Menorrhagia refers to cyclic menstrual bleeding which is excessive in amount or duration. It is clinically defined as menstrual blood loss in excess of 80 ml per cycle. Menorrhagia is not a disease in itself but a symptom observed in multiple gynecological disorders.
It is a common complaint that presents both to primary and secondary care and is more prevalent in the age group from 35 years till Menopause. Chronic and extreme cases of Menorrhagia put the health of women at risk. It affects the health of women at all levels including physical, mental, emotional, and social.
Range of Women Who Suffer From Menorrhagia
The World Health Organization reports that 18 million women aged 30-55 years perceive their menstrual bleeding to be exorbitant. Medical data indicates nearly 30% women of reproductive age to have reported heavy bleeding at some point. Out of these, 10% of the women experience severe blood loss that leads to anemia and is clinically defined as Menorrhagia.
Additionally, according to multiple studies, more than 75,000 hysterectomies (removal of uterus) are carried out every year. Out of these, nearly 30 % surgeries are mandated by the menstrual disturbances, primarily heavy periods.
Causes of Menorrhagia
Menorrhagia can occur due to many reasons, including menopause, excessive emotional stress, nutritional deficiency, reproductive system infections, miscarriage, certain blood thinning medications, and birth control pills.
Generally, the conditions affecting the uterus or its vascularity trigger heavy bleeding in periods. Hypothalamic- pituitary-ovarian axis disturbance is less of a reason for Menorrhagia.
Structural and Organic Factors to Heavy Bleeding
- Thyroid dysfunction
- Intrauterine Contraceptive Device
- Pelvic adhesions or congestion
- Progesterone-only pills
- Ovarian tumors
- Miscarriage
- Genital T.B.
- Certain Medications
- Infections in Vagina or Uterus
- Fibriods and or Polyps in Uterus or Ovaries
- Endometriosis
- Adenomyosis
- PCOS
Menorrhagia and Ayurveda
The symptoms of heavy periods are similar to a condition Asrigdara as has been described in Ayurvedic texts. Asrigdara means heavy vaginal bleeding during, before, or after the menstrual cycle. It is also sometimes referred to as Raktapradara.
Ayurveda described four types of Asrigdara – Heavy Bleeding in Periods
Vataja (vitiated with Vata): In this condition, menstrual blood is frothy, reddish or blackish in colour, flows quickly, does not clot, and is cold.
Kaphaja (vitiated with Kapha): In this condition, menstrual blood resembles water mixed with red ochre, excreted very slowly and gets clotted like a muscle (fibers joined together).
Pittaja (vitiated with Pitta): In this condition, menstrual blood becomes blue, yellow, green, blackish or resembles the water mixed with smoke, and does not coagulate. It may also contain white flecks and at times may be thin and stringy.
And Sannipataja: Blood has features of all three doshas together.
Symptoms of Asrigdara
According to Acharya Charaka, aggravated Vata vitiates Pitta and Kapha in the reproductive organs. Vitiated Pitta affects the uterine vessels and boosts blood supply in the luteal phase of menstrual cycle. This increase in blood thus creates Rakta-pradara. Additionally, vitiated Kapha blocks the channels creating painful cycle.
Some of the clinical features of Asrigdara as described in Ayurvedic texts include burning sensation in lower portion of groin, pelvic region, and back region of kidney. Severe pain in uterus may also accompany heavy vaginal bleeding.
- Excessive Menstrual Bleeding, more than 80 ml per cycle.
- Passage of blood clots
- Prolonged menstrual flow, more than 7 days
- Pain in the lower back portion and lower abdomen
- Bodyache
- Pain in hypogastric region
- Weakness, Fatigue, Giddiness, and Inability to do usual work
- Anemia may accompany
- Palpitations and shortness of breath
- Burning Sensation in the uterine region
Complications
Heavy menstrual flow leads to blood loss, resulting in Anemia and its trailing symptoms. Giddiness, extreme fatigue, severe backache, weakness, edema, and congestive heart failure usually accompany resulting in fainting or loss of consciousness in multiple cases. Menorrhagia also increases susceptibility to peripheral infections and local infections as bacterial vaginosis.
Ayurvedic Management of Menorrhagia
Asrigdara or heavy periods is considered to be a health disorder due to vitiation of Vata Dosha and Pitta Dosha. Hence Ayurvedic treatment of heavy periods focuses on the foods and lifestyle modifications to balance off the aggravated Dosha.
In addition, medicines and herbs that stop excessive bleeding and nourish the Rakta Dhatu (blood tissues) are prescribed. Since, Anemia generally accompanies menorrhagia, strength promoting rasayanas or concotions are also recommended to the patients.
Ahara – Foods and Diet
In Ayurveda Menorrhagia is considered to be a result of faulty lifestyle and foods. Excessive consumption of salty, sour, hot, spicy, and heavy to digest foods vitiates the Doshas resulting in heavy bleeding during menstrual cycle.
A diet involving Bitter and Astringent tastes is highly beneficial for heavy bleeding in periods. Both the tastes help to pacify Pitta and Vata Dosha and also supply the required nutrients to remove the deficiencies.
- Cooling and tonic herbs such as Shatavari, Ashoka, Aloevera, and Manjishtha should be consumed under supervision of Ayurvedic Practitioner.
- Consumption of iron-rich foods.
- No Alcohol.
- Avoid Caffeine.
- Drink plenty of fluids.
- Avoid hot, spicy, salty, and sour foods.
- Include herbs and spices such as cardamom, cinnamon, fennel, cumin, and basil.
- Inclusion of foods such as bitter gourd, pointed gourd, squashes, green leafy vegetables, and cruciferous vegetables.
Vihara – Lifestyle Modifications
A faulty lifestyle involving excessive stress, lack of sleep, sleeping during daytime, excessive travel, emotional distress involving trauma, anger, and jealousy, and excessive physical work trigger an imbalance of Dosha resulting in menorrhagia.
- Avoid excessive physical activity and exposure to the Sun.
- Practice mind relaxation and mindfulness by spending time in nature or meditation.
- Avoid excessive coitus.
- Apply ice-pack to lower abdomen during menstruation.
- Eating at consistent time and following a routine.
- Follow circadian rhythm. Sleep early and get enough sleep (7-8 hours everyday).
- No Smoking.
- Cooling physical activity and Yogasanas should be practiced. For yoga, no inverted poses should be followed during menstrual cycle.
References
ASRIGDHARA CHIKITSA W.S.R TO MENORRHAGIA – A CASE STUDY
Asrugdara (excessive menstrual bleeding) and its management