Effect of vamana in artavakshaya (oligomenorrhoea): A case story

Menstruation is the age-old sign of womanhood and fertility. Even a slight disturbance invariably leads to anxious uncertainty in the woman ,which, in most cases is willfully ignored and later panicked. Artavakshaya (decreased menstruation) is one such distressing condition drawing a large number of females to the gynecological OPD. Majority of them resort to Ayurvedic treatment only after a series of failed hormonal experiments. This further disturbs body metabolism making it tougher to accept superficial treatment.

Before proceeding into the case, understanding the following terms are important :

·         

ARTAVA

It represents the essence of female fertility. It is the upadhatu (by product) of rasa dhatu (the original dhatu). It is carried to the garbhashaya(uterus) and expelled by vata ( dosha ) . Shonita, asrk, raja, rakta, lohita, rudhira, pushpa, bija are synonyms used. It may be used to denote menstrual fluid, ovarian hormones or ovum. 

ARTAVA VYAPAD

It is a compilation of all  pathologies associated with artava .

ARTAVAKSHAYA

It is defined as a condition characterized with delayed menstruation (uchita kala adarshanam), decreased quantity (alpata), vaginal pain (yoni vedana) and a desire to have katu, amla, lavana , vidahi ahara(sour and pungent foods)

ANARTAVA

 It is the non- appearance of artava (artavam nashyati striyaaha). Kshaya(decrease) occurs and it is obstructed at the level of  srotas(channels)by vata and kapha . Artavakshaya existing over a period of time may lead to anartava (absence of menstruation).

The symptoms of artavakshaya can be explained as

ü  Oligomenorrhea- infrequent or very light menstruation.  Menstrual periods occurs at intervals of greater than 35 days, with only 4-9 periods in a year with previous regular menstrual history.

ü  Hypomenorrhea- release of small quantity of blood at menstruation and duration of bleeding being less than normal. Most authors use the term hypomenorrhoea both to describe a menstrual loss less than normal, and also a cycle less frequent than normal. Hence the term scanty menstruation is also given to the same.

ü  Dysmenorrhea- Painful menstruation

ü  Secondary amenorrhea- Absence of menstruation for more than 3 cycles or 6 months in women who previously had menstruation.

CASE SUMMARY

A 20 year old unmarried female with history of regular menstruation since menarche gradually developed irregular menstruation along with dysmenorrhea. She visited the OPD with complaints of amenorrhea since 5 months. Associated complaints included white discharge per vaginum and constipation since 4 months. She had history of hormonal treatment and also progesterone challenge test with disturbing side effects like weight gain and lethargy. Detailed history taking and examination was done. Secondary sexual characters +. 
Initially, Artavajanaka oushadhi (drugs that induce menstruation) was given. As the establishment of the cause was essential, further investigations were carried out. USG showed multiple ovarian follicles with central thickened ovarian stroma (PCOS) and ruled out tumours; Hb- 10.4gm%; RBS-100mg/dl, TSH- WNL. Prolactin levels were normal.

The first follow up showed no improvement. The treatment was improvised and the patient was advised to undergo Panchakarma. Based on the condition of the patient i.e. roga(disease) and rogi(diseased) bala (strength), vamana (emesis) was scheduled.

Day 1 & 2: Deepana pachana(carminatives & digestives) with chitrakadi vati 2 tid;

     panchakola phanta 30 ml tid

Day 3: snehapana (ghee intake) with mahakalyanaka ghrta 30 ml

Day 4: snehapana 60 ml

Day 5: snehapana 90ml

Day 6: snehapana 140ml

   Samyak snigdha lakshana (signs of adequate oleation)

Day 7: Visrama kala (rest) with kapha utkleshaka ahara (foods that provoke kapha)

Day 8: Vamana was carried out successfully.

           

           Vega: 6/ pittantam/no complications

Madhyama samsarjana karma (moderate diet) was advised to be followed.

Medicines advised: Kumaryasava & shatavari guda

The patient was asked to come for review after a month or with the onset of periods.

Result- The patient reported after 6 days elated with the onset of periods. She was advised to continue the above medicines along with tila kashaya and proper pathya (panned diet).

DISCUSSION

Artavakshaya- Anartava diagnosis was done by analysing presenting complaints and  chikitsa sutra (line of treatment) was implemented . The approach includes shodhana(detoxification), artavajanaka dravya prayoga(drugs that induce ovulation & menstruation) , anuvasana basti (enema therapy with oil).

As dosha avarana (block) included kapha & vata , vamana was adopted initially with consequent Basti  to regulate disturbed Vata. 
Vamana is a panchakarma procedure which is Kapha hara, thereby removing the obstruction and metabolic imbalance at the gross and root levels. It is agneya dhatu vardhana (increasing the hot elements) thereby stimulating the regulation of the the artava which is agneya (fiery) is nature.  

It also possibly helps to

     

• ·         Correct  hampered metabolism
• ·         Increase blood supply to brain by stimulating it
• ·         Tonic release of gonadotropins
• ·         Promote follicle growth
• ·         Proper enzymatic activity and conversion
• ·         Decrease fat cells, Decrease weight
• ·         Decrease peripheral aromatization
• ·         Regulate blood sugar and insulin levels
• ·         Decrease excess male hormones and hormonal activity, increase SHBG
• ·         Improve progesterone production
• ·         Ensure regular ovulation and menstruation 

CONCLUSION:

Menstruation is a complicated ritual, There are a lot of factors influencing its physiology. Geographical conditions, nutritional standards, environmental influences and indulgence in strenuous physical activity can affect pituitary functions, hormonal status and thereby menstrual cycles . The disturbance produced on the doshas is made visible by the varying hormonal levels. Shodhana (purification) along with Nidana parivarjana( following the regimen during menstruation) is necessary to restore optimum health without any undue complications. Vamana being the recommended procedure here, was helpful in clearing channels and setting the system back to normalcy. 

 In whole, Ayurveda focuses on prevention and maintenance of health. The purity of shukra (sperm)and artava (ovum) are treated with high priority so that the future progeny is not compromised.  Thus a holistic approach to the well being of the patient is required, rather than a mere reversal of symptoms. Correcting the basic underlying pathology is the aim of Ayurveda. 

The mode of treatment though time-tested and eternal, needs further clinical evaluation and validation to be established further.