MENOPAUSE – With Ayurveda IT’S “ For ME – There’s NO PAUSE ”


With the increasing life expectancy , women spend one third of their lifetime under menopausal period . Though menopause is a natural phase of the normal process of aging , it is turning into a major health problem in recent years , in the developed as well as developing countries mainly due to lifestyle changes . It is therefore need of the hour to address menopause related diseases and how Ayurveda can help from the preventive and curative aspect .

What is Menopause :

WHO has suggested the definition of Menopause as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. The diagnosis of menopause is retrospective following a period of amenorrhoea of 12 months . The average age of menopause is usually around 50 years with limits between 45 & 55 years .

Rajonivritti or Menopause is not described as a disease entity in Ayurveda. It is considered as a normal physiology which occurs due to aging .The age of Rajonivritti is mentioned as 50 years ( Jarapakwashariranaam yati pachashat kshayam ) . This is the probable age .

Rajonivritti is made up of ‘Rajah’ and ‘ Nivritti ’ where

Rajah means artava ( menstrual blood ) and stripushpa ( ovum )

Nivritti means end or cessation

Therefore , Rajonivritti can be defined as ‘Rajo stri pushpasya nivrittyasya’ ie cessation of menstruation and ovulation .

Jara ( old age ) and Rajonivritti are manifested due to progressive reduction in the function of Agni ( metabolism ) . During the period of Rajonivritti there is increase in Vata and Pitta dosha and decrease in Kapha dosha . So there is decline in nourishment and function of all the dhatus ( tissues ) of the body .

Symptoms of Menopausal Syndrome :

These can be described under 3 main headings –

1) Disturbance in menstrual pattern

2) Symptoms with Acute Onset : These are

a) Vasomotor : Hot flushes , night sweats , palpitation , headache etc

b) Genital & Sexual : Vaginal dryness , decrease in libido etc

c) Urinary : Incontinence – urge & stress , burning micturition etc

d) Gastrointestinal : Loss of appetite , bloating etc

e) Psychological : Mood swings , depression , memory loss etc

Alzheimer’s disease has been shown to be linked with declining estrogen .

3) Symptoms with Late Onset : These are

Osteoporosis :

It is responsible for greater incidence of fractures of spine (32%) , proximal femur (16%) and distal radius (15%) .

In Ayurveda , Asthikshaya (ie decrease in bone tissue ) can be compared with Osteoporosis . Strength of bone depends on the integrity of collagen matrix . Decrease in collagen matrix can be understood as decrease in Kapha ( resulting in osteoporosis ) due to increase in Vata .

Asthi is the main seat of Vata . The increase and decrease of Asthi and Vata are inversely proportional to each other ie when Vata increases , Asthi decreases and vice versa . Hence the factors which cause increase of Vata will cause decrease of Asthi .

Cardiovascular system :

Cardiovascular disease is the leading cause of death for women accounting for approximately 45% of mortality .

The incidence of coronary artery disease and myocardial infarction in women which is about a fourth of that in men in premenopausal years rapidly increases in the postmenopausal years to approximately same as men . Atherogenic lipids are also increased .

Decline in ojus and Avalambaka kapha due to increase in Vata causes cardiovascular diseases .

Cardiovascular Symptoms :

* Palpitations and precordial pains .

* Hot Flushes : They vary in number from 1-2 in 24 hours to 1 in every 15 – 30 minutes and often associated with profuse sweating .

They occur by night as well as by day and sleep is disturbed by night sweats which leave woman bathed in perspiration . Vasodilatation is followed by vasoconstriction, so after a flush comes a shiver .

Hormone Replacement Therapy :

Overall compliance with HRT is poor with dropout rates as high as 40 – 60 % . The main reasons for discontinuation of HRT are vaginal bleeding , breast tenderness , nausea , vomiting , weight gain and fear of breast cancer . A study published in Lancet by Tungstal et al in 1998 clearly established that there are no beneficial effects accrued by HRT on Cardiovascular disease .

Following the abrupt , early halt to HRT portion of Women’s Health Initiative , July 2003 , due to findings that HRT’s risks outweighed it’s benefits , headlines now read “ Menopause is not a disease , but a normal part of life ” . ‘Hormone Replacement Therapy has become simply Hormone Therapy ( HT ) ’ in recognition of the fact that replacing estrogen is not natural and brings dangerous side effects , rather than the foundation of youth once touted .

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AYURVEDIC MANAGEMENT :

To lead a quality and healthy life , Ayurveda has advocated Rasayana Therapy . Rasayana is made up of rasa and ayana.

Rasa primarily means essential seven vital tissues: rasa (lymphatics), rakta (blood), mamsa (muscle), meda (adipose tissues), asthi (bones), majja (bone marrow and nervous tissue) and shukra (reproductive element).

Ayana means the path or channel for the same.

So, rasayanas are the vitalizers ,that bring about proper uptake, growth and improvement and replenishment of the vital tissues.

Rasayana are broadly classified as three types :

a) Achara Rasayana b) Ahara Rasayana c) Dravya Rasayana

ACHARA RASAYANA ( CONDUCT ) :

It is mainly related to lifestyle management . Its two important pillars are Sadavritta ( Good conduct ) and Swasthavritta ( Healthy living ).

Sadavritta : It has been proved that good moral life with hygienic living improves the quality of life .

Swasthavritta : This includes regular exercise , hygiene , sleep and activities . Sedentary lifestyle , cigarette smoking , high intake of salt , consumption of alcohol, aerated drinks should be avoided as they are associated with a higher incidence of Osteoporosis and Cardiovascular diseases .

Muscular exercise is important to maintain strength and mineralization of bones. Yoga helps promotes better muscle co ordination and strength , also improves mental abilities and skills .

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AHARA RASAYANA ( DIET ):

Ghrita ksheeradi nityasu muditasu kaphatmasu| Artavam tishthati chiram viparitasvato anyatha || i.e daily intake of ghee ( clarified butter ) , milk , articles which increase kapha can delay the onset of menopause . Ghee is a good source of omega 3 fatty acids . It also reduces atherogenic lipids in serum. Sesamum seeds are good source of zinc and calcium , also have antioxidant property . It is best for balancing Vata . Chick peas , Bengal gram , Black grams are good sources of phytoestrogens .

Phytoestrogens are plant derived substances whose structure results in a chemical nature similar to endogenous estrogens of humans . They are adaptogens also .

All hormones act through receptors on the cell surface . Estrogen has two receptors – estrogen receptor α ( ER- α) and estrogen receptor β ( ER- β) . ER- α is predominant in uterus and pituitary . ER- β is present significantly in ovary , testis , prostate , brain , blood vessels and bones . Recent reports indicate that phytoestrogens exert their effect in a SERM ( Selective Estrogen Receptor Modulators ) like manner . They exhibit estrogenic and anti estrogenic activities in different target organs . Phytoestrogens preferentially bind ER- β . So , they act as anti estrogenic in breast and uterine tissue , but estrogenic in bone , brain and lipid metabolism .

There are four groups of phytoestrogens – isoflavones , lignans , coumestans and resorcylic acid lactones . The plants rich in lignans and isoflavonoids are : Soyabean, flax seeds , sunflower seeds , poppy seeds , caraway seeds , wheat grains , oat meal , carrots , garlic , peanuts , black and green tea . Among these flax seeds are the richest source .

Though there is no definite recommendation about the dietary amount needed for prevention of diseases but can be taken in small amounts from perimenopausal period . Lignans and isoflavonoids may have significant inhibitory role in cancer development .

Vegetarian diet helps in mineralization of bones whereas the non vegetarian diet especially containing meats causes demineralization of bones .

Menopause Myths Infographic

http://manage-your-menopause.com/8-common-myths-about-menopause/

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Ayurveda And Heart Care During Menopause


                                                      World Heart Day – 2013

This year’s theme addresses the importance of a life-course approach to the prevention and control of cardiovascular disease (CVD) with a focus on women and children. 

Today we have an opportunity to prevent the future impact of heart disease and stroke by adopting heart-healthy living from childhood throughout adulthood.

world heart day

Cardiovascular disease is the leading cause of death for women accounting for approximately 45% of mortality .The incidence of coronary artery disease and myocardial infarction in women which is about a fourth of that in men in premenopausal years rapidly increases in the postmenopausal years to approximately same as men  . Atherogenic lipids are also increased.

This has been attributed partly to alterations in lipid profile . The HDL or good cholesterol level is about 10 mg/dl higher in both pre and post menopausal women than in men . However total and LDL or bad cholesterol levels which are lower in premenopausal women rise rapidly after menopause .

According to Ayurveda , decline in ojus , avalambaka kapha due to excess of vata causes cardiovascular diseases .

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Menopause : According to WHO , Menopause is the permanent cessation of menstruation resulting from the loss of ovrian follicular activity . The average age is around 50 years with limits between 45 – 55 years .

According to Ayurveda , Rajonivritti ( menopause ) is a normal physiology which occurs due to ageing .

      Rajonivritti is made up of ‘ Rajah ’ & ‘ Nivritti ’ where

                              Rajah is artava ( menstrual blood ) , stri pushpa ( ovum )

                              Nivritti is end or cessation , therefore

‘ Rajo stri pushpasya nivrittyasya’ ie cessation of menstruation and ovulation is called Rajonivritti.

During the period of Rajonivritti , there is decline in the nourishment and function of all the dhatus ( tissues ) of body . Ageing process affects the homeostatic efficiency of the body .

Cardiovascular Symptoms :

*  Palpitations and precordial pains .

*  Hot Flushes : They vary in number from 1-2 in 24 hours to 1 in every 15 – 30 minutes and often associated with profuse sweating .

They occur by night as well as by day and sleep is disturbed by night sweats which leave woman bathed in perspiration . Vasodilatation is followed by vasoconstriction , so after a flush comes a shiver .

Ayurvedic Management :

          To lead a quality and healthy life Ayurveda has advocated Rasayan Therapy . Rasayan can be understood as a vitalizer which replenishes the vital tissues or dhatus . Rasayanas are of three types :

a)      Achara Rasayan ( Daily Routine )

b)      Ahara Rasayan ( Diet )

c)       Dravya Rasayan ( Herbs )

ACHARA RASAYAN : It is related to lifestyle management . It has been proved that good moral life with hygienic living and physically active routine improves quality of life .

                 Sedentary lifestyle , cigarette smoking , high intake of salt , consumption of alcohol , coffee , aerated drinks should be avoided as they are associated with high incidence of osteoporosis and cardiovascular diseases .

AHARA RASAYAN : A balanced vegetarian diet is the most important aspect of the preventive management of menopause . Daily intake of Ghee  ( clarified butter ) , milk  – articles  which increase kapha , can delay the onset of menopause . Ghee is a good source of omega -3-fatty acids and  reduces atherogenic lipids in serum .

                 Chickpea , Bengal gram , Black gram , Sesamum seeds , Flax seeds , Sunflower seeds , Poppy seeds , Caraway seeds , Wheat grains , Oatmeal, Garlic , Carrots , Peanuts , Green Tea etc are good source of phytoestrogens.  Though there is no definite dietary amount recommendation but can be taken in small amounts from premenopausal period .

                  Phytoestrogens are plant derived substances whose structure result in a chemical nature similar to endogenous oestrogens of humans. They have antioxidant property and are adaptogens also . Phytoestrogens act as SERM    ( Selective Oestrogen Receptor Modulators ) which produce the desired action without side effects .  They act as anti oestrogenic in breast and uterine tissue but oestrogenic in bone , brain , lipid metabolism and cardiovascular system .

DRAVYA RASAYAN : Herbal rasayanas are good anti oxidants. They also provide micronutrients in bioavailable form and are capable of nourishing the dhatus     ( tissues ) .Herbs having rasayan property are mainly – Tinospora cordifolia , Piper longum , Ocimum sanctum , Asparagus racemosa , Withania somnifera , Glycerrhiza glabra , Sida cordifolia , Punica granatum ,Embelica officinalis etc .

                For cardiovascular system Terminalia arjuna is the best cardioprotective and cardiac tonic . Along with this Allium sativum , Commiphora mukul , Vitis vinifera , Zingiber officinale , Nardostachys jatamansi etc can be taken under supervision .

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                Menopause is not an oestrogen deficient state . Rather it is a transition phase in which all the systems are affected . So Ayurveda can assist women in their journey towards better physical , mental & spiritual health during menopause .

                  Women, children and heart disease :

       ACT NOW  to protect the hearts of those you love