HTML Full Text

Introduction

Rajonivrutti marks the end of the fertile stage in a woman's life. She has to overcome the stigma, thus accepting and embracing it. Every person experiences three distinct stages during their life, which are governed by Tridosha's: childhood, adulthood, and old age, or balya, madhya, and Vriddha avastha. During Rajonivrutti kal Especially the Vata dosha, is much more predominant & Dhatukshaya occurs at the Vriddha avastha stage, which is more challenging for women during Menopause. Menopause is not just a state of few hot flushes, night sweats, or irritability and an end to the menstrual flow1. Still, it is a naturally occurring transitionary phase of a woman’s life and a normal ageing process, which is an inevitable process.  Menopause is the permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity2. The onset of menopause seems to be genetically predetermined and is not influenced by race, socioeconomic status, age at menarche, or the number of previous ovulations.3 Irregular periods, hot flushes, night sweats, vaginal dryness, mood swings, hair loss, digestive disturbance, cystitis, vaginitis, anxiety, depression, excessive sweating, irregular Joint pain, tachycardia, tension, Headache, Vaginal atrophy, Irritability, Insomnia, Palpation, diminished interest in most activities, memory loss, bladder incontinence, feelings of unhappiness, excitability, crying, and nervousness are all typical symptoms associated with menopause.  The long-term risks of menopause include heart disease, osteoporosis, and Alzheimer's disease, which causes a progressive loss of memory and focus. Menopausal syndrome4 refers to the collection of symptoms and indicators linked to the menopause phase. Symptoms in the menopausal phase, like insomnia, anxiety, urinary symptoms, and osteoporotic changes, are due to the dominance of vata dosha. Furthermore, symptoms associated with pitta dosha, such as hot flushes and irritability, are observed during this phase. Of course, it is temporary and will eventually go away on its own. However, occasionally, this transformation might manifest in ways that are too overwhelming and turn into a warning to give older women's health the utmost care. So, with awareness, we should consciously support this transition more healthily physically, mentally, socially, and spiritually by adopting preventive and promotive approaches. The safest and happiest way to shift into Rajonivrutti is to use Ayurveda, the science of life. It advocates a holistic treatment by modifying diet & lifestyle by utilising various purified herbs and minerals with deepana, pachana, Medhya, balya, vayasthapana, and srothoshodhana properties. Different therapies like Samshamana, Panchakarma, Rasayana, and Yoga are advocated as reliable options for conventional treatment. The Ayurvedic therapy program can effectively handle rajonivrutti, allowing the woman to pass the stage with grace.

Rajonivritti Kala: -

Although the classics do not specifically identify Rajonivritti as a sickness, Sushruta and other sources do mention Rajonivritti kala. Rajonivritti is said to be fifty years old. Acharya Arundatta opines that the age mentioned above is a probable age and not a fixed one5. As Ayurveda has given more importance to Ahara and Vihara in the maintenance of health these factors too, should be considered for this fluctuation6. As it is already mentioned that Rajonivritti is not described in the classics as a separate disease there is no information available regarding its Nidana panchaka so, to understand this Condition as a disease, certain Basic principles have to be considered here. Acharyas mentions a few of these elements in relation to "Rajah utpatti hetus" as well. These elements may also be regarded as Rajah nivritti hetus. In addition, a few extremely specific factors—all of which are described below—can also be thought of as the causes of Rajonivritti.

1.Kala7,.

2.Swabhava8

3.Vayu9

4.Dhatukshaya10

Types of Rajonivritti-

According to Ayurvedic science, there are four main categories of ailments. Agantu,Sharira, Manasand Swabhavika11 A group of naturally occurring diseases under the heading of swabhavabala pravritta includes Kshudha (Hunger); Pipasa (Thirst), Nidra (Sleep), Jara (Aging) and Mrityu(Death)12 Although these diseases are naturally occurring diseases, but sometimes they are being acquired also, which is described as "Doshaja”. So, they are further divided into two types Kalakrita and Akalakrita13 In the same manner, Rajonivritti too is a naturally occurring condition in every woman as that of Jaravastha etc. Swabhavika Vyadhies. So Rajonivrutti is divided into two types: 1) Kalaja Rajonivritti 2) Akalaja Rajonivritti

1) Kalaja Rajonivritti: If Rojonivritti occurs at its probable age (that is, around fifty years of age) is known as Kalaja Rajonivriti. The timely Rajonivritti occurs only when the protective measurements of healthcare being practiced. This condition is Yapya by Rasayana14,15 etc.

2) Akalaja Rajonivritti: Rajonivritti is referred to as Akalaja Rajonivritti if it manifests either before or after its probable age, which is approximately fifty years.

According to Acharya Dalhana, they should be treated on the basis of nature of illness (Roga) surfaced due to pathology of Rajonivrittiand on the basis of dosha involved in it16. Compared to Kalaja Rajonivritti, this Akalaja Rajonivritti is probably curable.

Lakshanas of Rajonivritti17

As there is no direct reference available regarding lakshanasof rajonivrittiin the Ayurvedic classics, the clinical symptoms manifested by the patients of rajonivritti have to be considered and can be grouped under following Ayurvedic parameters. -(A) Doshaja lakshanas.  (B) Manasika lakshanas.

(A) Doshaja lakshanas

The Vataja lakshanas are more frequently observed than the other two (Pittaja and Kaphaja) lakshanas because this condition is characterized by generalized vatavriddhi.

1. Vata dosha type menopausal symptoms include Sandhi Vedana, Anidra/Alpanidra, Bala Kshaya, Bhrama, Katishula

2. Pitta dosha type menopausal symptoms Yonidaha, Mutradaha, Trishna, Daha Swedadhikyata

3. Kapha dosha type menopausal symptoms include Angamarda, Bhrama, Raukshaya

(B) Manasika lakshanas

In Rajonivritti, Psychological symptoms also commonly observed due to vitiation of Manovaha srotas these are Krodha, Shoka, Bhaya, Dwesha, Smritihras, Shirah Shula, Chinta, Medhahras. Both patients and doctors find these symptoms extremely bothersome.  Some times that disturbed the whole family happiness of the patients. So, it is very necessary to treat these symptoms with proper medical help as well as counseling and family support too18.

Probable Samprapti of Rajonivritti19

As the pathogenesis of the rajonivrittiis not elaborately described in Ayurvedic text. First of all, according to classics, Rajonivritti is likely to be around 50 years old. This age limit is dominated by "Vatadosha" and obviously it easily is getting vitiating during this time. This dominant vatadosha will have effect all over the female body including all anatomical as well as physiological factors by virtue of its i.e. "laghuta" and "rukshata”. At the age about 50 years, the decline process starts in female body due to jaravastha as a natural process.

MEDICINE:

1.Rasayana

Ayurvedic drugs having properties of Rasayana, Vatashaman and Kapha vardhancan be helpful in the the management of menopausal syndrome. it includes Kushmand Rasayana,Ashagandha Kshirpaka, Ashokarishta, as well as Shatavri, Bramhi prayojana.

A Rasayana drug in Ayurveda not only prevents the aging process, but also give streng to body. Rasayana also increases life span and memory Acharya Charaka explains Rasayana Prayojana as life promoter, maintains positive health, preserves health, and preserves youth, and cures morbid sleep, drowsiness, physical and mental fatigue, laziness, weakness. Tridosha is balanced, stability is created, muscle smoothness is restored, digestion and metabolism-related enzymes are stimulated, and perfection in lustre, skin, and voice is achieved20.

2. Panchakarma21

Snehan- (Appling medicated oil all over the body) Bala oil, Mahanarayanoil.

Swedan- (taking steam) using Dashmul decoction, Pottalipindsweda.

Shirodhara- Shirodhara was shown to be useful in treating psychological symptoms that were disrupted. It can be beneficial to combine Shirodhara with Dashmoolkwath, Takradhara, and Shatavarioil.

Nasya- Panchendriy vardhan oil, Anutail.

Uttarbasti- Yastimadhutail.

Pichu- Shatavaritail, Shatdhautghrita.

Basti- especially Anuvasan Basti

3. Diet22

A balanced vegetarian diet is most important aspect in preventive management of menopause. Vatashamak and Kapha vardhak dietary constituents help in preventing effects of Dhatukshay. Vaghbhat quotes that who takes Ghee and milk regularly in diet enters menopause late. Black grams, black sesame seed promotes ovarian function, green vegetables are important for mineralization of bones. Legumes soya beans are known good source of phyto-estrogens. Ghee, milk and milk products, protein and calcium rich diet, phyto-estrogen rich food like soya, wheat etc. can be helpful.

4. Yoga, Exercise and Meditation23

Yoga, Pranayam, Suryanamaskar, Anulom vilom can be beneficial in relieving stress and other psychological symptoms as well as improve the muscle tone. Yoga is helpful to firstly decrease the anxiety, stress, depression of such patients. Along with that, some asana helps in Medopachan and Amapachan, resulting in proper formation of Ras dhatu. Yoga controls Pranvayu which regulates all Panchvatain human body.

5. Counseling24

It is very important to maintain her physical as well as mental status, many psychiatric symptoms occur during this period.The secret to better quality of life counseling with relation to stress is Sadvritta (righteous lifestyle) and Swasthvritta (healthy lifestyle).

Discussion

A collection of symptoms known as Rajonivrutti Janya Lakshan are brought on by the body's tissue degenerating. Degenerative changes are explained in Ayurveda as Dhatukshaya lakshana. Sushruta Acharya has explained that there is Shareera-shithilta in Vrudha-avastha and women attain Rajonivritti stage at around 50 years. This age is dominated by Vatadosha, this dominant Vata dosha affects the female body.

The dominant Vatadosha specially with Laghu and Ruksha guna results in reduction in Dravata of Rasadhatu.This further leads to Dhatukshya starting from Rasadhatu,further respective Updhatukshaya takes place. Consequently, Artavanasha Numerous psychiatric disorders result from the vitiated Vatadosha's disturbance of the other Sharir and Manasdosha (Raja and Tamadosha).

Conclusion

The medicines used were found to be highly effective in the management of menopausal syndrome. It strengthens the tissues of the reproductive system and improves the functional aspect of rasa dhatu. The snigdhatwa is improved by deepaka and pachaka, which also strengthen the rasa dhatu and dhatwagni. They are deepaka, pachaka, vata hara, rasayana, and balya. They also strengthen rasa dhatu and improve dhatwagni. Every medication has a vatahara character. By producing the snehana effect and regulating vata, the primary cause, yoni pichu with taila, which is vatahara, lessens the symptoms.

Thus, it reduces vaginal dryness and inflammation present in the pelvis, uterus, and vagina reduces mood swings and sleep disturbances and other symptoms. Shaman chikitsa as well as diet, yoga, meditation, panchakarma procedures which are exceptionally well proved for their psychological and cognitive better effects as a special line of therapy.