AMENORRHEA

Amenorrhea is the absence of menstruation — one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea. It may be primary or secondary.

• Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years. 
• Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for three or more months in the absence of pregnancy, lactation (the ability to breastfeed), cycle suppression with systemic hormonal contraceptive(birth control) pills, or menopause.

MENORRHAGIA

Menorrhagia is the most common type of abnormal uterine bleeding characterized by excessive and prolonged menstrual bleeding or frequent appearance of menstruation in spite of coming at regular interval. In Ayurveda, it is known as “Rakta Pradar” or “Atayartava”.

A normal menstrual cycle is around 28 days in duration with 5-7 days bleeding time and total amount of blood flow is approximately 40 to 80 mL. If loss of menstrual blood is more than 80 ml or lasting longer than 7 days, condition is known as Menorrhagia.

TYPES OF MENORRAGIA

1. Polymenorrhoea – It is defined as uterine blood flow of menstrual cycle, which is reduced from the normal twenty-eight days to a cycle of 2-3 weeks and remains constant at that frequency. It is also associated with excessive and prolonged bleeding.
2. Dysfunctional uterine bleeding (DUB) – It is a heavy or irregular menstrual bleeding without any obvious structural or systemic pathology such as a fibroid, tumour or any type of lesion. DUB is the most common type of abnormal uterine bleeding. The cause of this may be emotional imbalance.
3. Metrorrhagia - It is defined as irregular, acyclic bleeding from the uterus particularly between the expected menstrual periods. Metrorrhagia may also be a sign of an underlying disorder, such as hormonal imbalance, uterine fibroids or cancer of the reproductive organs. In metorrhagia, blood flow may be intermittent or continuous.
4. Dysmenorrhoea – Menstrual blood flow with colic pain in lower abdomen.

SYMPTOMS OF MENORRHAGIA

• Heavy blood loss (more than 80ml or longer than 7 days) during the menstrual period
• Bleeding or spotting between periods
• Pain in the lower abdomen.
• Low back pain
• Feeling of heaviness in the body
• Tenderness in breast
• Fatigue
• Feeling of pelvic congestion
• Constipation or indigestion
• Headaches
• Anaemia

CAUSES OF MENORRHAGIA

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. The most common causes are :

• Hormonal imbalance : Estrogens and Progesterone are two hormones, responsible for regulation of the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance of Progesterone & Estrugen occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
• Uterine fibroids : Fibroids are noncancerous tumors of the uterus, which may also responsible for heavier or prolonged menstrual bleeding.
• Polyps : They are Small, benign growths on the lining of the uterine wall, which may also cause heavy or prolonged menstrual bleeding.
• Medications : Improper use of hormonal medicines (contraceptive pills) are big cause of menorrhagia and some other types of medicine like anti-inflammatory medicines and anticoagulant medicines are also responsible for heavy or prolonged menstrual bleeding.

AYURVEDIC OVERVIEW OF MENORRHAGIA

According to Ayurveda, “Rakta Pradar” or “Atayartava” occurs due to aggravation of Pitta Dosha. Pitta is a biological element of the body that symbolizes agni or heat, which is responsible for management of the hormonal system of the body and also analogous (equivalent / similar) to blood or Rakta Dhatu. Aggravated pitta causes contamination of blood. When Contaminated blood moves towards the pelvic region, it causes imbalance of vata dosha, particularly Apana Vata dosha (Prana, Udana, Samana,Vyana and Apana are the 5 types of Vata Dosha). Apana vata dosha controls the flow of the menstrual blood through Artava-Vahi-Srotasa. Aggravated Apana Vata Dosha and Pitta contaminated blood increases menstrual blood, which leads to Menorrhagia.

Aggravation of Apana vata causes pain in the back and lower abdomen before commencement of the menstruation cycle. Aggravated apana vata also moves upwards and causes imbalance of other doshas such as samana vata and pachak pitta. These doshas are responsible for all types of digestive processes or regulation of digestive system. Constipation, indigestion, flatulence are the various symptoms of imbalanced Samana Vata Dosha and Pachak Pitta Dosha. When Apana vata moves above the digestive system, it causes imbalance of the Prana Vata Dosha, which is situated in the head and the brain. Prana Vata controls all functions of central nervous system. Aggravated Prana Vata weakens the Central Nervous System and triggers the psychological imbalance. It also affects the Neuro-Hormonal functions leads to symptoms such as mental imbalance, depression, anxiety, mood swings and insomnia etc.

Aggravated Apana Vata dosha also effects Sadhak pitta, which is situated in the heart and controls our emotions. Imbalanced sadhak pitta causes low mental stamina.

Aggravated Apana vata dosha may also cause aggravation of kapha dosha, which increases extra-cellular fluid throughout the body, causing swelling through water retention in some women.

All imbalanced doshas cause weakness of all body tissues and women feel tired, lethargic and sleepy during this period.

MENORRHAGIA DIET & LIFESTYLE

The Ayurvedic treatment of Menorrhagia focuses on vata and pitta pacifying medicines and diet, which includes ghrita (clarified butter), amla, milk, Sugarcane juice, banana, cucumber, pumpkin etc.

• Spices having medicinal properties such as black pepper, cinnamon, coriander, cardamom, ginger, cumin, black pepper, fenugreek, clove, mint and mustard seed should be included in your diet. 
• Foods that cause constipation or aggravation of vata should not be consumed and vegetables like potato, mushroom, cauliflower and peas should be avoided.
• You should also avoid Tea, Coffee, Caffeine, Alcohol, Chocolate, Fast Food, Pickles etc, which are aggravating factors for Manorrhagia.
• Do not control natural urges like urination and stool.
• Regular physical exercise for the whole month is a must for coping with these symptoms. But, exercise and heavy physical works should be avoided during this period.
• Stress, tension and negative mental feelings increasse Vata Dosha. Therefore, you should include YOGA in your daily life for relaxing your mind and body.

HOME REMEDIES FOR MENORRHAGIA

• Boil one teaspoon of Coriander seeds in 250ml of water till the water remains half in quantity. After cooling, drink it with half teaspoon of Cinnamon powder thrice in a day.
• Take 1 teaspoon of Sesame seeds powder twice in a day to get relief from menstrual problems.
• Take a glass of water and add juice of one lemon. Drink this in the morning to get relief from digestive problems that may arise during menstrual problems.
• Drink medicated milk twice a day
• First, prepare a mixture by adding ginger powder, fennels seeds powder, cardamom powder and black pepper powder in equal proportion.
• Second, mix ½ tsp of this mixture in glassful of warm milk and drink.
• This medicated milk is helpful to pacify vata dosha and also helpful to get relief in low abdominal pain and back pain during Menorrhagia or heavy menstrual bleeding.

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) or Polycystic Ovary Disease (PCOD) is a condition of hormonal imbalance. It is characterized by two to five times bigger ovaries and multiple cysts filled with fluid, which is caused by under-developed follicles. Follicles are sacs within the ovaries that contain ova. The ova in these follicles fail to mature due to lack of required hormones from the endocrine system and therefore, ova cannot be released from the ovaries into the uterus (womb) for fertilization. Instead, they build up as cysts in the ovary.

PCOS affects approximately 5-10% women of reproductive age (15-45 years) and is one of the leading causes of infertility and menstrual disorders in women.

SYMPTOMS

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

• Enlarged ovaries
• Acne, oily skin
• Irregular menstrual periods – no menstrual periods or irregular bleeding
• Dysfunctional uterine bleeding
• Pelvic pain
• Decreased breast size
• Excessive hair growth, usually in a male pattern / Male-pattern hair loss
• Weight gain, central obesity
• Thinning of scalp hair
• Hyper pigmentation on neck and face
• Anxiety or depression
• Lack of ovulation
• Infertility
• Thyroid disorder
• Liver disorders
• Insulin resistance and type 2 diabetes

CAUSES

The cause of PCOS / PCOD is unknown. But according to various scientific research it is found that the root cause of this problem is most probably resistance to the insulin hormone, which means your body needs more insulin than usual to regulate or maintain the levels of sugar in the body. In response, secretion of more insulin cause an imbalance in the hormones that usually regulate your menstrual cycle. Too much luteinising hormone (LH, which control the growth and release of eggs in the ovaries) is produced compared to follicle-stimulating hormone (FSH, which stimulates the maturation of ovarian follicles), which in turn causes the follicles in the ovaries to produce more male hormone testosterone than the female hormone oestrogen. The adrenal glands also start to produce increased amounts of testosterone. Too much testosterone prevents ovulation, along with other symptoms related to the syndrome such as facial hair. PCOS may be hereditary as well. Studies show that women with a family history of polycystic ovaries are 50 per cent more likely to develop PCOS.

AYURVEDIC VIEW OF PCOS / PCOD

According to Ayurveda, all three humors or biological elements plays an important and distinctive roles in the processes involved in the female reproduction, including ovarian cycle and menstrual cycle. But, the Kapha dosha is a root cause of the PCOS, which block or interrupt the functions of VATA and PITTA doshas.

As per Ayurveda, VATA dosha is responsible for the, development of the follicle during the ovarian cycle, rupture of the ovary wall for releasing the matured ovum into the uterus, movement of the fimbriae (the finger like projections that guide the ovum into the fallopian tubes and the movement of the ovum towards the uterus) and the movement of menstrual fluid during menstruation.

The PITTA dosha is responsible for the management of hormonal system of the body including female reproductive system and the energy responsible for transformation. All stages of the female reproductive process such as different stages of the ovarian and menstrual cycles are a result of the PITTA dosha or hormonal functions and

The KAPHA dosha is responsible for nourishing development of the tissues that form and support the female reproductive system including the supporting growth of the follicle with the VATA dosha during the ovarian cycle. In the absence of Kapha dosha, Vata dosha can’t develop follicle in the ovary. Kapha dosha is also responsible for the presence of mucosa layer of the fallopian tubes and endometrial layer of the uterus that protects the tissues from the drying effect of VATA dosha.

Therefore, when KAPHA dosha blocks the functions of VATA and PITTA doshas, development of follicles gets obstructed and transformation processes become suppressed. Due to poor eating habits and weak digestion, vitiated Kapha dosha suppress the digestive fire (agni) and food gets partially digested or partially undigested.

As a result of undigested food and suppressed digestive fire, toxins or ama created and circulate in the body along with plasma and vitiated Kapha dosha. Now, these toxins and Kapha dosha starts to coat the cells of the body, this begins to affect subtle channels or srothas. Due to the increased sticky and heavy qualities of rasa dhatu (plasma and lymph), kapha and ama the cell membrane of the tissues are coated and affects cellular intelligence causing insulin receptors on the cell do not recognize the chemical structures of insulin. Insulin unable to engage cellular receptors and begins to build up in the blood stream. Where they starts moving towards artava dhatu (the female reproductive system) and comes across free receptors of artava dhatu, that engage its molecular structure.

Aggravated kapha and ama also moves through the channels of medo dhatu (fat tissue). Meda dhatu is one of the first dhatus along with rasa dhatu affected by the aggravated kapha dosha resulting in obesity. As medo dhatu is increased, along with kapha and ama it starts to block the channels of the body. Artava dhatu thus affected by the heavy and sticky qualities of kapha and ama causes improper functioning of subtle channels of female reproductive organs or artavavaha srotas.

Apana VATA (subcategory of Vata dosha ) in artava vaha srotas is blocked, affects the normal functioning of VATA in the ovarian cycle. Free androgens moving throughout the body are processed at the level of medo dhatu and it is also affected.

Since VATA is blocked, PITTA fails in functions involving movement or otherwise it is also blocked. As PITTA is blocked the hormones that carry the energy of transformation are unable to initiate their action. The accumulated KAPHA dosha is manifested as the formation of the cyst in the ovary.

LINE OF TREATMENT FOR PCOS / PCOD

As per Allopathic medicine, patient has to take HRT (Hormone replacement Therapy ) to get relief in symptoms of PCOS / PCOD. But, Hormone replacement therapy depletes the already taxed Endocrinal system and puts it to sleep. The hormones that are meant to be naturally released by the body, now provided with artificial means pushes the body into lazy mode. The HRT treatment may provide excellent results period over a short but over time can lead to irreversible metabolic damage.But, the Ayurvedic treatment of PCOS / PCOD focus on balancing the aggravated doshas along with improving digestion, eliminating the build up of toxins and cleansing the blockage of channels through natural medicines as well as customized diet and lifestyle plans. The aims of Ayurvedic treatment are :-

• Proper menstrual cycle with good menstrual flow.
• Alleviation of symptoms like lower abdominal cramps, hair loss, acne, pigmentation etc.
• Production of healthy eggs and good uterine health for healthy fertilisation.
• Good mental health.

DIET AND LIFESTYLE

• Have your meals at regular timings and limit your overall intake.
• Eat low glycemic index foods such as jowar, bajra, wheat, walnuts and almonds as they will cause a slower rise in blood sugar levels.
• Eat fresh green vegetables as they are rich in fibres.
• Take 8 to 10 glass of water per day to get rid of harmful toxins from the blood stream.
• Put one cup of water into a copper vessel overnight and drink this water in the morning.
• Avoid refined sugary foods such as sweets, candies, cakes, pastries, chocolates etc.
• Avoid refined flour foods such as burger, patties, sandwich etc.
• Avoid coffee, tea, alcohol and soft drinks.
• Avoid sleeping at daytime, which aggravates Kapha dosha, responsible for non-recognition of Insulin by the body cells.
• Avoiding fresh grains – Eat at least one year old grains.
• Do regular exercise to keep your weight under control. Exercise also helps to improve your insulin sensitivity and increasing your metabolism.

HOME REMEDIES

• Curcumin in turmeric is an effective anti-tumor, anti-cancer, anti-inflammatory chemical content, which is also effective to dissolve all unnatural growths in our body. Take ½ teaspoon of turmeric powder, twice a day.
• Take ½ teaspoon of cinnamon powder twice a day. It helps to reduce insulin resistance by slowing the breakdown of carbohydrates.
• Eat 7 to 10 leaves of Holi Basil (Tulsi) plant on an empty stomach, daily early morning.
• Take one teaspoon of Amla (emblica officinalis) powder, daily at night before going to bed with lukewarm water.