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 .
Rajonivrittior 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
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 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 .
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 .
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 .
June 21 was declared as the International Day of Yoga by the United Nations General Assembly on December 11, 2014.
“Yoga is an invaluable gift of India’s ancient tradition. This tradition is 5000 years old. It embodies unity of mind and body; thought and action; restraint and fulfilment; harmony between man and nature; a holistic approach to health and well-being. It is not about exercise but to discover the sense of oneness with yourself, the world and the nature. By changing our lifestyle and creating consciousness, it can help us deal with climate change. Let us work towards adopting an International Yoga Day.”—Narendra Modi, UN General Assembly
What Is YOGA :
“ Yoga” means ‘Union’ . Etymologically it is derived from Sanskrit root ‘Yuj’ meaning to bind , join , attach or join . It signifies communion with the Supreme Universal Spirit to obtain relief from pain and suffering . According to Panini grammer it has three meanings : Union (Yujir yoge), Samadhi (Yuj samadhau) and Constraint , Restraint (Yuj samyamana) .
Yoga has it’s roots in the “Yoga Sutras” authored by sage Patanjali , popularly known as Ashtanga Yoga. They are :
YAMA (Restraints) : Non –violence , truthfulness , non-stealing , sexual restraint and self surrender .
NIYAMA (Observances) : Purity , contentment , intense dedication or austerity , study of self and scriptures and self surrender .
ASANA (Psycho-physical Postures ) : It is the ‘sitting posture’ or position of the body which contributes to the steadiness of the body and mind as well as sense of well being .
PRANAYAMA : It is controlled and regulated breathing , which regulates the flow of Prana and mental processes in the body .
PRATYAHARA (Withdrawal of Senses) : The rush of senses into the outer world are held back through an innate awareness of the subtle mental processes happening during the interaction of the senses with outside objects .
DHARANA : Developing concentration through focusing the mind on any chosen thought or object .
DHYANA (Meditation) : Featured by expanded awareness .
SAMADHI : A state of shifting to a higher level of consciousness.
These practices bring about a calm and balanced state of mind & body .
Of all the practices ASANA & PRANAYAMA form the base for other higher Yogic practices.
The word ‘Asana’ is etymologically derived from the Sanskrit root ‘as’ , which means to ‘sit’ .
Asana has been defined as a position or bodily posture which not only conforms to steadiness (sthairya) but which is also equally pleasant and comfortable (sukham) i.e ‘Sthirasukham aasanam’ .
Other two characteristics of Asana are ‘Prayatna shaithilya’ i.e relaxation of effort and ‘Ananta samaapatti’ i.e merger of mind with something ananta i.e infinite .
Asana are classified into three divisions :
MEDITATIVE ASANA : For peace and calmness of mind and mental health.
Asana in this group are aimed to provide a comfortable and a stable position of the body to make the mind steady for the process of Dharana, Dhyana and Samadhi . Asana included in this group are :
CULTURAL / CORRECTIVE ASANA : For preventive and promotive aspects of health.
Asana in this group are useful for reconditioning of the body and mind as they bring stability , peace and sense of wellbeing . The postural defects , disturbed functions of various systems , improper muscle tone must be corrected in order to cultivate correct mental attitude . Asana included in this group are :
RELAXATIVE ASANA : For lightness , calmness and re energizing energy channels.
Relaxative Asana eliminate the physical as well as mental fatigue/tensions and work at the level of chitta ( subtle aspect of consciousness ) . Asana in this group are helpful for advance yogic practices such as Pranayama and Dhyana . Asana included in this group are :
Balancing Asana : Asana included in this group are:
Mayurasana, Bakasana, Kukuttasana, Shirshasana.
Topsy turvy Asana : Asana included in this group are :
Vaparitakarani, Sarvangasana, Shirshasana.
Asana means to become that you which you are going to practice. It is not make believe, it is not mimicking, it is not performance, it is not rigidity, it is simply any body position in which mind takes a seat, expands and then is redirected towards a specific point which then triggers the extraction of the samskaras, vikrutis, vikalpas, negative thoughts and emotions held there. This allowing helps in peeling the layer of blockages and enter into anandamaya kosha.
Etymologically the word Pranayama has been derived from the combination of two Sanskrit words ‘Prana’ – which means subtle life force which provides energy to different organs and also controls many vital life processes . ‘Ayama’ means expansion , control and extension .
There are three types of Pranayama – PURAKA (regulated inhalation), KUMBHAKA (regulated retention) and RECHAKA (regulated exhalation). During Puraka and Rechaka there is a movement of Prana and thought, while in Kumbhaka the cessation of movement is held to facilitate the stillness and ultimate dissolution of chittavritti or mental modifications.
It is necessary to practice Pranayama correctly and systematically , otherwise more physical disturbances will develop .
The techniques are simply to remove the friction at the various points of entry of the prana into the body. For example: Anuloma viloma to remove friction at the level of nasal septum, nasal floor and sinuses; bhramari at the level of eye and nasal bridge, ujayi at the level of vocal chords, shitali and sitkari at the level of oral apparatus; bhastrika at the level of chest; Kagi at the level of throat and so on.
Bandha is generally considered ‘lock’ as it literally means ‘to bind’, ‘to hold captive’ or ‘to contact’. In Yoga terminology Bandha is an action that binds or tightly holds the Prana. In other words Bandha are psychic locks used to raise the level of Prana and reverse the downward flow of Apana vayu. This reversal causes Apana and Prana to meet at Samana and brings about an awakening of the Prana in that area.
The opposite poles of energy are bound together in this technique. Through contraction of muscles and organs in physical body, the Shakti is accumulated into a particular center.
The Bandhas are three in number:
Abdominal Lock or UDDIYANA BANDHA
Anal Lock or MULA BANDHA
Chin Lock or JALANDHARA BANDHA
Yogic viewpoint of Disease:
It can be seen that psychosomatic, stress related disorders appear to progress through four distinct phases. These can be understood as follows:
1) Psychic Phase: This phase is marked by mild but persistent psychological and behavioural symptoms of stress like irritability, disturbed sleep and other minor symptoms. This phase can be correlated with vijnanamayaandmanomaya koshas. Yoga as a mind body therapy is very effective in this phase.
2) Psychosomatic Phase: If the stress continues there is an increase in symptoms, along with the appearance of generalized physiological symptoms such as occasional hypertension and tremors. This phase can be correlated with manomaya and pranamaya koshas. Yoga as a mind body therapy is very effective in this phase.
3)Somatic Phase: This phase is marked by disturbed function of organs, particularly the target, or involved organ. At this stage one begins to identify the diseased state. This phase can be correlated with pranamaya and annamaya koshas. Yoga as a therapy is less effective in this phase and may need to be used in conjunction with other methods of treatment.
4)Organic Phase: This phase is marked by full manifestation of the diseased state with pathological changes such as an ulcerated stomach or chronic hypertension, becoming manifest in their totality with their resultant complications. This phase can be correlated with the annamaya kosha as the disease has become fixed in the physical body. Yoga as a therapy has a palliative and ‘quality of life improving’ effect in this phase. It also has positive emotional and psychological effects even in terminal and end of life situations.
Benefits of YOGA :
Yoga aids in a physiological process of rebalancing the endocrine system where by the individual relaxes and inner balance gets restored.
It improves intra organ space and hence the physiological functions in the body . Each organ gets proper blood supply . It cleanses the accumulated toxins through various shuddi kriyas and generates a sense of relaxed lightness through vyayama type activities. Free flow in all bodily passages prevents the many infections that may occur when pathogens stagnate therein. After removal of toxins, nutrients are absorbed properly and metabolism of body improves.
Abdominal muscles become strong and accumulation of fat on belly is reduced.
Regular practice of Pranayama reduces the workload on heart in two ways. First –deep breathing leads to more efficient working of lungs . More oxygen is brought into contact with blood sent to lungs by heart . So , heart doesn’t have to work hard to deliver oxygen to the tissues . Deep breathing leads to a greater pressure differential in the lungs which leads to an increase in the circulation , thus resting the heart a little .
Pranayama helps to increase the vital capacity and strength of the respiratory muscles , resulting in efficient breathing .
Co ordination among various functions is brought about by nervous system . The nervous tissue is highly sensitive to lack of oxygen and excess of carbon di oxide. Moderate practice of Pranayama and yogic exercises help to supply enough oxygen and remove carbon di oxide .
Nasal passages have many nerve endings and breathing techniques can stimulate calming centers of brain .
Yoga integrates body movements with the breath thus creating psychosomatic harmony. In Yoga the physical body is related to annamaya kosha (our anatomical existence) and the mind to manomaya kosha (our psychological existence). As the pranamaya kosha (our physiological existence sustained by the energy of the breath) lies in between them, the breath is the key to psychosomatic harmony.
The Thyroid and parathyroid are pressed in Jalandhar Bandha . The Thymus and Adrenals are influenced by the pressure changes in the thoracic and abdominal cavities while the Gonads are influenced by Uddiyana Bandha and Mula Bandha . All these glands are kept healthy by Pranayama .
Rejuvenates the skin . The skin becomes smoother and reduces the facial wrinkles .
Improves joint function and mobility:
The Asanas promote better muscle co ordination and strength. Scientific studies on yoga demonstrate that yoga improves dexterity, strength and musculo-skeletal coordination of the practitioners. Postures assumed during yoga practice are mainly isometric exercises which provide optimally maintained stretch (https://www.yogajournal.com/teach/what-s-in-a-stretch) to the muscles. Series of asanas involve assumption of the pose followed by counter pose i.e. it involves co-ordinated action of synergistic and antagonistic muscles which brings increased steadiness, strength, stamina, flexibility, endurance, anaerobic power, better neuro-muscular coordination and improved orthostatic tolerance. Body weight is itself used to provide load to the muscles and bones. This load bearing strengthens the bones and prevents age-related weakening, thus helping in prevention of osteo-porosis. A properly selected set of exercises stretches nearly all joints and joint capsules without much danger of injuries and exhaustion.
Bera & Rajapurkar have reported significant improvement in ideal body weight, body density, cardiovascular endurance and anaerobic power as a result of 1 year yoga training in children aged 12-15 years. Clearly, yoga practices should be started at an early life.
Yoga improves cognitive functions (Improves mental and emotional health) :
It reduces Anxiety levels. Cognitive functions are intellectual processes by which one becomes aware of, perceives, or comprehends ideas. These functions help us to focus on the problem, process the required information, arrive at the logical conclusion, make decision and then execute the task. Studies show that practice of yogic techniques cause improvement in aspects of perception, thinking, reasoning, and remembering the task. Yogic techniques especially dhyan and shavasan improve attentiveness. Increased attentiveness decreases response time or reaction time. Reaction time is an index of the processing ability of central nervous system and a simple means of determining sensory-motor performance.
Effect on pregnancy:
Narendran et al found that yoga practices including physical postures, breathing, and meditation practiced by pregnant women for one hour daily resulted in an increase in birth weight, decrease in preterm labor, and decrease in IUGR either in isolation or associated with PIH, with no increased complications.
Beddoe et al found that women practicing yoga in their second trimester reported significant reductions in physical pain from baseline to post intervention. Women in their third trimester showed greater reductions in perceived stress and trait anxiety. From this it is clear that yoga can be used to prevent or reduce obstetric complications.
Yoga affects every cell of the body. It brings about better neuro-effector communication, improves strength of the body, increases the optimum functioning of all organ-systems, increases resistance against stress and diseases and brings tranquilty, balance, positive attitude and equanimity in the practitioner which makes him lead a purposeful and healthier life.
Scientific research in recent times has showed that the physiological, psychological and biochemical effects of Yoga are of an anti-stress nature.
Yoga has preventive, promotive as well as curative potential and that a yogic lifestyle confers many advantages to the practitioner. Since lifestyle related diseases are alarmingly on the rise in our modern society, yogic lifestyle that is cost effective and relatively safe, should be given a special place in preventing and managing these diseases.
“A little practice of Hatha Yoga (Asana & Pranayama) will give you good Health. Raja Yoga will steady your Mind. Upasana & Karma Yoga will purify your Heart and prepare you for the practice of Vedanta. Sankirtan will relax your Mind and Inspire you. Meditation will take you to Liberation.” – Swami Sivananda
Obesity or Sthaulya is the most common nutritional disorder in the present era. It has reached epidemic proportions globally with more than 1 billion adults overweight – atleast 300 million of them clinically obese – is a major contributor to the global burden of chronic diseases and disability.
Childhood obesity is also on rise. An estimated 22 million children under five are estimated to be overweight worldwide. The prevalence of obese children aged 6 -11 years is becoming a global problem and increasingly extending into the developing world.
Sthaulya – In Ayurveda , Sthaulya or obesity is considered as one of eight condemned human constitutions.
Sthaulya according to Ayurveda is – when a person is having excessive and abnormal increase of medodhatu ( fat tissue ) along with mamsadhatu ( muscle tissue ) and results in pendulous appearance of buttocks, belly, breasts and whose increased bulk mass is not equal to a corresponding increase in energy.
Obesity – Excess deposition of adipose tissue in the body is known as obesity. It exists when body weight is 120% above the ideal weight.
Hina Sthaulya (Overweight)
Madhyama Sthaulya (Obesity class 1& 2)
Adhika Sthaulya (Severe or Morbid Obese)
Mainly faulty diet and sedantary lifestyle. It can be classified into
Physical activity should be increased. Research shows that exercise for 10 – 15 minutes at a stretch for 4 – 5 times a day is beneficial than doing exercise for 30 -40 minutes at a stretch. Optimum time to prevent obesity is during age 5 – 10 years.
Yoga is beneficial in controlling obesity. Nadi shodhan pranayam , meditation and asanas mainly surya namaskar (Sun Salutations), paschimottanasana (Posterior Stretch Posture), suptapavanmuktasana (Lying wind release Posture ), bhujangasana (Cobra Posture), katichakrasana (Lumbar – Wheel Posture) etc help one’s body and mind to stick to the conviction and to work with firm determination.
Diabetes is the most common medical complication of pregnancy and it has increased about 40% . The increasing prevalence of Type 2 Diabetes in general and younger people in particular has led to an increasing number of pregnancies with this complication .
Women can be separated into :
– those who were known to have Diabetes before pregnancy – Pregestational or Overt
– those diagnosed during pregnancy – Gestational .
There is keen interest in events that precedes Diabetes which includes the mini environment of the uterus , where it is believed that early imprinting can have effects later in life ( Saudek 2002) . For example in utero exposure to maternal hyperglycemia leads to fetal hyperinsulinemia , causing an increase in fetal fat cells, which leads to obesity and insulin resistance in childhood . This in turn leads to impaired glucose tolerance and Diabetes in adulthood . Thus a cycle of fetal exposure to Diabetes leading to childhood obesity and glucose intolerance is set in motion .
GESTATIONAL DIABETES MELLITUS :
Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy . An alternative explanation is that Gestational Diabetes is Type 2 Diabetes unmasked or discovered during pregnancy .
Risk Factors :
a) Positive family history of Diabetes
b) Having a previous birth of an overweight baby of 4 kg or more
c) Previous stillbirth
d) Unexplained perinatal loss
e) Presence of polyhydramnios ( excessive amniotic fluid ) or recurrent vaginal infection in present pregnancy
f) Persistent glycosuria
g) Age over 30 years
i) Ethnic groups ( East Asian , Pacific Island)
The method employed is by using 50 gm oral glucose challenge test without regard to time of day or last meal , between 24 – 28 weeks of pregnancy . A plasma glucose value of 140 mg percent or that of whole blood of 130 mg percent at 1 hour is considered as cut off point for consideration of a 100 gm ( WHO – 75 gm ) glucose tolerance test .
a) Increased perinatal loss is associated with fasting hyperglycemia . Fetal anomalies are not increased due to the absence of metabolic disturbance during organogenesis in early pregnancy.
b) Increased incidence of Macrosomia ( Fetal Macrosomia is defined as infants whose birth weight exceeds 4500 gm) .
d) Birth trauma
e) Recurrence of GDM in subsequent pregnancies is about 50 %
OVERT DIABETES :
A patient with symptoms of Diabetes Mellitus ( increased urination , increased thirst , weight loss ) and random plasma glucose concentration of 200 mg / dl or more is considered overt diabetic . The condition may be pre existing or detected for the first time during present pregnancy .
According to American Diabetic Association , diagnosis is positive if
a) The fasting plasma glucose exceeds 126 mg / dl
b) The 2 hour post glucose ( 75 gm ) value exceeds 200 mg / dl
Patients with poor glycemic control and vascular disease are at increased risk of complication of IUD , IUGR , Pre eclampsia and Ketoacidosis .
During Pregnancy :
Preterm Labour ( 20% )
Infection – Urinary tract infection and vulvo vaginitis
Increased incidence of Pre eclampsia ( 25 % )
Polyhydramnios ( 25 – 50% )
During Labour :
Prolongation of labour due to big baby
Fetal Macrosomia – With good Diabetic control , incidence of Macrosomia is markedly reduced .
Congenital Malformation – It is related to the severity of Diabetes affecting organogenesis , in the first trimester ( both in Type 1 and Type 2 Diabetes ) .
Hypoglycemia ( < 37mg / dl )
Respiratory distress syndrome
In Ayurveda Madhumeha disease can be correlated with Diabetes Mellitus . Though there is no direct reference of Gestational Diabetes but GarbhaVriddhi is described as a complication .
Garbha Vriddhi : In Garbha Vriddhi , there is excessive increase in size of abdomen and perspiration . Labour is difficult .
This can be understood as Overweight fetus or Macrosomia .
Ayurveda helps in limiting the maternal and fetal complications . Herbs are helpful as a supportive treatment along with the modern medicine under supervision .
Generally beneficial , congenial , purifying and suppressive dietetics and mode of life , not causing loss of doshas and dhatus but capable of decreasing the increased doshas and dhatus should be used .
Though the most appropriate diet for women with Gestational Diabetes has not been established , it is suggested that obese women with a body mass index greater than 30 kg / m2 may benefit from a 30 – 33 % caloric restriction .
This should be monitored with weekly tests for ketonuria because maternal ketonemia has been linked with impaired psychomotor development in the offspring .
Physical Activity : Physical activity during pregnancy reduces the risk of Gestational Diabetes .Resistance exercise helps avoid insulin therapy in overweight women with Gestational Diabetes .
Pranayam and Yogasana is beneficial .
Herbs : Tinospora cordifolia , Holarrhena antidysenterica , Rubia cordifolia , Emblica officinale , Boerhavia diffusa , Withania somnifera , Tribulis terrestris , Hemidesmus indica etc can be given under supervision .
One of the major causes of absenteeism from work , decreasing efficiency and quality of life amongst women is Dysmenorrhoea , also called Menstrual cramps . The word Dysmenorrhoea is derived from Greek word : Dys – difficulty , Menorrhoea – monthly flow . Thus it is defined as pain associated with menstruation . It is the commonest gynecological disorder affecting women in reproductive age group .
In Ayurveda , the diseases in women are described under ‘ Yonivyapad ’ where Yoni means genital organs and Vyapad means diseases . One of them having similarity with dysmenorrhoea is Udavartini Yonivyapad . The cause of painful menstruation is Vata . The pain is before onset of menses which is relieved with start of menses .
Classification of Dysmenorrhoea :
a) Primary or Spasmodic : It is the painful menstruation in the absence of pelvic pathology . It is essentially a first day pain .
b) Secondary or Congestive : It is the painful menstruation secondary to underlying organic disease of the pelvic organs . Pain may continue throughout flow.
Risk Factors :
a) Menstrual Factors : Early menarche ; long and heavy menstrual cycles.
b) Cigarette smoking
c) Behaviourial & Psychological Factors :
Just before and during menstruation , most women are less efficient physically and more unstable emotionally – these factors lower the pain threshold .
Expectation of pain can be fostered by overanxious parents and by curtailment of normal physical activities during menses .
Unhappiness at home or work .
d) Uterine hyperactivity and incoordinate muscle action of the uterus .
e) Hormonal Imbalance : It has been observed that progesterone induces high tone to the uterus .
f) Prostaglandins : They increase the sensitivity of the nerve endings to pain .
Sign & Symptoms :
Primary Dysmenorrhoea :
Pain is experienced a few hours before and after the onset of menstruation and rarely lasts for longer than 12 hours .
It is colicky in type and causes her to double up .
Pain is felt in lower abdomen , inner and front aspects of the thighs .
Some low backache may be present .
During severe attack , woman looks drawn , pale and may sweat . Nausea , vomiting are common . There may be diarrhea and rectal and bladder tenesmus .
In 50 % of cases the pain does not arise until 6 – 12 months after menarche .
It usually develops after a phase of painless menstrual cycles and is seen at older age .
Pain is worst premenstrually and relieved during menses .
It is diffuse , dull ache in the pelvis often accompanied by backache .
Most common causes are Pelvic inflammatory disease ( PID ) , endometriosis , IUCD etc .
a) General Measures :
i) Counselling : Explaining young girls regarding the condition and reassurance should be an essential component in the treatment plan . Girls should be taught to have a proper outlook on menstruation and health in general .
ii) Improvement in nutritional status and dietary changes .
b) Physical Activity : It can be in the form of yoga , walk , exercise , aerobics etc . The yogasanas which are helpful in dysmenorrhoea are pavanmuktasana , bhujangasana , paschimottanasana , katichakrasana , Pranayam etc .