Rajonivritti : A Physiological Study

Anita Bhardwaj; Deepak Kumar Sharma

doi:http://dx.doi.org/10.21760/jaims.7.11.10

Rajonivritti : A Physiological Study

Bhardwaj A.^1*, Kumar Sharma D.²

DOI: http://dx.doi.org/10.21760/jaims.7.11.10

^1* Anita Bhardwaj, Associate Professor, Dept. of Kriya Sharira, Rajkiya Ayurvedic, Yoga avam Prakritik Mahavidhyalaya, Jaipur, Rajasthan, India.

² Deepak Kumar Sharma, Chief Medical Officer, Ayurveda, ESIC Model Hospital, Jaipur, Rajasthan, India.

Perimenopause has become an important health issue for women with increasing life expectancy. Most of Perimenopausal women expercience various somatic & Phychological symptoms. Rajonivritti is consider as a normal physiological process in body, which an indication of Jaravastha (ageing) in women's life. Ageing is natural in every individual that is "Nishpratikrya", that mean it cannot be stopped. It this study total 100 women gère selected for the evaluation of physiological status of Rajonivritti. These all women divided into two groups, (A) Premenopausal, (B) Post menopausal. The women in whom menstruation stop atleast 12 consecutive months, put into post menopausal class. A Survey questionnaire was prepared for the details about physiology & other information. In this study, it was observed that food-habits, lifestyle, Sleep pattern, Kostha, Agni effect the Rajonivritti. Jara, Vata Vridhi, Pitta Rishi, Kapha Kshaya, Artava Kshaya etc. all these factors play role in causing symptomatology of perimenopausal syndrome.

Keywords: Rajonivritti, menopause, physiology, Jaravastha

Corresponding Author	How to Cite this Article	To Browse
Anita Bhardwaj, Associate Professor, Dept. of Kriya Sharira, Rajkiya Ayurvedic, Yoga avam Prakritik Mahavidhyalaya, Jaipur, Rajasthan, India. Email:	Anita Bhardwaj, Deepak Kumar Sharma, Rajonivritti : A Physiological Study. J Ayu Int Med Sci. 2022;7(11):59-66. Available From https://www.jaims.in/jaims/article/view/2168

Introduction

From the time immemorial woman has an important place in the society. Women is of prime importance to get a healthy. Women take many journeys in their lives : puberty and childbearing are two events that spring to mind and menopause is another. Menopause is an age old phenomina that might have been occuring with the inception of human society.

तद् वर्षात् द्वादशात् काले वर्तमानसृक पुनः ।

जरापक्व शरीराणाम् याति पंचाशतः क्षयम् ।। (सु.शा.3/9)

This quotation of Sushruta points out the start and end of the reproductive life of a female. Menopause is permanent cessation of menstruationat the end of reproductive life that occures arround the age 50 due to ovarian follicular inactivity.

The cause of menopause is ”burning out” of ovaries. Throught a woman’reproductive life, about 400 of the primordial follicles grow into mature follicllates and ovulate, and hundreds of thousands of ova degenerate. At about age of 45 years the production of estrogens by the ovaries decreases as the number of primordial follicles approaches zero.^[1]

Some important factors that affects menopause is – 1) Kala 2) Swabhava 3) Vayu 4) Karma 5) Dhatukshaya 6) Abhighata

1. Kala - according to Charaka, old age and death are natural and due to result of time. So menopause is a natural proccess related to time.^[2]

2. Svabhava - Acharya Charaka told that any object has cause in his origin but no cause for his destroy. So menstruation is a physiological product, and has natural phenomena to destroy.^[3]

3. Vayu - due to increase of Vata Dosha Vridhavastha, Dhatukshaya, Rukshata and Shosha may occur.

4. Dhatukshaya - in old age Annarasa is not nourish all the tissues not properely, it is result into Dhatukshaya by Rasakshaya and menopause is the result of Dhatukshaya.^[4]

5. Karma - Ayurveda believes in Karma for all the phenomena, there is two types of Karma, Purvajanmakrita and Ihajanma Krita. On average, women who smoke cigarettes experience menopause significantly earlier than non-smokers.^[5]

^[6]

6. Abhighata - Acharya Sushruta told that Abhighata in Artva Vaha Srotas Mula (Garbhashaya and Artavavahi Dhamani) is result in Aratvanasha. So, Akalaja Rajonivriti occures due to Abhighata in Artavaha Srotasa.

The typical age range for the menopause is between the ages of 45 and 55 years. In some developing countries, such as India, the median age of natural menopause is considerably earlier, at 44 years.

Clinical imprssion has suggested that mothers and daughters tender to experience menopause at the same Age.^[7]

Both users and non users of HRT (Hormone replacement therapy) identify lack of energy as the most frequent and distressing effect.^[8]

She requires changes in life style based on Ayurvtedic principles including exercises, optimistic outlook and emotional assurance and above all a safe remedy which can reduce the serious short and long term concequeces of hormonal decline and can slow down aging.

Materials and Methods

100 women were selected for survey to understood the subject ‘Rajonivritti : A Physiological Study.

Following parameters had been used in the selection of women ;

1. Women those are between the age of 40 – 50 years were selected for study.

2. Women those are below the age of 40 years and above 55 years were not included in this study.

3. Women those are suffering from any serious diseases were not selected for study.

4. Women those both ovaries were removed by surgery were also not selected.

5. Women those ovaries were inativeted by chemotherapy or radiotherapy were also not included in this study.

All the selected women were divided into two groups.

6. Prememopause

7. Postmemopause

The women whom menstruation stop atleast 12 consecutive months, put into Postmemopause.

A survey questionnaire was prepared for the details about physiology and other information under the following topics that was studied.

A. Vital statistic or Demography

B. General Phiological Examinations

C. Ashtavidha Pareeksha

D. Description of menstruation and delivery

Symptoms related to Menopause

Symptops due to Vata^[9,10,11]

1. Aniyamita Masika Chakra (Irregular Menstrual cycle)

2. Hridaspandana (Palpitation)

3. Adhmana (Flatulence)

4. Yoni Shushakata (Vaginal Atrophy)

5. Vibandha (Constipation)

6. Smrittihras (Loss of memory)

7. Anidra (Insomnia)

8. Adhira (Anxiety)

9. Shirashoola (Headache)

10. Katishoola (Backache)

11. Shandishoola (Joint Pain)

12. Ayasa (Fatigue)

13. Toda (Pricks & Pins sensation in Body)

14. Irritability

15. Maithunakrichata (Dyspareunia)

16. Twakaparushaya (Skin Dryness)

Symptoms due to Pitta^[9,10,11]

1. Ushnabhitapa (Hot Flushes)

2. Swedadhikya (Excessive Sweating)

3. Mutradaha (Burning Micturation)

4. Krodha (Anger)

Symptops due to Kapha Dhosa^[9,10,11]

1. Avashada (Depression)

2. Sthaulaya (Weight Gain)

3. Yonisrava (Vaginal Secretion)

4. Alasya (Lethargy)

Other major disorder

1. Osteoporosis

2. Cardio-vascular Diseases

3. Recurrent UTI

4. Recurrent vaginal infections

5. Genital Prolapse

6. Breast-Pain

Observation and Results

Age

SN	Age class (In years)	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	% Total
1.	40-45	23	39.6%	8	19	31
2.	46-50	26	44.8%	24	57.1	50
3.	51-55	9	15.5%	10	23.8	19

Religion

SN	Religion	No. of women
		Premenopausal		Postmenopausal		Total n=100
		Total 58	%Total	Total 42	% Total	Total n=100
1.	Hindu	56	96.5	36	85.7	92
2.	Muslim	2	3.4	5	11.9	7
3.	Other			1	2.4	1

Residence

SN	Residence	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Rural	20	34.5	10	23.8	30
2.	Urban	38	65.5	32	76.2	70

Occupation

SN	Occupation	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Service	1	1.7	4	9.5	5
2.	Labour	11	19.0	11	26.2	22
3.	Housewife	46	79.3	27	64.3	73

Economical Status

SN	Economical Status	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	LIG	9	15.5	12	28.6	21
2.	MIG	43	74.1	27	64.3	70
3.	HIG	6	10.3	3	7.1	9

Educational Status

SN	Educational Status	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Illiterate	7	12.1	4	9.5	11
2.	Primary	20	34.5	18	42.9	38
3.	Secondary	12	20.7	8	19	20
4.	Grad.	15	25.9	6	14.3	21
5.	Post-grad.	4	6.9	6	14.3	10

Marital Status

SN	Marital status	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Married	57	98.3	41	97.6	98
2.	Unmarried	1	1.7	1	2.4	2

Life-Style

SN	Life-style	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Active	29	50	12	28.6	41
2.	Inactive	29	50	30	71.4	59

Food Habits

SN	Food habits	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Vegetarian	40	69-0	27	64-3	67
2.	Non veg.	18	31-0	15	35-7	33

Sleep

SN	Sleep	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Samyaka	22	37-9	20	47-6	42
2.	Ati	5	8-6	5	11-9	10
3.	Alpa	18	31-0	14	33-3	32
4.	Vishama	13	22-4	3	7-1	16

Bowel

SN	Bowel	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Samyaka	19	32-8	14	33-3	33
2.	Ati	7	12-1	5	11-9	12
3.	Alpa	9	15-5	6	14-3	15
4.	Vishama	23	39-7	17	40-5	40

Micturition

SN	Micturition	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Samyaka	17	29-3	11	26-2	28
2.	Ati	5	8-6	5	11-9	10
3.	Alapa	10	17-2	5	11-9	15
4.	Vishama	26	44-8	21	50-0	47

Koshtha

SN	Koshtha	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Krura	15	25-9	17	29-3	32
2.	Madhyama	37	63-8	22	52-4	59
3.	Mridu	6	10-3	3	7-1	9

Agni

SN	Agni	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Mandagni	12	20-7	8	19-0	20
2.	Tikshnagni	7	12-1	7	16-6	14
3.	Samagni	13	22-4	7	16-6	20
4.	Vishamagni	26	44-8	20	47-6	46

Past-history of Menstruation

SN	Past-History of Menstruation	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Regular	47	81-0	30	71-4	77
2.	Irregular	11	26-2	12	29-6	23

Age of Menarche

SN	Age of Menarche	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	12-14 yrs.	40	69-0	28	66-6	68
2.	10-12 yrs.	11	26-2	10	23-8	21
3.	14-16yrs.	7	12-1	4	9-6	11

Present History of Menstruation

SN	Present History of Menstruation	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Regular	16	27-6	-	-	16
2.	Irregular	42	72-4	-	-	42
3.	Absent	-	-	42	100	42

Contraceptive History

SN	Contraceptive History	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Yes	54	93-1	29	69-0	83
2.	No	4	6-9	13	31-0	17

Parity

SN	Parity	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	0	2	3-4	2	4-7	4
2.	1	5	8-6	3	7-1	8
3.	2	9	15-5	6	14-3	15
4.	Multi-para	42	72-4	31	73-8	73

Symptoms which were found in Perimenopausal Syndrome

Symptoms due to Vata

SN	Symptoms	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Aniyamita Masika Chakra (Irregular Menstrual cycle)	48	82-8	0	0	48
2.	Hridspandana (Palpitation)	18	31-0	14	33-3	32
3.	Adhmana (Flatulence)	39	67-2	23	54-8	62
4.	Yoni Shushakata (Vaginal Atrophy)	49	84-5	39	92-8	88
5.	Vibandha (Constipation)	41	70-7	22	52-4	63
6.	Smrittihras (Loss of memory)	33	56-9	26	61-9	59
7.	Anidra (Insomnia)	31	53-4	17	40-5	48
8.	Adhira (Anxiety)	43	74-1	29	69-0	72
9.	Shirashoola (Headache)	42	72-4	27	64-3	69
10.	Katishoola (Backache)	41	70-7	30	71-4	71
11	Shandishoola (Joint Pain)	42	72-4	26	61-9	68
12	Ayasa (Fatigue)	49	84-5	32	76-2	81
13	Toda (Pricks & Pins sensation in Body)	47	81-0	30	71-4	77
14	Irritability	50	86-2	33	78-6	83
15	Maithunakrichata (Dyspareunia)	47	81-0	37	88-0	84
16	Twakaparushaya (Skin Dryness)	43	74-1	38	90-4	81

Symptoms due to Pitta

SN	Occupation	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Ushnabhitapa (Hot Flushes)	47	81-0	33	78-6	80
2.	Swedadhikya (Excessive Sweating)	43	74-1	30	71-4	73
3.	Mutradaha (Burning Micturition)	31	53-4	21	50-0	52
4.	Krodha (Anger)	35	60-3	24	57-1	59

Other major disorder

SN	Disorder	No. of women				Total n=100
		Premenopausal		Postmenopausal
		Total 58	%Total	Total 42	%Total
1.	Osteoporosis	43	74-1	28	66-6	71
2.	Cardio-vascular Diseases	21	36-2	20	47-6	41
3.	Recurrent UTI	36	62-1	24	57-1	60
4.	Recurrent vaginal infections	31	53-4	17	40-5	48
5.	Genital Prolapse	6	10-3	8	19-0	14
6.	Breast Pain	40	69-0	29	69-0	69

Discussion

Women selected for this study were between the age range of 40-55 years. Highest frequency, 50% was observed between 46-50 years of age, 31% women had their menopause between age 40-45 years & 19% between 51-55 years of age.

Out of 42 postmenopausal women 24 women were between 46-50 years of age, following average menopausal age between 46-50 years. 68% women in our study group had their menarche between 12-14 years of age and as the figures of pre and postmenopausal women in all the frequency groups were same, study indicate that there is no relation between age of menarche & menopause.

Maximum numbers of women (70%) belong to urban area. The reason for that high frequency of urban women can be their sedentary, stressful, fast and competitive life-style.

Women from middle socio-economic class were maximum (70%) probably because they face a more stressful life, though the lower economical group women also have problem they suffer more from social & comfortable lives and have the money & the mean to more their life for the better.

Observation related to marital status of selected women show that the majority of women were married. This is according to general structure of Indian society. 73% of women in the study were multipara.

92% of the women in study were Hindus. Highest frequency of Hindus may be due to predominance of Hindu community in surrounding area.

89% women were educated. Working women 27% suffer less from symptoms of menopause than housewife (73%).

59% women’s life were inactive while 41% women life were active. It indicates that inactivity increases during menopause.

67% of women in this study were vegetarian while remaining 33% were non vegetarian. Only 42% women were having Samyaka Nidra supporting the fact that incidence of sleep was very less during menopause.

28% of women were having Samyaka Mutra Pravritti, 47% were having Vishama Mutra Pravritti, 15% having Alpa Mutra Pravritti &

remaining 10 % were having Ati Mutra Pravritti. It is suggesting that Vata Dosha is more prone in perimenopausal women.

72.4% of premenopausal class women were having irregular menstrual bleeding remaining 27.6% were having regular menstrual bleeding. It is suggesting that irregular menstrual bleeding is one of the main symptoms of perimenopausal syndrome. It happens due to decrease of Germ cells & oocytes.

Maximum women, 83% were using the contraceptive. Only 17% women were not using the contraceptive. No conclusion can be drawn from this data.

Symptoms of Kshaya of all seven Dhatus & Oja were observed. Most of the symptoms of Dhatu Kshaya were related to Vata & Pitta Dosha, supporting to Vriddhi of Vata & Pitta and Kapha Kshaya, that main causative factor of this menopausal syndrome.

82.8% women of the premenopausal class were having Yathochitakala Darshana, that due to Vata Prakopa and Artava Kshaya.

Conclusion

Age of menopause is not related to religion, socio-economical-status, academic level, marital-status, Age of menarche, using of contraceptive and parity. Irregularity in menstrual bleeding is seen before menopause is suggesting that irregular menstrual is one of the main symptoms of perimenopausal syndrome. According to study average menopausal age is between the age of 46-50 years. According to study menopause is not effected by food-habits, life-style, Nidra, Mala Pravritti, Mutra Pravritti, Koshtha and Agni. Maximum numbers of were having Yathochitakala Darshana, 84% were having Maithunakrichata, 48% having vaginal infection. It is suggesting that degenerative changes in genital organs occur during perimenopausal stage. Symptoms of Sapta Dhatu Kshaya, Vata Prakopa, Pitta Prakopa and Kapha Kshaya, Artava Kshaya and Jaravastha were observed in perimenopausal women.

Reference

1. Text book of Medical Physiology, 11th edition, Guyton & Hall, Saunders, pg. no. 1022

2. Charaka, Charaka Samhita Sharira Sthana 1/115, part 1, Chaukhamba Bharti Academy, Varanasi 2009,826.

3. Charaka, Charaka Samhita Sutra Sthana 16/28, part 1, Chaukhamba Bharti Academy, Varanasi 2009,325.

4. Sushruta, Sushruta Samhita Sutrasthana 14/19, part 1, Chaukhamba Sanskit Sanshthan, Varanasi, thirteen edition, 2002,53.

5. Kaufman DW, Sione D, Rosenberg L, Miettinen OS and Shapiro S. Cigarette smoking and age of natural menopause. American journal of public health 70 (4): 420-422.

6. Sushruta, Sushruta Samhita Sharirasthana 9/12, part 1, Chaukhmba Sanskit Sansthan, Varanasi, thirteen edition, 2002,72.

7. Thomas RE et. Al. (1994), ref.62 chp. 17, sixth Edition, Clinical gynecologic, Endocrinology and Infertilty by Leon speroff et. al.

8. Twiss JJ, Wegner J, Hunter M & others (2007). “Perimenopause symptoms-quality of life and health behaviors in users and non-users of hormone therapy” courtesy by http://www.blackwellsynergy.com.

9. Charaka, Charaka Samhita Chikitsasthana 28/20-23, part 2, Chaukhamba Bharti Academy, Varanasi 2011,780.

10. Sushruta, Sushruta Samhita Sutrasthana 15/18, part 1, Chaukhamba Sanskit Sansthan, Varanasi, thirteen edition, 2002,59-60.

11. Vagbhata, Ashtang Hridya Sutrasthana 11/17, Chaukhamba Sanskit Sansthan, Varanasi, thirteen edition, 2002.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-10-29	2022-10-31	2022-11-07	2022-11-14	2022-11-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Research Article

Rajonivritti

Journal of Ayurveda and Integrated Medical Sciences

Rajonivritti : A Physiological Study

Bhardwaj A.^1*, Kumar Sharma D.²

Introduction

Materials and Methods

Observation and Results

Discussion

Conclusion

Reference

Research Article

Rajonivritti

Journal of Ayurveda and Integrated Medical Sciences

Rajonivritti : A Physiological Study

Bhardwaj A.1*, Kumar Sharma D.2

Introduction

Materials and Methods

Observation and Results

Discussion

Conclusion

Reference

Bhardwaj A.^1*, Kumar Sharma D.²