADT.Govan / D.Mckayhart Robin. Callander, Gynaecology illustrated, church hill living stone

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Jyoti Kanwar Solanki et al. Menopausal Syndrome - Ayurvedic Review ISSN: 2456-3110 REVIEW ARTICLE August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 195 Publications Chapter 19 th. The menopause pg no 472 - 483 2 http://en.m.wikipedia.org/wiki/Menopause 3 Bavadam L. HRT and older women in India. HAI News, 108, August 1999. Available from: http://www.haiweb.org/pubs/hainews/aug 1999.html [Accessed on 2012 Mar 19]. 4 Kaviraaja Ambika Dutta Shastri edited with Ayurveda Tattva Sandeepika. Susrutha Samhitha hindi commentary. Chaukhambha Sanskrit Sansthan, Varanasi. reprint 2007, 5 Howkins & Bourne Edited by V.Padubidri & Shrish N Daftrary, Shaw text book of Gynaecology by 11 th edition, Church hill living stone Pvt. Ltd. New Delhi Chapter 3 Physiology, pg no. 53-57 6 Mamta Rani. Post graduate dept of Prasutitantra & Streeroga, Thesis. A clinical study on th e role of “Mensol compound” in the management of Menopausal Syndrome, NIA, Jaipur. 7 http://mymenopausejourney.com 8 Sri Satya Narayana Sastri. Charaka Samhita of Agnivesa, Vidyotin Hindi Commentary. Published By Chaukhambha Bharati academy, Varanasi. 2009, Page- 5. 9 Kaviraja Ambikadutta Shastri. Susruta samhita of Maharsi Susruta Ayurveda, Tattva-Sandinpika Hindi Commentary. Published by Chaukhambha Sanskrit Sansthan, Varanasi. 2010, Page-6. 10 Sri Satya Narayana Sastri. Charaka Samhita of Agnivesa, Vidyotin Hindi Commentary. Published By Chaukhambha Bharati academy, Varanasi. 2009, Page- 39. ******************************* How to cite this article: Jyoti Kanwar Solanki, Sushmita Rajpurohit, Sanoor Bano. Menopausal Syndrome - Ayurvedic Review. J Ayurveda Integr Med Sci 2023;08:190-195. http://dx.doi.org/10.21760/jaims.8.8.29 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2023 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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