CONSERVATIVE MANAGEMENT OF MENOPAUSAL SYNDROME: A CASE STUDY

Abstract

When menopausal syndrome incorporates vasomotor, genito-urinary, psychological, and general indicators of natural ageing, it can be disturbing. Hormone Replacement Therapy (HRT) was assumed to be the only therapeutic approach for menopause. HRT and selective oestrogen receptor modulators (SERMs) are only advantageous for short-term usage since they are associated with a risk of developing breast cancer, ovarian cancer, heart attacks, strokes, gall bladder disease, thromboembolism, and urine incontinence. Single drugs and compound formulas described in several Ayurvedic scriptures and validated by scientific findings open new paths in the treatment of menopausal syndrome which is reported in this paper.
Diagnosis and outcome- The onset of dyslipidemia, osteoarthritis, and metabolic disorders with the onset of menopause confirmed the diagnosis of menopausal syndrome. The patient became asymptomatic at the end of three months of treatment with improved liver, lipid, and diabetic profile.
Conclusion- The findings of this case paper can be useful in the prevention of harmful effects of prolonged HRT and a holistic treatment protocol can opt for the management of similar cases.

Full text

Case Report ISSN: 2320-5091 Impact Factor: 6.719
CONSERVATIVE MANAGEMENT OF MENOPAUSAL SYNDROME: A CASE STUDY
Varsha1, Tarun Arya2
1. BAMS, MS(Ayu) Prasuti Tantra and Stree Roga 2. BAMS ,MD (Ayu) Kriya Sharir
Corresponding Author: panchalvarsha612@gmail.com
https://doi.org/10.46607/iamj2911052023
(Published Online: May 2023)
Open Access
© International Ayurvedic Medical Journal, India 2023
Article Received: 03/04/2023 - Peer Reviewed: 18/04/2023 - Accepted for Publication: 09/05/2023.
ABSTRACT
Introduction- When menopausal syndrome incorporates vasomotor, genito-urinary, psychological, and general
indicators of natural ageing, it can be disturbing. Hormone Replacement Therapy (HRT) was assumed to be the
only therapeutic approach for menopause. HRT and selective oestrogen receptor modulators (SERMs) are only
advantageous for short-term usage since they are associated with a risk of developing breast cancer, ovarian can-
cer, heart attacks, strokes, gall bladder disease, thromboembolism, and urine incontinence. Single drugs and com-
pound formulas described in several Ayurvedic scriptures and validated by scientific findings open new paths in
the treatment of menopausal syndrome which is reported in this paper. Diagnosis and outcome- The onset of
dyslipidemia, osteoarthritis, and metabolic disorders with the onset of menopause confirmed the diagnosis of
menopausal syndrome. The patient became asymptomatic at the end of three months of treatment with improved
liver, lipid, and diabetic profile. Conclusion- The findings of this case paper can be useful in the prevention of
harmful effects of prolonged HRT and a holistic treatment protocol can opt for the management of similar cases.
Keywords: Ayurveda, geriatrics, HRT, Jara, menopause, Rajonivrutti
INTRODUCTION
Throughout her existence, a woman goes through
numerous stages that have a significant impact on her
health. In a culture that values youth and productivi-
ty, thinking about menopause and the alterations that
follow it can be intimidating. Menopause can be dif-
ficult, but it can also provide an opportunity to re-
INTERNATIONAL AYURVEDIC
MEDICAL JOURNAL

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align with your health and embrace self-care. The
first references to the description of menopause stem
from the time of Acharya Charaka and Sushruta.
Menopause is not referred to as a condition in Ayur-
vedic scriptures. The natural phenomenon is referred
to in Ayurveda as “Rajonivrutti”. Menopausal women
are identified as Nishphala, Gatartava, and the ad-
vent of old age is recognised. Vata Vruddhi, as well
as Kapha and Pitta Kshaya, are related to this stage
of life and are accountable for all morphological and
cognitive changes.
Case details
A 50-year-old female, housewife by occupation came
to the outpatient department on 24th Dec 2021 with
complaints of-
1. Bilateral knee joint pain for 4-5 years
2. Increased weight, increased frequency of urina-
tion, hot flushes for 3 months
3. Abdominal pain for 3days.
Menstrual history- attained menopause 1 year back.
Previous menstrual history-
1. Regularity- Regular
2. Interval- 30-31 days
3. Duration- 4-5 days
4. No. of pads used- 2-3/day (fully soaked)
5. Consistency- thin
6. Colour- red
7. Odour- no foul smell
Obstetric history- P4 A1L1 D2
Table 1- obstetric history
YEAR
MODE OF DELIVERY
Sex
LIVE/DEAD
P1
30 years back
Full-term vaginal delivery at home
Male child
Death a few days after birth
P2
28 years back
Full-term vaginal delivery at the hospital
Female child
Death 3 months after birth
P3
26 years back
Full-term vaginal delivery at the hospital
Female child
Live
P4
23 years back
Vaginal delivery after induction in the 8th
month of pregnancy at the hospital
Male child
Still birth
General examination
1. Blood pressure-150/90 mmhg
2. Pulse rate-80 beats per minute
3. Temperature- afebrile
4. Weight- 81 kg
5. Diet- vegetarian
6. Appetite- Decreased
7. Sleep- Disturbed
8. Bowel- Clear (1time/day)
9. Urine- 8-9/ 1-2, no burning micturition
10. Pallor- absent
11. Icterus- absent
12. Clubbing- absent
13. No lymphadenopathies
K/C/O – HTN/CAD/IHD/ lumbar spondylosis/ adhe-
sive capsulitis of bilateral shoulder joint HTN – on
medication for 20 years
Family history of – DM-II/ HTN/CAD (father and
both brothers)
Surgical history of –
1. Benign tumour resection from the urinary bladder
in 2009
2. Abscess- incision and drainage o from anterior
abdominal muscles in 2015
Local examination
1. P/A- no discoloration was observed.
• Longitudinal Incision mark present from umbili-
cus up to the suprapubic region
• Horizontal incision mark present in the left lumbar
region. Palpation- soft, no tenderness, hepatomeg-
aly +
2. P/S- not done.
3. P/V- not done.
The patient had no complaints regarding genitouri-
nary symptoms (e.g., dryness of the vagina, abnormal
discharges, incontinence of urine, dyspareunia, etc.)
Chikitsa /treatment adopted.
1. Oral Medications-

Varsha & Tarun Arya: Conservative Management of Menopausal Syndrome: A Case Study
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Table 2- Drugs prescribed to the patient.
S. NO.
DRUG
DOSE
TIME OF ADMINISTRATION
1.
Arjuna twak churna
4-5 grams BD
After food with warm water
2.
Phalatrikadi kwath
20 ml BD
Empty stomach
3.
Nishamalki churna
3-5 grams BD
Before food with little milk or warm water
4.
Chandraprabha vati
2 tablet BD
After food with warm water
5.
Ksheerbala oil
L/A on the knee
joint
Two times daily
2. Marma stimulation for knee joint: Lower
limb- Kshipra, Gulpha, Indravasti, Janu
3. Yoga and pranayama
• Anulom vilom
• Kapalbhati
• Suryanamaskar
• Vajrasana
Pathya advised.
1. Vegetable juice in morning ( Aloe vera + beet
root+ carrot+ spinach)
2. The patient was advised to change the flour from
wheat to a mix of Bajra+ yava + soyabean+ gram
flour.
3. The patient was advised to consume fruits daily at
least once a day.
a. Strawberry
b. Cherry
c. Apple
d. Orange
e. Kiwi
f. Peach
g. Pears
4. Vegetables
a. Spinach
b. Carrot
c. Tomato
d. Peas
e. Chenopodium album (bathua )
f. Fenugreek (Methi)
g. Bitter gourd
h. Radish
i. Beans
j. Garlic
k. Onion
l. Cucumber etc.
5. In dry fruit almonds, walnuts can be consumed.
Apathya advised.
1. Vegetables
a. Potato
b. Sweet potato
2. Fruits
a. Banana
b. Kharjoor/ dates ( Phoenix dactylifera)
c. Chikoo/ Naseberry
d. Mango
e. Pineapple
f. Watermelon
g. Papaya
3. Raisins, cashews
4. Curd, butter, fried food, refined wheat flour,
packed fruit juice, stale food
5. Sleeping during daytime
Table 3- Results
S NO.
ASSESSMENT
BEFORE TREATMENT
AFTER TREATMENT
1.
DIABETIC PROFILE
HbA1c
7.6%
5.7%
Average blood glucose
171 mg/dl
117 mg/dl
RBS
265 mg/dl
108 mg/dl
2.
ULTRASONOGRAPHY
Fatty liver
Grade II
Grade I

Varsha & Tarun Arya: Conservative Management of Menopausal Syndrome: A Case Study
doi:10.46607/iamj2911052023 | IAMJ May 2023 | www.iamj.in
1191
Size of liver
19.9 cm
16.5 cm
3.
LIPID PROFILE
HDL
44 mg/dl
42 mg/dl
LDL
128 mg/dl
91 mg/dl
Non-HDL
154 mg/dl
105 mg/dl
4.
CBC
Within normal limit
Within normal limit
5.
Weight
81 kg
70 kg (17/03/2022)
6.
Knee joint pain
+ +
Pain decreased significantly; the patient
was able to climb stairs without difficul-
ty.
7.
LFT
SGPT
67.43 U/L
49 U/L (11/02/2022)
GGPT
75.59 U/L
47 U/L (11/02/2022)
Alkaline phosphatase
174.04 U/L
120 U/L (11/02/2022)
DISCUSSION
Because menopause marks the shift from the Pitta to
the Vata phases of life, if a woman has a large Pitta
or Vata imbalance in the years preceding menopause,
things are likely to worsen during menopause, which
is a time when hormonal and other natural changes
occur in the body. Mode of action of drugs prescribed
for the patient-
1. Arjuna churna- Triterpenoids,- sitosterol, flavo-
noids, and glycosides are among its beneficial
phytoconstituents. Triterpenoids and flavonoids
are thought to be responsible for their antioxidant
and cardiovascular effects. The medication has
shown encouraging results in the treatment of is-
chemic cardiomyopathy. It has been shown to be
effective in the treatment of angina pectoris,
moderate hypertension, and dyslipidemia.1 The
hypolipidemic action is thought to be mediated
through increased hepatic clearance of cholester-
ol, down-regulation of lipogenic enzymes, and
inhibition of HMG-CoA reductase.2
2. Phalatrikadi kwath- Its main constituents are
alkaloids, Cardiac glycoside, Flavonoids, Tan-
nins, Anthraquinone glycoside, Steroids, and
Triterpenoides. Thus, Phalatrikadi Kwath proves
to be a good antidiabetic drug.
3. Chandraprabha vati – Antihyperglycemic,3 hy-
potensive, hypoglycaemic, anti-inflammatory,
vasodilator, anti-bacterial, anti-fungal, spas-
molytic, analgesic, anti-microbial.4
4. Nishamlaki churna – Nishamlaki is a group of
various combination formulations of Haridra and
Amalaki. It is effective in the clinical manage-
ment as well as prevention of complications of
Madhumeha, Prameha, and Diabetes.5
5. Marma chikitsa- In this study, osteoarthritis of
the knee was managed by marma therapy, a knee
joint also known as Janu, a type of Vaikalyakara
Marma, recent studies show that when a marma
point is wounded or sensitive, stimulating neigh-
bouring marma points can relieve the discomfort.
These subjective criteria were used to evaluate it:
Sandhi Shoola (joint discomfort), Sandhi Shotha
(joint swelling), Sandhi Stabdhata (joint stiff-
ness), and Atopa / Sandhisphutana (crepitus).
CONCLUSION
In the current times with increasing cases of several
cancers, Ayurvedic management of menopausal syn-
drome is serving unconventional information. This
case paper provides preliminary evidence and may
encourage clinicians to indulge in a holistic approach
HbA1= Glycated haemoglobin, RBS= Random blood glucose, HDL= High density lipoprotein, LDL= Low
density lipoprotein, CBC= Complete blood count, SGPT= Serum glutamic-pyruvic transaminase SGOT= Se-
rum glutamic-oxaloacetic transaminase

Varsha & Tarun Arya: Conservative Management of Menopausal Syndrome: A Case Study
doi:10.46607/iamj2911052023 | IAMJ May 2023 | www.iamj.in
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to this common problem faced by millions of women
every year.
REFERENCES
1. Kumar S, Enjamoori R, Jaiswal A, Ray R, Seth S,
Maulik SK. Catecholamine-induced myocardial fibro-
sis and oxidative stress are attenuated by Terminalia ar-
juna (Roxb.) J Pharm Pharmacol. 2009; 61:1529–36
2. The hypolipidemic action is thought to be mediated
through increased hepatic clearance of cholesterol,
down-regulation of lipogenic enzymes, and inhibition
of HMG-CoA reductase.
3. Manish M. Wanjari, Sujata Mishra, Yadu Nandan Dey,
Deepti Sharma, Sudesh N. Gaidhani, Ankush D.
Jadhav, Antidiabetic activity of Chandraprabha vati –
A classical Ayurvedic formulation, Journal of Ayurve-
da and Integrative Medicine,
Volume 7, Issue 3, 2016, Pages 144-150, ISSN 0975-
9476, https://doi.org/10.1016/j.jaim.2016.08.010.
4. Bhuvad, Sushama. (2012). Pharmaco-Therapeutic Pro-
files of Chandraprabhavati- An Ayurvedic Herbo-
Mineral Formulation. International Journal of Pharma-
ceutical & Biological Archives. 3. 1368-1375.
5. Dr. Prashant Bedarkar, REVIEW OF NISHA AMA-
LAKI-AN AYURVEDIC FORMULATION OF
TURMERICAND INDIAN GOOSE BERRY IN DIA-
BETES, WORLD JOURNAL OF PHARMACEUTI-
CAL AND MEDICAL RESEARCH, 2017,3(9), 101-
105.
Source of Support: Nil
Conflict of Interest: None Declared
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