Ayurveda on Menopause

Yoga, Pranayama, Herbs, Diet & Lifestyle

Evidence-based research by Celia Roberts

Ayurveda, the ancient medical tradition of India, coupled with yogic practices like pranayama and herbal remedies, offers holistic approaches to alleviate the adverse symptoms of menopause.

The term menopause often leads to widespread misinformation, causing feelings of insecurity and fear among women in their late 30s and early 40s. Various support groups and societies address these concerns.

According to Ayurveda, perimenopause and menopause are natural phases of change, representing a time for self-understanding. A balanced woman typically does not display menopausal symptoms. Ayurveda sees an imbalance of mind and body when a woman fails to recognise the value of her age, leading to stress, fear, anxiety, and other issues. These imbalances aggravate Vata and, combined with a dominating constitution, result in the formation of Ama, manifesting in symptoms such as irregular menstrual cycles, missed menstruation, depression, mood swings, and more.

From an Ayurvedic perspective, pre-menopausal symptoms arise when the Shukra Dhatu (reproductive tissue) or seventh tissue level is disturbed, primarily due to an unbalanced lifestyle or attempts to suppress natural changes. Many cultures view this phase as a welcome change, with women in countries like China, Japan, and India typically experiencing fewer symptoms, likely due to their state of mind and lifestyle factors. In the Vedic tradition,  it can be considered a time for deep spiritual introversion and the opportunity to release family duties and focus on self-liberation. 

Ayurvedic intervention for these symptoms is straightforward: regulate diet and lifestyle while nourishing the tissues, especially the reproductive tissue, Shukra Dahtu. 

In the context of Western medicine, the onset of menopause is marked by a significant shift in hormonal equilibrium, characterised by decreased oestrogen and increased follicle-stimulating hormone (FSH) and luteinising hormone (LH)[1]. Natural menopause is confirmed when there has been no menstruation for 12 consecutive months as long as there is no alternative explanation for its absence[1]. Though menopause is a natural part of a woman’s life, it can lead to various discomforting symptoms. Western medicine acknowledges that healthy women generally experience smoother menopause when the gradual hormonal decline is recognised and adjusted to by the body’s natural processes.

Notably, women entering menopause earlier due to surgery or genetic factors tend to have fewer hot flashes. Similarly, women undergoing rapid oestrogen withdrawal after ovary removal demonstrate that these symptoms result from an underlying state of imbalance.

Certain menopausal symptoms, such as constipation, dry skin, dry mucous membranes, hair and bone thinning, and disrupted sleep, are viewed in Ayurveda as Vata imbalances. These can be addressed and prevented through Vata-balancing measures.

Ayurveda provides a clear explanation for hot flashes, attributing them to transitioning from a Pitta-dominated age to a Vata-dominated age. If Pitta intelligence was in balance before menopause, the shift to Vata will likely be smoother. During menstruation, Ama (toxins) eliminated with the flow is Pitta. In menopause, excess Pitta can accumulate, especially in the presence of Ama. Ayurveda likens hot flashes to a heater turned too high in a closed room, where trapped Ama-generated heat raises the temperature. The solution lies in turning off the heat or adopting Pitta-balancing practices. Additionally, the imbalance in Pitta affects metabolism, governed by Pitta, and hormone metabolism, leading to issues such as cholesterol, heart disorders, and osteoporosis in the Meda Dhatu. Ayurveda does not view menopause and pre-menopause as deficiencies, eliminating the need for replacement therapy. While not all women encounter issues during these phases, those who do may not necessarily opt for HRT due to its associated side effects and limited efficacy in symptom prevention. Common side effects of HRT include increased blood pressure, vaginal bleeding, weight gain, sore breasts, bloating, uterine cramps, headaches, depression, and fibrocystic breast conditions.

Claims by some companies about producing “natural” estrogens and progesterone are misleading, as these hormones are derived from horses and undergo processes altering their natural state. The use of such products has been linked to pre-cancerous conditions in some studies.

The primary justification for HRT is its perceived role in preventing osteoporosis, although research suggests it doesn’t enhance calcium absorption or prevent bone cell death effectively. Discontinuing HRT leads to a swift loss of any bone-related benefits while simultaneously increasing the risk of breast or uterine cancer. Notably, the onset of osteoporosis and heart disease, typically occurring around age 70-80 without HRT, shifts to around age 60 with its use.

Recent research indicates that osteoporosis isn’t exclusive to post-menopausal women; rather, it signifies a progressive imbalance in bone metabolism starting as early as the thirties in both genders. Ayurveda aligns with this perspective, attributing osteoporosis to impaired tissue metabolism at the fat tissues, Meda Dhatu stage, resulting in a gradual loss of bone mass over the years.

A balanced lifestyle is crucial for maintaining bone density. Adequate calcium intake, approximately 1200-1600 milligrams per day in early years and 800 milligrams for adults is essential. Women with irregular menstrual cycles often exhibit lower bone density, emphasising the importance of balance.

According to Ayurveda, balanced Doshas and Ama-free  Dhatus (toxin-free tissues) enable the body’s homeostatic mechanisms and intelligence to regulate oestrogen needs. After menopause, the body naturally adjusts, slowing down bone loss. Overweight women may benefit from menopause as the body relies on non-ovarian sources of oestrogen, such as fat tissues, called Meda Dhatu.

Ayurveda posits that ageing and illness after menopause result from the production of toxins, damaging tissues. To counteract this, Ayurveda offers a comprehensive rejuvenation program, including structured daily routines, spiritual counselling for emotional stability, and specific herbal formulas and physical therapies. This approach surpasses the limited benefits of HRT by addressing underlying imbalances in digestion and metabolism during menopause. Even individuals using HRT can benefit from the Ayurvedic program, reducing potential side effects.

Ayurveda’s strength lies in recognising the uniqueness of each individual, allowing for personalised adjustments in daily oestrogen requirements. This stands in contrast to HRT, where the body grapples with the challenge of adapting to a fixed daily dose, potentially leading to imbalances. In conclusion, Ayurvedic menopausal and perimenopausal programs, rooted in nature’s wisdom, present a more balanced and holistic approach.

Evidenced-Based Pranayama, Yoga for Menopause 

There have been various studies that provide evidence of pranayama’s capability to improve the quality of life of women undergoing menopause. One study involved a 30-day practice, where, on alternating days, subjects performed pranayama, surya namaskar, and savasana techniques[2]. This study measured the effectiveness of these techniques to alleviate somatovegative, psychological, and urogenital symptoms. Somatovegative symptoms include hot flashes, heart discomfort, sleep problems, and joint and muscle pains. Psychological symptoms included irritability, anxiety, and physical and mental exhaustion. Lastly, urogenital symptoms involve sexual situations, bladder issues, and vagina dryness. At the end of the study, all three measurement groups showed a significant improvement in symptoms following the 30-day yoga practice[2]. Another lengthier study, which involved one year of three weekly yoga sessions involving ujjayi breathing, bhastrika breathing, om chanting, and sudarshan kriya, also found promising results[3]. In this study, vasomotor, psychosocial, and physical symptoms were measured. Vasomotor symptoms include hot flashes, night sweats, and sweating in general. Psychosocial symptoms include difficulty sleeping, anxiety, depression, and poor memory. Physical symptoms include gas pains, aching muscles and joints, lower back pain, and fatigue. Like the previously mentioned study, all three categories of symptoms reduced in severity following the yogic practice[3]. Other research has added to the evidence that pranayama, in this case, bhramari pranayama, can decrease anxiety in menopausal women, which leads to reduced blood pressure and improves attention, concentration, and hand-eye coordination[1]. There is a substantial body of evidence that pranayama can alleviate many of the symptoms of menopause, improving the quality of life of women undergoing this change in life. 

Ayurvedic diet, lifestyle, and herbal remedies 

Ayurveda is a medical tradition that focuses more on balance in the body rather than treating disease. Menopause is linked to aging and is, therefore, like the vata dosha rising in the body, upsetting the balance[4]. There are various methods through diet, lifestyle, and herbal remedies that are useful to counterbalance this change[4]. Regarding diet, one should consume warm food and drinks and include spices, fennel, and cumin in their dishes[4]. Additionally, one should decrease caffeine consumption[4]. Some lifestyle changes can also help, such as going to bed early, oil messages using almond and olive oil, meditation, yoga, and regular exercise such as walking[4]. Anti-vata herbs include ashwagandha, arjuna, astragalus, cardamom, comfrey root, garlic, ginseng, guggul, hawthorn berries, sandalwood and ziziphus[4]. The Ayurvedic tradition contains a wealth of knowledge that can be incredibly helpful in alleviating the symptoms of menopause and finding balance within the body during this time.  

Holistic Menopausal Program Based on Ayurvedic Principles 

Self-Reflection and Affirmation:

• Allocate 20-30 minutes daily for personal reflection.
• Begin with a calm and quiet setting.
• Initiate the month with a positive affirmation, addressing thoughts that arise during the day, and actively work on self-evaluation.

Meditation:

• Incorporate meditation or self-enquiry into your daily routine after the affirmation process for at least twenty minutes

Light Exercise:

• Engage in light exercises, with walking being a beneficial option.
  Consult an Ayurvedic doctor for specific seasonal exercise recommendations.

Adequate Rest:

• Prioritise sufficient rest to support overall well-being.

Ayurvedic Seasonal Dieting:

• Adhere to Ayurvedic body type seasonal dieting guidelines.
  Emphasise a low-protein diet.

Lifestyle Choices:

• Avoid coffee, cigarettes, and junk food for optimal health.

Therapeutic Teas:

• Drink Pitta therapeutic tea to address hot flashes.
• For symptoms like vaginal dryness, emotional mood swings, or insomnia, follow a Vata-balancing diet and drink Vata tea.

Body Massage:

• Massage your body using warm Mahanarayan Oil or a specific massage oil tailored to your condition.

Panchkarma Program:

• Undergo a 7-day Panchakarma program in collaboration with your Ayurvedic doctor.

Hydration Practices:

• Consume only warm or hot water for hydration.

Nasya and Surya Ayurvedic Meditation:

• Incorporate daily Nasya with Anu Oil for nasal care.
• Practise “Surya Ayurvedic Meditation” on a regular basis.

Pranayama Techniques:

• Include pranayama practices such as ujjayi breathing, bhastrika breathing, om chanting, and sudarshan kriya.
• Evidence suggests that pranayama can significantly improve somatovegative, psychological, and urogenital symptoms associated with menopause.

Yoga Asana:

• Engage in regular yoga sessions incorporating pranayama techniques for at least three weekly sessions.
• Studies show that a consistent yoga practice can reduce the severity of vasomotor, psychosocial, and physical symptoms related to menopause.

Dietary Adjustments:

• Consume warm food and drinks, incorporating spices like fennel and cumin into meals.
• Reduce caffeine consumption to support balance during menopause.

Lifestyle Modifications:

• Implement healthy lifestyle changes such as early bedtime, oil massages using almond and cold pressed black sesame oil, meditation, and regular exercise like walking.
• These adjustments contribute to maintaining balance in the body during the menopausal transition.

Herbal Remedies:

• Consider anti-vata herbs such as shatavari, ashwagandha, arjuna, astragalus, cardamom, comfrey root, garlic, ginseng, guggul, hawthorn berries, sandalwood, ziziphus, Neemguid, and liver-supporting supplements for hormonal balance.

Ayurvedic Wisdom:

• Embrace Ayurvedic principles that prioritise balance in the body over merely treating disease.
• Recognise menopause as a natural transition linked to ageing, akin to the vata dosha rising, and work towards restoring balance through holistic methods.

Holistic Approach:

• Combine Ayurvedic insights with yogic practices for a holistic approach to managing menopausal symptoms.
• Focus on achieving balance through diet, lifestyle, and herbal remedies to enhance the quality of life during this significant life change.

By integrating pranayama, yoga, Ayurvedic dietary guidelines, lifestyle adjustments, and herbal remedies, women can approach menopause holistically, addressing various symptoms and promoting overall well-being.

In conclusion, Ayurveda views menopause as a positive transition, marking a new chapter in a woman’s life. Embrace this phase with joy as it aligns with your true self. Overcome any fears of ageing positively by integrating Ayurvedic principles into your daily life.