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|description=The term ‘artava’ has many meanings like ovum, menstruation and menstrual fluid or blood. It denotes the female reproductive functions.
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<p style='text-align:justify;'>The term ‘artava’ has many meanings like ovum, menstruation and menstrual fluid or blood. It refers to normal physiological process of periodic per vaginal uterine bleeding, symbolizing the forthcoming fertile period. The term is also used to denote ‘ovum’ and functions of female reproductive hormones. [SAT-B.453] <ref>Available from http://namstp.ayush.gov.in/#/sat</ref>
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This article describes normal physiological process of menstruation in Ayurveda and contemporary medical texts.The pathological morbidities related to menstruation are described in detail in a separate article on [[menstrual disorders]]. 
</p>
{{Infobox

|title =  Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Artava]]

|label2 = Authors
|data2 = Anagha S., [[Yogesh Deole|Deole Y.S.]]

|label3 = Reviewer and Editor
|data3 = [[Gopal Basisht|Basisht G.]]

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar 

|label5 = Correspondence email
|data5 = carakasamhita@gmail.com

|label6 = Publisher 
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label7 = Date of first publication:
|data7 = January 24, 2021

|label8 = DOI
|data8 =  [https://doi.org/10.47468/CSNE.2021.e01.s09.042 10.47468/CSNE.2021.e01.s09.042]

}}
</div>
== Etymology, derivation and synonyms==
<div style="text-align:justify;">
The term ‘‘artava’ literally means pertaining to/ dependent on/ accompanying the seasons or some particular period (ritu).<ref>http://spokensanskrit.org/index.php?tran_input=Artava&direct=se&script=hk&link=yes&mode=3</ref>  The synonyms like artava, shonita, asrik, raja, rakta, lohita, rudhira, pushpa are used to denote menstruation and ovum. The references of each term denoting either menstrual blood or ovum are given in appendix 1.
</div>
== Contextual meanings and importance==
<div style="text-align:justify;">
Following are the different contextual meanings indicating its physiological importance.
 
*Artava is a subordinate body constituent (upadhatu) of blood (rakta dhatu) [Cha.Sa.[[Chikitsa Sthana]] 15/17]

*It is also considered in the category of ‘dhatu’.[B.P.29/223]

*The term artava is applied to denote the feminine genetic character.  At the time of conception, if the artava is dominant, it leads to female progeny. [Cha Sa [[Sharira Sthana]]  2/12-13] As per the recent researches, the sex of a baby is determined by its chromosome make-up at conception. The X chromosome dominance at conception determines female gender. An embryo with two X chromosomes becomes a girl. Further, the researchers have identified enhancers or regulators called SOX9 on DNA. The level of SOX9 determines development of sex organs in embryo.<ref>Brittany Croft, Thomas Ohnesorg, Jacky Hewitt, Josephine Bowles, Alexander Quinn, Jacqueline Tan, Vincent Corbin, Emanuele Pelosi, Jocelyn van den Bergen, Rajini Sreenivasan, Ingrid Knarston, Gorjana Robevska, Dung Chi Vu, John Hutson, Vincent Harley, Katie Ayers, Peter Koopman, Andrew Sinclair. Human sex reversal is caused by duplication or deletion of core enhancers upstream of SOX9. Nature Communications, 2018; 9 (1) DOI: 10.1038/s41467-018-07784-9 available from niversity of Melbourne. "Geneticists make new discovery about how a baby's sex is determined." ScienceDaily. ScienceDaily, 15 December 2018. www.sciencedaily.com/releases/2018/12/181215141333.htm cited on 17/01/2021 </ref>    

Ayurveda texts describe clinical observations during pregnancy that indicate female progeny are as mentioned below: 

*Foetus position in the left side of the womb

*Activities of the foetus mostly observed in the left side of the mother

*Profuse lactation in the left breast

*The woman develops desire for spending more time with males.

*Sees dreams of activities of feminine nature. [Cha.Sa.[[Sharira Sthana]] 2/24-25]

However, these observations need to be researched further for its validation in current times. 

*It denotes the endocrinal secretions related to reproduction. [Su.Sa. Sharira Sthana 2/36]

*The manifestation of artava (menstruation) is applied to assess the status of female reproductive health. 

It also denotes normal physiology of female reproductive system.

*Drushtartava / bahi pushpa (manifested form) denotes endometrial cycle evidenced by menstrual bleeding.

*Adrushtartava/ antah pushpam (unmanifested form) denotes the ovarian cycle and ovulation that is not visible externally. [Su. Sa. Sharira Sthana 3/6] 

*The word Pushpa is analogous to blossoming of a flower seen in female reproductive organs during fertile period.  
</div>
==Panchabhautika constitution and properties: ==
<div style="text-align:justify;">
Artava is ‘agneya’ which implies the predominance of teja mahabhuta.[Su.Sa Sutra Sthana 14/7] Other [[mahabhuta]] are present in minute form.[Su Sa. Sutra Sthana 3/3]

The characters of ‘artava’ (ovum) are, it is less in quantity(alpa), in coagulated state(styanibhuta), is minute(sukshma) and is immobile (asanchari). [Su.Sa Sharira Sthana 2/36,Dalhana] 
</div>
==Formation ==
<div style="text-align:justify;">
Artava is a subordinate constituent (upadhatu) formed during metabolism of [[rasa dhatu]] [Cha.Sa.[[Chikitsa Sthana]] 15/17] and [[rakta dhatu]]. [Sharangadhara Sa. Purva khanda 5/16-17]. 

The digestion and metabolism (agni) at the level of [[rasa dhatu]] influence formation of artava [A.Hr.sharira sthana 1/7 Arunadatta]. 

Functions of [[rasa dhatu]] include nourishment of all body constituents similar to functions of hormones. The menstrual cycle is regulated by  hypothalamo-pitutary –ovarian(HPO) axis. Normal metabolism of rasa dhatu is essential for normal menstruation.  

'''Time span:''' 

[[Shukra dhatu]] (reproductive constituent) in female is formed in the course of one month through the process of transformation of tissues (dhatu parinamana). [Su. Sa. Sutra Sthana  15/14] Some scholars opine that menstrual blood (rajas) is formed as a byproduct of metabolism of [[rasa dhatu]] on the seventh day itself. [Su. Sa. Sutra Sthana  15/14 Dalhana]

'''Quantity:'''

The quantity of normal artava is four Anjali or 35 ml. [A. Hr. sharira sthana 3/81]

One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person specific.  As per current understanding, the average volume of menstrual fluid during a monthly menstrual period is 35 ml with 10–80 ml considered typical.<ref>Carlson KJ, Eisenstat SA, Ziporyn TD (2004). The new Harvard guide to women's health. Cambridge, Massachusetts: Harvard University Press. ISBN 0-674-01343-3 available from https://en.wikipedia.org/wiki/Menstruation#cite_note-isbn_0674013433-11 accessed on 12/01/2021 </ref>  
</div>
==Female reproductive system (artava vaha srotas)==
<div style="text-align:justify;">
The channels of transformation and transportation of female reproductive constituents (artavavaha srotas) and menstrual blood originate from uterus(garbhashaya) and its vessels (artavavahi dhamani). Its injury leads to sterility, intolerance of copulation and loss of menstrual flow (amenorrhoea). [Su Sa Sharira Sthana  9/12]
</div>
===Functions:===
<div style="text-align:justify;">
Artava is essential for the formation of embryo(garbha) and overall female reproductive health.

'''Properties of normal menstrual blood (shuddha artava):''' 

Menstrual fluid is reddish-brown, a slightly darker color than venous blood.  Various shades of red colored menstrual fluid are described with the similes of fruit of abrus precatorius (gunja fruit), red lotus flower(pinkish red), indragopaka insect(dark red) [Cha Sa [[Chikitsa Sthana]] 30/226] colour of rabbit blood or solution of lac. The blood does not stain cloth is considered as normal. [Su Sa Sharira  Sthana  2/17] It has typical odour [A. Hr. sharira sthana 1/22-23] or honey odour (madhugandha) [Ma. Ni. 61/7] 
</div>
==Physiology of menstruation:==
<div style="text-align:justify;">
The normal menstrual cycle ranges from 21 to 35 days with an average of twenty-eight days. The fluid is consistent without any stickiness (sliminess), without causing burning sensation and pain, is moderate in quantity, lasting for average three to five days. [Cha. Sa. [[Chikitsa Sthana]] 30/225] 

This period is divided into three phases according to the physiological changes taking place in the body. The menstrual cycle is counted from first day of menstruation.

The following table 1 shows three phases of menstrual cycle and changes in female body. 

'''Table 1: Phases of menstrual cycle''' 
{|class="wikitable" |}
|-
!Sl No:!!Name of Phase !!Days!! Physiological events!!Clinical features 
|-
|1.|| Menstrual phase (raja kala)||1st - 3rd or 5th day ||The blood accumulated in earlier month in the uterine vessels and endometrial capillaries (dhamani) is brought downwards to vaginal orifice by [[vayu]]. ||The daily amount of bleeding is individual specific. This phase is mainly influenced by [[vata]]. The spasm in the straight stem of arterioles as a causative phenomenon of bleeding is similar to the action of [[vata]] through dhamani.
|-
|2.|| Proliferative/follicular and ovulatory phase (Rutu kala)||Upto to 12th or 16th day||After menstruation, proliferation of endometrium starts. It makes the female reproductive organs healthy and  suitable for conception.||In this phase, the fertile female (rutumati) shows following features: 

•She looks bright and healthy 

•her mouth and teeth are moist

•anxious to hear love stories and have sexual relations

•flanks, eyes and hair are lax

•twitching over arms, breasts, pelvis, umbilicus, thighs and hips 

These changes can be considered as the effect of estrogen hormone, that is predominant during this phase.
|-
|3.||Secretory/luteal /post ovulatory phase (ritavateeta kala)||17th -28th day	||The cervix (yoni) do not promote the entry of sperms (shukra) into the uterus. The  cervical mucus becomes hostile to the sperms due to the influence of progesterone.||The hot (agneya) nature of artava is more evident in this phase and there is predominance of [[pitta]] [[dosha]]. 

The glandular and vascular changes in the endometrium, and the thermogenic effect of progesterone during this phase may be considered in this context.  
|}

[A. Hr. Sharira Sthana 1/47], [A.S. Sharira Sthana 1/46], [Cha. Sa. [[Sharira Sthana]] 4/ 7], [Su. Sa. Sharira  Sthana 3/7-8]

The contemporary medical texts attribute these three phases to physiological changes in female reproductive hormones.
 
The following table 2 shows hormonal changes in different phases. 

'''Table 2: Endocrinal changes in phases of menstruation''' 
{| class="wikitable" |}
|-
|Cycle Days||	1-5  || 6-14 ||	15-28
|-
|Endometrial cycle ||Menstrual Phase ||Proliferative Phase ||	Secretory Phase
|-
|Ovarian cycle ||Early follicular ||	Late follicular	|| Luteal
|-
|Estrogen/Progesterone dominance ||	Low||	Estrogen||Progesterone
|-
|Gonadotropins FSH*/LH**|| Low ||FSH|| LH
|}

* *Follicle Stimulating Hormone **Luteinizing Hormone
</div>
==Importance in preservation of health and prevention ==
<div style="text-align:justify;">
Menstruation is an important physiological event in life cycle of a female.Female reproductive health and health of progeny significantly depends upon normal menstruation.A specific diet and lifestyle regimen (rajaswala charya) are prescribed during menstrual phase to preserve and maintain health. 

The menstruating woman should observe chastity, avoid day time sleep, anointing, massaging, vigorous exercise, excess laughing and talking etc. The diet shall be light to digest with food items like rice, barley with small quantity of ghee and milk. [A. Hr.Sharira Sthana 1/25]  

Apana vata dosha is responsible for normal menstruation. Abovementioned activities can vitiate vata dosha leading to disorders. 

Hence, moderate lifestyle and diet regimen is advised to help normal physiological process of menstruation.
</div>
==Current researches ==
<div style="text-align:justify;">
*The endometrium functions as a complex multicellular structure that involves interactions of immune, endocrine and vascular systems. The strict regulation of this tissue to allow cyclical ‘injury’ and ‘repair’ at menstruation results in a remarkable physiological response that allows pregnancy to occur.<ref>Maybin JA, Critchley HO. Menstrual physiology: implications for endometrial pathology and beyond. Hum Reprod Update. 2015;21(6):748‐761. doi:10.1093/humupd/dmv038</ref>

*Overall, 1753 genes were differentially expressed in one or more comparisons related to menstrual breakdown and repair. Significant canonical pathways, gene clusters and upstream regulators enriched during menstrual bleeding included those associated with immune cell trafficking, inflammation, cell cycle regulation, extracellular remodeling and the complement and coagulation cascade.<ref>Paiva P, Lockhart MG, Girling JE, et al. Identification of genes differentially expressed in menstrual breakdown and repair. Mol Hum Reprod. 2016;22(12):898‐912. doi:10.1093/molehr/gaw060</ref> 

*A non-invasive sampling method is developed by collecting menstrual blood and filtering endometrial tissue. In combination with advanced experimental technology, the sample of menstrual endometrium is studied further for researches on endometriosis, endometrial lesions or other menstruation-related diseases.<ref>Shu S et al, Investigation on endometrium from menstrual blood as a source of non-invasive tissue, Zhonghua Fu Chan Ke Za Zhi. 2019;54(8):527‐533. doi:10.3760/cma.j.issn.0529-567x.2019.08.005.</ref> 

*A study investigated the effects of donor age and passage number on the biological characteristics of menstrual blood-derived stem cells (MenSCs) by comparing MenSCs derived from donors with three different age ranges and after different passage times. Continuous passage, flat cloning, cell proliferation assays, flow cytometric phenotyping and whole human genome microarray were performed to systematically analyse the relationship between the self-renewal ability of MenSCs as well as their potential to maintain their stem cell characteristics and to resist aging. The results demonstrated that the immune phenotypes and in vitro cultural characteristics of MenSCs did not change significantly with the progression of aging.<ref>Chen J, Du X, Chen Q, Xiang C. Effects of donors' age and passage number on the biological characteristics of menstrual blood-derived stem cells. Int J Clin Exp Pathol. 2015;8(11):14584‐14595. Published 2015 Nov 1.</ref> 

*Some studies have shown the evidences regarding the feeling like craving for certain type of food articles like chocolate in women during the menstrual phase.<ref>Hormes JM, Niemiec MA. Does culture create craving? Evidence from the case of menstrual chocolate craving. PLoS One. 2017;12(7):e0181445. Published 2017 Jul 19. doi:10.1371/journal.pone.0181445</ref>

*Ayurveda emphasizes the importance of diet and life-style for maintaining the proper menstrual health. Dysmenorrhea, premenstrual syndrome (PMS), and menstrual irregularities are directly associated with dietary habits and physical activities. Diet, characterized by a high consumption of sugars, salty snacks, sweets and desserts, tea and coffee, salt, fruit juices and added fat (labeled as “snacks” pattern), is associated with an increased risk of dysmenorrhea among young women.<ref>Najafi, N., Khalkhali, H., Moghaddam Tabrizi, F. et al. Major dietary patterns in relation to menstrual pain: a nested case control study. BMC Women's Health 18, 69 (2018). https://doi.org/10.1186/s12905-018-0558-4</ref> 

*In a study, it is observed that smoking is associated with increased risk of reporting psychological and behavioral symptoms in premenstrual syndrome. High calorie/fat/sugar/salt foods intake is associated with increased risk of reporting physical symptoms. Fruit consumption shows decreased risk of reporting behavioral symptoms.<ref>Hashim MS, Obaideen AA, Jahrami HA, et al. Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE. Nutrients. 2019;11(8):1939. Published 2019 Aug 17. doi:10.3390/nu11081939</ref> 
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===List of thesis done===
1. Shinde Vaishali S.(2004) : A study on the concept of Upadhatu in Samhitas with applied aspect to Artava-Dushti. Samhita, department of basic principles , IPGT & RA .Jamnagar

==More information ==
[[Grahani Chikitsa]] 

[[ Yonivyapat Chikitsa]] 

==Appendix 1:==
The list of references Synonyms of artava and contextual meanings can be seen [[Media: Appendix_1-converted.pdf|here.]]

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