What is Amenorrhea?
Amenorrheais known as an Anartava in Ayurveda. It is a condition mentioned in the Stree Roga Chikitsa(female-related diseases). The Sanskrit termfor amenorrhea is Anartava or Nashta Artava (Nashtameans ‘lost, destroyed or missing’ while Artavmeans ‘monthly cyclical bleeding or menstruation’). Anartavais one of the symptoms ofVata imbalance. Amenorrhea is a condition in which there is an absence of menstruation.
This absence can be considered normal (physiological) – before puberty, after menopause, as well as during pregnancy and lactation. The state of absence of menstruationafter puberty and before menopause can be considered pathological amenorrhea.
The absence of menstruation for six consecutive months before menopause in women who have previously had regular periods is also termed pathological amenorrhea. This condition is called Artav Avrodh (suspension of menstruation).
Types of Amenorrhea
Primary amenorrhea occurs when a woman reaches 18 years of age and has never had a monthly cycle.
Causes of Primary Amenorrhea
- Hormonal imbalance
- Ovarianfailure and polycystic ovary syndrome
- Tumor in the pituitary gland
- Disturbed function of the endocrine systemthat affects maturation at puberty, i.e. hypothyroidism or hyperthyroidism
- Birth defects in the reproductive structures, i.e. transverse disorders of the functional uterine endometrium and Mullerian anomalies.
Secondary amenorrhea is characterised by the lack of menstrual cycle for three or more than three months in women who have had a normal menstrual period before.
Causes of Secondary Amenorrhea
- Problems that affect the estrogen levels, e.g. stress, weight loss, intense exercise, illnesses, hormonal imbalance
- Problems affecting the pituitary, thyroid, or adrenal glands
- Ovarian tumorsor surgical removal of the ovaries
- Resultant from the intake of birth control pills
Organs Responsible for the Regular Menstruation
According to Charaka Samhita, “a woman would never suffer from gynecological diseases exceptdue to aggravated Vayu“. Therefore, the aggravated Vayushould be alleviated first, prior to administering any therapy for balancing the other energiesinvolved.
Causes of Amenorrhea Related to the Condition of the Doshas (Etiology with an Ayurvedic Perspective)
State of the doshas: High Vata and Kapha, low Pitta
Eating excessively cold, light and dry foods or taking cold or fizzy drinks increases the Vata energy in the body. The regular consumption and excessive intake of food that generates gas during digestion (cabbage, broccoli, cauliflower, beans, lettuce, mushrooms, parsley, peas, yeast-based products, white flour and white sugar) aggravates Vata.
Excessive consumption of fried foods, heavy creams, and puddings increases the Kapha energy. The gradual aggravation of Vata and Kaphaleads to a blockage of the Artavavahi srotas and causes amenorrhea. The inappropriate and stressful way of life is the main cause of Vata deterioration.
Excessive physical exercise, improper ways of sexual intercourse, use of artificial objects for reaching orgasm, sedentary lifestyle, lack of exercise, temperature extremes (both cold and hot) also lead to an energy imbalance.
Symptoms besides amenorrhea
- Weight loss (in hyperthyroidism) or weight gain (in myxedema or PCOD)
- Absence of menstruation
- Changes in breast size
- Breast discharge
- Abnormal hair growth and acne on the face (for PCOD)
- Vaginal dryness (related to Vata vitiation)
- Changes in voice
Laboratory Tests Required
- Hemogram: to rule out Pandu (anemia), and WBC count to rule out infection
- Thyroid function(Vata and Pitta vitiation causes hyperthyroidism while Vata and Kapha vitiation causes hypothyroidism)
- Ultrasound imaging(USG abdomen, to rule out bicornuate uterus or infantile uterus)
- HSG (hysterosalphingography) to rule out Srotorodha (Fallopian tube obstruction)
Ayurvedic Pathogenesis of Amenorrhea
When digestion is impaired (by Vata or Kapha, or both), instead of healthy nutrient plasma, Ama or toxinsare produced. Ama accumulates in the weaker channels of the body. When toxins accumulate in the Rasavahi srotas (which carries the nutrient plasma), Artavavahi srotas(which carries the menstrual flow) or Purishvaha Srotas(responsible for the downward movement) and block them, the flow of menstruation stops, which can lead to amenorrhea. This is principally Samana, Vyana, and Apana Vayu Pathology.
Aggravated Vata and Kapha increase the cold aspect of the body, which leads to low Pitta, or a decrease in the hot aspect. Menstrual blood is analogous to Pitta. Thus, low Pitta or a low hot aspect leads to a decrease or loss of menstrual blood.
Panchakarma and Amenorrhea
Women with amenorrhea should consider a series of Ayurvedic Panchakarma treatments. The first stage is cleansing the body. Sroto rodha (blockages in the micro- and macro channels of the body system) will be relieved and proper nourishment will take place.
Oil Massage and Steam (Abhyanga, Seka, Swedana)
Oil ayurvedic massages and steam baths are beneficial as these treatments are Vata-pacifying and very nourishing to the system. The Dhanwantaram Tailam oil is particularly appropriate. The Udvartnam treatment with Triphala churnam is very effective in combating amenorrhea.
Different kinds of medicated enemas also help for treating the condition.
- Basti – Anuvasana vasti(oil-containing enemas)
- Uttara Basti– medicated oils are applied directly inside the uterus. Phala Ghritham is used for Uttara Basti. In case of an underdeveloped uterus, the therapy is performed with Kshara Tailam. Kasis Tailam is used for patients with blocked tubes.
- Anuvasana and Uttara Bastihelp to encourage the downward movement of Vata. This is known asAnuloman, meaning to facilitate the downward movement through action. The therapy has a Vata-pacifying effect (Vata Shaman) while also unblocking the Artavavahi and the Purishvaha srotas.
Shirodhara with various oils such as Jatamansi and Brahmi can help pacify Vata, relieve anxiety and stabilize the mind. It also works on the pituitary gland and thus helps in hormonal regulation. Shirodhara with a Triphaladecoction is another possible option.
These treatments would be most helpful if the woman repeated them several times per month until her menstruation returned.
Herbs to Treat Amenorrhea
Aloe vera juice is best for primary amenorrhea.
Asparagus racemosus roots known as Shatavari are used medicinally in Ayurveda. Shatavari is a heavy and oily tonic often used for gynecological purposes by Ayurveda, as well as to strengthen female hormones. Its demulcent properties help to nurture the mucous membranes. It acts simultaneously by nourishing and cleansing the blood and the female reproductive organs.
Vidarikand or ‘Ipomoea digitate’ falls into the category of rasayana and demulcent herbs. Vidarikand has a marked estrogenic and progesteronogenic activity with no toxicity. In addition, patients have responded positively when taking Vidarikand as a replacement for routine hormonal therapies.
Turmeric (Curcuma longa)helps to regulate menses by cleaning the liver. It is an important herb to decongest the Artavavahi srotas, which also works on the metabolism of fats by reducing Kapha and Ama,and increasing Pitta.
Classical Ayurvedic Formulations Used to Treat Amenorrhea
- Rajatha Bhasmam
- Hinguvachadi Churnam
- Gulguluthiktham Kashayam
- Sukumaram Kashayam
- Kulathadi Kashayam
- Rajahpravarthini Vati
Herbal Tea or Drinks
Medicated wines such as Drakshasavam or Kumaryasavam, half-diluted takra, curd and cumin tea, ginger tea, and cinnamon tea are recommended to remove blockages, increase Pitta, and pacify Vata and Kapha. They also increase menstrual flow.
Diet and Lifestyle Advice
A diet that will stimulate Pitta while pacifying Vata and Kapha is advised.
Unhealthy diet – not recommended for patients with amenorrhea
- Intake of excessively cold and dry foodsthat increase Vata in the body;
- Consumption of gas-producing vegetablessuch as cabbage, broccoli, cauliflower, beans, lettuce, mushrooms, parsley, peas, as well as excessive yeast-based products, white flour and white sugar products, as these all increase Vata;
- Excessive consumption of fried foods, heavy creams, and puddings, as these increase Kapha;
- Dry lentils, dry food, fried potatoes, etc. should be avoided by patients with indigestion.
Healthy diet – recommended to alleviate the symptoms of amenorrhea
- Grains: red lentils, mung dhal and their boiled watery essence should be included in the diet;
- Vegetables, such as snake gourd, viper gourd, banana green, white pumpkin, fenugreek leaf, and mint leaf are good for the condition;
- Pickles: lemon pickle, orange pickle, or ginger pickle in sesame oil or sunflower oil are recommended;
- Fruit: grapes, raisins, apples, sweet oranges, and papaya are good to consume;
- Non-vegetarian: mutton and goat meat can be used in moderation (twice weekly);
- Butter milk: fresh, without cream;
- Milk: low-fat cow’s milk is advisable. Add a pinch of turmeric or ginger powder to the milk before you warm it up for drinking. This helps to reduce the Kapha-increasing qualities of the milk;
- Spicessuch as black pepper, cinnamon, coriander, cardamom, fennel, ginger, cumin, black pepper, fenugreek, clove, celery seed, salt, soya seed and mustard seed can be used for garnishing the foods.
- Follow a lifestylethat will stimulate Pitta and pacify Vata and Kapha. Practicing Surya Namaskar (the Sun Salutation) every morning will help correct Pitta and metabolism in general;
- Negative feelingssuch as stress and tension should be avoided;
- Do not undertake physical or mental work beyond your capacity;
- Excessive intercourse should be avoided. The recommended frequency of intercourse differs as per the season – it is higher in winter and lower in summer. It also depends on age. Individuals below 22 are not advised to practice sex routinely;
- Normal sleepand normal walking exercise are essential;
- If possible, avoid chemical contraceptives;
- Follow an active lifestyle, yet only take exercise according to your individual capacity.
Daily Physical Activity and Yoga
30 minutes of walking and a full range of motions focusing on inversions, twists, and backbends. Inversions increase blood circulation and balance your endocrine system, backbends tone your liver, and twists massage your internal organs.
- Surya Namaskar (the Sun Salutation) – this is the best pose for amenorrhea. It is recommended to be repeated 6-7 times.
- Pawanmuktasana (Wind-Relieving pose)– stimulates the organs in the pelvic cavity, for example the intestines, urine bladder, uterus etc. to perform the correct function and stimulate the menstrual cycle;
- Chakrasana (Wheel pose)– puts a greater stretching or pressure effect on the abdominal organs of the body, especially those in its middle and lower parts. Chakrasana helps to stimulate the function of the uterus;
- Paschimottanasanais a seated forward bend with the upper body over the legs. There are different versions of it, e.g. ardha baddha padma paschimottanasana, tring mukhaikapda paschimottanasana, urdhva mukha paschimottanasana, parivrtta paschimottanasana, all of which are used to treat amenorrhea;
- Matsyasana (Fish pose) – both Matsyasana and ardha Matsyasana are helpful in stimulating the ovarian function. They are also recommended for patients with polycystic ovary syndrome.