RAJONIVRITTI (MENOPAUSE)

🔺CASE STUDY: RAJONIVRITTI (MENOPAUSE)

🔺NIDANAM (ETIOLOGY / CAUSATIVE FACTORS)

• Natural aging process (Jaraavastha)

• Dhatukshaya (especially Rasa and Artava Dhatu)

• Vata prakopa due to tissue depletion

• Imbalance in Agni (digestive and metabolic fire)

• Reduction in estrogen and progesterone levels (modern view)

• Classical References:

  • Charaka Samhita Sharira Sthana 1/15-17 – cessation of menstruation with age

  • Sushruta Samhita Sharira Sthana 3/4 – Rajah cessation by 50 years

🔺PURVAROOPAM (PRODROMAL SYMPTOMS)

• Irregular menstrual cycles (Artava Vaishamya)

• Hot flashes (Daha)

• Vaginal dryness (Yoni Shosha)

• Mood swings, irritability (Manodaurbalya)

• Body aches, joint pain (Sandhi Shoola)

• Insomnia (Nidranasha)

• Fatigue, anxiety, restlessness

🔺LAKSHANA (CLINICAL FEATURES)

• Permanent cessation of menstruation (Artavanivritti)

• Hot flashes, excessive sweating (Daha, Santapa)

• Vaginal atrophy and dryness (Yoni rukshata)

• Psychological changes: anxiety, mood disorders (Manovyatha)

• Insomnia, memory loss, poor concentration

• Osteoporosis-like features (Asthi Kshaya)

• Palpitations (Hriddrava), weight changes (depending on dosha)

• Decreased libido, dyspareunia (painful intercourse)

🔺GENERAL EXAMINATION

• Age: Typically between 45–55 years

• BMI: To assess risk for osteoporosis or metabolic syndrome

• Pallor: Indicative of anemia

• Skin: Dry, wrinkled, pigmented

• Hair: Thinning, hair fall

• Nails: Brittle

• Vital signs:

  • Blood pressure (risk of hypertension)

  • Pulse rate (tachycardia with anxiety)

  • Temperature (rule out infections)

🔺SYSTEMIC EXAMINATION

• Cardiovascular:

  • Risk of atherosclerosis, arrhythmias

  • Palpitations, hypertension

• Respiratory:

  • Usually unaffected

• Abdominal & Pelvic:

  • Uterine atrophy, rule out masses

• Locomotor:

  • Joint stiffness, osteoporosis signs

• Neurological:

  • Memory loss, emotional instability, insomnia

• Genitourinary:

  • Vaginal atrophy, urinary frequency/incontinence

🔺LABORATORY INVESTIGATIONS

• Hormonal Profile:

  • FSH ↑, LH ↑, Estradiol ↓, Progesterone ↓

• Thyroid Function Tests: T3, T4, TSH

• CBC: Rule out anemia

• ESR/CRP: Inflammation

• Fasting Blood Sugar & Lipid Profile: Rule out metabolic issues

• Bone Health Tests:

  • Serum calcium, vitamin D3, phosphorus

  • DEXA scan (Bone mineral density)

• Urine Examination:

  • UTI screening

• Pelvic USG:

  • Endometrial thickness, ovarian status

🔺DIFFERENTIAL DIAGNOSIS (DD)

• Menopause

• Perimenopause

• Uterine fibroids

• Endometrial hyperplasia

• Atrophic vaginitis

• Vaginal infections (vaginitis, candidiasis)

• Cervical or endometrial carcinoma

🔺SAMPRAPTI (PATHOGENESIS)

• Jaraavastha → Dhatukshaya (Rasa and Artava)

• Vata prakopa due to tissue depletion

• Rasa Kshaya → Artava Kshaya → Rajonivritti

• Agni Mandya → impaired digestion and metabolism

• Dosha Involved: Vata pradhana Tridosha dushti (especially Apana Vata)

🔺SAMANYA CHIKITSA (GENERAL MANAGEMENT)

LINE OF TREATMENT:

• Vata-Pitta Shamana

• Rasayana Chikitsa – rejuvenation and anti-aging

• Brimhana (nourishing therapy)

• Snehana and Swedana – for Vata pacification

DIETARY RECOMMENDATIONS:

• Snigdha, warm, nourishing food

• Ghee, milk, sesame, dates, almonds

• Avoid ruksha, katu, tikta, kashaya ahara

LIFESTYLE:

• Regular Abhyanga (oil massage)

• Yoga and Pranayama

• Avoid stress, ensure adequate rest

🔺UPASHAYA (PALLIATIVE MEASURES)

• Warm oil massage, nourishing diet

• Rasayana herbs (Ashwagandha, Shatavari, Amalaki)

• Meditation, Pranayama for mood stabilization

• Herbal teas (Brahmi, Jatamansi) for sleep and relaxation

🔺ANUPASHAYA (AGGRAVATING FACTORS)

• Dry, cold, light foods

• Excess fasting (Langhana)

• Overexertion, stress

• Late nights and disturbed sleep

• Excessive spicy or bitter food

🔺VISHESHA CHIKITSA (SPECIFIC TREATMENT)

SHAMANA CHIKITSA (PALLIATIVE):

SHODHANA CHIKITSA (PURIFICATORY):

• Mridu Virechana – Triphala churna, Avipattikara churna (for Pitta)

• Basti Karma:

  • Anuvasana Basti: With Ksheera Bala Taila, Ashwagandha Taila

  • Niruha Basti: Herbal decoction enemas for Vata pacification