Nowadays, gynecological problems are becoming common. One of the common problems is termed as endometriosis. It affects 10 to 20 percent of women of childbearing age worldwide.
What is Endometriosis?
Every month ovaries produces hormones that cause swelling and thickening of endometrium (mucus cells linings) of the uterus. The uterus sheds these mucous membranous cells along with menstrual blood through the vagina during the menstruation. When endometrium grows outside of the uterus, it results in the endometriosis.
The presence of endometrium (uterine mucous membrane) outside the lining of uterus is known endometriosis. It causes painful periods and premenstrual pain.
According to Ayurveda, the Bija Dosha or Genetic Defects in the ovum caused due to vitiation of Vata Dosha in the embryonic stage coupled with the unhealthy diet and lifestyle in the present life leads to compromised immunity. There is retrograde flow of menstruation because of the vitiated Apana and Vyana Vata mainly, which are the two subtypes of Vata Dosha the normal functions of which are regulating the flow of menses in the menstrual channels and to expel timely menstrual fluid. However, since they are aggravated, they cause imbalance in menstruation and lead to lymphatic and vascular spread of endometrial tissues. Consequently, with subsequent menstrual cycles, there is enlargement of the ectopic implants of endometrium. In association with Kapha Dosha, adhesions develop. Thus, Vata and Kapha Doshas are involved in the pathogenesis of endometriosis, hence Ayurvedic treatment approach is to bring equilibrium of Vata and Kapha Doshas mainly.
Although there is no direct mentioning of modern-day diseases like endometriosis in Ayurveda texts, the diseases can be correlated with the causative factors and pathogenesis. ‘Yoni Vyapat’ explained in Ayurveda texts explain most of the female reproductive problems. There are many types of ‘Yoni Vyapat’ mentioned in Ayurveda, however Endometriosis can be correlated with ‘Vataja Yoni Vyapat’. According to Ayurveda, menstrual fluid is the Upadhatu (Sub-tissue) of Rasa Dhatu or Lymphatic fluid, which is the first formed tissue from the nutrient portion of food. The chief function of Vata Dosha, mainly the sub-type of Vata namely, Vyana Vata is the circulation of nutrients. After digestion of food, Vyana Vata carries the nutrient portion of food to the respective tissues for nourishing them. Apana Vata, another sub-type of Vata Dosha located in the pelvis is responsible for timely elimination of menstrual fluid from the body. But as Vata Dosha is aggravated in Endometriosis, there is partial reverse flow in the channels carrying menstrual fluid resulting in ectopic placement, that is endometriosis.
Menstrual Cycle and Doshas
Normal functioning of all the Doshas regulate menstruation. Imbalance in any Dosha affects the menstrual cycle.
Increase of Vata Dosha causes dryness in the uterus which inhibits the ascent of sperm, functional defects in the egg, difficulty with implantation thereby causing infertility. Aggravated Vata Dosha is also responsible for painful menstruation.
Pitta Dosha vitiation causes inflammation and burning type of pain, increased menstrual bleeding and hormonal imbalances.
Aggravated Kapha Dosha is responsible for the formation of cysts, irregular bleeding and irregular cycles.
For proper conception, the following 4 factors and the normal functioning of Vata Dosha are important.
In endometriosis there is generally a vitiation of the Uterus and Ovum (Kshetra and Bija Dushti) which impair fertility.
The causative factors are multifactorial, more important ones are explained below.
Because of the above causative factors, Vata Dosha gets aggravated and vitiates the reproductive tissue. This impaired reproductive tissue gets implanted at various sites by the upwards movement of Vata Dosha. Vitiated Vata Dosha affects the proper formation of reproductive tissue as well which results in immunodeficiency. This helps in growth of ectopic implants which respond to hormonal changes during menstrual cycle and get enlarged. There will be formation of new lesions and development of adhesions causing progression of the disease in subsequent menstrual cycles. There is formation of cysts in the ovary because of association of increased Kapha Dosha with Vata Dosha. There is distortion in the anatomy of pelvic organs because of the extensive adhesions. The defective reproductive tissue, hormonal imbalance and ovulation problems and the distorted anatomy results in infertility. As Vata Dosha dominates the stage of menstruation there is increased pain during menses. The vitiated Vata Dosha gets localised at the sites of vitiation of the channels caused by the vitiation at the embryonic stage and produce symptoms of endometriosis.
As this is a disorder caused due to aggravated Vata Dosha, women having Vata Prakriti (Constitution) are more prone to be affected with endometriosis especially when they indulge in Vata aggravating factors. Endometriosis manifests mostly during reproductive age. It is associated with pain and infertility mostly.
Pain is a major symptom caused by endometriosis. The various other symptoms of endometriosis explained in Ayurveda text books are as below.
Acharya Charaka has mentioned the following symptoms of endometriosis –
Toda: Pricking pain
Vedana: Different types of pain
Pipeelika Sharira Abhisarana: Feeling like ants crawling on the body
Ayasa: Fatigue / Lethargy
Yoni Bhramsha: Utero-Vaginal prolapse
Vankshana – Parshva Shula: Pain in the groin and flanks
Gulma: Mass in abdomen
As Vata Dosha is vitiated in endometriosis, menstrual blood will be vitiated and will have the following features -
Artava Dushti: Irregular cycles and bleeding
Aruna and Krishna Varna: Reddish or Blackish menstrual blood
Acharya Chakrapani has noted that bleeding during intermenstrual cycle also occurs.
According to the other text books namely, Susrutha Samhita, Bhava Prakasha, Madhava Nidana, Yoga Ratnakara, due to decreased oestrogen, the woman affected with endometriosis experiences the following symptoms – Roughness, Stiffness, Numbness and Pricking Pain in vagina.
According to Vagbhata, there is vaginal flatulence, lax perineum and vaginal stretching especially due to oestrogen deficiency in endometriosis. The menstrual blood is blackish – pinkish colour and there is scanty flow. Other disorders caused due to increased Vata Dosha, severe pain in the groin and flanks also occur.
Although endometriosis is a disorder of the reproductive system, it greatly affects one’s daily routine and has a significant impact on the lives of women. It has a negative impact on the physical health, psychological health, sexual life, social life and work. Pain which occurs due to increased Vata Dosha limits normal physical activities like walking and exercise. Vata is the controller of the nervous system, as Vata Dosha is aggravated in the body, it will be aggravated in the mind too. In other words, we can understand that hormonal imbalance is there in endometriosis which means the functions of pituitary gland located in the brain and adrenal glands located on top of the kidneys are affected. This means stress, sexual functions and chemical balance in the body are affected because these are the functions of the pituitary and adrenal glands. Hence there is negative effect on self-esteem, self-confidence, feeling of anger, depression, mood swings, frustration. Fear of painful intercourse or bleeding and failure to have orgasm reduces the frequency of sex leading to frustration and strained relationship with their partner. Unmarried women with endometriosis have anxiety about initiating a new relationship. Social activity or outings are also reduced due to fear of exaggeration of symptoms of endometriosis like pain, bleeding and fatigue on strain. There is difficulty to focus and reduced productivity. Relationship with others are affected due to anger, stress, mood swings caused by endometriosis. Thus, this disease affects different aspects of one’s life and hence timely treatment is important.
As endometriosis is a distressing disorder that affects the life of a woman, proper and effective treatment approach is needed. Ayurveda may offer non-invasive yet effective treatment and management approach which includes the following –
Agni Dipana – Ama Pachana: Endotoxins are caused due to improper functioning of digestive and metabolic fire which in turn lead to many diseases including endometriosis. Thus, eliminating endotoxins and regulating the normal functioning of digestive and metabolic fire through the intake of digestive and carminative herbs like Trikatu, Hingwashtak churna, Chitrakadi vati, etc. and eating meals at proper time.
Vata Anulomana: As endometriosis is primarily a disorder caused due to aggravated Vata Dosha, Vata balancing herbs, therapies, diet and lifestyle are recommended. Aggravated Apana Vata should be directed to move in the normal downward direction to help relieve the symptoms of endometriosis.
Shodhana: Panchakarma nourishes the uterus, facilitates proper coitus, enhances entry of the sperm into the uterus and increases receptivity of the genital tract. Also, detoxification helps in removal of endotoxins thereby removing obstruction in circulatory channels, which in turn increases the cellular nutrition and circulation thereby improving the quality of the reproductive tissue. Snehana (Oleation), Swedana (Fomentation), Virechana (Purgation), Vamana (Emesis), Basti (Therapeutic enema) are suggested to improve the functions of the uterus and restore normalcy.
Abhyantara Snehana: Internal oleation using suitable medicated ghee helps in lubricating the body thus counteracting the Vata Dosha which is aggravated in endometriosis. Medicated ghee is like a vehicle which has a special property of carrying the qualities of herbs into the targeted tissue (here the targeted tissue is reproductive tissue) making the herbal properties available at the place of its utilisation. Also, this medicated ghee will be absorbed at the cellular level and mixing with the endotoxins enabling them to be removed from the body through the subsequent procedures – Swedana and Virechana or Vamana decided according to one’s Prakriti, health status and Doshas vitiated.
Abhyanga: Massage rejuvenates the body, improves quality of uterine lining, strengthens the muscles and ligaments of the uterus, improves sexual arousal, balances the Doshas, decreases the mechanical blockages, reduces pelvic pain and improves blood flow to the reproductive area.
Swedana: Fomentation is generally done following therapeutic massage. The warmth of the swedana balances the Vata Dosha. Also, swedana helps to relieve any obstruction in the channels thereby facilitating the downward movement of Vata Dosha and regulating the menstrual flow.
Vamana: Therapeutic Emesis is done to balance the Kapha Dosha and to normalize the functioning of all Doshas.
Virechana: Purgation is best to remove endotoxins thereby rekindling the digestive and metabolic fire thus improving the formation of tissues and tissue quality.
Basti: Medicated enema is the best to balance Vata Dosha. Basti has a quick local action in the reproductive system hence beneficial in relieving symptoms like pain, dryness, irregularity in menstrual cycle and helping one to conceive.
Shirodhara: Since stress, mood swings and anxiety are inevitable in endometriosis, Shirodhara is effective to bring calmness of the mind.
Nasya: Nasal medication is effective in improving the functions of the brain, thereby indirectly having a positive effect on the hormonal functions thus helping in endometriosis.
Sthanika Chikitsa (Local Therapies)
Local therapies have a synergetic effect with oral therapies and Panchakarma. The following local therapies are effective in endometriosis and other gynaecological problems.
Yoni means Vagina and Prakshalana means Washing. In this therapy, the vaginal area is cleansed using lukewarm medicated liquids. Herbs like Tuvaraka, Palasha, Triphala, Nimba, Dhataki are generally used for this purpose. These herbs have astringent and bitter tastes, three Dosha balancing, anti-inflammatory and antimicrobial properties. This therapy may be beneficial in menstrual disorders. It may provide strength to vaginal muscles and helps to relieve vaginal inflammation, fungal infection and localised pain.
Pichu can be broadly co-related to a Tampon. In this procedure, a sterile cotton swab dipped in lukewarm Ayurveda medicated oil is placed inside the vagina and retained for a specific time period for exhibiting local action. Commonly used medicated oils are Mushaka taila, Udumbara taila, Dhatakyadi taila and Guduchyadi taila. The herbs used for this therapy have Vata balancing, Pain relieving and lubricating properties. Yoni Pichu may be beneficial in the management of all gynaecological problems. It may help to balance all three Doshas, strengthens the vaginal muscles and ligaments, may help to improve hygiene, heal cervical erosion, prevent recurrent miscarriages, may help relieve fungal infection and vulvo-vaginitis; subsides vaginal roughness, dryness and pain and may help in genital prolapse.
Dhupana means fumigation or steaming. It is done using herbs like Neem, Guggulu, etc. The gentle warmth and moisture of the fumigation increases localised circulation, carries the effect of the herbs and permeates the vaginal mucosa thus increasing absorption into the cell membrane. The herbs used for this therapy generally have anti-microbial and analgesic effect. This therapy may be beneficial in chronic vaginal infections. It may help to reduce dryness, pain, increased menstrual bleeding and exhaustion or fatigue during menstruation. It helps enhance healing effect and improves the strength of the uterus making it supportive for fertility.
In this procedure, lukewarm Ayurvedic herbal oil is instilled into the uterine cavity per vagina through the cervix. Uttara Basti is generally effective when done following a Yoga Basti course (8-day Basti course). It is done during the ovulatory or late proliferative period as the orifices are open during this period and reproductive organ are free from any adhesions, thus enabling better absorption of the medicated oil. Uttara Basti is best to balance Vata Dosha and may benefit in dysmenorrhoea, oestrogen deficiency, abnormal uterine bleeding, menstrual disturbances, secondary amenorrhoea, irregular menstruation, utero-vaginal prolapse, pain in vagina, habitual abortion, infertility or sub-fertility especially those due to ovulatory factors, hyperplasia or hypoplasia of the endometrium, pain in sacrum, dysfunctional uterine bleeding and retention of urine. Uttara Basti has a uterine cleansing action. It also imparts strength and lubrication to the uterus. The herbal oils used in this therapy are absorbed through the utero-vaginal mucosa and transported through circulation thus bringing desirable effects. Commonly used oils / ghee is Phala ghrita, Shatavari ghrita, Dashmool oil, Guduchyadi oil processed with strength promoting herbs.
Herbs and Formulations:
Ayurveda herbs and formulations help in synergistic hormone balance, ovulation problems, premature ovarian failure, adhesions, prevents recurrent miscarriage, regulates cervical mucosa. Some of the herbs that have been used traditionally in Ayurveda with their positive effects on the various symptoms of endometriosis are explained below.
Recommended herbs and formulations are mentioned below.
Herbs - Yashtimadhu (Glycyrrhiza glabra), Sariva (Hemidesmus indicus), Manjishta (Rubia cordifolia), Haridra (Curcuma longa), Guduchi (Tinospora cordifolia), Gokshur (Tribulus terrestris), Brihati (Solanum indicum), Kantakari (Solanum xanthocarpum), Rasna (Pluchea lanceolata), Bhringaraj (Eclipta prostrata), Pippali (Piper longum), Ashwagandha (Withania somnifera), Shatavari (Asparagus racemosus), Amalaki (Emblica officinalis), Varuna (Crateva religiosa), Latakaranj (Caesalpinia crista), Dashmool (Root of 10 herbs), Vidarikand (Pueraria tuberosa), Punarnava (Boerhavia diffusa), Guggulu (Commiphora mukul), Brahmi (Bacopa monnieri), Shilajit (Asphaltum punja-bianum), Kumari (Aloe vera), Jivanti (Leptadenia reticulata), Ashoka (Saraca asoca)
Tablets - Kaishora Guggulu, Kanchanara guggulu, Triphala guggulu, Punarnava guggulu, Yogaraja guggulu, Chandraprabha vati
Kashaya (Decoctions) – Dashmool kwath, Punarnavadi Kwath, Varunadi Kwath
Asava-Arishta (Fermented preparations) – Kumaryasavam, Ashokarishtam, Dashamoolarishtam
Lehya (Linctus) – Shatavari gulam, Chyavanaprash
Ghrita (Medicated ghee) – Phala Ghrita, Shatavari ghrita
Diet plays a major role in the treatment of any disease. There is a saying ‘Annam Brahmam’ which means food is compared to God as it sustains and nourishes life. One should indulge in food that increase Ojas (Essence of all tissues) and immunity to regulate ovulation and enhance fertilization. Proper diet boosts fertility, cleanses the uterus, improves hormonal function, boosts physical and mental health.
Recommended Diet: Milk, ghee, nuts, sesame seeds, pumpkin seeds, plant-based protein – beans, peas, whole grains, honey, cumin, turmeric, asafoetida, saffron, dates, fresh fruits and vegetables, garlic.
Unwholesome Diet: Spicy food, food that cause burning sensation, cold food and drinks, dry food items like crackers, salads; incompatible foods.
A healthy lifestyle is important in treating endometriosis. One should avoid excess thinking, worries and stress; have timely food, proper sleep, follow daily and seasonal routine according to Ayurveda; do simple exercise but avoid strenuous sport activities; avoid over indulgence in sex and follow proper hygiene.
If you wish to consult Ayurveda, you may choose to contact one of our Ayurveda Practitioners Gurnam Saini or Pooja Saini in Melbourne. Both of our Practitioners are Qualified Ayurveda Doctors from India. You may contact us at "Pure Herbal Ayurved Clinic". People who can't reach us personally, may choose for online Ayurveda consultation.
PH- 0061 430 799 515
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1. Santosh Kumar, R K Mehla and A K Dang, ‘Use of Shatavari (Asparagus Racemosus) as a Galactopoietic and Therapeutic Herb’, Research Gate, https://www.researchgate.net/publication/267963002_USE_OF_SHATAVARI_ASPARAGUS_RACEMOSUS_AS_A_GALACTOPOIETIC_AND_THERAPEUTIC_HERB-A_REVIEW
2. Neelam Kumari Singh, ‘Management of uterine fibroid with Ayurvedic intervention’, Ayurscientifica- An International Journal of Traditional and Integrative Medical Sciences, https://ayurscientifica.com/ReportFile/d76398e601694ad29525afdd71b21fc3.pdf
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Ayurveda stads for extensive and elaborate clinical examination to understand thenature of the disease