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Line 293: + + + − On examining the patient, the general health status should be the prime concern. In case of clinical conditions like scanty bleeding or amenorrhea, the patient may be emaciated(krusha) and there may be discoloration of skin (vaivarnya) or pallor which is mentioned as the clinical features of a disorder of reproductive tract namely “arajaska yoni vyapad” [Cha.Sa.Chikitsa Sthana 30/17]. The same presentation is found in heavy menstrual bleeding also.+ − − Line 284:
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Line 595: + + − *PCOS is diagnosed as per the standard Rotterdam criteria . Recent studies suggest the incorporation of raised level of Anti mullerian Hormone (AMH) along with the sonography findings to define polycystic ovarian morphology (PCOM). + − − − + − + − + − + − + − + − + − + + + + − + + + + + + + + + − *Sa. = Samhita+ − *Cha. = Charak+ − − *Su. = Sushruta − − *Ka. = Kashyapa − − *Sha. =Sharangadhara − − *A. = Ashtanga − − *Hr. = Hridaya − − *S. = Sangraha − *Ha. = Harita+ − + − + + +
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The physiology of menstruation can be understood by studying the concept of “artava” and its disorders. Fundamentally artava is originated from agni (fire) element. Therefore, menstrual blood is pitta dosha dominant. Menstruation and regulation of hypothalamo-pituitary-ovarian axis are important functions of vata dosha. Whereas the repair and restore functions in uterus after menstruation are carried out by kapha dosha. Hence all three dosha play role in physiology of menstruation. Therefore, the menstrual disorders need to be understood on the dosha axis and their abnormalities. The duration of normal menstrual flow is generally 5 days, and the normal menstrual cycle typically lasts between 21 and 35 days.
{{#seo:
|title=Menstrual disorders
|titlemode=append
|keywords=Menstrual disorders, artava (menstruation), asrugdara (menorrhagia), dysmenorrhoea, amenorrhoea, Ayurveda, Indian system of medicine, charak samhita.
|description=Sharira / Artava / Menstrual disorders
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=charak samhita
|type=article}}
<p style="text-align:justify;">The physiology of menstruation can be understood by studying the concept of “artava” and its disorders. Fundamentally artava is originated from agni (fire) element. Therefore, menstrual blood is [[pitta]] [[dosha]] dominant. Menstruation and regulation of hypothalamo-pituitary-ovarian axis are important functions of [[vata]] [[dosha]]. Whereas the repair and restore functions in uterus after menstruation are carried out by [[kapha]] [[dosha]]. Hence all three [[dosha]] play role in physiology of menstruation. Therefore, the menstrual disorders need to be understood on the [[dosha]] axis and their abnormalities. The duration of normal menstrual flow is generally 5 days, and the normal menstrual cycle typically lasts between 21 and 35 days.
</p>
{{Infobox
{{Infobox
|label2 = Authors
|label2 = Authors
|data2 = Anagha S., Deole Y.S.
|data2 = Anagha S.<sup>1</sup>, [[Yogesh Deole|Deole Y.S.]]<sup>1</sup>
|label3 = Reviewers and Editor
|data3 = [[Gopal Basisht|Basisht G.]]<sup>1</sup>, Tandon S.<sup>2</sup>
|label4 = Editor
|data4 = [[Gopal Basisht|Basisht G.]]<sup>1</sup>
|label3 = Reviewed by
|label5 = Affiliations
|data3 = Basisht G.
|data5 = <sup>1</sup>[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar,
<sup>2</sup> Obstetrician-Gynecologist, Orlando, USA
|label4 = Affiliations
|label6 = Correspondence email
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar
|data6 = carakasamhita@gmail.com
|label5 = Correspondence email
|label7 = Publisher
|data5 = carakasamhita@gmail.com
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label6 = Date of first publication:
|label8 = Date of first publication:
|data6 =July 31, 2020
|data8 = July 31, 2020
|label9 = DOI
|data9 = [https://doi.org/10.47468/CSNE.2020.e01.s09.025 10.47468/CSNE.2020.e01.s09.025]
}}
}}
== Age specific classification ==
== Age specific classification ==
<div style="text-align:justify;">
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.
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.
'''1)Adolescent age:'''
'''1)Adolescent age:'''
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]
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.Hr. Sharira Sthana 1/7] However,clinical variations are observed due to two factors. [Ka. Sa. Sharira Sthana 5/4]
'''a)Time factor(kala):''' Age of puberty, environmental conditions as per geographical area
'''a)Time factor(kala):''' Age of puberty, environmental conditions as per geographical area
'''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. <ref>Wang Z, Dang S, Xing Y, Li Q, Yan H. Correlation of body mass index levels with menarche in adolescent girls in Shaanxi, China: a cross sectional study. BMC Womens Health. 2016;16:61. Published 2016 Sep 6. doi:10.1186/s12905-016-0340-4</ref>, <ref>Laitinen J, Power C, Järvelin MR. Family social class, maternal body mass index, childhood body mass index, and age at menarche as predictors of adult obesity. Am J Clin Nutr. 2001;74:287–294. [PubMed] [Google Scholar]</ref>
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. <ref>Wang Z, Dang S, Xing Y, Li Q, Yan H. Correlation of body mass index levels with menarche in adolescent girls in Shaanxi, China: a cross sectional study. BMC Womens Health. 2016;16:61. Published 2016 Sep 6. doi:10.1186/s12905-016-0340-4</ref> <ref>Laitinen J, Power C, Järvelin MR. Family social class, maternal body mass index, childhood body mass index, and age at menarche as predictors of adult obesity. Am J Clin Nutr. 2001;74:287–294. [PubMed] [Google Scholar]</ref>
'''Disorders related to menarche are as below:'''
'''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]
*'''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.<ref>Kriplani A, Goyal M, Kachhawa G, Mahey R, Kulshrestha V. Etiology and management of primary amenorrhoea: A study of 102 cases at tertiary centre. Taiwan J Obstet Gynecol. 2017;56(6):761‐764. doi:10.1016/j.tjog.2017.10.010</ref>
*'''Secondary amenorrhoea :''' After the establishment of menarche, some girls may experience a secondary amenorrhea which may extend upto many months or even years.
*'''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 coordination in the reproductive axis of vata-pitta-kapha.
Both these conditions are due to the lack of coordination 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.
*'''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:'''
'''2)Reproductive age:'''
'''3)Climatric and perimenopause age:'''
'''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.
*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.
</div>
==Causes of menstrual disorders==
==Causes of menstrual disorders==
<div style="text-align:justify;">
'''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]
*Consumption of excessive salty, sour, heavy, pungent substances, those producing burning sensation(vidahi), excessive use of unctuous substances, meat of domestic, aquatic and fatty animals, mixture of cooked rice and pulses (krushara), curd, vinegar, curd-water(mastu) and wine leads to excessive menstrual bleeding. [Cha.Sa. ChikitsaSthana 30/204]
*Consumption of excessive salty, sour, heavy, pungent substances, those producing burning sensation(vidahi), excessive use of unctuous substances, meat of domestic, aquatic and fatty animals, mixture of cooked rice and pulses (krushara), curd, vinegar, curd-water(mastu) and wine leads to excessive menstrual bleeding. [Cha.Sa. [[Chikitsa Sthana]] 30/204]
'''2. Lifestyle factors:'''
'''2. Lifestyle factors:'''
*The daily activities in general and those during menstruation influence reproductive health. [Cha. Sa. Chikitsa Sthana 30/7-8], [Su.Sa. ShariraSthana 2/24-25]
*The daily activities in general and those during menstruation influence reproductive health. [Cha. Sa. [[Chikitsa Sthana]] 30/7-8], [Su.Sa. Sharira Sthana 2/24-25]
*Suppression of natural urges (vega dharana) of micturition, defecation etc. leading to aggravation of “apana vayu” cause menstrual disorders. [Cha. Sa. Chikitsa Sthana 30/25-26].
*Suppression of natural urges (vega dharana) of micturition, defecation etc. leading to aggravation of “apana vayu” cause menstrual disorders. [Cha. Sa. [[Chikitsa Sthana]] 30/25-26].
A case control study in 300 subjects has proven the association of suppression of urges of micturition and defaecation with primary dysmenorrhoea.
A case control study in 300 subjects has proven the association of suppression of urges of micturition and defecation with primary dysmenorrhoea.<ref>Vrinda Roy(2011),A case-control study to evaluate the association between Mutra-purisha vegadharana and primary dysmenorrhoea,PG dissertation,department of Swasthavrutta, VPSV Ayurveda college, Kottakkal, Kerala.</ref>
*The specific activities like continuous travelling especially in jerky vehicles,continuos sitting or standing in one position , excessive walking and exersion cause vitiation of “apana vayu” and lead to menstrual disorders. [A. Hr. Ni. 16/27]
*The specific activities like continuous travelling especially in jerky vehicles,continuos sitting or standing in one position , excessive walking and exersion cause vitiation of “apana vayu” and lead to menstrual disorders. [A. Hr. Nidana thana 16/27]
*Use of artificial objects for sexual pleasure are considered as risk factors for menstrual disorders. [Cha.Sa. Chikitsa Sthana 30/7-8] [A. Hr. Uttara Sthana 33/27-28]
*Use of artificial objects for sexual pleasure are considered as risk factors for menstrual disorders. [Cha. Sa. [[Chikitsa Sthana]] 30/7-8] [A. Hr. Uttara Sthana 33/27-28]
'''3. Psychological factors:'''
'''3. Psychological factors:'''
*Mental stress, anxiety and excessive thinking causes vitiation of channels of transportation of [[rasa dhatu]] and lead to disturbances in the physiology of menstruation. [Cha. Sa. Vimana Sthana 5/13] Stress is a major cause for hormonal disturbance in HPO axis leading to menstrual abnormalities.
*Mental stress, anxiety and excessive thinking causes vitiation of channels of transportation of [[rasa dhatu]] and lead to disturbances in the physiology of menstruation. [Cha. Sa. [[Vimana Sthana]] 5/13] Stress is a major cause for hormonal disturbance in HPO axis leading to menstrual abnormalities.
'''4. Improper use of therapeutic interventions:'''
'''4. Improper use of therapeutic interventions:'''
*Administration of nasal medication (nasya) during menstrual phase, administration of strong medication for purification therapy (shodhana) in a woman who is sensitive to mild purgatives (mrudu koshtha) leads to disorders of menstruation. [Ka. Sa. Siddhi Sthana4/6] [Ka.Sa Siddhi Sthana 3/20]
*Administration of nasal medication (nasya) during menstrual phase, administration of strong medication for purification therapy (shodhana) in a woman who is sensitive to mild purgatives (mrudu koshtha) leads to disorders of menstruation. [Ka. Sa. Siddhi Sthana 4/6] [Ka. Sa Siddhi Sthana 3/20]
'''5. Congenital factors:'''
'''5. Congenital factors:'''
*The defects in gametes (beejadosha), especially in the ovum of mother can cause congenital anomalies related to female reproductive system. [Cha. Sa. Sharira Sthana 4/ 30].It is responsible for altering the reproductive physiology and causing menstrual abnormalities. [Cha Sa Chikitsa Sthana 30/7-8], [Cha Sa Chikitsa Sthana 30/34-35]
*The defects in gametes (beejadosha), especially in the ovum of mother can cause congenital anomalies related to female reproductive system. [Cha. Sa. [[Sharira Sthana]] 4/ 30].
It is responsible for altering the reproductive physiology and causing menstrual abnormalities. [Cha Sa [[Chikitsa Sthana]] 30/7-8], [Cha Sa [[Chikitsa Sthana]] 30/34-35]
</div>
===Pathophysiology===
===Pathophysiology===
'''Functions of 5 types of vata in reproductive physiology''' [A.S.Sutra Sthana 20/2]
'''Functions of 5 types of vata in reproductive physiology''' [A.S. Sutra Sthana 20/2]
{| class="wikitable"
{| class="wikitable"
|-
|-
!Type of Vayu !!Related Functions !! Physiological functions
!Type of Vayu !!Related Functions !! Physiological functions
|-
|-
|Prana vayu ||Maintanance and control of intellect(buddhi), sense organs (indriya),mind, vasomotor activities. || Neural regulation at hypothalamo-pitutary level
|'''Prana vayu''' ||Maintenance and control of intellect(buddhi), sense organs (indriya),mind, vasomotor activities. || Neural regulation at hypothalamo-pitutary level
|-
|-
|Udana vayu ||Production of strength(bala), energy(urja), memory(smriti), nourishing channels of body tissues(srota preenana)||Neural regulation at hypothalamo-pitutary level
|'''Udana vayu''' ||Production of strength(bala), energy(urja), memory(smriti), nourishing channels of body tissues(srota preenana)||Neural regulation at hypothalamo-pitutary level
|-
|-
|Samana vayu|| Helps in the function of digestive fire(agni), moves inside the channels of menstrual blood as well as ovum(artava vaha sroto vichari) || Any kind of transformation process related to reproductive physiology like Synthesis of all hormones,
|'''Samana vayu'''|| Helps in the function of digestive fire(agni), moves inside the channels of menstrual blood as well as ovum(artava vaha sroto vichari) || Any kind of transformation process related to reproductive physiology like Synthesis of all hormones,
Eg:-Aromatization of testosterone into estrogen
Eg:-Aromatization of testosterone into estrogen
Receptor mechanism in cells, functions of gap junctions
Receptor mechanism in cells, functions of gap junctions
|-
|-
|Vyana vayu|| All kinds of movements,clearing/widening the channels of transportation(sroto vishodhana),Flow of sweat and blood(sweda- asruk sravana)|| Helps in ejaculation of semen and helps in fertilization, nourishment of all the tissues Circulation of reproductive hormones
|'''Vyana vayu'''|| All kinds of movements,clearing/widening the channels of transportation(sroto vishodhana),Flow of sweat and blood(sweda- asruk sravana)|| Helps in ejaculation of semen and helps in fertilization, nourishment of all the tissues Circulation of reproductive hormones
Spasm followed by relaxation in spiral arteries- damage of arteriolar wall- escape of blood(mechanism of menstrual bleeding)
Spasm followed by relaxation in spiral arteries- damage of arteriolar wall- escape of blood(mechanism of menstrual bleeding)
|-
|-
|Apana vayu|| Elimination of menstrual blood(artava nishkramana) || Shedding of superficial functional layer of endometrium along with blood from the uterine cavity.
|'''Apana vayu'''|| Elimination of menstrual blood(artava nishkramana) || Shedding of superficial functional layer of endometrium along with blood from the uterine cavity.
|}
|}
<div style="text-align:justify;">
*The vitiation of vata occurs in two ways:
*The vitiation of vata occurs in two ways:
1)Primary vitiation: Due to degenration of body components(dhatukshaya)
1)Primary vitiation: Due to degeneration of body components(dhatukshaya)
2)Secondary vitiation: Obtructive pathology (avarodha)
2)Secondary vitiation: Obtructive pathology (avarodha)
*The pathology of excessive menstrual bleeding (asrugdara) is explained as the occlusion of apana vayu with [[pitta]] (pittavruta apana).[Su. Sa. Nidana Sthana 1/37]
*The pathology of excessive menstrual bleeding (asrugdara) is explained as the occlusion of apana vayu with [[pitta]] (pittavruta apana).[Su. Sa. Nidana Sthana 1/37]
*Heavy menstrual bleeding is also included in the disorders of blood (raktapradoshaja vikara).[ Cha. Sa. Sutra Sthana 28/11]
*Heavy menstrual bleeding is also included in the disorders of blood (raktapradoshaja vikara).[ Cha. Sa.[[Sutra Sthana]] 28/11]
*The obstructive pathology due to kapha usually leads to decrease in the fuction due increase in the properties like coldness[[sheeta]], dullness/slowness[[manda]] and immobility[[sthiratva]]. While explaining the pathology of secondary amenorrhoea(artava nasha), it is clarified that the [[dosha]] causing the occlusion of [[vata]] here is either [[kapha]] or another form of [[vata]] itself, but not [[pitta]].[Dalhana commentary on Su.Sa. Sharira Sthana 2/21]
*The obstructive pathology due to [[kapha]] usually leads to decrease in the function due increase in the properties like coldness (sheeta), dullness/slowness (manda) and immobility (sthiratva). While explaining the pathology of secondary amenorrhoea(artava nasha), it is clarified that the [[dosha]] causing the occlusion of [[vata]] here is either [[kapha]] or another form of [[vata]] itself, but not [[pitta]].[Dalhana commentary on Su. Sa. Sharira Sthana 2/21]
</div>
===General features===
===General features===
<div style="text-align:justify;">
The increase or decrease in quality and/or quantity of menstrual blood(artava)can lead to various abnormal conditions. The states can be assessed by following clinical features.
The increase or decrease in quality and/or quantity of menstrual blood(artava)can lead to various abnormal conditions. The states can be assessed by following clinical features.
{| class="wikitable"
{| class="wikitable"
|}
|}
*[Su. Sa. Sutra Sthana 15/12], **[Su. Sa. Sutra Sthana 15/16]
* *[Su. Sa. Sutra Sthana 15/12], **[Su. Sa. Sutra Sthana 15/16]
A special condition characterized by excessive menstrual loss is explained in Ayurveda which is known as “Asrugdara”.
A special condition characterized by excessive menstrual loss is explained in Ayurveda which is known as “Asrugdara”.
It includes:
It includes:
a)'''Menorrhagia''': excessive bleeding in terms of quantityand duration(atiprasangena pravruttam). It is defined as menstrual blood loss greater than 80 ml.
a)'''Menorrhagia''': excessive bleeding in terms of quantity and duration(atiprasangena pravruttam). It is defined as menstrual blood loss greater than 80 ml.
b)'''Metrorrhagia''': intermenstrual bleeding(anrutavapi pravruttam)
b)'''Metrorrhagia''': intermenstrual bleeding(anrutavapi pravruttam)
e)Other bleeding disorders(anyad raktalakshana)
e)Other bleeding disorders(anyad raktalakshana)
</div>
===Special features===
===Special features===
{| class="wikitable"
{| class="wikitable"
|-
|-
!Sl no: !! Type !! Characteristic features !! Probable gynecological correlation
!Sl no: !! Type !! Characteristic features !! Probable gynecological correlation<ref>Prof.Premvati Tewari, Ayurveda Prasutitantra evam Striroga, Part 2, Chapter 2, Artavavyapad,Chaukhambha orientalia,Varanasi, vol. 2, 2012, Page No:187,190,192,194.</ref>
|-
|-
|1. ||Vata dominant || •Menstrual blood is frothy, thin, rough, blackish or reddish, resembling washings of flower of Butea monosperma (palasha).*
|1. ||Vata dominant || •Menstrual blood is frothy, thin, rough, blackish or reddish, resembling washings of flower of Butea monosperma (palasha).*
•Continuously suffering from thirst, burning sensation, fever, anaemia, and weakness*
•Continuously suffering from thirst, burning sensation, fever, anaemia, and weakness*
•Resembles a sour liqid called “Kanji” prepared from rice and foul smelling.**
•Resembles a sour liquid called “Kanji” prepared from rice and foul smelling.**
•Blue like bronze, dirty and foul smelling.***
•Blue like bronze, dirty and foul smelling.***
|}
|}
*[Cha. Sa. Chikitsa Sthana 30/211-224], **[ Su. Sa. Sutra Sthana 14/21], ***[A. S. Sutra Sthana 36/16]
* *[Cha. Sa. [[Chikitsa Sthana]] 30/211-224], **[ Su. Sa. Sutra Sthana 14/21], ***[A. S. Sutra Sthana 36/16]
==== Types of vitiation of menstrual blood (artava) ====
==== Types of vitiation of menstrual blood (artava) ====
<div style="text-align:justify;">
There are eight types of deviated/abnormal states of menstrual blood (artavadushti) as mentioned in the table.
There are eight types of deviated/abnormal states of menstrual blood (artavadushti) as mentioned in the table.
{| class="wikitable"
{| class="wikitable"
|-
|-
!Sl. No !!Type !!Characteristic features !! Vitiating factor !! Clinical gynecological disorders
!Sl. No !!Type !!Characteristic features !! Vitiating factor !! Clinical gynecological disorders<ref>Prof.Premvati Tewari, Ayurveda Prasutitantra evam Striroga, Part 2, Chapter 2, Artavavyapad,Chaukhambha orientalia,Varanasi, vol. 2, 2012, Page No:150-151.</ref>
|-
|-
|1. ||Vataja || Red, black or dark violet in color, thin, dry, frothy and scattered (very small clots mixed with liquid substance), excreted slowly with perforating or piercing type of pain* || Vata* || Oligomenorrhea with dysmenorrhea caused by nutritional deficiency
|1. ||'''Vataja''' || Red, black or dark violet in color, thin, dry, frothy and scattered (very small clots mixed with liquid substance), excreted slowly with perforating or piercing type of pain* || Vata* || Oligomenorrhea with dysmenorrhea caused by nutritional deficiency
|-
|-
|2. ||Pittaja || Yellowish or bluish in color, free from unctuousness, excreted blood is hot and associated with burning sensation*
|2. ||'''Pittaja''' || Yellowish or bluish in color, free from unctuousness, excreted blood is hot and associated with burning sensation*
The color of blood resembles that of hibiscus (japa),or saffron, associated with dysuria **
The color of blood resembles that of hibiscus (japa),or saffron, associated with dysuria **
||Pitta* || Inflammatory condition of reproductive organs due to infection especially chronic pelvic cellulitis associated with oligomenorrhoea.
||Pitta* || Inflammatory condition of reproductive organs due to infection especially chronic pelvic cellulitis associated with oligomenorrhoea.
|-
|-
|3. || Kaphaja || Whitish or slightly yellowish in color, appears as if mixed with bone marrow, too thick and slippery, unctuous and settles down if put in the water*
|3. || '''Kaphaja''' || Whitish or slightly yellowish in color, appears as if mixed with bone marrow, too thick and slippery, unctuous and settles down if put in the water*
Retention of urine, body stiffness or idleness, lethargy, drowsiness, sleepiness**
Retention of urine, body stiffness or idleness, lethargy, drowsiness, sleepiness**
|| Kapha* || Chronic endometritis, endocervicitis or cervicitis associated with oligomenorrhoea.
|| Kapha* || Chronic endometritis, endocervicitis or cervicitis associated with oligomenorrhoea.
|-
|-
|4. || Kunapagandhi || Smell of dead tissue, excessive blood discharge, associated with features of pitta like burning sensation* || Rakta* || Early stage of endometrial carcinoma.
|4. || '''Kunapagandhi''' || Smell of dead tissue, excessive blood discharge, associated with features of pitta like burning sensation* || Rakta* || Early stage of endometrial carcinoma.
|-
|-
|5. || Granthibhuta || Clotted appearance, features of both kapha and vata.* || Kapha-vata* ||Malignant disorders of reproductive system specially cervical carcinoma
|5. || '''Granthibhuta''' || Clotted appearance, features of both kapha and vata.* || Kapha-vata* ||Malignant disorders of reproductive system specially cervical carcinoma
|-
|-
|6. || Puti-puya || Putrid and purulent discharge.* associated with other features of pitta and kapha. || Pitta-kapha*/
|6. || '''Puti-puya''' || Putrid and purulent discharge.* associated with other features of pitta and kapha. || Pitta-kapha*/
Rakta- Pitta#
Rakta- Pitta#
|| Acute infection of reproductive system especially acute endometritis leading to pyometra.
|| Acute infection of reproductive system especially acute endometritis leading to pyometra.
|-
|-
|7. || Ksheena || Delayed, scanty and associated with pain.* || Vata-pitta* || Hypoestrogenic oligomenorrhoea caused by nutritional deficiency.
|7. || '''Ksheena''' || Delayed, scanty and associated with pain.* || Vata-pitta* || Hypoestrogenic oligomenorrhoea caused by nutritional deficiency.
|-
|-
|8. || Mutra-purishagandhi || Smell of urine and feces. || Sannipata* ||Cervical carcinoma specially 3rd or 4th stage.
|8. || '''Mutra-purishagandhi''' || Smell of urine and feces. || Sannipata* ||Cervical carcinoma specially 3rd or 4th stage.
|}
|}
*[Su. Sa. Sharira Sthana 2/4], [A.S. Sharira Sthana 1/24], **[Ha.Sa. Trutiya Sthana 48/19,22, 23], #[A. Hr. ShariraSthana 1/11]
* *[Su. Sa. Sharira Sthana 2/4], [A.S. Sharira Sthana 1/24], **[Ha.Sa. Trutiya Sthana 48/19,22, 23], #[A. Hr. Sharira Sthana 1/11]
Currently, apart from the three types of vitiation 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 focusing on the diagnosis and treatment aspects of abnormal variations in the characteristic features of menstrual blood(artava dushti) are needed.
Currently, apart from the three types of vitiation 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 focusing on the diagnosis and treatment aspects of abnormal variations in the characteristic features of menstrual blood(artava dushti) are needed.
</div>
== Examination of patients ==
== Examination of patients ==
=== Observation (darshana) ===
=== Observation (darshana) ===
<div style="text-align:justify;">
On examining the patient, the general health status should be the prime concern. In case of clinical conditions like scanty bleeding or amenorrhea, the patient may be emaciated(krusha) and there may be discoloration of skin (vaivarnya) or pallor which is mentioned as the clinical features of a disorder of reproductive tract namely “arajaska yoni vyapad” [Cha.Sa. [[Chikitsa Sthana]] 30/17]. The same presentation is found in heavy menstrual bleeding also.
In case of primary amenorrhoea, development of secondary sexual characters should be noted. For example, the breast development is absent or less in conditions called “ shushka revati”[Ka. Sa. Kalpa Sthana 6/31] and “shandhi yoni vyapad”. [Cha.Sa.[[Chikitsa Sthana]] 30/35]
In case of primary amenorrhoea, development of secondary sexual characters should be noted. For example, the breast development is absent or less in conditions called “ shushka revati”[Ka. Sa. Kalpa Sthana 6/31] and “shandhi yoni vyapad”. [Cha.Sa. ChikitsaSthana 30/35]
The features like obesity, enlargement of thyroid gland, excessive androgenic hair growth, etc. which give a clue regarding the metabolic and endocrinal disorders like poly cystic ovary syndrome(PCOS), thyroid dysfunction, hyperprolactinemia etc. leading to menstrual irregularities also should be observed.
The features like obesity, enlargement of thyroid gland, excessive androgenic hair growth, etc. which give a clue regarding the metabolic and endocrinal disorders like poly cystic ovary syndrome(PCOS), thyroid dysfunction, hyperprolactinemia etc. leading to menstrual irregularities also should be observed.
The color index for normal menstrual blood (artava) is available in the text books of Ayurveda. It is mentioned as different shades of red having resemblance with the followings.
The color index for normal menstrual blood (artava) is available in the text books of Ayurveda. It is mentioned as different shades of red having resemblance with the followings.
*the color of fruit of Abrusprecatorius(gunja)[Cha. Sa. Chikitsa Sthana 30/226]
*the color of fruit of Abrusprecatorius(gunja)[Cha. Sa. [[Chikitsa Sthana]] 30/226]
*the color of red lotus flower[Cha. Sa. Chikitsa Sthana 30/ 226]
*the color of red lotus flower[Cha. Sa. [[Chikitsa Sthana]] 30/ 226]
*the color of an insect called red velvet mite(indragopa)[Cha. Sa. ChikitsaSthana 30/226]
*the color of an insect called red velvet mite(indragopa)[Cha. Sa. [[Chikitsa Sthana]] 30/226]
*the color of blood of rabbit[Su. Sa. ShariraSthana 2/ 17 ]
*the color of blood of rabbit[Su. Sa. Sharira Sthana 2/ 17 ]
*the color of solution Lacciferlacca(laksha rasa)[Su. Sa. Sharira Sthana 2/17]
*the color of solution Laccifer lacca(laksha rasa)[Su. Sa. Sharira Sthana 2/17]
*blackish red[Su. Sa. Sharira Sthana 3/ 10]
*blackish red[Su. Sa. Sharira Sthana 3/ 10]
The abnormal range of color shades are mentioned as the clinical features of different types of abnormal states of menstrual blood(artavadushti) as well the features of different types of excessive bleeding(asrugdara).
The abnormal range of color shades are mentioned as the clinical features of different types of abnormal states of menstrual blood(artavadushti) as well the features of different types of excessive bleeding(asrugdara).
Apart from the color, the smell and consistency also should be noted. The peculiar nature of menstrual blood as it does not stain the cloth is particularly observed. [Su. Sa. ShariraSthana 2/ 17]
Apart from the color, the smell and consistency also should be noted. The peculiar nature of menstrual blood as it does not stain the cloth is particularly observed. [Su. Sa. Sharira Sthana 2/ 17]
All these are supposed to be noted in direct observation in clinically practice even though it is not always feasible in regular set up. But, per speculum examination of vaginal tract reveals many hidden diagnoses.
All these are supposed to be noted in direct observation in clinically practice even though it is not always feasible in regular set up. But, per speculum examination of vaginal tract reveals many hidden diagnoses.
</div>
===Palpation(sparshana) ===
===Palpation(sparshana) ===
<div style="text-align:justify;">
Per abdominal examination by palpation as well as bi-manual examination of uterus and adnexa is important in the diagnosis of menstrual disorders.
Per abdominal examination by palpation as well as bi-manual examination of uterus and adnexa is important in the diagnosis of menstrual disorders.
The typical feature suggestive of a particular pathology can be reveled through proper interrogation.
The typical feature suggestive of a particular pathology can be reveled through proper interrogation.
Ex- immediate relief of pain after proper establishment of bleeding in primary/spasmodic dysmenorrhea (udavartini yoni vyapad).[ Cha. Sa. Chikitsa Sthana 30/25-26]
Ex- immediate relief of pain after proper establishment of bleeding in primary/spasmodic dysmenorrhea (udavartini yoni vyapad).[ Cha. Sa.[[Chikitsa Sthana]] 30/25-26]
The etiological factors should be traced out through proper history taking which helps in both diagnosis as well as treatment.
The etiological factors should be traced out through proper history taking which helps in both diagnosis as well as treatment.
In cases where direct observation of characters of menstrual blood is not feasible, it can be understood by proper interrogation. Detailed history regarding diet, life style and sexual activity is necessary for the successful treatment of menstrual disorders.
In cases where direct observation of characters of menstrual blood is not feasible, it can be understood by proper interrogation. Detailed history regarding diet, life style and sexual activity is necessary for the successful treatment of menstrual disorders.
</div>
==Laboratory investigations==
==Laboratory investigations==
'''Purification therapy(shodhana chikitsa):'''
'''Purification therapy(shodhana chikitsa):'''
<div style="text-align:justify;">
Purification therapy is the first line of treatment in quantitative or qualitative decrease of menstrual blood due to obstructive/occlusion pathology(avarodha). Here, therapeutic emesis([[Vamana]]) has major role as the condition is predominantly due to [[kapha]].
Purification therapy is the first line of treatment in quantitative or qualitative decrease of menstrual blood due to obstructive/occlusion pathology(avarodha). Here, therapeutic emesis([[Vamana]]) has major role as the condition is predominantly due to [[kapha]].
Some scholars opine that therapeutic purgation (virechana) is contraindicated as it may lead to further decrease of [[pitta]].[Dalhana commentry, Su.Sa.Sutra Sthana 15/12] However, in chronic pathology both therapeutic emesis (vamana) and purgation (virechana) are recommended and practically both the procedures are found to be effective.
Some scholars opine that therapeutic purgation (virechana) is contraindicated as it may lead to further decrease of [[pitta]].[Dalhana commentry, Su.Sa.Sutra Sthana 15/12] However, in chronic pathology both therapeutic emesis (vamana) and purgation (virechana) are recommended and practically both the procedures are found to be effective.<ref>Chauhan M; From the proceedings of Insight Ayurveda 2013, Coimbatore. 24th and 25th May 2013. OA03.05. A clinical study on the effect of vamana in anartava wsr to secondary amenorrhoea. Anc Sci Life. 2013;32(Suppl 2):S28. doi:10.4103/0257-7941.123842</ref> <ref>Bhingardive KB, Sarvade DD, Bhatted S. Clinical efficacy of Vamana Karma with Ikshwaaku Beeja Yoga followed by Shatapushpadi Ghanavati in the management of Artava Kshaya w. s. r to polycystic ovarian syndrome. Ayu. 2017;38(3-4):127-132. doi:10.4103/ayu.AYU_192_16</ref> <ref>Sreelakshmi Chaganti(2016), Evaluation of efficacy of virechana in polycystic ovarian syndrome,PG Dissertation, KLE Academy of higher education and research, Belgavi</ref>
'''Pacification therapy(shamana chikitsa):'''
'''Pacification therapy(shamana chikitsa):'''
Substances promoting the properties of pitta (agneya dravya) like sesame oil (tila tail), black gram(masha)are advised to be taken regularly by the women. But in case of extreme decrease of endometrial thickness, ghee(ghrita) is having greater role than oil(taila)for promoting the endometrial proliferation and maintenance of preferred level of growth.[A.S. Sharira Sthana 1/64]
Substances promoting the properties of pitta (agneya dravya) like sesame oil (tila tail), black gram(masha)are advised to be taken regularly by the women. But in case of extreme decrease of endometrial thickness, ghee(ghrita) is having greater role than oil(taila)for promoting the endometrial proliferation and maintenance of preferred level of growth.[A.S. Sharira Sthana 1/64]
</div>
===Treatment for increased state of menstrual blood ===
===Treatment for increased state of menstrual blood ===
<div style="text-align:justify;">
'''Purification therapy:'''
'''Purification therapy:'''
In case of excessive menstrual bleeding, therapeutic purgation(virechana) is the treatment of choice.[Ka.Sa .SidhiSthana 2/13]
In case of excessive menstrual bleeding, therapeutic purgation(virechana) is the treatment of choice.[Ka.Sa .Sidhi Sthana 2/13]
'''Pacification therapy:'''
'''Pacification therapy:'''
*Hemostatic drugs (rakta stambhaka) are given only if the strength of patient is low and the vital parameters are disturbed. In this case, the medicines used for stopping blood as indicated in treatment of diarrhea with blood(raktatisara),bleeding disorders (raktapitta) and bleeding piles(raktarsha).[Ch.Sa.Chikitsa Sthana 30/228]
*Hemostatic drugs (rakta stambhaka) are given only if the strength of patient is low and the vital parameters are disturbed. In this case, the medicines used for stopping blood as indicated in treatment of diarrhea with blood(raktatisara),bleeding disorders (raktapitta) and bleeding piles(raktarsha).[Ch.Sa.[[Chikitsa Sthana]] 30/228]
*If the vital parameters are normal and strenghth of patient is normal, then no medicine is advised to stop bleeding in the initial stage. Hemostasis treatment of vitiated blood leads to complications. [Ch.Sa.Chikitsa Sthana 30/228]
*If the vital parameters are normal and strenghth of patient is normal, then no medicine is advised to stop bleeding in the initial stage. Hemostasis treatment of vitiated blood leads to complications. [Ch.Sa. [[Chikitsa Sthana]] 30/228]
*By considering the association of [[doshas]] diagnosed on the basis of color and smell of blood,haemostatic drugs should be given to arrest the bleeding.[Ch. Sa Chikitsa Sthana 30/86]
*By considering the association of [[doshas]] diagnosed on the basis of color and smell of blood,haemostatic drugs should be given to arrest the bleeding.[Cha. Sa [[Chikitsa Sthana]] 30/86]
</div>
===Treatment for abnormal state of menstrual blood: ===
===Treatment for abnormal state of menstrual blood: ===
<div style="text-align:justify;">
'''Purification therapy :'''
'''Purification therapy :'''
In abnormalities of menstrual blood (artava dushti), oleation(snehana),sudation(swedana), purification therapies(vamana, virechana, basti) as well as local therapies including intra uterine drug administration(uttarabasti) is advised.[Su. Sa. Sharira Sthana 2/12]
In abnormalities of menstrual blood (artava dushti), oleation (snehana),sudation(swedana), purification therapies(vamana, virechana, basti) as well as local therapies including intra uterine drug administration(uttarabasti) is advised.[Su. Sa. Sharira Sthana 2/12]
In the management of dysmenorrhoea (udavartini) also, oleation(snehana), sudation (swedana), enema therapy (both unctuous as well as decoction like dashamoola and milk) especially unctuous enema(anuvasanabasti) and intra uterine oil administration(uttara basti) are recommended.[Ch. Sa. ChikitsaSthana 30/228]
In the management of dysmenorrhoea (udavartini) also, oleation(snehana), sudation (swedana), enema therapy (both unctuous as well as decoction like dashamoola and milk) especially unctuous enema(anuvasana basti) and intra uterine oil administration(uttara basti) are recommended.[Ch. Sa. [[Chikitsa Sthana]] 30/228]
'''Pacification therapy:'''
'''Pacification therapy:'''
!Type of abnormality !!Drugs
!Type of abnormality !!Drugs
|-
|-
|Vataja ||| •Unctuous,hot,sour and salty substances*
|'''Vataja''' ||| •Unctuous,hot,sour and salty substances*
Internal:
'''Internal:'''
•Ghee processed with Clerodendrum serratum (bharangi) ,Madhuca longifolia(madhuka), Cedrus deodara ( bhadradaru)**
•Ghee processed with Clerodendrum serratum (bharangi) ,Madhuca longifolia(madhuka), Cedrus deodara ( bhadradaru)**
•Milk processed with Gmelina arborea(kashmari), Phaseolus trilobus(kshudrasaha)**
•Milk processed with Gmelina arborea(kashmari), Phaseolus trilobus(kshudrasaha)**
External:
'''External:'''
•Paste of Callicarpa macrophylla(priyangu) and sesame oil-applied in vagina**
•Paste of Callicarpa macrophylla(priyangu) and sesame oil-applied in vagina**
|-
|-
|Pittaja || •Sweet, cold and astringent substances*
|'''Pittaja''' || •Sweet, cold and astringent substances*
Internal:
'''Internal:'''
•Decoction of Lilium polyphyllum (kakoli)/ root of Pueraria tuberose(vidarimula)/ Nymphaea alba(utpala)/ Madhucalongifolia (madhuka)/ Gmelina arborea (kashmari) mixed with sugar.**
•Decoction of Lilium polyphyllum (kakoli)/ root of Pueraria tuberose(vidarimula)/ Nymphaea alba(utpala)/ Madhucalongifolia (madhuka)/ Gmelina arborea (kashmari) mixed with sugar.**
•Paste of Anogeissuslatifolia (dhava) and Woodfordiafruticosa (dhataki) flowers mixed with ghee**
•Paste of Anogeissuslatifolia (dhava) and Woodfordiafruticosa (dhataki) flowers mixed with ghee**
External:
'''External:'''
•Vaginal application of paste of Santalum album (chandana)and Ipomoea digitata(payasya)**
•Vaginal application of paste of Santalum album (chandana)and Ipomoea digitata(payasya)**
•Vaginal douche with decoction of red ochre(gairika) and neem.**
•Vaginal douche with decoction of red ochre(gairika) and neem.**
|-
|-
|Kaphaja || •Hot,dry and astringent substances*
|'''Kaphaja''' || •Hot,dry and astringent substances*
Internal:
'''Internal:'''
•Decoction of Holarrhena antidysenterica (kutaja), Picrorhiza kurrooa (katuka)and Withania somnifera (ashwagandha)**
•Decoction of Holarrhena antidysenterica (kutaja), Picrorhiza kurrooa (katuka)and Withania somnifera (ashwagandha)**
•Decoction of tender leaves of latex yielding trees mixed with honey**
•Decoction of tender leaves of latex yielding trees mixed with honey**
External:
'''External:'''
•Vaginal application of paste of Randia dumetorum (madanaphala)**
•Vaginal application of paste of Randia dumetorum (madanaphala)**
•Decoction of Cissampelospareira (patha),Tribulus terrestris(trikandaka), Holarrhenaantidysenterica(vrukshaka)**
•Decoction of Cissampelospareira (patha),Tribulus terrestris(trikandaka), Holarrhenaantidysenterica(vrukshaka)**
|-
|-
|Kunapagandhi(foul smelling) , Puti-puya(pus like appearance)|| For removing bad smell-
|'''Kunapagandhi(foul smelling) , Puti-puya(pus like appearance)'''|| For removing bad smell-
•Oral intake of decoction of Santalum album(chandana)*
•Oral intake of decoction of Santalum album(chandana)*
•Vaginal irrigation with decoction of Emblicaofficinalis ,Terminalia bellirica,Terminalia chebula (triphala)**
•Vaginal irrigation with decoction of Emblicaofficinalis ,Terminalia bellirica,Terminalia chebula (triphala)**
|-
|-
|Ksheena(scanty) || Same as artavakashaya**
|'''Ksheena(scanty)''' || Same as artavakashaya**
|}
|}
*[A.Hr. Sharira Sthana 1], **[A.S. Sharira Sthana 1]
*[A.Hr. Sharira Sthana 1], **[A.S. Sharira Sthana 1]
</div>
===Diet and lifestyle modification for prevention of menstrual disorders ===
===Diet and lifestyle modification for prevention of menstrual disorders ===
<div style="text-align:justify;">
In general, cereals like rice(shali), barley(yava), alcoholic preparations (madya),meat preparations capable of increasing [[pitta]] are beneficial for promoting the female reproductive health.[Su.Sa. Sharira Sthana 2/16]
In general, cereals like rice(shali), barley(yava), alcoholic preparations (madya),meat preparations capable of increasing [[pitta]] are beneficial for promoting the female reproductive health.[Su.Sa. Sharira Sthana 2/16]
All these activities are likely to cause physical strain for the woman and their adverse effects are reflected even in her future progeny.[Su. Sa. Sharira Sthana 2/24-25]
All these activities are likely to cause physical strain for the woman and their adverse effects are reflected even in her future progeny.[Su. Sa. Sharira Sthana 2/24-25]
</div>
==Menstrual Hygiene ==
==Menstrual Hygiene ==
Menstrual hygiene management (MHM) refers to management of hygiene associated with the menstrual process.
Menstrual hygiene management (MHM) refers to management of hygiene associated with the menstrual process.<ref>https://www.unicef.org/wash/files/UNICEF-Guide-menstrual-hygiene-materials-2019.pdf</ref>
It includes,
It includes,
==Current Researches==
==Current Researches==
<div style="text-align:justify;">
*PCOS is diagnosed as per the standard Rotterdam criteria<ref>Rui Wang, Ben Willem J. Mol, The Rotterdam criteria for polycystic ovary syndrome: evidence-based criteria?, Human Reproduction, Volume 32, Issue 2, 1 February 2017, Pages 261–264, https://doi.org/10.1093/humrep/dew287</ref>. Recent studies suggest the incorporation of raised level of Anti mullerian Hormone (AMH) along with the sonography findings to define polycystic ovarian morphology (PCOM).<ref>Fraissinet A, Robin G, Pigny P, Lefebvre T, Catteau-Jonard S, Dewailly D. Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome. Hum Reprod. 2017;32(8):1716-1722. doi:10.1093/humrep/dex239</ref>
PCOS is considered as [[Vata]]- [[kapha]] dominant vitiation (artava dushti) in Ayurveda and many clinical trials are being conducted on Ayurvedic management of PCOS.
PCOS is considered as Vata- kapha dominant vitiation (artava dushti) in Ayurveda and many clinical trials are being conducted on Ayurvedic management of PCOS.
A series of clinical trials on effect of a classical formulation of Cissampelos pareira (patha), Piper longum Linn, Zingiber officinale, Piper nigrum Linn (trikatu), Holarrhena antidysenterica, (vrukshaka) mentioned for clotted type presentation (vata-kapha predominant granthibhuta artava dushti) was carried out. Oral administration of the formulation, therapeutic purgation(virechana), medicated enema(basti) showed good results in 170 patients of PCOS. The efficacy in terms of symptomatic relief, correction of hormonal levels and improvement in the quality of life was observed.
A series of clinical trials on effect of a classical formulation of Cissampelos pareira (patha), Piper longum Linn, Zingiber officinale, Piper nigrum Linn (trikatu), Holarrhena antidysenterica, (vrukshaka) mentioned for clotted type presentation (vata-kapha predominant granthibhuta artava dushti) was carried out. Oral administration of the formulation, therapeutic purgation(virechana), medicated enema(basti) showed good results in 170 patients of PCOS. The efficacy in terms of symptomatic relief, correction of hormonal levels and improvement in the quality of life was observed.<ref>Dr. krupa D. Patel (2011) A clinical study on Polycystic Ovarian Disease (PCOD) & it’s management by Shatpushpa tail matra basti & Pathadi Kwatha ,PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Ashokan (2014) ,Clinical study on Ayurvedic treatment modalities in the management Vata – Kaphaja Artavadushti (w.s.r.to PCOS), PhD thesis ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Pravin Dhote (2015),Clinical study on Vata Kaphaja Artavdushti (w.s.r. to PCOS) and it’s management by Ayurvedic treatment Modalities” , PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Ashiya (2018), Managementof Artava Dushti w.s.r to Polycystic Ovarian Syndrome with Virechana and Pathadi kwatha – a randomized controlled clinical trial, PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Archana S. (2019),Management of ArtavaDushti w.s.r to polycystic ovarian syndrome by PalashadiBasti and PathadiChoorna : A randomized controlled clinical trial , PhD thesis ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref>
*Various methods have been developed to quantify the menstrual blood loss and validated for the purpose of research. Among them, alkaline hematin method is considered as the gold standard and is considered as the best when used in conjunction with a pictorial method like menstrual pictogram.
*Various methods have been developed to quantify the menstrual blood loss and validated for the purpose of research. Among them, alkaline hematin method is considered as the gold standard and is considered as the best when used in conjunction with a pictorial method like menstrual pictogram.<ref>Magnay JL, O'Brien S, Gerlinger C, Seitz C. A systematic review of methods to measure menstrual blood loss. BMC Womens Health. 2018;18(1):142. Published 2018 Aug 22. doi:10.1186/s12905-018-0627-8</ref>
*Medical therapies for heavy menstrual bleeding include hormonal treatments; levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives are most commonly used. Endometrial ablation is a minor surgical procedure that is associated with low operative morbidity and can be performed as an outpatient. Hysterectomy remains the definitive treatment of choice when medical therapies have failed and endometrial ablation is not suitable.
*Medical therapies for heavy menstrual bleeding include hormonal treatments; levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives are most commonly used. Endometrial ablation is a minor surgical procedure that is associated with low operative morbidity and can be performed as an outpatient. Hysterectomy remains the definitive treatment of choice when medical therapies have failed and endometrial ablation is not suitable.<ref>Davies J, Kadir RA. Heavy menstrual bleeding: An update on management. Thromb Res. 2017;151 Suppl 1:S70‐S77. doi:10.1016/S0049-3848(17)30072-5</ref>
Clinical trials using certain Ayurveda formulations and therapeutic purgation (virechana) have shown appreciable results in the management of excessive menstrual bleeding, especially in case of dysfunctional uterine bleeding.
Clinical trials using certain Ayurveda formulations and therapeutic purgation (virechana) have shown appreciable results in the management of excessive menstrual bleeding, especially in case of dysfunctional uterine bleeding.<ref>Pooja Chauhan(2019)Management of Asrigdara with Virechana and Vasadi Ghanavati : An open labeled Randomized comparative clinical trial, PG dissertation,Department Stree Roga and of Prasuti Tantra, IPGT&RA, Jamnagar, Gujarat.</ref> <ref>Roopa K.V(2011),A critical study on the role of virechana in the samprapti vighatana of asrigdara w.s.r to DUB, PG Dissertation,Department of Prasuti tantra and stree roga, RGUHS,Bangalore.</ref> <ref>Jamuna Devi R(2004), Management of asrigdara with special reference to dysfunctional uterine bleeding with “ashoka yoga, PG Dissertation, Department of Prasuti tantra and stree roga,GAM,Puri,Orissa</ref>
*Conventional management options for dysmenorrhea include non-steroidal anti-inflammatory drugs and hormonal contraceptives. In Ayurveda, the drugs or procedures which pacify [[vata]] are advised for the treatment of dysmenorrhea .
*Conventional management options for dysmenorrhea include non-steroidal anti-inflammatory drugs and hormonal contraceptives. In Ayurveda, the drugs or procedures which pacify [[vata]] are advised for the treatment of dysmenorrhea .
Clinical trials have shown that enema with medicated oil (matra basti) is an effective protocol for the management of dysmenorrhea.
Clinical trials have shown that enema with medicated oil (matra basti) is an effective protocol for the management of dysmenorrhea.<ref>Dr. Kaumudi Karunagoda (2010)A comparative clinical study of Dashmoola Taila Matra Basti and Tila Taila Matra Basti in the management of Kashtartava, PG dissertation, Department Stree Roga and of Prasuti Tantra, IPGT&RA, Jamnagar, Gujarat</ref> <ref>Dr.Amit Tanna (2011),A further study of Kashtartava (Dysmenorrhea) and its management by Dashmula Taila Matra Basti and Tila Taila Matra Basti, PG dissertation, Department of Stree Roga and Prasuti Tantra IPGT&RA, Jamnagar, Gujarat.</ref> <ref>Dr. HLMG Sajeewani (2012),Further Clinical Study on Kashtartava with special reference to Primary Dysmenorrhea and its management by Matra Basti, PG Dissertation, Department of Stree Roga and Prasuti Tantra IPGT&RA, Jamnagar, Gujarat</ref>
Various Ayurvedic formulations having carminative, analgesic and anti-inflammatory properties are also proven their efficacy in the management of dysmenorrhea.
Various Ayurvedic formulations having carminative, analgesic and anti-inflammatory properties are also proven their efficacy in the management of dysmenorrhea.<ref>Arun gupta(2020),Management of Udavartini Yoni Vyapad(Dysmenorrhoea), with Shoola Prashamana Dashemani and Eranda Brusht Haritaki Shunthi Churna-a comparative clinical study, PG Dissertation, Department of Stree Roga and Prasuti Tantra IPGT&RA, Jamnagar, Gujarat</ref> <ref>Chayaa Der (2002),A comparative clinical study of Satapushpa Vati and Krishna Tila Kwatha on Artava Kshaya , PG Dissertation, Department of Stree Roga and Prasuti Tantra IPGT&RA, Jamnagar, Gujarat</ref>
*Topical heat, exercise, and nutritional supplementation are also beneficial and practice of Yoga has greater impact in patients of dysmenorrhea.
*Topical heat, exercise, and nutritional supplementation are also beneficial and practice of Yoga has greater impact in patients of dysmenorrhea.<ref>Habeeb Mini (2003),A study on the effect of selected Yoga and Nature cure techniques in Udavarta Yoni Vyapada, Deptt. Of Swasthavrutta by Govt.Ayurvedic College Thiruvananthapuram, Kerala.</ref>
*Menstrual blood-derived stem cells (MenSCs) are a novel source of mesenchymal stem cells (MSCs). They are found to be having therapeutic effects in various diseases, including liver disease, diabetes, stroke, Duchenne muscular dystrophy, ovarian-related disease, myocardial infarction, Asherman syndrome, Alzheimer's disease, acute lung injury, cutaneous wound, endometriosis, and neurodegenerative diseases.
*Menstrual blood-derived stem cells (MenSCs) are a novel source of mesenchymal stem cells (MSCs). They are found to be having therapeutic effects in various diseases, including liver disease, diabetes, stroke, Duchenne muscular dystrophy, ovarian-related disease, myocardial infarction, Asherman syndrome, Alzheimer's disease, acute lung injury, cutaneous wound, endometriosis, and neurodegenerative diseases.<ref>Chen L, Qu J, Xiang C. The multi-functional roles of menstrual blood-derived stem cells in regenerative medicine. Stem Cell Res Ther. 2019;10(1):1. Published 2019 Jan 3. doi:10.1186/s13287-018-1105-9</ref>
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===List of Thesis works===
The list of thesis works done on various menstrual disorders can be seen [[Media:Thesis_list-Menstrual_disorders.pdf |here.]]
==='''List of abbreviations of classical Ayurveda texts:''' ===
===Abbreviations ===
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Sa. = Samhita, Cha. = Charak, Su. = Sushruta, Ka. = Kashyapa, Sha. =Sharangadhara, A. = Ashtanga, Hr. = Hridaya, S. = Sangraha,
Ha. = Harita
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=== Reference list of Menstrual disorders ===
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The list of references for menstrual disorders in classical texts of Ayurveda can be seen [[Media:References_table-_menstrual_disorders.pdf |here.]]
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