Hypomenorrhoea: Causes, Remedies, Ayurvedic Treatment

Hypomenorrhoea is simply put, less bleeding during periods. It is also called scanty periods or short periods. It commonly appears in lean people, people with stress, anxiety etc.

Menstrual variations are of many kinds. The duration of flow or the type of menstrual cycle may differ in different individuals. The menstrual cycle may be shortened, the interval may be increased or it may totally be absent or it may be associated with pain. These variations are expressed by various terminologies.

menstrual cycle

Hypomenorrhoea – In hypomenorrhoea the menstrual flow is scanty but menstruation is cyclical. Scanty menstruation may be from the date of menarche or may develop secondarily after normal menstruation for some time. It can be constitutional hypomenorrhoea, i.e. it is a normal pattern in that individual.

Secondary hypomenorrhoea can date back to parturition with postpartum haemorrhage which results in partial necrosis of pituitary gland. It can also be due to prolonged lactation which is commonly observed in the rural areas or it may develop after unilateral oophorectomy or partial resection of the ovary.

When the menstrual bleeding is unduly scanty and lasts for less than 2 days, it is called hypomenorrhoea. Uterine bleeding may be slight in amount, short in duration or both, but the menstrual function varies so widely within normal limits. Bleeding which lasts 2 days or less is unusual, if not pathological, and is termed as hypomenorrhoea.

Causes for hypomenorrhea: 
The causes may be –
Constitutional
Uterine
Hormonal
Nervous and Emotional
Intake of oral contraceptive pills
Stress, anxiety
Low body fat, heavy exercise schedule
Less intake of food, as in people suffering from anorexia nervosa
Hormonal imbalances

Oligomenorrhoea- Menstrual bleeding occurring more than 35 days apart and which remains constant at that frequency is called oligomenorrhoea.

In oligomenorrhoea or infrequent menstruation the interval between the two menstrual cycles is increased. It is a reduction in the frequency of menstruation. In the majority of cases infrequent menstruation represents a peculiarity of the individual and is not out of keeping with health and good fertility. It can be familial.

The bleeding can be ovular in type, which means that ovarian cycle is drawn out or temporarily arrested at some phase. As a rule the luteal phase tends to be fairly constant at 14 days; it is the follicular phase which is either lengthened or slow to commence.

It can be defined arbitrarily as one in which the cycle lasts longer than 35days. Menstruation may be both infrequent & irregular or may be regularly infrequent.

Causes:
The causes are –
Constitutional and Physiological:
Hormonal
Chromosomal

Ayurvedic line of treatment:
Artavakshaya should be treated through shodana (purificatory therapy) and agneya dravyas (ushna-teekshna-laghu). Srotoshodhaka, Vatakaphahara, Balya, Pachana, Deepana medicaments are recommended.

Formulations:
Bruhat kalyanaka ghrita
Kalyanaka ghrita
Phala ghrita
The above three are especially used when the hypomenorrhea is associated with infertility.
Chandraprabha vati – Useful during pelvic inflammatory disease is associated.
Kumaryasava
Balarishta – Useful in underweight patients
Aravindasava – Useful in teenage patients with anorexia and eating problems.
Lohasava – Useful in anemic patients
Rajapravartini vati
Tankana Bhasma etc

Pathya:
The patient is asked to take a diet consisting of below ingredients:
Rakta shali anna (red colored rice)
Yava (barley)
Sura (sour beverages)
Krishna tila kwatha (decoction of black sesame seeds) mixed along with guda(jaggery)
Tila (sesame seeds) and karavi (Krishna jeeraka)mixed with guda (jaggery)
Mamsa rasa (flesh soup)
Masha (black gram)
Kulattha (horse gram)
Dadhi (curd)
Matsya (fish)
Amla kanji (sour gruel)
Gomutra (cow’s urine) etc

Ayurvedic concept of hypomenorrhoea:
This condition is called Arthava Kshaya in Ayurveda.
The term artavakshaya consists of two words viz; artava and kshaya. The word artava means which flows out at a specific time, that too once in two months! You may wonder what a nonsense is uttered in Ancient Indian texts about a general, well known phenomenon which happens once in a month is quoted that what happens in two months.
Yes…Here lies the great intellect of Ayurvedic Acharyas.

Even without hormonal analysis, chemical studies and USG they narrated the contribution of Ovaries which liberate the ovum once in two months, alternatively, is significantly explained by the simple word-Artava (Ritu bhavam-Ritu is seasons and a period of two months).If one understands the deep insight of our Acharyas surely will feel the great treasure of age old Ayurvedic science.

The artava (menstruation/liberation of ovum) is one of the essential factors for the production of garbha in the females. It makes its appearance only when the woman has attained adulthood and during her active reproductive phase.

The word kshaya has been derived from “kshi” dhatu, which means “to cease” or “to get reduced”.
According to Acharya Charaka, the word kshaya means “hrasa” or “nyunata”. Ayurvediya mahashabda kosha refers it as that means reduction in quantity of artava from its normal measurement.

It is one among the ashta artava dusti and also as lakshana in various yoni vyapads (uterine disorders).

It also stands as a single disease condition with cardinal features like-
Yatochitakala adarshanam (absence of flow in the expected period of time)
Alpartavam (reduced menstrual flow)
Yoni vedana (painful menstruation)

Acharya Bhela describes that even though the blood circulates throughout the body, because of alpata (reduced amount) and vikritatva (vitiation), it cannot nourish artava; and thus resulting depletion or desiccation of artava.

According to Acharya Charaka, it is mere a symptom of a disease caused sometime because of their subordinate nature; they are only symptoms and not the disease.

While commenting on this, Acharya Chakrapani says that any symptom may manifest as a separate disease.
Acharya Susrutha in Sutrasthana has described that, in the event of deficiency of artava, the menstruation does not appear in its appropriate time or is delayed (intermenstrual period is prolonged), scanty and does not lasts for three days, and also appear with pain in yoni (genital tract).

According to Chakrapani, yonivedana (uterine/vaginal pain) is due to aggravation of vayu caused by loss of artava which fills the genital region.

In Bhavaprakasa, specific desires of woman suffering from artavakshaya have been enlisted i.e. she desires food and beverages of katu (pungent), amla (sour), lavana (salty), ushna (hot), vidahi (spicy) and guru (heavy) food articles. Here the desire to consume these substances is probably due to deficiency of artava, where katu etc. food articles increase the artava.

Disorders like vataja artavadushti, ksheenartava etc. closely resemble artavakshaya to some extent. Acharya Charaka has not mentioned artavakshaya separately, but mentioned it as symptom in many diseases.

Causes for hypomenorrhoea: 
In initial classical literatures of Ayurveda there is no direct reference for aetiological factors leading to artava kshaya. The factors responsible for aggravation of particular doshas can be considered in this context.

Here in this condition, artava is in kshaya avastha (declined/diminished), so also pitta dosha; which is due to margavarana (blockage in the corresponding channels) done by vata and kapha doshas and hence they are in prakopavastha (aggravation). So here we can state that factors which vitiate and aggravate vatakapha and factors which cause decrease of pitta (pitta kshaya) should be considered.

Dalhana has given the causative factors for decline in the commentary on dosha dhatu mala kshaya vruddhi vigyana of sushruta samhita, sutrasthana. He mentions the nidana as:
Kshaya karanas:
Aharaja Viharaja Manasika
Asathmyaanna Atisamshodhana Manasthapa
Anashana Atisamshamana
Vegadharana
Vyayama
Atimaidhuna

Roopa (Features)
The features of artavakshaya are:
Yatochitakala adarshanam – prolonged intermenstrual period
Alpartavam – scanty menstruation not lasting for three days
Yoni vedana – pain in genital tract

These cardinal symptoms can be explained as:
Yatochitakala adarshanam:
The inter menstrual period between two menstrual cycles is one month. Here the menstruation does not appear in its appropriate time or is delayed.
Alpata:
The word meaning of alpa according to shabdhakalpadruma is kshudra pramana. This may be taken as reduced menstrual flow or scanty menstruation. In this condition normal quantity (4 anjali pramana) and duration of flow (3-5 days) is decreased.
Yonivedana:
Aggravation of vata causes pain in yoni. Here apana vata is mainly affected. This is due to depletion in accumulated artava, which makes the vata to fill the yoni and hence pain appears.

Samprapthi (Pathophysiology)
The samprapti related to artavakshaya occurs because of either rasa dhatu kshaya, vatakaphavruta margavarodha (blockage of the channels) or artavavaha sroto-viddhata (injury or harm to uro genital system).

Causative factors lead to vitiation of doshas and causes dhatu vaishamyata(disturbance). Vitiated doshas have done kshaya of rasa and raktha dathu. Artava is an upadhatu of rasa, hence resulting in kshaya of artava.
Causative factors vitiate vata and kapha doshas. The kapha dosha does avarana of apana vata and this kaphavritha vata causes margavarodha resulting in reduced flow of artava.

Any trauma to artavavaha sroto mula i.e. garbhashaya(uterus) and artavavaha dhamanies (uro genital tract), leads to artava nasha. Here the artava is not destroyed completely, but there is suppression of artava resulting in irregularity in menstruation.

According to Acharya kashyapa, in a mrudu koshta person, after proper snehana and swedana, if indulges in adhika aushada sevana, atyushna annapana sevana etc. then jeeva raktaskalana occurs, which inturn causes vata prakopa leading to beejopaghata (viryadushti), pushpopaghata (artavadushti) etc.

Samprapti ghataka:
Dosha – vata, kapha
Dhatu – Rasa, Raktha
Upadhatu – Artava
Srotas – Rasavaha, Artava vaha
Srotodushti – sanga
Udbhava sthana – pakvashaya
Adhishtana – yoni & garbhasaya
Rogamarga – Abhyantara

 

Last drop-
Dear readers of easyayurveda.com, Artavakshaya or Hypomenorrhoea is a common health complaint for which most of the young ladies approach the physicians. The number of such patients is significantly increased in recent past of about 10-15 years. But the direct impact of food and beverages is found in the causation of such disorders.

History of fast food and junk food stand as the main evidences in this regard. So it has become common to ask all the patients to avoid such food from the beginning of the treatment itself. Quite good result in less period of time can be assured by this.

References: 
Atridev. Sushruta Samhita Part-I commented by Ghanekar Shribaskar Govindji. Varanasi, Chaukhamba Vidyabhavan, 1988.
Atridev. Sushruta Samhita Part-II commented by Ghanekar Shribaskar Govindji. Varanasi, Chaukhamba Vidyabhavan, 1998.
Bourne and Hawkins, Shwas textbook of Gynaecology. Delhi, B.I Churchill living stone Pvt.ltd. 1989.
Brahmanand Tripathi .Charaka Samhita of Agnevesh with Hindi Commetry Charak Chandrika. Vol I and II. I edition, Varanasi, Chaukhambha Surbharati Prakashan, 2004.
Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2009.
C.S. Dawn. Textbook of Gynaecology. Contraception & Demography. Fourteenth edition, Kolkatta, Dawn Books, 2003.
Chaudhary. Concise Medical physiology. Fourth edition, Calcatta, New Central Book agency (P) Ltd., 2002.
Churchill Livingston. Davidson’s Principles & Practice of medicine. Eighteenth edition, Toranto, 1999.
D.C. Dutta. Text book of Gynaecology. II Edition, Calcutta, New Central book agency (P) Ltd, 1994.
Dr. Nirmala G. joshi, Ayurvedic concepts in gynaecology, chaukhamba Sanskrit pratistha, delhi
Guyton & Hall. Textbook of Medical Physiology.Tenth edition, Delhi, a division of Reed Elsevier India pvt. Ltd. 2003.
P.V. Sharma. Cakradatta, A treatise on principles & Practices of Ayurvedic Medicine. I edition, Varanasi, Chaukhabha publishers, 1998.
P.V. Tewari. Kashyapa Samhita with English translation & commentary. I edition, Varanasi, Chaukhambha Vishvabharathi, 2002.
Prof. P.V Sharma.Dravayaguna-vijnana.vol II- I edition , Varanasi, Chaukhambha vishwabharathi, 2002.
Shastri Ambika Datta. Bhaishajya Ratnavali, Varanasi: Chaukhambha Sanskrit Sansthan Publishers, 1993.
Shastri Ramavalabha. Harita Samhita (Hindi) . I edition , Varanasi, Prachiya Prakashan,1985.
Shri Misra Brahmasankara and Sri Vaisa Rupaliji-Bhavaprakash of Sri Bhavamisra. with “Vidyotini” Hindi commentary. I & II part, Varanasi, Choukhamba Sanskrit Samsthan, 1984, 1983.
Tripathi Bramhananda, Sharangdhara Samhita (Hindi).I edition, Varanasi, Chaukhambha Surbharathi Prakshan. 1990.


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Comments

  1. Dose of medicine is missing? ?

  2. Is this condition effect on conception ??

    • Dr J V Hebbar MD(Ayu) says:

      Yes, it could point out to infertility issue in some cases, especially if menstrual cycles are irregular.

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