Changes

==Age specific classification ==

==Age specific classification ==

Chronological age is an important factor of examination. [Cha.Sa. Vimana Sthana 8/122]. Therefore, it is considered in diagnosis of menstrual disorders.  

Chronological age is an important factor of examination[Cha.Sa. Vimana Sthana 8/122]. Therefore, it is also considered in the diagnosis of menstrual disorders.  

Menarche is appearance of first menstrual bleeding in an adolescent girl. The age of menarche is mentioned as 12 years in the Ayurveda classics. [A.H. Sharira Sthana 1/7]However,clinical variations are observed due to two factors. [Ka. Sa. Sharira Sthana 5/4]

'''1)Adolescent age:'''

a)Time factor(kala): Age of puberty, environmental conditions as per geographical area

Menarche is the appearance of first menstrual bleeding in an adolescent girl. The age of menarche is mentioned as 12 years in the Ayurveda classics. [A.H. Sharira Sthana 1/7] However,clinical variations are observed due to two factors. [Ka. Sa. Sharira Sthana 5/4]

b)Activities of the girl child(karma): Diet, life style, exercise, exposure to light,psychological state etc.

 

'''b)Activities of the girl child(karma):''' Diet, life style, exercise, exposure to light,psychological state etc.

Observational studies reveal the fact that menarcheal age is influenced by diverse variables such as genetics, geographic location, climate, psychological factors, socioeconomic status, body weight and height, nutrition, body fat and exercise, as well as the presence of chronic diseases.   

Observational studies reveal the fact that menarcheal age is influenced by diverse variables such as genetics, geographic location, climate, psychological factors, socioeconomic status, body weight and height, nutrition, body fat and exercise, as well as the presence of chronic diseases.   

Disorders related to menarche are as below:

 

• Primary amenorrhoea: The condition is characterized by absence of menarche even at the age of 16 years(i.e. after completion of childhood). It is mentioned as condition of“Shushka revati”[Ka. Sa. Kalpa Sthana 6/31]and “Shandhi yoni vyapad”.[Cha. Sa. Chikitsa Sthana 30/34-35]

'''Disorders related to menarche are as below:'''

 

*'''Primary amenorrhoea:'''

 

The condition is characterized by absence of menarche even at the age of 16 years(i.e. after completion of childhood). It is mentioned as condition of“Shushka revati”[Ka. Sa. Kalpa Sthana 6/31]and “Shandhi yoni vyapad”.[Cha. Sa. Chikitsa Sthana 30/34-35]

 

In primary amenorrhea, a retrospective study concluded that Mullerian anomaly was the most prevalent etiological factor leading to amenorrhea followed by gonadal dysgenesis and racial, genetic and environmental factors could play role in the cause of primary amenorrhea.  

In primary amenorrhea, a retrospective study concluded that Mullerian anomaly was the most prevalent etiological factor leading to amenorrhea followed by gonadal dysgenesis and racial, genetic and environmental factors could play role in the cause of primary amenorrhea.  

• Secondary amenorrhoea : After the establishment of menarche, some girls may experience a secondary amenorrhea which may extend upto many months or even years.

 

• Dysfunctional uterine bleeding: Irregular or Excessive menstrual bleeding mainly due to anovulatory cycles and/or Hormonal disbalance.

*'''Secondary amenorrhoea :''' After the establishment of menarche, some girls may experience a secondary amenorrhea which may extend upto many months or even years.

Both these conditions are due to the lack of cordination in the reproductive axis of vata-pitta-kapha.

 

• Primary dysmenorrhea: It is mentioned as “udavartini yoni vyapad”in Ayurveda[Cha. Sa. Chikitsa Sthana 30/25-26] which is a prevalent condition among the adolesent age group.

*'''Dysfunctional uterine bleeding:''' Irregular or Excessive menstrual bleeding mainly due to anovulatory cycles and/or hormonal dis-balance.

2)Reproductive age:

 

• It extends from the menarche to menopause during which all kinds of menstrual disorders are likely to be manifested if the female does not follow proper diet,regimens, hygeine and code of conduct advised during different phases of menstrual cycle.

Both these conditions are due to the lack of coordination in the reproductive axis of vata-pitta-kapha.

3)Climatric and perimenopause age:  

 

• Menopause is the permanent cessation of menstruation and declining Ovarian function. It is a natural physiological process due to aging(jaravastha). The age of menopause is 50 years.[Su. Sa. Sharira Sthana 3/11] As all  the tissue components get depleted gradually during this age, menstruation also gets diminished naturally. But this transition stage of reproductive physiology may create many symptoms like excessive bleeding, irregularity in the cycle, psychological and vasomotor disturbances in the female.

*'''Primary dysmenorrhea:''' It is mentioned as “udavartini yoni vyapad”in Ayurveda[Cha. Sa. Chikitsa Sthana 30/25-26] which is a prevalent condition among the adolesent age group.

 

'''2)Reproductive age:'''

 

*It extends from the menarche to menopause during which all kinds of menstrual disorders are likely to be manifested if the female does not follow proper diet,regimens, hygeine and code of conduct advised during different phases of menstrual cycle.

 

'''3)Climatric and perimenopause age:'''

 

*Menopause is the permanent cessation of menstruation and declining ovarian function. It is a natural physiological process due to aging(jaravastha). The age of menopause is 50 years.[Su. Sa. Sharira Sthana 3/11] As all  the tissue components get depleted gradually during this age, menstruation also gets diminished naturally. But this transition stage of reproductive physiology may create many symptoms like excessive bleeding, irregularity in the cycle, psychological and vasomotor disturbances in the female.

 

1. Dietary factors:  

1. Dietary factors:  

• Food and beverages that are excessively hot in potency cause disturbances in the physiology of menstruation especially in the growth and development of follicles/ovum. (andopachaya). [ Ka. Sa. Kalpa Sthana 7/32]

• Food and beverages that are excessively hot in potency cause disturbances in the physiology of menstruation especially in the growth and development of follicles/ovum. (andopachaya). [ Ka. Sa. Kalpa Sthana 7/32]

In the opinion of Vagbhata, the condition of mutra-purishagandhi in incurable and all other disorders are difficult to cure.[Su.Sa.Sharira Sthana 2/5] [A.Hr. Sharira Sthana 1/ 12]

In the opinion of Vagbhata, the condition of mutra-purishagandhi in incurable and all other disorders are difficult to cure.[Su.Sa.Sharira Sthana 2/5] [A.Hr. Sharira Sthana 1/ 12]

Currently, apart from the three types of vitiations due to vata-pitta-kapha, clotted appearance(grandhibuta) as well as scanty menstruation(ksheena) are also treated with good efficacy by Ayurvedic treatment modalities. More research studies focussing on the diagnosis and treatment aspects of abnormal variations in the characterestic features of menstrual blood(artava dushti) are needed.

Currently, apart from the three types of vitiations due to vata-pitta-kapha, clotted appearance(grandhibuta) as well as scanty menstruation(ksheena) are also treated with good efficacy by Ayurvedic treatment modalities. More research studies focussing on the diagnosis and treatment aspects of abnormal variations in the characterestic features of menstrual blood(artava dushti) are needed.

== Examination of patients ==

== Examination of patients ==

=== Observation (darshana) ===

=== Observation (darshana) ===