Low Menstrual Bleeding: Causes, Remedies, Ayurvedic Treatment

By – Dr JV Hebbar

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.

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

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

Rajapravartini vati – Contains Kasisa Bhasma, aloe vera, purified borax and asafetida. Probably the most important medicine for inducing periods. It is usually administered from the 21st day of the menstrual cycle till the periods sets in. it is stopped after that and started again from the 21st day. It is used in PCOS and obesity patients suffering with scanty periods. It is advised both in primary and secondary amenorrhea.
Tankana Bhasma – Calx of purified Borax. It has alkaline (Kshareeya) properties.
Annabhedi Sindhooram – It is advised very similar to Rajapravartini Vati. Being a good source of iron, it is also useful in anemia and weak immunity.
Sukumara Ghrita, Sukumara Kashayam, Sukumara Leham, Sukumara Eranda – these are used when Vata Dosha is afflicted and is moving in upward direction.
Hingvashtaka Churna – Also called Ashta Choornam, is useful when Vata Dosha is aggravated, when the patient has severe bloating, anorexia, junk food habits associated with low bleeding.
Lohasava – Useful in anemic and weak patients.
Bruhat kalyanaka ghrita – This is useful in improving overall nourishment of the reproductive tissues and the whole body. It is very useful in people with very low body weight, low nourishment and with this, they suffer from scanty periods.
Kalyanaka ghrita – Same as above
Phala ghrita – Along with regularizing periods, it also improves chances of conception.
The above three are especially used when the hypomenorrhea is associated with infertility.
Chandraprabha vati – Useful during pelvic inflammatory disease is associated. This is especially useful when there is infection in the reproductive system or urinary system.
Kumaryasava – With Aloe vera as the main ingredient, it is useful as a uterine tonic. It is advised for a period of 2 – 4 months to regularize periods.
Balarishta – Useful in underweight patients, to improve strength and immunity.
Aravindasava – Useful in teenage patients with anorexia and eating problems.

Medicinal Yogas for Yoni Roga from Sahasra Yoga Text book

Maha Rasnadi Kwatha
Sukumara Ghrita
Varahyadi Ghrita
Dhanvantara Taila
Sahacharadi Taila
Satavari Guda
Yonisoolahara Kashaya
Amritaprasa Ghrita
Maha Mayura Ghrita

Pathya

The patient is asked to take a diet consisting of below ingredients:
Aliv seeds (Garden pepper cress)
Rakta shali anna (red colored rice)
barley,
Sour beverages, lemon juice, using more tamarind in diet
Krishna tila kwatha (decoction of black sesame seeds) mixed along with jaggery
Sesame seeds and black caraway, mixed with jaggery are made a laddoo and administered.
Black gram,
sour curd, fish
Cow urine,
Panchamrita Gomutra (cow’s urine) etc

Ayurvedic concept of hypomenorrhoea

This condition is called Arthava Kshaya in Ayurveda.
Arthava can mean menstrual fluid and it can also mean ovum.
In the context of ovulation (release of egg from ovary), Ancient masters have mentioned that it happens once in 2 months.

There are two ovaries, left and right. Each ovary releases ovum (egg) alternatively, every month. So, if we consider only one ovary, it releases egg once every two months.

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

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.

Addition by
Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Artava Kshaya

Meaning of Artava Kshaya

Artava Kshaya is a variant of Artava Vyapad i.e. menstrual disorders, but is not counted in the eight types of menstrual disorders. It is marked by deficiency or loss of menstrual blood. Read – Physiology Of Menstruation, Menstrual Cycle – Ayurvedic Perspective

Artava = menstrual blood Kshaya = deficiency / absence / loss

Symptoms

Symptoms of deficiency of menstrual blood

• Menstruation is delayed i.e. inter-menstrual period is prolonged
• Menstrual blood is scanty
• Menstruation does not last for three days
• Pain in vagina (due to vitiation of vata caused by loss of menstrual blood)
• Woman in menstruation desires for pungent, sour, salty, hot, corrosive and heavy food articles, fruits, vegetables and beverages Read – Ayurvedic Diet And Lifestyle During Menstruation (Periods)

Modern gynecological conditions which fall under the umbrella of artava kshaya

In the context of explaining and enlisting the deficiency symptoms of doshas, tissues, sub-tissues and excreta etc, Sushruta has described the deficiency of menstrual blood too. Menstrual blood is said to be the sub-tissue of rasa tissue. Therefore this description can be compared to estrogen deficiency. Pain in vagina is said to be one of the symptoms of deficiency of artava. Vaginal pain is also noted in estrogen deficiency, whereas it is not found in those suffering from hypomenorrhea due to general debility or loss of body tissues.

There is yet another condition called ksheena-artava mentioned as one among the eight types of menstrual disorders. Meaning of ksheena-artava is same as artava kshaya. Ksheena artava is characterised by oligomenorrhea. Oligomenorrhea can be due to deficiency of lymph, blood etc tissues or estrogen deficiency or both these causes. Artava-kshaya is caused only due to estrogen deficiency. In both these conditions, the associated symptoms are different. And we also find both these conditions explained separately. Therefore both these conditions are different. Read – Artava – Menstrual Blood Formation, Healthy Characteristic Features

Another condition i.e. vataja artava dushti / vyapad, i.e. menstrual disorder caused by vata aggravation, counted as one among the 8 types of menstrual disorders also resembles deficiency of menstrual blood. Even in this condition there is scanty menstruation. Presence of red or black coloured blood, frothy, thin, dry and scattered blood associated with pain in the menstrual disorder caused by vitiated vata differentiates this condition from artava kshaya since these symptoms are absent in deficiency of menstrual blood. Read – Menstrual Pain, Painful Periods – Natural Ayurvedic Herbal Home Remedies

Treatment

Administration of purifying treatments, especially emesis – In the treatment of menstrual blood deficiency, purifying treatments, especially therapeutic emesis should be administered. Commentator Dalhana contradicts use of purgation therapy since purgation eliminates pitta which in turn causes further deficiency of menstrual blood. Emesis removes kapha and other elements which tend to cause blocks in the channels of the body leading to deficiency of menstrual blood. He tells that it removes soumya substances (watery, milder substances) and relatively increases agneya substances i.e. fiery substances, consequently increasing the menstrual blood. We need to remember that menstrual blood, according to Ayurveda is fiery in nature. Read – Heavy Periods, Menstrual Bleeding: Ayurvedic Treatment

Administration of both emesis and purgation – Commentator Chakrapani is of the opinion that the purifying treatments cleanses the channels of the body. Emesis and purgation, both should be used. Read – Vaginal Itching: Causes, Symptoms, Ayurveda Remedies, Tips Emesis clears the channels directed upwards and purgation clears the channels directed downwards. Therefore both shall be used but after considering the dosages of medicines for purification, the strength and fitness of the woman. This means to tell that mild purgation can be given under supervision. Read – Vaginitis: Ayurvedic Treatment, Medicines, Home Remedies

Use of Agneya substances – Medicines and food substances which have fiery character should be administered in the treatment of ‘deficiency of menstrual blood’. Fiery substances increase menstrual blood because of similarity in characters between both these substances and menstrual blood. Read – Lifestyle, Food And Factors That Cause Pitta Dosha Increase Example of fiery substances – sesame, black gram, wine, sukta i.e. fermented liquid etc.

Other remedies –

• Treatment prescribed for nastartava i.e. destruction of menstrual blood
• Anuvasana vasti – oil / fat enema
• Shitakalyana ghrita – ghee described as remedy for pradara (menorrhagia)
• Desires of the woman (as explained in Bhavaprakasha) should be fulfilled

Ksheena Artava Dushti

Ksheena Artava Dushti is one among the 8 types of menstrual disorders mentioned in Ayurveda. This is caused by vitiation of pitta and vata doshas. In this condition, discharged menstrual blood is scanty and associated with pain.
Read – Artava – Menstrual Blood Formation, Healthy Characteristic Features

Signs and symptoms

Signs and Symptoms of Kshina Menstrual Disorders

Ksheena means less. Ksheena menstrual disorder is a
condition wherein there is scanty discharge of menstrual blood.

Ksheena menstrual disorder occurs due to excessive and regular consumption of foods and life activities which cause simultaneous vitiation of both pitta and vata.
Read – How To Balance Pitta Vata Dosha? 6 Points To Consider

Since this pathological manifestation of this menstrual
disorder is caused by dual dosha vitiation, the signs and symptoms of this
condition too will have mixed symptoms of pitta and vata.

General disease specific
symptoms  

• Ayatha kala upasthiti – Menstrual bleeding doesn’t occur in proper time, there is delay in menstruation in this condition.
• Artava alpata – Scanty menstrual bleeding.
• Yoni vedana – Associated with severe pain in vagina.
  Read – Hypomenorrhoea: Causes, Remedies, Ayurvedic Treatment

Symptoms of dual vitiation of pitta and vata in this disorder would be –

Dwi dosha varna – Menstrual blood will have colours manifested by both vitiated pitta and vata in mixed proportions. Colour may be yellowish or bluish as caused by vitiated pitta or red, black or dark violet colors due to vitiated vata. Colours specific to pitta and vata vitiation may mix up to give weird colours of menstrual blood due to dual vitiation of doshas.
Read – Physiology Of Menstruation, Menstrual Cycle – Ayurvedic Perspective

Dwi dosha vedana – Pain and discomfort associated with menstrual bleeding in ksheena menstrual disorder will also be caused by both pitta and vata. Pain will be of mixed proportions comprising of pains specific to both pitta and vata.

Woman may experience sucking and burning pain, burning sensation, raised heat, fever etc symptoms due to pitta vitiation. At the same time she may also experience pricking, throbbing, stabbing or piercing types of pain, severe pain etc due to vata vitiation. Pains specific to pitta and vata vitiation may combine to give weird types of pain. Pitta type and vata type of pains may occur in mixed proportions or intermittently.
Read – Menstrual Pain, Painful Periods – Natural Ayurvedic Herbal Home Remedies

Treatment

Treatment of Ksheena Menstrual Disorder

Administration of purifying treatments, especially emesis –
In menstrual blood deficiency, purifying treatments, especially therapeutic emesis should be administered. (read about therapeutic emesis)

Administration of both emesis and purgation –
Commentator Chakrapani is of opinion that both emesis and purgation, both should be used. Emesis clears the channels directed upwards and purgation clears the channels directed downwards.
Read – Pittaja Yoni Vyapad – Causes, Symptoms, Treatment

Use of Agneya substances –
Medicines and food substances which have fiery character should be administered in treatment of ‘deficiency of menstrual blood’. Fiery substances increase menstrual blood because of similarity in characters between both these substances and menstrual blood. Example of fiery substances – sesame, black gram, wine, sukta (fermented liquid) etc
Read – Ayurvedic Diet And Lifestyle During Menstruation (Periods)

Other remedies –

• Treatment prescribed for nastartava (destruction of menstrual blood)
• Anuvasana vasti – fat enema
• Shitakalyana ghrita – ghee described as remedy for menorrhagia
• Desires of the woman (as explained in Bhavaprakasha) should be fulfilled
  Read – Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment

Modern Correlation, Comparative Study

Scanty menstrual blood is the
predominant symptom of ksheena menstrual disorder. It is also associated with
pain in vagina and delayed menstruation. Seeing the entire description of this
menstrual disorder, ksheena menstrual disorder can be closely correlated and
compared to the description of ‘hypoestrogenic
condition i.e. deficit functioning of ovaries caused due to nutritional
deficiency’.

Click to Consult Dr Raghuram Y.S. MD (Ayu) – Email / Skype

References

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