Dysfuncational Uterine Bleeding Ayurveda Management

Dysfunctional Uterine Bleeding

 

 

Asrigdara and Raktapradara are the Ayurvedic terms for Dysfunctional Uterine bleeding.

 

Asrigdara: Asrik Dirana meaning excessive secretion (Dirana) of menstrual blood (Asrik).

Raktapradara: Raja Pradirana meaning excess excretion (Pradirana) of menstrual blood (Raja).

 

Aartava

 

In women, there is periodical blood discharge through the vagina. This is because of the action of Vata Dosha. Menarche occurs between 12 to 16 years of age and menopause occurs around 50 years of age. Aartava is the Sanskrit term for menstrual blood. It performs three different types of functions.

 

In the form of Dhatu (Tissue): Artava, the seventh tissue in female is an essential factor for the formation of embryo. It is called as tissue when it serves the function of reproduction. Regular menstrual cycle and ovulation is important for conception.

 

In the form of Upadhatu (Sub-tissue): Substances that constitute the body but has no specific qualities to be generated like the Dhatu are considered Upadhatu. Also, unlike Dhatu, the functions of Upadhatu are limited. Artava is considered as the Upadhatu of first tissue, Rasa Dhatu. Nourishment and Sustenance of female genital organs and foetus are the main functions of Artava.

 

In the form of Mala: Artava or menstrual fluid that occurs regularly at monthly intervals and is excreted through the female genital tract is called Mala Rupa Artava (that is Artava in the form of wastes) due to presence of wastes or toxic substances in it. Its regular excretion is necessary for cleansing the female reproductive system.

 

It is important to know about the formation and excretion of menstrual blood in order to understand the pathogenesis of Raktapradara. Ingested food is digested under the action of digestive fire and Bhutagni (Elemental fire) and differentiated into two portions – nutrients and waste. Wastes are excreted from the body through urine and faeces. Just after completion of the action of digestive fire, the action of metabolic fire related to Rasa Dhatu (Rasadhatvagni) begins. Rasadhatvagni along with Bhutagni differentiates the Rasavaha Srotas Annarasa (Nutrient portion transported in Rasavaha Srotas) into two main parts – the Sthulamsha (Poshya or Major nutrient portion) and Sukshmamsha (Poshaka or Minor nutrient fraction). Rasadhatu proper will be nourished by the major nutrient portion whereas the minor nutrient portion will lead to the formation of Rakta Dhatu because of the action of Raktadhatvagni (Metabolic fire related to the blood tissue), Upadhatu (Sub-tissue) of Rasa - Artava (Menstrual fluid) and Stanya (Breast milk) and Dhatumala (Tissue wastes) – Kapha or Phlegm. Upadhatu can be considered as a tissue inferior in quality to the main tissue. Upadhatu nourishes the body, hence can be considered as supporting blocks to the main constructive blocks or tissues.

 

Time of formation of Rasa Dhatu from nutrient portion of food is 24 hours. Formation of Artava Dhatu takes one month approximately. Formation of tissues from nutrients is a continuous process like the moving wheel and depends upon strength of Agni. Although Rasa Dhatu is Soumya or Cooling, Artava formed from Rasa Dhatu is Agneya or Heating. This is because of the action of Panchamahabhutas and involvement of Agni during the transformation process of Rasa Dhatu into Artava. As the Shonita (Menstrual blood) has predominance of fire element, it is hot in nature.

 

During the reproductive period in females, uterine vessels and endometrial capillaries collect blood during 28 days through the Rajovaha Srotas (Channels carrying menstruation) and this collected blood is brought downwards to the vagina and excreted every month by the action of Vata, mainly Apana Vata which is a subtype of Vata located in the female reproductive system (Ref Sloka 1). This menstrual blood which is excreted is known as Aartava and the features of normal menstrual bleeding are explained in the below table.

 

Colour	Resembles the colour of Gunja phala (fruits of Abrus precatorius) Rakta Kamal (Red lotus flower) Indragopa (Rain bug or Red velvet bug) Laksha Rasa (Resin of Laccifer lacca) Rabbit’s blood
Quantity	Neither less nor more in amount is the normal quantity of menstrual blood. According to the geographical location, season, diet, lifestyle, Prakriti, etc. quantity of menstrual blood changes.
Duration	Varies in different individuals, however lasts for 3 or 5 or 7 days.
Nature	Heating in nature, has the characteristics of Rakta Normal menstrual blood does not clot and does not stain clothes. Not associated with pain or burning sensation
Composition	Predominance of Panchamahabhutas - Earth, Water and Fire elements Air element helps in regular formation and excretion of menstrual blood. Space element gives space and lightness for flow of blood

 

 

Normal menstrual cycle occurs every month and the bleeding is normal, neither excess nor scanty and lasts for upto 5 days. However, in Raktapradara these criteria are affected. The quantity of menstrual discharge which is not very less nor more and does not cause any pathology during or after the menstrual cycle is considered the normal quantity. Any quantity which is different from this is considered as Raktapradara and is roughly estimated from the number of sanitary napkins the woman uses.

 

Causes of Raktapradara

 

• Ati Lavana – Amla – Katu – Vidahi Anna: Excess intake of salty, sour and pungent tastes and food that causes burning sensation
• Ati Kshira – Dahi Prayoga: Over use of milk and yoghurt
• Guru Snigdha Bhojana Atisevana: Excess intake of heavy to digest and unctuous food
• Mithya Ahara Sevana: Regular intake of incompatible food
• Atimaithuna: Excess coitus
• Abhigata: Injury
• Divashayana: Day sleep
• Shoka: Grief
• Garbhaprapata: Miscarriages or Abortions
• Atikarshana: Weakness due to Chronic illness, etc.
• Anya Nidana (Other causative factors) –
  1. Blood disorders such as coagulation defects or diseases of the CVS
  2. Psychological upsets such as stress and nervous disorders
  3. Endocrine problems such as hypothyroidism, hypoestrogenism, diseases of the pituitary and hypothalamus, premature ovarian failure, PCOS, etc.
  4. Local injuries such as trauma to the cervix or vagina, cervical polyps may cause abnormal bleeding.
  5. Endometrial polyps, chronic endometriosis, pelvic inflammatory diseases, myoma, etc.
  6. Intake of certain medications such as birth control pills and blood thinners.

 

Pathogenesis

 

When a woman indulges in the above said causative factors, the three Doshas get vitiated leading to low digestive and metabolic fire. This vitiates the first tissue, Rasa. As Artava or menstrual fluid is the sub-tissue of Rasa, it gets vitiated too. Also, Rakta is vitiated because of Pitta vitiation and increases in amount because of the increase in the mobile and liquidity nature of Pitta Dosha. This leads to uterine congestion and increased uterine circulation along with Vata obstructed by Pitta Dosha. Increase of mobility nature of Apana Vata leads to excessive and irregular bleeding known as Raktapradara. The mobile nature of Vata Dosha, mobile and liquidity nature of Pitta Dosha are important factors in the pathogenesis of Raktapradara and are the main factors for profuse bleeding. (Ref Sloka 2)

 

Apana Vata and Vyana Vata play an important role in genesis of Raktapradara. Both these subtypes of Vata are vitiated in Raktapradara.

 

Role of Apana Vata

 

Due to blockage of circulatory channels or depletion of tissues such as blood, Apana vata becomes imbalances in its properties and characteristics. The intensity of vitiation of Apana Vata affects the nature and severity of Raktapradara. The nature of menstrual discharge will be non-slimy, scanty with clots if the dryness, coldness and roughness properties of Apana Vata are vitiated. Whereas if the lightness, mobility and minuteness properties of Apana Vata is vitiated, then there will be increased bleeding and severity of Raktapradara.

 

Role of Vyana Vata

 

Vyana Vata is responsible for all activities and functions in the body. Its vitiation will lead to impairment in the normal functioning of Rajovaha Srotas or channels carrying menstrual fluid and may lead to deformities in the fetus or miscarriages.  

 

Thus, Vata Dosha is responsible for discharge of menstrual blood, Pitta is responsible for the formation of blood tissue and menstrual blood whereas Kapha Dosha gives viscosity to the menstrual blood.

 

Factors involved in Pathogenesis

 

Dosha	Tridosha
Dhatu involved	Rasa, Rakta
Digestive & Metabolic fire	Low
Srotas involved	Channels carrying Rasa, Rakta and Menstrual blood
Type of vitiation of Srotas	Excess flow
Organs involved	Uterus & Uterine vessels
Site of manifestation	Vagina

 

General Symptoms

 

Raktapradara: Excessive bleeding per vaginum

Angamarda: Body ache

Shula: Pain

Klama: Weakness

Bhrama: Giddiness

Tamo Darshana: Blackouts

Trishna: Thirst

Daha: Burning sensation

Pandu: Anemia

Ati Nidra: Sleepiness

Vata Vikara: Other Vata disorders

 

 

 

Cardinal symptoms of Raktapradara are excessive bleeding per vaginum, weakness and whole-body pain.

 

• Weakness occurs because of loss of blood.
• Giddiness and black outs are due to reduced oxygen carrying capacity of blood causing cerebral hypoxia.
• Decrease of Rasa causes loss of fluids from the body and results in increased thirst.
• Hotness property of Pitta causes burning sensation.
• Complexion is due to adequate quantity of blood in the body and pallor occurs from excessive blood loss. Pallor is a result of anemia.
• Due to loss of blood tissue, Vata Dosha increases and causes pain, body ache and such other Vata type of problems. 

 

Characteristics of Raktapradara

 

• Excess bleeding during normal menstrual period or prolonged duration of menstrual cycle which occurs at regular intervals - In this case, there is mostly problems with uterus and its vascular apparatus and there is no ovarian disturbance.
• Regular and normal amount of bleeding but menstrual cycles occurring in frequent intervals – Here there is disturbance in normal ovarian function or pelvic infection, however the condition of uterus is normal.
• Too frequent cycles and excess menstrual bleeding – This can occur because of pelvic infections, disturbances in the uterus and ovarian function, high stressful conditions.
• Excess bleeding during menstrual period or inter menstrual period - This is because of altered ovarian function, especially because of benign or malignant growth and in ectopic pregnancy.
• Other characteristics are
  1. Irregular and prolonged bleeding
  2. Spotting or variable amount of bleeding during inter menstrual period
  3. Delayed or irregular menstrual cycles
  4. Menstruation occurring in menopausal woman after more than 12 months after last menstrual period.
• Dalhana, the commentator of Susrutha Samhita says that heavy menstrual bleeding even if it is for short period and regular or irregular should be considered as Raktapradara.

 

Types of Raktapradara

 

Vataja Raktapradara

 

Causes: This type of Raktapradara is caused due to vitiated Vata Dosha.

• Excess use of dry food items, pungent taste and those food items which deplete the tissues such as spicy food, alkaline food vitiated Vata Dosha.
• Too much riding on vehicles or animals such as horse & camel, over exertion as in dancing, cycling, etc and excess sexual intercourse increases Vata Dosha because of hyperactivity. Also, blood circulation to the female genital parts increases and hence Raktapradara can occur because of increased pressure of blood in this area.
• Excess grief, fear, anxiety or anger increase Vata Dosha, expecially Prana Vata is vitiated (Pituitary) which in turn vitiates the Apana Vata (Female reproductive system) by causing hormonal imbalances causing Raktapradara and other menstrual irregularities.
• Nutritional deficiencies lead to malnourishment of tissues which aggravates the dryness quality of Vata Dosha causing Raktapradara.
• In miscarriages and abortions, parts of the placenta and pieces of mucous membrane remain in the uterus which cause irritation of the endometrium leading to increased flow of blood.
• Trauma vitiated Vata Dosha, also increases the pressure on uterus affecting its vascularity immediately resulting in Raktapradara.

 

Pathogenesis: Vitiated Pitta obstructing the functions of Vata, especially Apana Vata leading to flow of menstrual blood.

 

Symptoms:

 

Color of menstrual blood	Dark red or blackish in color, resembles the washings of flowers of Butea monosperma or meat washings
Amount of menstrual blood	Irregular
Temperature of discharge	Cold
Smell	Has smell of iron
Nature of flow	Due to increase in the dryness property of Vata, the menstrual discharge is frothy, non-slimy and is discharged in small amounts repeatedly with pain especially in the low back region and pelvis.
Clotting	The menstrual blood does not clot
Associated Symptoms	There is body ache and pain in lower abdomen and low back region because of the obstruction to the flow of menstruation because Vata Dosha is blocked from moving in its normal pathway.
Duration between two successive menstrual cycles, bleeding quantity and nature of bleeding	Irregular

 

 

Pittaja Raktapradara

 

Causes: This is caused by vitiated Pitta Dosha. Excess intake of sour, salty, hot, alkaline substances such as yoghurt, alcohol, wine increase Pitta and vitiates Rakta producing Raktapradara. Sun bathing increases hotness property of Pitta and leads to Raktapradara because of the hotness and vitiation of Rakta caused by provoked Pitta.

 

Pathogenesis: The hotness, liquidity and mobility qualities of Pitta get vitiated. As Pitta resides in Rakta, hence vitiation of Pitta leads to vitiation of Rakta as well causing Pittaja Raktapradara.

 

Symptoms:

 

Color of menstrual blood	Reddish, resembles water mixed with smoke or cow’s urine
Amount of menstrual blood	Abundant
Temperature of discharge	Hot
Smell	Musty or Fishy smell
Nature of flow	Flows out in profuse amounts rapidly with force, this is because of the liquidity and mobility properties of Pitta.
Clotting	No clots because of the heat of Pitta Dosha
Associated Symptoms	Burning sensation, Pricking pain, Feeling of Increased body heat and Giddiness.
Duration between two successive menstrual cycles	Less

 

Kaphaja Raktapradara

 

Causes: Imbalanced Kapha Dosha is the cause of this type of Raktapradara. Kapha gets vitiated because of excess use of heavy to digest, unctuous and cold food items such as milk pudding, red meat, etc. Being predominant in earth and water elements, these type of food items move in downward nature helping in normal excretion of waste products. Also, Kapha Dosha provides nourishment, hence increase of Kapha enhances the blood flow to the endometrium leading to Raktapradara. Sleeping during daytime increases Kapha Dosha. Intake of incompatible food and food before digestion of previously taken food leads to Ama or endotoxin formation which provokes all three Doshas and these vitiated Doshas get lodged in the reproductive organs thereby increasing the menstrual blood flow.

 

Pathogenesis: Due to indulgence in above causative factors, there is increase of unctuous and liquidity properties of Kapha Dosha and Ama (endotoxin) formation leading to low digestive and metabolic fire thereby vitiating the first tissue, Rasa (Lymph). As menstrual blood is the sub-tissue of Rasa, it gets increased in quantity.

 

Symptoms:

 

Color of menstrual blood	Pale, resembles flower of Bauhinia variegate, resembles water mixed with red ocher or washings of paddy plant
Amount of menstrual blood	Less
Temperature of discharge	Cold
Smell	Smell of muscle fat
Nature of flow	Blood is excreted slowly and is less in quantity. Menstrual blood is unctuous, slimy, cold, heavy, pale, thick and has mucoid texture. It is discharged with mild grade pain.
Clotting	Gets clotted like the shape of fibers or lumpy in texture
Associated Symptoms	Nausea, Anorexia, Vomiting, Heaviness, Dyspnea
Duration between two successive menstrual cycles	Normal or More

 

 

Sannipatika Raktapradara

 

Causes: Vitiation of all three Doshas causes this type of Raktapradara especially in an anemic or severely ill women when she indulges in incompatible diet which aggravates all three Doshas.

 

Symptoms: Clinical features of all three Doshas are present.

 

Color of menstrual blood	Resembles ghee or marrow or muscle fat and has the colour of rice gruel or bronze
Temperature of discharge	Cold
Smell	Foul smelling
Nature of flow	Menstrual discharge occurs continuously with force and is slimy
Clotting	The menstrual blood does not clot
Associated Symptoms	Anemia, burning sensation, weakness, thirst and combined symptoms of all Tridosha.
Duration between two successive menstrual cycles, bleeding quantity and nature of bleeding	Variable

 

Ayurveda Treatment Approach

 

1. Shodhana Chikitsa (Detoxification Therapies): Basti, Vamana and Virechana.

 

1. Shamana Chikitsa (Pacification Therapies)

 

• Vata Shamaka (Vata Balancing): As there is excess vitiation of Vata Dosha in Raktapradara and in all gynecological disorders, Vata Dosha should be treated first with herbs and diet articles which are heavy and unctuous.

 

• Pitta Shamaka (Pitta Balancing): As Rakta Dhatu and Pitta Dosha are vitiated in Raktapradara, Pitta and Rakta balancing herbs which are sweet, bitter, astringent in taste and cooling in property are given.

 

• Rakta Sangaraha Chikitsa (To Arrest Bleeding): As there is blood loss is Raktapradara, bleeding should be arrested using Sthambhana (Astringent) herbs and Raktavardhaka Dravya or herbs that increase the blood tissue such as Laghusutasekar vati, Dhatri Lauh, Punarnava Mandoor, etc are given.

 

• Bala Vardhaka Chikitsa (Strength Promoting): As there is vitiation in the channels carrying menstruation (Aartavavaha Srotas), herbs for improving the strength of the Srotas should be given.

 

• Ahara & Aushadi Prayoga (Oral use of diet and herbs)

 

• Pathya Ahara Vihara (Adopting Wholesome Diet & Lifestyle)

 

Detoxification Procedures

 

Vamana (Therapeutic Emesis) is indicated for Adhogata Raktapitta (That is excess bleeding from lower tracts like through vagina or anus). Specially, mixture of emetic nut, honey and cane sugar; sugarcane juice with honey and cane sugar; emetic nut macerated in water; Decoction of emetic nut, licorice and nut grass are beneficial for Vamana in Raktapradara.

 

Virechana (Therapeutic Purgation) is the best therapy for Raktapradara as it is mainly indicated in vitiation of Pitta Dosha. As treatment of Pitta Dosha is beneficial for Rakta also, hence Virechana is beneficial for vitiation of Rakta as in Raktapradara. Jeerakadi churna is given twice a day, half an hour before meals for 3 days for Ama Pachana, followed by Snehapana for 5 to 7 days with Mahatiktaka ghrita till signs of proper oleation appears. Abhyanga (Ayurveda massage) with Dashmool or Kshirabala oil and Pariseka Swedana (A type of fomentation therapy where lukewarm water or oils are poured on the body in a rhythmic manner) with lukewarm water are done daily before administration of Snehapana. During this period, specific diet and lifestyle protocol, that is drinking lukewarm water in small quantities, dry ginger infusion, taking light to digest food, eating only when hungry, not sleeping during daytime, doing mild exercise, avoiding over exertion are practiced. After signs of proper oleation appears, Abhyanga and Parisheka Swedana are done and Virechana medicine (Trivrit Lehya) is administered on empty stomach. Purgation occurs for approximately 4 to 5 hours. Then specific diet regimen advised by the physician is followed for 5 to 7 days.

 

• Jeerakadi churna being hot in potency, having bitter and pungent tastes, is a digestive and carminative, hence helps in the elimination of Ama and enhances digestive fire thereby preventing further Ama formation.

 

• Trivrit Lehya has bitter taste, light to digest and dryness property thus corrects the metabolic fire related to Rasa Dhatu and purifies blood.

 

Basti (Therapeutic Enema): Yoga Basti, that is Basti treatment for 8 days is beneficial. Madhukadi Anuvasana Basti, Mustadi Yapana Basti, Rasnadi Niruha Basti are used in Raktapradara. Beginning with Anuvasana Basti, Niruha and Anuvasana Basti are given alternatively and at the end two Anuvasana Basti are given in a span of 8 days. After this process, Uttarabasti (Intra – Uterine enema) with Panchavalkala Kashaya is given for 3 consecutive days at the end of menstrual cycle. This is repeated every month for upto 3 to 6 months. As just after menstrual cycle, the internal orifice is still open, the uterus receives the herbal medicine easily, hence brings beneficial results. Also, as medicines administered through the vaginal route does not pass through the gut, it does not undergo metabolism. There is effective drug absorption because of the vast network of blood vessels in the uterus and hence targeting of herbal medicine to the reproductive organs for optimum results is achieved.

 

Nasya (Nasal Cleansing): Plain ghee, Vasa ghrita, Shatavari ghrita, fresh juice of Vasa or leaves of lotus can be used for Nasya therapy. Kapha, mainly Tarpaka Kapha which provides nourishment increases with the use of plain or medicated ghee in Nasya because ghee and Kapha have similar properties and according to Ayurveda, similar substances increase similar properties in the body. When Kapha increases, vitiated Vata Dosha subsides naturally. Hence Nasya is useful in Raktapradara. Also, when the herbal medicine is administered through the nasal route, it stimulates the processing center of the brain, hypothalamus which acts on the pituitary gland thereby regulating hormonal production and function in females. Nasya with ghee is known as Brmhana Nasya or Nourishing / Strengthening Nasal Therapy.

 

Oral Use of Herbs

 

• Kwath (Decoction): Darvyadi kwath, Nyagrodadhi kwath, Pathyamalakyadi kashaya, Vasadi kashaya
• Churna (Herbal Compound Powder): Pushyanuga churna with honey followed by intake of rice water. Other Churnas like Vishveladi churna, Bharangi churna, Nagara churna
• Avaleha (Linctus): Madhukadhyavleha, Jirakavaleha, Khandakushmandavaleha
• Ghrita (Medicated ghee preparations): Mudgadya ghrita, Shalmali ghrita, Shita Kalyanaka ghrita, Mahatiktaka ghrita, Shatavari ghrita, Ashoka ghrita, Phala Ghrita
• Vati (Pills): Gokshuradi guggulu, Chandraprabha vati
• Asava - Arishta (Fermented liquids): Ashokarishta, Patrangasava
• Kshirapaka (Milk Decoction): Ashoka Kshirapaka
• Taila (Medicated oil): Shatavari taila, Shatapushpa taila
• Single Herbs: Ashoka (Saraca indica), Nagakesar (Mesua ferrea), Dhataki Pushpa (Flowers of Woodfordia fruticosa), Shatavari (Asparagus racemosus)
• Other recipes:
  1. Paste of roots of Tanduliyaka Mula with honey
  2. Rasanjana with honey and rice water
  3. Rasanjana and Laksha powder with goat’s milk
  4. Vasa Putapaka Swarasa with honey

 

Use of Diet, Herbs & Therapies in Raktapradara

 

In general, use of diet articles and herbs having sweet, bitter and astringent tastes is recommended in Raktapradara. Astringent and Bitter tastes have astringent property, hence arrest bleeding. Sweet taste is nourishing hence helps to nourish blood tissue and rejuvenate the body thereby reducing symptoms such as weakness and giddiness caused due to blood loss.

 

Type of Raktapradara	Use of Diet, Herbs & Therapies
Vataja Raktapradara	Diet: Sweet, Sour and Salty tastes Unctuous, Heavy and Hot properties That which helps in downward movement of Vata Dosha Diet articles: Sesame oil, Honey, Salt, Meat soup Herbs: Nagara, Ela Therapy: Basti
Pittaja Raktapradara	Diet: Sweet, Bitter and Astringent tastes Unctuous, Cold, Astringent properties That which have Carminative, Digestive action Diet articles: Ghee, Honey Herbs: Lodhra, Musta, Triphala, Nimba, Guduchi Therapy: Virechana
Kaphaja Raktapradara	Diet: Bitter, Pungent and Astringent tastes Light to digest and hemostatic property That which helps in elimination of endotoxins Diet articles: Honey Herbs: Nimba, Lodhra, Triphala Therapy: Vamana

 

Pathya - Apathya

 

Pathya Ahara - Wholesome Diet	Apathya Ahara - Unwholesome Diet
Cereals - Shastika Shali (Red variety of rice harvested in 60 days) Pulses – Green gram, Orange lentil, Chickpea Vegetable – Pointed gourd Fruit – Pomegranate, Dates Dairy products – Milk, Ghee, Fresh butter Soup of green gram Gruel mixed with ghee Fresh butter or cream of milk mixed with cane sugar and honey Fried paddy mixed with ghee and honey	Excess use of salt, sour, spicy tastes Over use of unctuous and heavy to digest food items Aquatic meat Alcohol

 

 

Pathya Vihara - Wholesome Lifestyle	Apathya Vihara - Unwholesome Lifestyle
Good amount of rest Proper and timely sleep Tub bath in lukewarm water	Too much Exercise Excess Sexual intercourse Sun bathing Exertion Too much riding on animals or vehicles

 

 

Thus, Ayurveda management of Dysfunctional Uterine Bleeding is safe and effective.