A Journey to Happiness – Ayurvedarian

A woman–wonderful wife, outstanding friend, marvelous daughter, adorable sister and a nurturing mother–are some of the roles she takes along with her professional roles. During this journey of her life, she transits through another journey that is her reproductive health journey. From an innocent small cute girls transiting through menarche, fertile years, then through perimenopause, menopause and post menopause years, the female body and mind goes through immense physical, physiological and psychological changes. Today’s lifestyle and stress levels along with unhealthy diet and food habits has multiplied the mild symptoms to transform into major conditions hampering the normal life of a women during the menopausal years. Ayurveda being a lifestyle science has definitely mentioned menopause but not as a disease but as a natural aging process. One of the most important branches of Ayurveda-Rasayana tantra gives numerous methods, treatments and medicines to balance, maintain and heal the body during this journey and make it a Merry Menopause instead of suffering and depression.

The word menopause is derived from two Greek words meno & pause–meaning monthly stops. It basically indicates that the monthly production of eggs in the female comes to an end and thereby cessation of menstrual cycles is seen. It is a simple natural process which happens only in humans and actually is not a disease.

Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity. A woman is considered to have attained menopause when she experiences cessation of menses for a period of 12 months. During the fertile reproductive years, woman and her health are protected exclusively by female hormones like estrogen and progesterone. During perimenopause, menopause and post menopause, a decline in the amount of hormones estrogen and progesterone is seen. There are 03 phases of endocrinal changes–

1. Hypothalamic Pituitary Hyperactivity–starts 5-15years before menopause
2. Ovulation and Corpus Luteum Failure-Anovulatory cycle and shortened luteal phase–deficient progesterone and estrogen may lead to abnormal uterine bleeding and endometrial hyperplasia.
3. Ovarian follicular failure–failure in follicular development due to reduced estrogen.

Increase in FSH, decrease in estrogen, increase in LH and decrease in AMH is seen. Physiologically ovaries shrink, wrinkle in size. Fallopian tubes show atrophy and cilia disappear. Uterus becomes smaller, endometrium becomes thin, cervical secretion becomes scanty. Vagina becomes narrow due to loss of elasticity, pH becomes alkaline. Breast fat is reabsorbed and so becomes flatter. Bladder and urethra epithelium becomes thinner and prone to infections.

Menopausal symptoms-Other than cessation of menses, women experience various symptoms during the period. These symptoms may vary from woman to woman.

1. Vasomotor symptoms-hot flushes, night sweats etc
2. Osteoporosis and weak bones
3. Cardiovascular diseses
4. Urogenital symptoms-UTI, vaginal dryness etc
5. Psychological changes
6. skin and hair changes
7. Breast changes
8. Sexual dysfunction
9. Ophthalmic dysfunction
10. Dementia and cognitive decline

According to Ayurveda, Human lifespan is divided into Balyavastha (kapha predominant), Madhyamavastha(pitta predominant), & Vrudhavastha (Vata predominat). Sushrutacharya explains thus–Rajonivrutti is that phase of woman’s life where she is transcending from Madhyamavastha to Vrudhavastha. Because of predominance of Vata laghu & especially ruksha guna (dryness) starts in the body leading to Rasa dhatu kshaya inturn to Arthava (menses) kshaya or diminishment and finally stopping of menses/Rajas. The symptoms observed are also generally related to imbalance of Vata dosha. Some of the causative factors Ayurveda mentions for Rajonivrutti are:

1. Swabhava–natural phenomenon experienced by all women
2. Kala or Vayas–As the women starts moving into Vrudhavastha age -it occurs
3. Dhatukshaya–because of increase in Vata, rasa dhatu kshaya is observed. This can be the natural increase in Vata or can be observed in younger women due to their diet and lifestyle as well.
4. Karma–deeds performed–Purvajanmakrita or even Ajanmakrita-lifestyle and diet disruption causing Vata imbalance.
5. Abhighata–Injury to the arthava srotas or the reproductive system can cause early menopause or Akalaja rajonivrutti.

Treatment & Lifestyle Protocols

Modern medicine advises symptomatic treatments/medicines in perimenopausal/menopausal conditions. Since there is decrease in estrogen and this is the main cause of all symptoms HRT or Hormone Replacement therapy is one of the widely used treatments. In severe cases of heavy bleeding, prolapse etc complete hysterectomy or partial hysterectomy is suggested.

Ayurveda being a holistic science believes that vata imbalance as the cause of all the various symptoms and thereby vatahara or vatashamana therapies are advised. Both internal and external medicines and treatments as well as Panchakarma therapies are advised. Rasayana chikitsa which helps to rejuvenate body and mind is also administered after proper cleansing is done.

Before going on further into specific herbs and diet indicated for Menopause in Ayurveda, I would like to just discuss few points on Estrogen, its importance, its deficiency symptoms, and phytoestrogens usage.

Estrogen are a group of hormones that play an important role in growth and reproductive development in a woman-estradiol, estriol and estrone. Estrogen contributes health and other bodily processes in addition to reproductive functions. It is present in both male and female but more in females. The ovaries, adrenal glands and the fat tissues in the skin produce estrogen. Estradiol produced in both men and women, is the hormone which maintains the reproductive health of a woman. Estrone the weaker form of estrogen is seen after menopause. Estriol helps and prepares the uterus during pregnancy and maintains uterine health. Some of the main functions of estrogen include:

1. Stimulation of growth of egg follicle
2. Maintains vaginal wall thickness and lubrication
3. Maintains the uterine membranes and secretions
4. Aids in formation of breast tissue

Estrogen levels vary between individuals. Estrogen levels also vary in various periods of woman’s lifetime. They are influenced by factors like pregnancy, breast feeding, puberty, menopause, age, obesity, diabetes, high blood pressure, extreme dieting, strenuous exercise/training, PCOS, underactive pituitary function, congenital conditions, tumors of ovaries or adrenal glands and usage of certain medications like steroids, antibiotics etc.

Imbalance of estrogens leads to some of the symptoms like

1. Irregular or no menstruation
2. Light or heavy bleeding
3. Severe pre menstrual or menopausal symptoms
4. Hot flashes, night sweats
5. Mood swings, sleeping problems
6. Weight gain, low sexual desire
7. Vaginal dryness and strophy
8. Fatigue, depression and anxiety
9. Dry skin

Most of these symptoms are seen during menopause and hence we can say that estrogen imbalance is the cause of menopause. From the Ayurvedic perspective, all these symptoms are because of imbalance of Vata thereby confirming the fact that Vata increases during the later ages in woman.

Hormone Replacement Therapy or estrogen therapy is the most commonly used line of treatment for menopausal women.

Ayurveda being an holistic science believes in treating the natural transition symptoms naturally and thereby lot of stress is given on diet and lifestyle changes along with Rasayana therapy. The diet and the medicines used in rasayana therapy mainly include phytoestrogens–which are compounds naturally present in plants. When substances rich in phytoestrogens are consumed, our bodies respond as if natural estrogens are released and thereby symptoms are reduced. According to modern nutrition some of the most significant and notable sources of phytoestrogens include angelica, black cohosh, broccoli, carrots, chaste tree berry, coffee, dong quai, evening primrose, legumes, licorice, oranges, red clover, soy and soy products and tea.

Ayurveda considers rajonivritti as Dhatu Kshaya and therefore Rasayan therapy is followed. Most of the diet and herbs mentioned for Rasayana therapy are rich in Phytoestrogens and they exert theri effect in Selective Estrogen Receptor Modulator (SERM) through this they effect the endogenous production of estrogen. Madhura Rasa (sweet taste), Madhura vipaka & Sheetavirya drugs/food which pacify vata & pitta are used. Some of the most commonly used herbs include:

1. Yastimadhu, brahmi-Medhya Rasayans-improve neural functions
2. Amalaki, ashwagandha, Shatavari, Arjuna-as rasayanas
3. shankha Bhasma, Praval bhasma, Ashwangandha preparations to improve calcium
4. Garlic based preparations help in reducing harmful lipids in the body

Ayurvedic treatments like Abhyanga, Shirodhara, Shiro pichu, are very effective for reducing hot flushes, aches and pains. Ayurveda also advises diet-

Pathya:

1. Consume vata pitta pacifying diet which is warm, fresh and consciously cooked
2. Consume regular meals on time
3. Consume lots of green leafy vegetables and legumes
4. Drink coconut water

Apathya:

1. Avoid high sugar food items
2. Avoid sour and spicy foods
3. Avoid too much of caffeine and stimulants
4. Avoid alcohol, cold drinks
5. Avoid eating late at night

Some of the daily regimens which have to be followed includes:

1. Early to bed and early to rise
2. Regular oil massage (Abhyanga) with suitable vata pacifying oil
3. Regular Nasya treatment
4. Regular morning walk (at least 30min)
5. regular practise of yoga and pranayama like supta baddha konasana, setu bandasana, marjalasana, seetali, bramari, anuloma-viloma pranayama.

Menopause or Rajonivrutti is a natural process experienced by all women but the modern lifestyle, diet, stress and other factors has either had to untimely menopause or complications during menopause, HRT in modern medicine just targets balancing of hormones i.e., estrogen but Ayurveda takes into account the vata pitta vitiation, kapha and dhatu kshaya-and thereby offers a holistic approach to the condition whether timely or untimely menopause. Inclusion of phytoestrogen rich herbs and diet shows the knowledge of our ancient sages in providing a healthy and holistic wellness for women during this difficult stage of her journey. Socio-psychological support of the family and friends is also of utmost importance.

Menopause or for that matter any of the milestones in a woman’s life or even a man’s life has to be celebrated. Superstitions, myths, irrelevant customs and traditions have to be avoided. Knowledge of what is happening in one’s body has to given to a girl or a boy, man or a woman. Supporting each other physically or emotionally during this journey will make the journey enjoyable. So it is everyone of our duty to empower each other (without any gender bias) with the knowledge and thereby support each other. Speaking to each other about the subject without any embarrassment is very important. Finally as Dr. Macha says-“It is better to stay well than to get well”

So Be Informed Stay Healthy Stay Well Enjoy the beautiful Journey of Life.