By Kester Marshall
Menopause is the cessation of a woman's monthly menstrual cycle. It typically happens during a woman's late 40's or 50's (but certainly not always) and occurs due to the ovaries stopping the ripening and release of ova (eggs) and the associated hormones that cause both the creation and subsequent shedding of the uterine lining.
According to Ayurveda this is a very important and special time in a woman's life - a time of transition from one phase of life into another and a time that, if possible, should be cherished and celebrated.
Unfortunately this is often not the case. As the lunar cycles are drawing to a close and the hormones in a woman's body are trying to establish a new state of equilibrium, all manner of uncomfortable symptoms are possible.
These can include any of the following in varying degrees:
• Cyclical changes such as irregularity or heavy bleeding
• Dry skin, hair and nails
• Itching
• Insomnia
• Anxiety
• Palpitations
• Depression
• Fatigue
• Low libido
• Scattered thoughts
• Poor memory
• Confusion or difficulty concentrating
• Mood swings
• Irritability
• Hot flushes
• Night sweats
• Headaches or migraine
• Vaginal dryness
• Fluid retention
• Weight gain
• Breast tenderness
• Increased frequency of urination or incontinence
• Increased possibility of urinary tract infection
• Muscle and joint pain and inflammation
• Osteopenia and over time, increased risk of osteoporosis.
From an Ayurvedic point of view, this sort of suffering is totally preventable and much can be done to help remedy the underlying causes of these symptoms even when they are already present.
Causes
How dramatic these hormonal fluctuations are and the severity of the resulting symptoms is simply a reflection of doshic imbalance that is exacerbated by the presence of circulating Ama or toxins.
Different phases of our life are marked by a predominance in activity of one or other of the Doshas. Kapha naturally predominates from birth through to puberty, Pitta naturally predominates from puberty through to menopause and Vata from menopause into the later stages of our life.
Menopause marks the natural transition from a Pitta predominant phase of life to into a Vata predominant phase. This means it is a time of life when we are particularly prone to imbalances of these two doshas. Because it is also a time of flux, transition and change, Vata is naturally more disturbed, making it a double whammy!
During the Pitta phase of life, the natural monthly elimination of the endometrial lining helps to release and eliminate any imbalanced Pitta (Pitta is very closely associated with the blood) and accumulated toxins (Ama). As peri-menopause dawns, a woman's cycle often becomes less frequent or more irregular. As a result, the Pitta that is usually eliminated accumulates. It is like closing the door of a room with the heater on - hence the tendency towards hot flushes and night sweats. How hot the room gets depends on how high the heater is turned up!
As well as this, through the middle stage of our lives we also live in ways that feed an underlying (or not so underlying) imbalance of Pitta and Vata Dosha. When the natural Vata fluctuation of menopause occurs these Doshic imbalances are bought to the surface and exacerbated, which is why many conditions such as hypothyroidism or autoimmune disorders can appear at this time.
The presence of undigested toxins (Ama) makes this situation much more difficult. Ama impedes the flow of Vata through the channels, disturbing it further, and hampers the exchange of hormones in the channels. It also makes the liver sluggish, preventing it from breaking down hormones efficiently - worsening a situation where the body is already trying hard to do it's best.
However, potentially the most influencing factors affecting a woman's menopausal transition are those that affect the mind. Many women are faced not only with hormonal changes at this age, but life changes as well. Children may be leaving home, parents are aging and roles are usually changing. In addition to this, our culture tends to esteem productivity, youth and robust sex drives. It tends not to value wisdom, slowing down and aging gracefully in quite the same way. As many women move from the middle to the later stage of life, this can tend to put a dent in their sense of self-worth causing uncertainty, unsettledness and even more disturbance of Vata.
Management
Ayurveda teaches that prevention is always the best course of action so getting things in shape pre-menopause is of course preferable. But whether it is early on or smack bang in the middle of things, there are four main aspects to focus on in order to make this time of transition a little smoother:
1) Balancing Vata
2) Balancing Pitta
3) Strengthening Agni
4) Eliminating Ama
But... calming and stabilising Vata, especially Apana Vata (the downward moving Vata) is definitely the most important of these. Although there are a variety of dietary and lifestyle techniques, herbal medicines and treatments to help with this, one of the best remedies is actually learning to care for the mind. Learning how to slow down, calm and settle the mind is key when it comes to caring for feelings of confusion, lack of direction or lack of self-worth. Without this essential medicine it is impossible to pacify a Vata disturbance in the body/mind. Approaches to working with the mind such as Ayurvedic psychology and mindfulness techniques can help enormously with this.
The second best remedy for aggravated Vata is REST. Unfortunately, women with aggravated Vata and Pitta tend to be particularly bad at this one!! Regular rest calms both Vata and Pitta so it is vital at any time of life, but especially at this time of life. Some Ayurvedic teachers recommend women should rest for at least 20 mins a day, for a longer period once a week and then a day or more if possible each month (on the first day of their menstruation, if still menstruating).
Introducing a Vata/Pitta pacifying, Agni-promoting and Ama-eliminating diet is also recommended. Favour warm, light and slightly oily, fresh home-cooked meals. Avoid dry, cold, excessively heating and fermented foods. Particularly avoid alcohol, caffeine (especially coffee), red meat and refined sugars or flours. Red wine should be the first thing to go if women are suffering from difficult menopausal symptoms. Not only is it excessively heating, it also puts undue pressure on the liver which is very busy metabolising hormones. I have seen many women who have made simple changes to their diet, including giving up red wine, and experienced an immediate reduction in their hot flushes and night sweats. A diet high in animal protein, especially red meat, is also not recommended as this has a depleting effect on bone tissue and can lead to increased risk of osteopaenia and osteoporosis.
Another very important thing to mention is exercise. My wife has noticed a trend at the moment of female friends in their late thirties or early forties taking up marathon running or some other high-exertion sports. It is completely understandable why this appeals, but from an Ayurvedic perspective, excessive exercise tends to aggravate both Vata and Pitta, deplete Ojas and deplete the tissues (including Shukra or sexual reproductive tissue). Regular, moderate exercise is wonderful but it is possible to do too much and from an Ayurvedic perspective it isn’t a good idea, especially for women at this time of life. Forms of exercise that regulate the flow of Vata and nourish the nervous system such as walking, swimming, Tai chi, Qi jong and some forms of yoga are great!
Regularity in daily routine (going to bed and waking up at a similar time each day and regular meal times) is very important for calming aggravated Vata, as is regular self-abhyanga / warm oil massage (this is excellent wherever there is excessive dryness). Nasya (the application of medicated or sesame oil to the nasal passages) can also assist with balancing hormones.
Simple herbal remedies can help enormously to smooth the balance of hormones and reduce flushes during this transition, and in more extreme situations, where there are a lot of toxins and deeper imbalances that have surfaced, stronger cleansing programs can be of great benefit.
Ayurvedic treatments will also help in both the lead up to menopause and in reducing difficult menopausal symptoms. Ayurvedic Massage with light steam therapy will pacify Vata and aid circulation through the channels. Shirodhara will help to pacify aggravated Vata in the mind, reduce anxiety, alleviate headaches, balance hormones and settle mood swings. Heart Dhara will also help to improve circulation, pacify Vata and balance emotions. Importantly, Ayurvedic treatments also provide an opportunity for women to rest and spoil themselves - to feel deeply cared for and nourished.
Menopause is a perfectly natural and very gradual process with oestrogen levels often taking many years to decrease. Women with balanced doshas and balanced agni have a far easier time during menopause, as their body’s intelligence is more capable of facilitating a smooth and gradual change in hormone levels.
If simple lifestyle measures and dietary changes do not seem to be working, please see a doctor and/or qualified Ayurvedic Practitioner as more help is certainly available.
If you are in any doubt about your health please be sure to consult an Ayurvedic Practitioner or your local health physician.
**Check out our COURSES page for our online Course on Ayurveda fo Menopause**
Menopause: An Ayurvedic Perspective
