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LAKSHANA

Amenorrhoea is the absence or cessation of menstruation. It may be physiological, pathological, or iatrogenic.
Primary amenorrhoea is generally defined as the failure to establish menstruation by 16 years of age in girls with normal secondary sexual characteristics, or by 14 years of age in girls with no secondary sexual characteristics.
Secondary amenorrhoea is generally defined as the absence of menstruation for at least 6 consecutive months in women with previously
normal and regular menstruation, or for 12 months in women with prior oligomenorrhoea.  

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NIDANA

Causes of primary amenorrhoea include:
Physiological causes: Before puberty and constitutional.
Pathological causes associated with normal secondary sexual characteristics. The most common are congenital genito-urinary malformations, including imperforate hymen, transverse septum, absent vagina, or absent uterus.
Pathological causes associated with no secondary sexual characteristics. The most common are ovarian failure (for example in Turner’s syndrome)
and hypothalamic-pituitary dysfunction in central nervous system tumours, Kallman’s syndrome.
Other causes like dysfunctional thyroid and adrenal cortex in cretinism, juvenile diabetes, malnutrition, anaemia, tuberculosis also lead to primary amenorrhoea.

Causes of secondary amenorrhoca include:
Physiological causes: pregnancy, lactation, menopause.
Iatrogenic/illicit drugs: progestogen methods of contraception, radiotherapy, cocaine.
Uterine causes: cervical stenosis, Ashcrman’s syndrome.
Ovarian causes: Premature ovarian failure, androgen secreting tumours ofovary, pelvic radiation, chemotherapy.
Hyperbaiamic dysfunction: weight loss, eating disorders, excessive exercise, stress, depression, chronic systemic illness.
Pituitary causes: prolactinoma, hypopituitarism, Sheehan’s syndrome, sarcoidosis, cranial irradiation.
Thyroid disease: hypothyroidism, hyperthyroidism. Endocrine causes: polycystic ovary syndrome, Cushing’s syndrome, late, onset congenital adrenal hyperplasia, or tumours of adrenal gland.  

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LABORATORY

Estrogen, Progesrrone, LH, FSH, Thyroid profile, USG. 

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PRICIPAL OF CHIKITSA 

1.If kapha pradhana, Kaphavrit vata (PCOD cases with obesity), then Shodhana (Vamana).
2.Vataja (malnourished, stress-induced, anxiety, less Endometrial thickness)-Basti with Sukumara kashaya shatapusha kalka and shatapusha taila, anuvasana with dashmoola taila.
3.Pittaja (PCOD without obesity, hormonal imbalance)-Shodhana (Virechana) in cases where pittavrit vata, or vata pitta dominant symptoms are seen only virechana causes menstruation.
4. Cases of oligomenorrhagia-Rx same as amenorrhoea.
5.In married patients with secondary amenorrhoea, uttarbasti with shamapushpa taila, phalaghrita.

Shamana-
Knpha Pradhana-Gomutra haritaki, rajah pravartini, dashmoola kwath, trikatu, tankana combination.
Vata Pradhana-Dashmoola kwatha, rajah pravartini vati, Rasayana chuma.
Pitta Pradhana-Shatavari, rasayana, dashmoola kvatha.  

1.If kapha pradhana, Kaphavrit vata (PCOD cases with obesity), then Shodhana (Vamana).

2.Vataja (malnourished, stress-induced, anxiety, less Endometrial thickness)-Basti with Sukumara kashaya shatapusha kalka and shatapusha taila, anuvasana with dashmoola taila.

3.Pittaja (PCOD without obesity, hormonal imbalance)-Shodhana (Virechana) in cases where pittavrit vata, or vata pitta dominant symptoms are seen only virechana causes menstruation.

4. Cases of oligomenorrhagia-Rx same as amenorrhoea.

5.In married patients with secondary amenorrhoea, uttarbasti with shamapushpa taila, phalaghrita  

1. Dashmoolarishta + Kumaryasava -20ml (Adhobhakta 3 times with water)

2. Shatpuspa churna-2gm +

Nashtapushpantaka rasa-125mg +

Svarnamakshika bhasma-100mg +

Pushpadhanva rasa-125mg (Adhobhakta 3 times with warm water or honey)

3. Tab sukumara kashya-2tab (Apana kalal 2 times)

ASANA

- Dhanurasana (3 rounds)

- Paschimottasana (1 minute)

- Shalabhasana (1 minute)

- Sarwangasana (3 minutes

- Shavasana (when needed)

PRANAYAMA

- Nadishodhana Pranayama with Kumbhaka for 10 minutes.

- Bhramari Pranayama without Kumbhaka for 10 minutes.

DIET AND LIFESTYLE

Pathya(DO):

Mudga, shali, godhuma, tila, fruits and green vegetables.

Apathya(DON’T):

Abhishyandi, Guru, Viruddha Ahara, fish, curd, heavy, fried food, stress. 

Recommended Classical Formulations

Nastapushpantaka rasa-125mg-250mg TID with honey

Pushpadhanva rasa-125mg-250mg TID with honey

Gomutra haritaki-500mg TID

Phala sarpi-10-20ml BD

Phala kalyanaka sarpi—10-20ml BD

Shatapushpa kalpa

Shatavari ghrita-l 0-20ml

Tila rasayana

Rajah Pravartini Vati-250mg TID

Kanyalohadi vati-250mg TID

Dashmoolarishta-10-20ml AF

Kumariasava-l 0-20ml AF

Recommended Proprietary Formulations

Tab. M2 tone (Charaka)-1-2 TID

Cap. Ovarin (Ban)-1-2TID

Tab. Aloes compound (Alarsin)-1 TID

Tab. Leptaden (AJarsin)-1TID

Tab. Ashotone (Solumiks)--1-2 TID

Tab. femi forte (Charaka)--1-2 TID

Tab. Gynocare (Dr. Palep’s)-1-2 TID

Tab. Femitab (Jain)-1-2TID

Syrup femisolve (DHC)