MENOPAUSE: THE WISE WOMAN YEARS

by Marisa Laursen

A thesis submitted in partial fulfillment of the requirements for the degree of Clinical Ayurvedic Specialist

California College of Ayurveda 1117A East Main Street Grass Valley, California September 3, 2004

California College of Ayurveda

Abstract MENOPAUSE: THE WISE WOMAN YEARS by Marisa Laursen

In America today there are an unprecedented 40 million woman undergoing the change of life (from the childbearing years to the menopausal years), and the number is growing steadily as the baby boomers enter this phase of their lives. In past generations, this time of life was rarely talked about, and even today the vast majority of women are largely unaware of what to expect during this transition. As a result, many women experience confusion and uncertainty during their perimenopausal years, along with a host of symptoms that are easily controlled or eliminated by Ayurvedic methods. My goal in writing this paper is to bring to women the knowledge and tools they need to sail smoothly through perimenopause, while at the same time empowering them with the understanding that menopause is not a disease or a deficiency but the entrance into a wondrous new phase of life, the Wise Woman Years.

3 TABLE OF CONTENTS MENOPAUSE: THE WISE WOMAN YEARS ......................................................................... 4 THE LIFTING OF THE VEIL .................................................................................................... 4 THE HORMONAL DANCE ........................................................................................................ 5 THE ROLES THE HORMONES PLAY .............................................................................................. 5 COMMON PERIMENOPAUSAL/MENOPAUSAL COMPLAINTS ..................................... 6 TO HRT OR NOT TO HRT......................................................................................................... 7 HRT: A BRIEF OVERVIEW........................................................................................................... 8 AYURVEDA TO THE RESCUE................................................................................................. 8 PHYTOHORMONES: OUR GREEN FRIENDS, READY TO ASSIST .................................................. 11 PHYTOHORMONE FOODS AND HERBS........................................................................................ 12 SPECIFIC SYMPTOMS WHAT TO DO? ............................................................................ 12 HOT FLASHES ............................................................................................................................ 12 HEART DISEASE, PALPITATIONS ............................................................................................... 13 OSTEOPOROSIS AND OSTEOPENIA ............................................................................................. 15 EMOTIONAL DISTURBANCES ..................................................................................................... 17 INSOMNIA .................................................................................................................................. 19 FIBROIDS .................................................................................................................................... 19 SKIN PROBLEMS/DRYNESS/VAGINAL DRYNESS ....................................................................... 20 WEIGHT GAIN ............................................................................................................................ 21 YOGA YOUR WAY TO A BLISSFUL MENOPAUSE .......................................................... 22 AROMATHERAPY: DOORWAY TO THE SOUL................................................................ 23 LIGHTING THE TORCH ......................................................................................................... 24 APPENDIX A: MENOPAUSE TERMS DEFINED ................................................................ 25 APPENDIX B: SYMPTOMS OF HORMONAL DEFICIENCY AND EXCESS ..................... 26 APPENDIX C: KEY HERBS FOR THE FEMALE REPRODUCTIVE SYSTEM .................. 28
ALOE....................................................................................................................................................... 28 ASHOK.................................................................................................................................................... 28 BLACK COHOSH................................................................................................................................... 29 DONG QUAI ........................................................................................................................................... 29 GINSENG ................................................................................................................................................ 29 AMERICAN GINSENG.......................................................................................................................... 29 LODHRA................................................................................................................................................. 30 MUSTA, NUTGRASS............................................................................................................................. 30 RASPBERRY .......................................................................................................................................... 31 SHATAVARI........................................................................................................................................... 31 VIDARI KANDA .................................................................................................................................... 32 VITEX, CHASTEBERRY....................................................................................................................... 32 WILD YAM............................................................................................................................................. 32

REFERENCES ............................................................................................................................ 34

4 MENOPAUSE: THE WISE WOMAN YEARS Persons desirous of (long) life, which is the means for achieving dharma (righteousness), artha (wealth), and sukha (happiness), should repose utmost faith in the teachings of Ayurveda; thus said treya and the other great sages. -Aga Hdayam The natural progression of our lives unfolds as naturally as the turning of the seasons, if we but allow it to be so. In childhood, our bodies grow, develop and strengthen; during our middle years, our minds expand and sharpen; and in our latter years, our spiritual selves come to fruition, as we journey toward the transition into the hereafter. As with all of nature, our own natural metamorphosis mirrors the fresh rosebud that blooms then fades, the acorn that sprouts, grows to mighty heights, drops a bounty of new acorns, and eventually returns to the earth. Each phase of our lives carries with it its own special beauty, its own opportunity for growth and personal expansion. In Western society, these opportunities are most apparent during the early and middle years, as we are a culture that values the rosebud more than the rosehip. Our attitudes about aging reflect this oversight in our collective thinking, and our health responds accordingly. We expect our later years to be a time of limitations, memory lapse, and decay. This is, of course, ultimately what may lie at the end of the road, but there is much road to explore and experience prior to that eventuality. And much, especially much, to offer those not yet so far along the road. This is where the beauty of this time of life is found, if we but take the time to look. A lifetime of ever-expanding wisdom, just waiting to be passed along. Nature, in her wisdom and foresight well-honed by eons of experience, knows that if we simply follow her lead, live in sync with her natural cycles, listen and watch her subtle cues, our lives can be lived with such balance, such synchronicity, that the flow from one phase of life to the next is as smooth and effortless as the transition from spring to summer, and summer to fall. Ayurveda, the science of life, is our experienced guide on this journey, helping us to traverse the complexities of our lives so that we can find the way to our own personal pathway to health and well-being. Ayurveda understands the cycles, the rhythms, the ebb and flow of nature, and teaches us how to heed the knowledge it imparts. And so, our journey to health and well-being all the days of our lives, begins THE LIFTING OF THE VEIL Throughout our childbearing years, women are bathed in a nurturing blend of hormones that keeps us contentedly taking care of our loved ones. Our own needs are often set aside in deference to others, and in general we do this willingly, lovingly, finding much fulfillment in our care-taking, peacekeeping roles. And then, sometime usually in the late 30s or early 40s, a change starts to take place; this bath of hormones begins to change, to shift. Over a period of 5 to 13 years, this change continues. Noted author Christiane Northrup, M.D. calls this period of time the perimenopausal lifting of the hormonal veil. Dr. Northrup goes on to say In addition to the hormonal shift that means an end to childbearing, our bodies and specifically, our nervous systems are being, quite literally, rewired. Its as simple as this: Our brains are changing. A womans thoughts, her ability to focus, and the amount of fuel going to the intuitive centers in the temporal lobes of her brain all are plugged into, and

5 affected by, the circuits being rewired.1 What this change translates into is a time of potential unprecedented personal transformation a time of giving birth to our own spiritual selves. The nurturing and love that had been (and may continue to be) directed outwardly can be redirected inwardly, into a deeper self-understanding and expression of our own inner selves. And, perhaps, this storehouse can be released upon the world at large, where our newly discovered wisdom and strength can be channeled into causes that bring us fulfillment. The world stands ready to benefit, in great need of our feminine energy and perspective. If one is not prepared for them, though, these changes can be unsettling, viewed as unseen forces at work within our bodies, making changes which we do not understand, and which frighten us and shake our foundation. If prepared, though, the changes can be uplifting, freeing, an exciting entry into a new phase of life. THE HORMONAL DANCE The primary players in this hormonal dance include estrogen, progesterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Each month during our reproductive years, the levels of these hormones ebb and flow in a prescribed manner, beginning with the secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus. GnRH stimulates the pituitary gland, which releases LH and FSH. FSH stimulates a follicle on the ovary to mature; LH stimulates the follicle to mature and, at the proper time, to be released. Estrogen is secreted by the maturing follicle on the ovary, and progesterone is secreted first by the maturing follicle, later by the corpus luteum (the structure that forms from the tissues of a ruptured ovarian follicle), and, if fertilization is achieved, later still by the placenta. hypothalamus GnRH pituitary gland FSH and LH ovaries (follicle) estrogen and progesterone The Roles the Hormones Play Follicle-stimulating hormone (FSH): Stimulates a follicle on the ovary to mature. Luteinizing hormone (LH): Stimulates the follicle to mature and, once mature, to be released. Estrogen: There are three estrogenic compounds produced by the body: estradiol, estrone, and estriol. Until menopause, the primary estrogen a womans body produces is estradiol. During perimenopause, the body starts making more estrone, which is produced both in the ovaries and in body fat.2 Estrogen is responsible for developing and maintaining the secondary sexual characteristics, including breast development, increased adipose tissue and increased vascularization of the skin. Estrogen also stimulates enlargement of the vagina, uterus, uterine tubes, ovaries and the external reproductive structures. Progesterone: During the female reproductive cycle, progesterones primary role is to prepare the body for sustaining pregnancy by causing the lining of the uterus to thicken and fill with fluids and nutrients; preparing the breasts for lactation; and decreasing uterine contractions, reducing the likelihood of miscarriage. Androgens (testosterone): Produced in both the ovaries and the adrenal glands, testosterones primary job in the female body is to provide vital assertive energy and sexual desire. It, along with other androgens (male sex hormones), can increase the ease with which a woman

1 2

Christiane Northrup, M.D., The Wisdom of Menopause, 2-3. Ibid, 127.

6 becomes sexually aroused, increase the sensitivity of the erogenous zones, increase bone density and improve mood. Two to eight years prior to menopause, these hormones begin to fluctuate, and most women begin skipping ovulations. However, women often continue to have regular periods during this time. As Dr. Northrup states, during these years, the ovarian follicles, which ripen eggs each month, undergo an accelerated rate of loss, until the supply of follicles is finally depleted.3 Dr. Northrup goes on to state, Contrary to the standard belief, our estrogen levels often remain relatively stable or even increase during (early) perimenopause. They dont wane until less than a year before the last menstrual periodTestosterone levels usually do not fall appreciably during perimenopause. In fact, the postmenopausal ovaries of many women (but not all) secrete more testosterone than the premenopausal ovariesOn the other hand, progesterone levels do begin to fall in perimenopause, often long before changes in estrogen or testosteroneThis is the most significant perimenopausal issue for the majority of women.4 Other sources, such as Nancy Lansdorf, M.D., state that there is a rapid decline in both estrogen and progesterone during perimenopause and menopause5. There is agreement, though, that the perimenopausal years are a time of such fluctuation that our experience of it is ever-changing, making it difficult to identify the bodily changes that are occurring. Dr. Northrup, in her book The Wisdom of Menopause, brings clarity to our understanding of these hormonal fluctuations by providing reference lists of the symptoms associated with hormonal deficiency or excess (see Appendix B). Since we live in a society where menopausal issues are rarely discussed openly (at least until fairly recently), many women are unaware of the symptoms that may occur during this time of their lives and in fact often find themselves bewildered by the changes they experience. Television host Oprah Winfrey stated on one of her shows that she began experiencing heart palpitations at the age of 53 and was quite concerned by this. She went to five different specialists, trying to discover the cause, and not one of the doctors suggested it could be related to perimenopause, even though Oprah was well within the normal perimenopausal age range and palpitations are a common perimenopausal symptom. She finally discovered that what she was experiencing was related to perimenopause by reading about it in a book. This is a sad statement about our culture, and one that hopefully will change as increasing numbers of people begin to understand this important time of life and speak openly about it. Many women glide through perimenopause with few if any symptoms. In many cultures, including in non-Western India, women simply stop menstruating. Other women, however, do experience symptoms such as those listed below. COMMON PERIMENOPAUSAL/MENOPAUSAL COMPLAINTS
3

Changes in menstrual cycles PMS (which worsens or occurs for the first time) Hot flashes, night sweats Insomnia Irritability, mood swings, depressive symptoms

Christiane Northrup, M.D., The Wisdom of Menopause, 106. Ibid, 127. 5 Nancy Lansdorf, M.D., A Womans Best Medicine for Menopause, 8.
4

7 Fatigue Digestive disturbances Headaches Vaginal dryness Concerns about memory and ability to concentrate Changes in sexual response Thinning hair Muscle/joint aches and pains Fibroids Incontinence Weight gain Osteoporosis Heart palpitations Heart disease TO HRT OR NOT TO HRT That is, indeed, the question. As a result of the symptoms listed above, many women turn to hormone replacement therapy, or HRT. According to Leslie Kagan, M.S., N.P., Estrogen was popularized in the 1960s and 1970s as a treatment for menopausal symptoms and even a cure for menopause. Estrogen was promoted by some doctors as a risk-free way to remain young. Then came the first cold dash of reality. In 1975, studies linked estrogen to an increased risk of uterine cancer. However, it was then shown that this risk was eliminated when estrogen was combined with progestin (synthetic progesterone)In the 1980s, hormone therapy again gained momentum when research suggested combined estrogen and progestin therapy could help prevent chronic diseases including heart disease, osteoporosis, and colon cancer. By the 1990s, most published evidence favored the long-term use of combined hormone therapy6. Doctors confidently prescribed HRT to women who wished to reduce their chances for these diseases, as well as to those wishing for a pill that could keep them young, and sales hit an all-time high. Then, however, a dramatic turn of events occurred; studies contradicting these benefits began to appear. In July 2002, one branch of the huge Womens Health Initiative, a long-term government-funded study of HRT, was stopped abruptly because the data showed the risks of long-term use of these hormones actually increased the risk of breast cancer, heart attack, stroke, blood clots, and dementia7. Stunned confusion resulted, with many women and doctors rethinking the use of HRT. Certainly it is no longer viewed as a magic pill, and all options must be carefully considered before making the decision whether or not to use HRT. Studies on HRT are continuing. According to a recent article in Medline, New research suggests that for certain women the benefit of short-term hormone therapy may outweigh the risks...Women with menopausal symptoms may benefit from such therapy, provided that their symptoms are severe enough and that their risk of heart attack and stroke is relatively lowAll of the other studies were largely looking at the effects of long-term hormone therapyLong term therapy provides more harm than goodThe main indication for hormonal therapy is for the relief of menopausal symptoms, which usually only last 1 to 2
6 7

Leslee Kagan, Mind Over Menopause, 174. Ibid, 175.

8 years.8 The most common reasons for taking HRT include the relief of hot flashes (especially hot flashes that disrupt sleep); urogenital symptoms (such as incontinence, recurrent bladder or vaginal yeast infections, or vaginal dryness); osteoporosis; menopause reached prematurely or through artificial means (such as surgery, illness, chemotherapy or radiation). HRT: A Brief Overview The first female hormone to be marketed was Premarin, introduced in 1949. It is an estrogenonly compound derived from the urine of pregnant mares. In the 1970s Premarin was given along with Provera, a synthetic progesterone, to prevent the likelihood of uterine cancer. Eventually, Premarin and Provera were combined into one pill, known as Prempro or Premphase, and for women with a uterus, these continue to be the main hormones prescribed. For women without a uterus, estrogen-alone is often used, since they are not at risk of contracting cancer of the uterus.9 There are numerous other HRT options now available, including various forms of estrogen or progesterone alone or in combination, available as pills, creams, patches or gels. Creams are commonly available at health food stores and are applied topically on a small patch of skin. In addition, a new designer category of synthetic estrogen has been created called SERMS (selective estrogen receptor modulators). SERMS were designed to have the positive effects of estrogen without the negative effects, however, it does carry risks and limitations and is in no way natural10. There is an alternative form of hormones available, called bioidentical hormones. As Dr. Lansdorf explains, These hormones are extracted from soybeans or wild yam and then chemically altered in the laboratory to make an exact replica of your bodys own. She goes on to say that they are not in fact natural because Nature did not put them in your body in the first placelong-term side effects have not yet been studied in human trialsin their favor, bioidenticals may have fewer side effects in the short term.11 Bioidentical hormones are available from formulary pharmacies (pharmacies that make preparations to order). The decision to take HRT or not is certainly a very personal one between a woman and her health care practitioner. The benefits vs. potential risks and side effects need to be carefully weighed. Fortunately, there is available to us an ancient healing wisdom that does not involve these risks and side effects, which works in harmony with a womans own body so that menopausal symptoms are reduced or eliminated. This ancient healing wisdom is Ayurveda. AYURVEDA TO THE RESCUE
True healing of any condition, prakriti sthapana, means to restore the mind, body, and spirit to their naturally balanced states. -Caraka Samhit

More and more women are realizing intuitively that there is another option available to them then what western allopathic medicine has to offer. As Dr. Lansdorf states, The wisdom offered by older traditions, along with a deepening trust in our intuitive experience of whats
8 9

Medline Plus, August 9, 2004, www.nih.gov/medlineplus/news/fullstory_19413.html. Christiane Northrup, M.D., The Wisdom of Menopause, 135-136. 10 Nancy Lansdorf, M.D., A Womans Best Medicine for Menopause, 17. 11 Ibid, 18-19.

9 right for our bodies, points in a new, promising direction towards a more natural approach to menopause.12 Ayurveda, the healing system that originated in India more than 5,000 years ago, is just such an approach. Menopause is known as rajoni vriti in Ayurveda. Contrary to common perception, it is not a disease or disorder; it is a naturally occurring stage of a womans life, the transition from our reproductive years to our wise woman years, which should be honored and embraced. According to the usruta Sahit, The three stages of man may be roughly described as 1) infancy or childhood, 2) youth or middle age, and 3) old age or dotage. Kapha is increased during the years of childhood and pitta in middle age; while an increase of vayu (vata) marks the closing years of life.13 (Reader Note: For the purposes of this paper and for the sake of brevity, the assumption is made that the reader already has a basic understanding of Ayurveda; this basic understanding forms the foundation from which salient points regarding menopause can be constructed). Menopause occurs in the vata time of life and is dominated by the vata elements of air and ether. As such, it is a time of depletion and reduction as the body gradually diminishes, ultimately culminating in the letting go of the body altogether. However, because it is dominated by the elements of air and ether, it can be a time of great expansion, especially spiritual expansion. At the same time, ailments that occur during menopause have vata at the root. As Dr. Marc Halpern states, Most imbalances related to menopause are imbalances of vata.14 However, Dr. Halpern goes on to say, These (imbalances) can easily be managed with Ayurvedic methods. The management of menopausal symptoms, as with all conditions, is a matter of restoring balance to our body, mind and soul. It is not a given that women will experience symptoms during menopause; in those societies where age is valued over youth, a woman is seen as coming into her own at menopause, and so is likely to have fewer problems with the transition.15 Ailments that occur during this period are the result of an accumulation of imbalances that have built up over a womans lifetime, including diet, lifestyle, and emotional imbalances. According to Dr. Lansdorf, Ayurveda doesnt rely on intervention by a foreign substance to correct or replace the hormones your body has been using all of your life. Instead, it supports your health during menopause by strengthening your bodys own selfhealing and balancing mechanisms.16 She goes on to say that Nature has a plan for a natural, healthy menopause for every woman, despite our loss of estrogen at this time. This plan is essentially twofold. It combines an internal hormonal backup system that kicks in at menopause and an external hormone-building supply of food sources rich in phytoestrogensyou can be doubly assured that your menopause will be balanced, healthy, and emotionally rewarding.17 Although symptoms that arise during menopause are essentially vata in nature, pitta and kapha also can enter into the picture. According to Abbas Qutab, M.D., The range of
12 13

Nancy Lansdorf, M.D., A Womans Best Medicine for Menopause, 5. Bhishagratna KK., usruta Sahit, Vol. 1, Chapter XXXV, 306. 14 Dr. Marc Halpern, Clinical Ayurvedic Medicine, Students Textbook, Part II, 5-34. 15 Dr. Robert E. Svoboda, Ayurveda for Women, 129. 16 Nancy Lansdorf, A Womans Best Medicine for Menopause, 25. 17 Ibid, 35.

10 symptoms in rajoni vriti are wide, and they vary with each dosha. Each constitution, due to its own uniqueness, also expresses its own physiological and psychological symptomology.18 Dr. Qutab describes the following symptoms that are related to each dosha: Vata Tingling and numbness in the body, joint pain, anxiety, lack of concentration, vaginal dryness, insomnia, palpitations, restlessness, backaches, fear, depression, confusion, mood swings, and degeneration of the cervical spine. Pitta Hot flashes, sweating, anger, irritability, short temper, inability to adjust to warm temperatures. Kapha Weight gain, sleepiness, edema in joints (esp. in the ankles), lack of motivation, feeling of heaviness and lethargy. According to Dr. Qutab, Individuals of each dosha can experience a gradual or sudden onset of symptoms. No matter what the constitution might be, all systems are involved, including the nervous, cardiovascular, locomotor and endocrine systems.19 Menopausal symptoms, according to Dr. Halpern, are precipitated and aggravated by vatavitiating regimes such as cold, dry and light foods and a high-stress, fast-paced lifestyle. The condition is further aggravated when a woman does not embrace the change of life and attempts to continue on with the responsibilities of the pitta time of life. Child rearing and professional accomplishment during the vata phase of life is out of harmony with lifes rhythms.20 Elimination of menopausal symptoms involves, first and foremost, the balancing of your doshas. Doshas can get out of balance when they are continually disturbed by poor eating habits, insufficient sleep, mental and emotional stress, and a daily routine that is not in tune with the natural biological rhythms of your body. Since vata is at the root of menopausal imbalances, it needs to be brought into proper balance, followed by restoring balance to the other doshas if needed. In brief (since the assumption is made that the reader is already familiar with the basic techniques used to balance the doshas), vata is balanced by establishing a regular routine, eating mainly warm, cooked, vata-reducing, wholesome foods, drinking plenty of fluids, warmth, quiet and performing daily self-massage (abhyanga) to calm your nerves and soothe dry skin. All therapies that are nurturing, warming, moistening, calming, and grounding are important. Pitta is balanced by chilling out your nervous system through decreased stimulation (such as by avoiding TV, computer and telephone after 9:00 p.m.), never skipping or delaying meals, coolness, balance of rest and activity and moderation. Kapha is balanced by arising early each morning, stimulation, weight control, warmth, dryness, reduced sweetness and exercise, exercise, exercise. The above dosha-balancing recommendations help eliminate and prevent mild menopausal symptoms. If more severe symptoms exist, such as frequent hot flashes, painful vaginal
Abbas Qutab, M.D., Ayurvedic Specific Condition Review: Menopause, The Protocol Journal of Botanical Medicine, Volume 1, Number 4, 104. 19 Ibid, 104. 20 Dr. Marc Halpern, Clinical Ayurvedic Medicine, Students Textbook, Part II, 5-34.
18

11 dryness, extreme mood swings, etc., you may have blockages in your system. According to Dr. Lansdorf, these blockages are the result of metabolic wastes and toxins called ama that build up in your tissuesama accumulates for many reasons, but it is predominantly an accumulation of wastes and toxins that are generated by poor diet and weak digestion.21 Poorly digested food travels through your bloodstream and eventually lodges in narrow passageways, cutting off channels that would otherwise carry nutrients and hormones into your cells. Dr. Lansdorf goes on to say that Ama can block the delivery of your bodys own hormones to your cells, directly throwing off your delicate hormone balance and causing symptoms at menopauseyour body still produces a small amount of estrogen after menopause, but accumulated ama can prevent it from getting to important organs.22 According to the Caraka Samhit, all disease occurs due to imbalance in agni (the power of digestion) and agni is the single most important factor in the build up of ama. As a result, the treatment of ama must always include the treatment of agni, including the use of digestive herbs and spices, eating meals on schedule and the elimination of cold foods and drinks. Pancha karma, the Ayurvedic deep internal cleansing procedure, can also be utilized to eliminate ama. In addition, in the book A Womans Best Medicine for Menopause, Dr. Lansdorf offers self-assessment quizzes and guidelines for creating your own personalized wise water and smart spice mixtures to reduce or eliminate ama and restore balance to the doshas. Healthy agni will also contribute to healthy ojas. Dr. Lansdorf describes ojas as The most refined and subtle essence of the physical body. When fully activated, ojas is the bliss factor that goes beyond good health to keep you fully immune against all disease.23 Optimum ojas is key to perfect health, as well as to balanced emotions and to spiritual development. As a result, building ojas is crucial and is enhanced in numerous ways including right diet, tonic herbs, control of sexual activity, control of the senses and devotion (Bhakti Yoga)24. Phytohormones: Our Green Friends, Ready to Assist Nature, in her infinite wisdom, has provided over 300 plants that provide powerful yet gentle hormonal support at menopause. Phytohormones are a class of compounds found in plants that are similar in structure to human estrogen and progesterone. When consumed on a regular basis, they partner with your bodys own hormones, helping to maintain a healthy balance. And, since we have evolved alongside phytohormones over millions of years, there are no side effects. Interestingly, they are adaptogenic, so that if, for example, your estrogen levels are low, they will have an estrogenic effect, but if your estrogen levels are too high, they will block the stronger estrogens (which is why some herbs such as dong quai can be used for conditions in which there is too much estrogen (such as PMS) as well as for those in which there is too little (hot flashes).25 Furthermore, phytoestrogens do not stimulate the growth of estrogen-sensitive tissue such as in the breast and uterus; in fact, they have been shown to inhibit breast tumors in some animal studies26 (for women who are at risk for breast cancer, estrogen supplementation is contraindicated since estrogen stimulates breast tissue and can increase the likelihood of breast cancer). However, according to Dr. Lansdorf, Isolating and ingesting the active ingredients in phytoestrogen-rich foods may create side
21

Nancy Lansdorf, A Womans Best Medicine for Menopause, 25. Ibid, 107. 23 Ibid, 114. 24 David Frawley, American Institute of Vedic Studies Ayurvedic Correspondence Course, Part IV, 126. 25 Christiane Northrup, M.D., The Wisdom of Menopause, 177. 26 Ibid, 177.
22

12 effects, acting more like drugsrecent research has found that soy phytoestrogen can be more powerful when given as whole food than when concentrated into a pill.27 Phytohormone Foods and Herbs Foods: Soy and flaxseed are particularly rich sources of phytohormones. Other sources include wheat, cashews, apples, almonds, turmeric, fennel, carrots, oats, plums, olives, potatoes, tea, sunflower seeds, alfalfa, clover and wild yam. Herbs:28 Phytoestrogens include shatavari, dong quai and black cohosh. Phytoprogesterones include wild yam, chaste berry (vitex) and licorice. SPECIFIC SYMPTOMS WHAT TO DO? Hot Flashes There are varying explanations for hot flashes. According to Dr. Marc Halpern, hot flashes are caused by samana vayu (a subdosha of vata) fanning agni in an irregular manner. The heat suddenly rises and quickly dissipates. Dr. Lansdorf says that hot flashes are the result of a combination of unbalanced vata and pitta, stating that some women have in a sense accumulated the hot effects of pitta through the years and have more pitta symptoms at menopause, making this the second most common dosha to be disturbed (second to vata)29 Dr. Lansdorf likens this disturbance to what happens when a gust of wind (vata) hits your campfire (pitta); the flames suddenly flare up and the heat of the fire increases. An additional cause of hot flashes cited by Dr. Lansdorf is the result of ama clogging your srotas (channels), causing pitta (heat) to build up in your tissues; you experience as flashing the sudden surges of heat and flushing as the body tries to dissipate the buildup quickly.30 From a more western perspective, according to Dr. Lansdorf, most physiologists attribute hot flashes to fluctuating temperature regulation by the hypothalamus; when the hypothalamus becomes unstable, your bodys temperature control fluctuatesyour body responds by shunting blood to the surface of your body in an effort to dissipate heat quickly.31 According to Dr. Northrup, hot flashes are the most common perimenopausal symptom, occurring in about 70 to 85 percent of all perimenopausal women. She states that they are Triggered by falling estrogen and rising FSH, hot flashes tend to become more frequent after our periods actually stophot flashes go away a year or two after menopausealso called vasomotor flushing, hot flashes occur when blood vessels in the skin of the head and neck open more widely than usual, allowing more blood to shift into the area, creating heat and redness. Dr. Northrup also states that, Besides hormonal changes, external factors can influence the intensity and duration of a womans hot flashes. Anxiety and/or tension can magnify them, as can a diet high in simple sugars and refined carbohydrates.32

27

Christiane Northrup, M.D., The Wisdom of Menopause, 24. Dr. Marc Halpern, Clinical Ayurvedic Medicine, Students Textbook, Part II, 5-36. 29 Nancy Lansdorf, A Womans Best Medicine for Menopause, 67. 30 Ibid, 104. 31 Ibid, 62. 32 Christiane Northrup, M.D., The Wisdom of Menopause, 125.
28

13 Treatment for hot flashes: Utilize the basic techniques for pacifying vata (primarily) and pitta (secondarily) through diet and lifestyle. Enhance digestion and increase agni (cooler digestive herbs are recommended such as cumin, coriander and fennel). Clear accumulated ama. Consume phytohormone foods. Massage with cooling oils such as coconut. Meditation Yoga Key herbs include black cohosh, dong quai, chaste berry, shatavari and wild yam. Heart Disease, Palpitations First of all, the following are important cardiovascular facts that every woman should know:33 Heart disease is rare in premenopausal women. Heart disease (including hypertension and stroke) is the most frequent cause of death in women over the age of fifty. Heart attack, though usually occurring later in life, is twice as deadly in women as in men. One in two women will eventually die of coronary artery disease or stroke. These statistics are, hopefully, enough to give one reason to pause and consider ones own heart health. In western society, we eat a diet far removed from its natural state and engage in far less activity than in earlier generations, which has set the stage for the heart crisis that we face today. The good news is that recent research shows that we have considerable control over the destiny of our heart health. Findings from a study of over 84,000 women participants in the Nurses Health Study, as reported in The New England Journal of Medicine, reveal that by simply following a healthy lifestyle, you can lower your heart attack risk by as much as 82 percent.34 The accumulation of ama (as elevated cholesterol, triglycerides, and other artery-harming toxins) is the root physical cause of heart disease. At menopause, toxic ama build up can lead to any number of heart health risks, making it imperative that this be addressed through dietary and lifestyle changes. In Ayurveda, the heart is considered the seat of consciousness and the dwelling place of the superior form of ojas. There are actually two hearts; the physical heart, which pumps our blood, and our emotional heart, which experiences love, fear, anger, and all human emotion. In treating the heart, one must address both of these aspects to be truly effective. Many of us carry burdens of unexpressed emotions, hidden grief, anger, fear, etc., which, when left unexpressed, can surface as heart problems during the perimenopausal/menopausal years. Since there is a hormonal lifting of the veil during perimenopause, as described previously, this could be the ideal time to finally address these issues, relieving the heart of this burden before it has a chance to turn into a potentially life-threatening illness. According to the Caraka Samhit, Those who want to preserve ojas and maintain heart and the vessels attached to it in good condition should avoid such of the factors as may lead to unhappiness (mental

33 34

Christiane Northrup, M.D., The Wisdom of Menopause, 455. Nancy Lansdorf, A Womans Best Medicine for Menopause, 150.

14 worries). Diets and drugs which are conducive to the heart, ojas and channels of circulation should be taken. Tranquility and wisdom should be followed meticulously for this purpose.35 Dr. Northrup states that heart palpitations, which often occur at menopause, may very well be your hearts wake-up callwhen issues of love, issues of the soul, or issues of a womans unmet passions cry out for attention, they often take the form of heart palpitations. If we are willing to be open to their meaning, we will be giving our hearts a chance to be heard. If we act on what we hear, the symptom often goes away.36 She goes on to say that although they can be frightening, palpitations are rarely dangerous, and are the result of imbalances between the sympathetic and parasympathetic nervous systems. It is important to note that heart symptoms differ between men and women. According to Dr. Northrup, Men who are having a heart attack typically present with chest pain that begins under the breastbone and spreads to the jaw and the left arm. Women with heart attacks may not have chest pain at all. Instead, they may experience primarily jaw pain and indigestion. Or the first sign of a heart attack may be congestive heart failure, with no evidence of the heart attack preceding it except for telltale changes on an electrocardiogram. They may die from this silent heart attack.37 Risk factors for heart disease including smoking, chronic mental and emotional stress or depression, lack of exercise, improper diet, obesity, hypertension, age, family history, diabetes and high levels of LDL (bad cholesterol, greater than 130 mg/dl), low levels of HDL (good cholesterol, less than 46 mg/dl) or high triglycerides (greater than 200 mg/dl). According to David Frawley, Most coronary heart disease is kapha in nature, reflecting overweight and stagnation in the tissues and organs. Yet as pitta relates to the blood, heart disease, particularly hypertension, is commonly a pitta disorder. The red faced, angry, ambitious, hard driving executive who suddenly dies of a heart attack is typically a pitta person who denies his true heart. Vata type heart disease is more common in the elderly, where there is drying out of the tissues and hardening of the blood vessels. Kapha type occurs mainly from overeating and the accumulation of mucus, fat and cholesterol that obstructs heart functioning.38 Suggested treatments for heart health: Ensure the proper balance of your doshas by following the appropriate vata, pitta and/or kapha pacification regime according to your specific heart symptoms. Eat a doshically-appropriate diet low in unhealthy fats. If you smoke, quit; ask for guidance to assist you. Exercise, exercise, exercise. Reduce the stress in your life and lower your blood pressure through techniques such as meditation and yoga. Deal with unresolved emotional issues in your life. Increase ojas; this will enhance the health of your physical as well as your emotional heart. Clear accumulated ama.
35

R.K. Sharma and Bhagwan Dash translation, Caraka Samhit, Vol. 1, 596. Christiane Northrup, M.D., The Wisdom of Menopause, 456-457. 37 Ibid, 459-460. 38 David Frawley, Ayurvedic Healing, 210.
36

15 Ensure adequate calcium intake to help keep blood pressure normal, as well as adequate magnesium (which works in tandem with calcium) to help stabilize electrical conduction in the cardiac muscle and help relax smooth muscle in the blood vessels. Ensure adequate antioxidant and vitamin intake, including vitamins E, C, B and folic acid. Decrease sodium and increase potassium in your diet. Ensure adequate intake of omega-3 fats; flaxseed is an excellent source of this, at a recommended daily allowance of cup.39 Key herbs include hawthorne berries, arjuna, bala, guggulu, triphala, ashwaganda and garlic. Licorice may be counter-indicated if hypertension is present. For heart palpitations due to nervous anxiety, a combination of valerian, hawthorn berries, cinnamon and bala may be helpful. Get a pet it has been shown to lower blood pressure!

Osteoporosis and Osteopenia Next to heart disease, osteoporosis is the other big health problem that can occur at menopause. However, as with many other ailments of the western world, it is rare or unknown among indigenous peoples living time-honored lifestyles characterized by a strong connection to the earth. There is nothing inherent in the human condition in general, or the postmenopausal woman in particular, that causes our bones to weaken and break as we age.40 In our culture, many factors combine to cause the slow, silent onset of bone loss. In the early stages it is usually asymptomatic and is called osteopenia. Over time, at a rate of approx. 1% per year beginning at about age 30 (and approx. 2% per year during perimenopause and menopause), womans bones become increasingly porous, brittle, and subject to fracture. Osteoporosis can, eventually, prove fatal, usually from fractures that lead to complications. Contrary to popular belief, osteoporosis is not caused solely by declining estrogen levels after menopause. As Dr. Lansdorf states, In actuality, only about 15% of total body bone mass on average is lost due to estrogen-related factors. Roughly another 15% of the total average lifetime bone loss of about 30% is due to other factors.41 Some of these other factors are listed below. Risk factors for osteoporosis include: vata body type (thin, tall, slight build, less than 18% body fat); smoking; little time spent outdoors; sedentary lifestyle; chronic over-exercising; history of amenorrhea (no periods) associated with excessive exercise and/ or anorexia nervosa; drinking more than 25 g of alcohol per day; overstressed liver; drinking more than two units of caffeine per day (8 oz of coffee = 1 unit; 12 oz of soda = 0.4 units); clinically depressed; poor diet; premature menopause; regular use of steroid drugs; regular use of anticonvulsant medication ; thyroid disorder.42 Our bones are the storehouse of essential minerals, including calcium, phosphorus and magnesium, all of which are vital for our health. When the level of these minerals in the blood drops, a biofeedback mechanism in our bodies causes the required minerals to be released from the bones. Our bones are always under construction; bone destroyers, called osteoclasts, break down bones while bone builders, osteoblasts, build new bone. As long as
39

Christiane Northrup, M.D., The Wisdom of Menopause, 422. Ibid, 371. 41 Nancy Lansdorf, A Womans Best Medicine for Menopause, 170. 42 Christiane Northrup, M.D., The Wisdom of Menopause, 378-379.
40

16 the osteoblasts outpace or keep up with the osteoclasts, there is no bone loss. However, as we age, many factors (such as those listed above) can contribute to osteoblasts outpacing the osteoclasts, and bone loss results. However, as Dr. Northrup explains, One of the amazing properties of the basic bone cell, the osteocyte, is its ability to act like a strain sensor, evaluating the amount of stress placed on a bonestress on a bone sets up a tiny electrical current that attracts calcium and other minerals to the sitethis process takes into account precisely where bone is needed and where it needs to be reduced.43 What this translates into is the need for exercise, especially weight-bearing exercise, as an important way to maintain strong, healthy bones. A recent NIH Consensus Panel on Osteoporosis Prevention, Diagnosis, and Therapy declared: Once thought to be a natural part of aging among women, osteoporosis is no longer considered age- or sex- dependent. It is largely preventable. An adequate intake of calcium is an important part of ensuring healthy bones. The current recommended daily allowance for calcium intake (from food and/or supplements) in postmenopausal women is 1,500 milligrams per day. However, if you are digesting and assimilating well, you may not need this much, and overdosing of calcium (in supplement form) could be dangerous.44 Of course, the safest (and best) way to ensure adequate intake of calcium is through diet. Foods that are high in calcium include milk, yogurt, cheese, tofu, sesame seeds, tahini, oats, seaweed, almonds, broccoli, chickpeas (garbanzo beans), and dark green leafy vegetables such as spinach, kale, collard greens and dandelion leaves. Furthermore, high amounts of protein can have a detrimental affect on the bones, says Dr. Carolyn Dean, The digestion of protein produces acids which are buffered with calcium. Thus foods rich in protein but low in calcium (such as red meat) result in calcium loss from the bones.45 As a result, vegetarians need less calcium than meat eaters.46 According to Dr. Lansdorf, Combining exercise with adequate calcium and vitamin D intake can reduce your risk factors of fractures by over 30%.47 Bone loss is a vata disorder, and as such, a vata-pacifying diet and lifestyle are helpful, including the use of oil therapies. According to the Caraka Samhit, If the (vitiated) vayu is located in the bone and bonemarrow, then the patient should be given oleation therapies both internal and external types.48 Another important factor in maintaining bone health is the health of your colon. In Ayurveda, vata dosha has its main site in the colon, and any disorders of the colon, including chronic constipation or chronic diarrhea, can affect bone health. Suggestions for the Prevention and Treatment of Osteoporosis: Follow a vata-pacifying diet and lifestyle regime. Cut back on or eliminate alcohol, caffeine, carbonated drinks, white sugar, alcohol, table salt, phosphates, diuretics and antacids containing aluminum, all of which leach calcium from your bones.49 If you smoke, quit; ask for guidance to assist you.
43

Christiane Northrup, M.D., The Wisdom of Menopause, 373. Nancy Lansdorf, A Womans Best Medicine for Menopause, 180. 45 Carolyn Dean, M.D., Menopause Naturally, 24. 46 Dr. Robert E. Svoboda, Ayurveda for Women, 130. 47 Ibid, 182. 48 R.K. Sharma and Bhagwan Dash, translation, Caraka Samhit, Volume V, 49. 49 Atreya, Ayurvedic Healing for Women, 130-131.
44

17 Engage in weight-bearing exercise (or reduce exercise if you over-exercise). Strengthen and enhance digestion and agni. Ensure healthy, regular elimination. Utilize oil therapies including abhyanga. Clear accumulated ama. Pancha karma, an Ayurvedic technique for clearing ama, is classically considered the best treatment for osteoporosis.50 Eat phytoestrogens (soy and ground flaxseed are particularly good. There is some scientific evidence that soy may increase bone density in the spine). Include dairy in your diet. If you are depressed, get proper treatment. Ensure adequate intake of minerals, preferably through diet . Spend time in sunlight (preferably in the early morning or late afternoon) to ensure adequate amounts of Vitamin D. Key herbs include praval pishti, ashwaganda, bala, haritaki, triphala, horsetail, flaxseed, nettle, alfalfa, oatstraw and slippery elm.

Emotional Disturbances During perimenopause and menopause, emotions can bubble to the surface in a way similar to PMS or postpartum. In fact, according to Dr. Northrup, It is estimated that 27 percent of all women who experience agitation and depression during their periods, and 36 percent of all women who become depressed premenstrually, will be very sensitive to the hormonal changes that occur at menopause.51 Dr. Northrup goes on to say that Though our culture leads us to believe that our mood swings are simply the result of raging hormones, and do not have anything to do with our lives, there is solid evidence that repeated episodes of stress (due to relationship, children, and job situation) are actually behind many of the hormonal changes in the brain and body. This means that if your life situation whether at work or with children, your husband, your parents, or whatever doesnt change, then unresolved emotional stress can exacerbate a perimenopausal hormonal imbalance.52 In fact, Dr. Northrup states that From the standpoint of physical health, there is plenty of evidence to suggest that life-threatening illnesses after midlife, which cannot be accounted for by aging alone, is partly rooted in the stresses and unresolved relationship problems that simmered beneath the surface during the childbearing years of a womans life, then bubbled up and boiled over at perimenopause, only to be damped down in the name of maintaining the status quo.53 At perimenopause, you may find yourself feeling irritable, for example, over seemingly trivial things. However, this can in fact be a message that your own wants and needs have gone unmet and unacknowledged, and unless you address this, the simmering anger will remain, or turn into illness. The rewiring of a womans brain that occurs during perimenopause makes it the perfect time to address any unresolved issues, ensuring that the remaining years of ones life will be free of accumulated rubbish that festers into illness. As Dr. Northrup states, Natural foods, supplements, herbs, meditation, acupuncture, and so on are all powerful tools for building and protecting your health. But regardless of what supplements you take and what kind of exercise you do, when all is said and done it is your attitude, your beliefs, and your daily thought patterns that have the most profound effect on your health.54
50 51

Nancy Lansdorf, A Womans Best Medicine for Menopause, 184. Ibid, 42. 52 Christiane Northrup, M.D., The Wisdom of Menopause, 38. 53 Ibid, 10. 54 Ibid, 56.

18

Clearly, then, the first and most important step in addressing emotional issues is to take an honest look at what in your life might be causing them, utilizing your emotions as your inner guidance system, and address any unresolved issues at this deep level. Diet, herbal and lifestyle changes then become a boost to the real work, the emotional healing that must occur to effect real change. Another important factor to consider during perimenopause is the condition of our adrenals and the role our emotions play in their health. The adrenals produce a hormone called cortisol, which gives us a much-needed boost through crisis, as part of our fight or flight mechanism. As a result of the fast-paced, high-stress lifestyle that most of us lead, our adrenals often receive the nearly continuous message that this extra boost of cortisol is needed, and the production of cortisol remains at an elevated state. This sets us up for a host of problems. As Dr. Northrup states, Long-term overexposure to cortisol causes your skin to become thin, your bones to become weaker, your muscles and connective tissue to break down, your body to develop abnormal insulin metabolism, your tissues to retain fluids, your arms and legs to bruise more easily, and your moods to tend toward depression.55 As we head into menopause, it is our adrenal glands (and stored fat) that take on the job of producing the estrogen that our body still needs. If our adrenals have become exhausted from overproduction of cortisol, this can interfere with their ability to produce estrogen, which can lead to symptoms of estrogen-deficiency. This is one more reason (there are, of course, many) to eliminate or reduce stress from our lives. If vata gets disturbed from too much activity, lack of sleep, irregular eating, excessive caffeine, etc., then worry, anxiety and even panic attacks can result. Pitta dosha is often disturbed at menopause as well, resulting in anger and irritability. Techniques to soothe, reduce or eliminate emotional disturbances: For vata mood swings, worry, anxiety, feelings of overwhelm, fear and vata type depression, follow a vata-pacifying regime. For pitta mood swings, irritability, anger and resentment, follow a pitta-pacifying regime. For kapha type depression follow a kapha-pacifying regime. Engage in stress reduction techniques such as meditation, yoga, tai chi and pranayama. When you feel stressed during the day, breathe in and out slowly through the nose. Address unresolved emotional issues. Exercise regularly. Clear accumulated ama. Follow a regular routine of bedtimes and mealtimes. Go to bed before 10:00 p.m. Do one activity at a time, not 2 or 3 (or more). Express yourself artistically. Spend time in nature. Key herbs include jatamamsi, valerian, brahmi (Bacopa monniera), ashwagandha, shatavari, skullcap, gotu kola (Centella asiatica), tulsi, St. Johns Wart, sandalwood, bhringaraj, shanka pushpi, bala, dong quai.

55

Christiane Northrup, M.D., The Wisdom of Menopause, 62.

19 Insomnia During perimenopause, hot flashes and night sweats, as well as worry, anxiety and palpitations, can result in difficulty sleeping. Lack of sleep then results in difficulty concentrating, irritability and mood swings. In Ayurveda, sleep is considered one of The Three Pillars (Supports) of Life (the other two being intake of food and sexual restraint), making adequate, restful sleep an extremely important part of ensuring our health and wellbeing. As it says in the Caraka Samhit, Being supported by these three well regulated factors of life, the body is endowed with strength, complexion and growth, and continues uptill the full span of life, provided a person does not indulge in such regimen as are detrimental to health.56 Suggestions to improve sleep: Follow a vata-pacifying diet and lifestyle regime. Eat a light, easy-to-digest dinner, and eat by 7:00 p.m. Avoid caffeine and alcohol. Take a warm bath before bed. Exercise regularly. Eliminate hot flashes and calm palpitations (refer to these sections of this paper). At bedtime, rub a small amount of coconut oil into your scalp and the bottoms of your feet. Sleep with your head pointing east or south, never north (sleeping with your head pointing north has been shown to increase restlessness, confusion and irritability).57 Reduce stimulating activities in the evening (such as watching TV or working on the computer). Instead, take a walk, meditate, listen to music, read a spiritual book. Drink a cup of milk boiled with a pinch of cardamom before bedtime; this is calming to vata and promotes restful sleep. If your insomnia is due to anxiety, address the issues that are causing the anxiety. Key herbs include ashwaganda, jatamamsi, brahmi (Bacopa monniera), chamomile, nutmeg, skullcap, valerian, hops, lemon balm and shanka pushpi. Fibroids According to Dr. Marc Halpern, uterine fibroids are a tridoshic imbalance. The main problem is kapha, as with most benign tumors. If there is bleeding, pitta is vitiated. The uterus (pelvis) is the home of vata in the body, so vata must be managed as well. Dr. Northrup states that About 40 percent of women develop benign fibroid growths in the uterus during perimenopause. Their growth is stimulated by estrogen, and they can become quite large. Fibroids shrink dramatically after menopause and, like heavy bleeding, do not usually require surgery or other treatment, especially if they dont produce symptoms.58 According to Atreya, Some of the many problems associated with fibroids are excessive bleeding, fatigue, pelvic pain, spotting, pressure in the pelvis, lower back pain, frequent urination, constipation, and a distortion of the uterus.59

56 57

R.K. Sharma and Bhagwan Dash, translation, Caraka Samhit, Volume I, 220. Nancy Lansdorf, A Womans Best Medicine for Menopause, 202. 58 Christiane Northrup, M.D., The Wisdom of Menopause, 128. 59 Atreya, Ayurvedic Healing for Women, 167.

20 Treatment for Fibroids: Follow a kapha-pacifying diet and lifestyle regime (primarily); vata secondarily; and pitta if bleeding is present. Wait for the fibroids to shrink after menopause. Consume a low saturated fat diet (since fats are a precursor to estrogen, and estrogen stimulates the growth of fibroids), avoiding meat, dairy, alcohol, coffee, chocolate, sugar, salt, fried or fatty foods and anything processed or refined.60 Consume unsaturated fatty acids such as evening primrose oil and fish oils. Consume bioflavanoids and vitamin C to lessen the heavy bleeding that may accompany fibroids. Apply castor oil packs externally to reduce tissue mass. If necessary, find a doctor who can remove the fibroid without removing the uterus (this is often possible with very large fibroids). Key herbs include chaste berry, dong quai, licorice, shatavari, wild yam, and sarsaparilla. Astringent herbs such as turmeric, gotu kola, black walnut bark, and haritaki could also be beneficial. Skin Problems/Dryness/Vaginal Dryness Female hormones make womens skin softer and thinner than mens skin. Womens skin also secretes less oil from the fat layer then mens, making womens skin drier and more prone to the effects of aging. These factors become even more pronounced at menopause, the vata time of life. As the skin thins, it becomes more sensitive and susceptible to pitta conditions such as infection, inflammation, dermatitis, breakouts, sunburn, and allergens.61 Furthermore, the flow of blood to your skin decreases as you age, bringing less nutrition to the skin. Decreased estrogen results in thinning and drying of the vaginal tissue, which can be painful, especially during intercourse. As a result, practices to enhance the moistness and resilience of the skin at this time are quite important. Although vata skin problems are most common during menopause, the other doshas can also play a part. Vata skin conditions include skin that is dry, thin, fine-pored, delicate, cool to the touch, rough, flaky. Pitta skin conditions include rashes, warmth, reddness, rosacea, liver spots, or pigment disorders. Kapha skin conditions tend to be oily, soft, cool, enlarged pores, moist types of eczema, blackheads, pimples, water retention and fungal infections. Techniques for Restoring Moisture and Suppleness to the Skin: Follow a vata-pacifying diet and lifestyle regime, coupled with pitta or kapha pacification techniques if these symptoms exist. The most important tool is oleation, both internally and externally. o Externally, daily abhyanga or massage is extremely beneficial, using doshically-appropriate oils such as sesame oil for vata, coconut or sunflower oil for pitta, and mustard or safflower oil for kapha. o Internally, drink at least eight glasses of water daily and eat plenty of sweet, juicy fruits. Ensuring the adequate intake of healthy oils such as ghee, evening primrose oil, and fish oils is important. If you smoke, quit; ask for guidance to assist you.

60 61

Carolyn Dean, M.D., Menopause Naturally, 37. Nancy Lansdorf, A Womans Best Medicine for Menopause, 243.

21 Ensure the adequate intake of antioxidants such as vitamins C and E, preferably through diet. Ensure adequate healthy, regular elimination (chronic constipation can show up on the skin, including leading to acne). Drink plenty of water (at least eight 8oz glasses per day). Protect your skin from the harmful effects of the sun. Enhance ojas. Douche with sesame oil or ghee, or moisten tampon with these oils and place in vagina. Key herbs include black cohosh, shatavari, marshmallow, aloe vera and licorice.

Weight Gain One of the biggest complaints that many women have about the perimenopausal/menopausal years is that it can lead to weight gain. Even women who have never had a weight problem suddenly find themselves unable to shed pounds that in the past came off easily. According to Dr. Northrup, the underlying reason for this weight gain is that midlife women experience a slowdown in metabolic rate of about 10-15 percent compared to earlier in life. Our bodies also become more efficient at taking energy into our cells and storing it in the form of fat. In addition, as estrogen levels fall, our appetite increases. Nature designed this for two reasons: to allow us to survive on less food as we get older and, in some cases, less able to fend for ourselves; and to assist us in putting on a supply of body fat that can produce the estrogen and androgens our ovaries are no longer producing at the same rate.62 It is as if your body is trying to grow a little ovary made of fat, since fat produces estrogen. In some cultures, this isnt a big deal but in our thinner is better culture, it tends to not be a welcome addition. From an Ayurvedic perspective, the extra weight gain is a disturbance in medas dhatu. As stated by Dr. Lansdorf, Since all your hormones interact on the level of medas dhatu, it is not surprising that as key hormones begin to fluctuate and then drop off sharply, your fat and carbohydrate metabolism may go a bit haywire also. She goes on to say that in midlife you tend to lose lean muscle mass, especially if you do not exercise regularly, causing you to burn fewer calories. At the same time, your weak muscles do not cook well for your fat tissue (since muscle (mamsa) is created before fat (medas), the production of medas is affected by the health of the mamsa). This results in an accumulation of ama in your fat tissue and a weakened ability to metabolize fat. In addition, ama blocks delivery of food to your cells, causing them to send out hungry signals even though you may have eaten a big meal. This can lead to a viscous cycle of cravings, overeating, and more ama, and potentially can result in elevated cholesterol levels, diabetes, and thyroid problems, all of which are common during menopause.63 The good news, according to Dr. Northrup, is that midlife weight gain (within limits) is not necessarily a health risk. In fact, those extra pounds we gain at perimenopause often go away once we get past menopause and our metabolism restabilizes. However, Dr. Northrup goes on to state that Central obesity (excess belly fat) is a problem. Abdominal fat cells are more metabolically active - and potentially more dangerous - than the fat cells on your hips and thighs. They can contribute to insulin resistance and can pump out too much androgens and estrogen. The classic apple-shaped figure is associated with an increased risk for heart disease,

62 63

Christiane Northrup, M.D., The Wisdom of Menopause, 193. Nancy Lansdorf, A Womans Best Medicine for Menopause, 111-112.

22 breast cancer, uterine cancer, diabetes, kidney stones, hypertension, arthritis, incontinence, polycystic ovary disease, gallstones, stroke and sleep apnea.64 Tips for Keeping Weight Under Control: Follow a doshically-appropriate diet and lifestyle regime. A kapha or vata/kapha diet may be appropriate. Reduce or eliminate consumption of foods high in simple (or refined) sugars and starches, the wrong kind of fats, and low-fiber, nutrient-poor foods. Eat a light, easy-to-digest dinner, and eat by 7:00 p.m. (no late-night meals!) Cleanse ama from your body. Exercise, exercise, exercise. Strengthen and enhance digestion and agni. Ensure healthy, regular elimination. Drink plenty of water (at least eight 8oz glasses per day). Hot water is especially beneficial. To determine your health risk, have your percentage of body fat measured; this can be accomplished through your doctor, at a health club, the YMCA, and many other health-oriented locations. Have your thyroid checked; often the only symptom of thyroid problems is weight gain, and about 25 percent of women develop or have preexisting thyroid problems by the time they reach perimenopause (additional symptoms include fatigue, cold hands and feet, thinning hair or constipation).65 Key herbs include lekhanas such as black pepper, chitrak, gurmar, hot water, shalijit, guggul, barley (as barley water), calamus and trikatu. YOGA YOUR WAY TO A BLISSFUL MENOPAUSE Yoga offers a menopausal medicine that can help you adjust to changing hormone levels while feeding your mind, body and soul. As David Frawley explains, Yogic methods cover the entire field of our existence from the physical, sensory, emotional, and spiritual to the highest Self-realization. It includes all methods of higher evolution in humanity physical posture, ethical disciplines, breath control, sensory methods, affirmations and visualizations, prayer and mantra, and complex meditative disciplines. Yoga understands the nature of interrelationship of the physical, subtle and formless universes into the boundless infinite beyond time and space, and shows us how these also exist within each human individual.66 Clearly, the potential benefits of yoga are limitless, able to support us through each phase of our lives. Whether you have been practicing yoga all your life or are new to this ancient science, it matters not one of the beautiful things about yoga is that you are able to start wherever you are, whatever your physical condition. As long as you go slowly, start with simple poses, breathe deeply, and offer your full intent, you will progress. In general, a gentle, slow-paced yoga practice that emphasizes floor poses is recommended for perimenopause/menopause. Inversions (upside-down poses) are particularly effective in treating menopausal symptoms. They can either calm an overly excited nervous system or jump-start a sluggish one by allowing fresh, oxygenated blood to flow into the head and neck.
64 65

Christiane Northrup, M.D., The Wisdom of Menopause, 196-197. Ibid, 200. 66 David Frawley, Yoga and Ayurveda, 3-4.

23 By positioning all or part of the body upside-down, the incidence and intensity of hot flashes and night sweats is greatly reduced. 67 However, inversions should be learned under the guidance of an experienced teacher to prevent injury and promote confidence. Asanas for Perimenopause/Menopause Inversions such as Forward Bend (sitting or standing), Headstand, Shoulder Stand, Handstand, Elbow Stand and Downward Dog. Low back bending poses such as Bridge, Cobra and Bow to tonify the kidneys, nourish the adrenal glands and alleviate fatigue. Chest opening poses such as Fish and Standing Yoga Mudra to calm the mind and reduce anxiety. Bound Angle Pose to increase circulation to the abdomen and pelvis and improve function of the reproductive organs. Wide-Angle Seated Pose I to increase circulation to the pelvis and stimulate blood flow to the ovaries. Head on Knee Pose to revitalize the adrenal glands (which can help mitigate hot flashes). Be sure to include meditation and pranayama, as these are important cornerstones of every yogic practice. Following is a simple sequence of asanas to help ease menopausal symptoms:68 1. Standing Forward Bend with your bottom against a wall 2. Downward Facing Dog Pose 3. Headstand and Shoulderstand (experienced students only) 4. Supported Lying Down Bound-Angle Pose 5. Supported Legs-Up-the Wall Pose 6. Supported Bridge Pose, lying back on bolsters or blankets 7. Supported Childs Pose 8. Lying Down Bent-Knee Twist 9. Rest Pose (Savasana) AROMATHERAPY: DOORWAY TO THE SOUL Aromatherapy is based on the ancient principle that optimal health is achieved by bringing the body and soul into harmony. Aromas, unlike food and herbs, work directly on the mind and subtle body. By using a subtle combination of different essential oils, aromatherapy promotes both physical health, and mental and emotional well-being. Aromas and essential oils can be utilized in numerous ways including incense sticks, added to steam therapies, diluted with carrier oils and used for massage, placed in a misting bottle and used to mist the body or room (1 drop of oil to two ounces of water), added to salves or rubbing alcohol and applied to the skin, added to bath water, inhaled, etc. Essential Oils for the Treatment of Menopausal Symtoms69 Key essential oils include clary sage, geranium, sandalwood and lavender.
67

www.yoga.com.au/yoga_and_menopause.htm www.yoga.com/ydc/enlighten 69 Sandra White, Aromatherapy, 45-48.

68

24 For depression: chamomile, geranium, lavender, sandalwood, ylang-ylang. Suggested uses: add to a carrier oil for massage or add to bath water. For anxiety: bergamot, cedarwood, chamomile, geranium, lavender, sandalwood, ylang-ylang. Suggested uses: add to a carrier oil for massage or add to bath water. For constipation: rosemary, marjoram, orange, black pepper. Suggested uses: add to a carrier oil and massage on the abdomen. For headache: chamomile, rosemary, lavender, peppermint. Suggested uses: add to a carrier oil and massage around the temples, the base of the skull and counterclockwise on the solar plexus. For tension headaches, also massage the neck and shoulders. These essential oils can also be used as a compress or inhaled. For insomnia: chamomile and lavender. Suggested uses: add to a carrier oil and give a relaxing back massage, add to bath water or place one drop on your pillow. For dry skin: chamomile, sandalwood, rose, lavender, neroli. Suggested uses: combine with oil, cream or lotion. For fatigue: lavender, geranium, rosemary. Suggested uses: add to a carrier oil for general massage. Add to bath water. For stress: rosemary, chamomile, and lavender. Suggested uses: add to a carrier oil and give a full body massage. If time is limited, massage the back, shoulders, neck and face. Add a few drops to bath water.

LIGHTING THE TORCH From the time that a young woman enters puberty, her life is ruled by fluctuating hormones. These hormones are a gift, the elixir of life that allows a woman to experience the full bloom of her femininity, her organic connection to the rhythms of nature, the wonders of bleeding, pregnancy, giving birth, nursing, orgasm, fertility, the moon. As this wondrous time of life subsides, the hormones settle down and stabilize, no longer vacillating with each passing month. In their place, a new sort of magic emerges, as a butterfly from its cocoon; the wise woman is born, and the shining wings long held in abeyance spread wide in beautiful, glorious splendor. For this is, indeed, an entry into a new phase of life, a time when the stressful bonds of the pitta years are shed and the knowledge, the wisdom, the clarity so painstakingly earned can shine magnificently forth, unimpeded. Within the grasp of the emerging wise woman lies the potential of bringing to fruition her own true spiritual nature and, if she so chooses, the Divine honor of lighting the torch for others who follow, giving hope to the hopeless, understanding to the misunderstood, vision to the visionless. Our greatest joy and accomplishment awaits fulfillment. And in so doing, our own consciousness along with the consciousness of the entire world is elevated. We need only to grasp the splendid torch and free the wise woman inside. The world awaits us

Om Namaste

25

Appendix A: Menopause Terms Defined 70

Menopause: The acknowledged end of menstruation. Technically only one day in a womans life, when she has gone twelve consecutive months in a row without a period or her ovaries are removed or damaged. Natural menopause: 1) Medical definition: Menopause that occurs according to the bodys own timing and not due to any medical intervention, such as hysterectomy or chemotherapy. 2) Common definition: Menopause that occurs according to the bodys own timing and does not involve any prescribed medicines, such as HRT or drugs, for treating symptoms or complications. Perimenopause: The approx. 5 to 13 immediately before natural menopause when changes begin, up to the point when there have been twelve consecutive months without a period. Also called the female climacteric. Postmenopause: All the years of a womans life after menopause. Premature menopause: Menopause that occurs naturally before age forty.

70

Nancy Lansdorf, M.D., A Womans Best Medicine for Menopause, 9.

26

Appendix B: Symptoms of Hormonal Deficiency and Excess

From The Wisdom of Menopause by Dr. Christiane Northrup

Symptoms of Decreased Progesterone and Estrogen Dominance This is particularly common in early menopause. Decreased sex drive Irregular or otherwise abnormal periods (most often, excessive vaginal bleeding) Bloating (water retention) Breast swelling and tenderness Mood swings (most often irritability and depression) Weight gain (particularly around the abdomen and hips) Cold hands and feet Headaches, especially premenstrually Symptoms of Estrogen Deficiency Hot flashes Night sweats Vaginal dryness Mood swings (mostly irritability and depression) Mental fuzziness Headaches, migraines Vaginal and/or bladder infections Incontinence; recurrent urinary tract infections Vaginal wall thinning Decreased sexual response Symptoms of Estrogen Excess Bilateral, pounding headache Recurrent vaginal yeast infection Breast swelling and tenderness Depression Nausea, vomiting Bloating Leg cramps Yellow-tinged skin Excessive vaginal bleeding PMS Symptoms of Testosterone Deficiency Decreased libido Impaired sexual function Decreased energy overall Decreased sense of well-being Thinning pubic hair Symptoms of Testosterone Excess Mood disturbances

27 Acne, particularly on the face and scalp Increased facial hair growth Deepened voice

28

Appendix C: Key Herbs for the Female Reproductive System

ALOE (Aloe spp.; Liliaceae) Sanskrit: kumari, a young girl or virgin; aloe is so called because it imparts the energy of youth and brings about the renewal of the female nature. Part used: gel (fresh or powdered) Energetics: bitter, astringent, pungent, sweet/cooling/sweet VPK= (gel); powder except in very low doses will aggravate vata Tissues: works on all tissues Systems: circulatory, digestive, female reproductive, excretory Actions: alterative, bitter tonic, rejuvenative, emmenagogue, purgative, vulnerary Indications: fever, constipation, obesity, inflammatory skin conditions, swollen glands, conjunctivitis, bursitis, jaundice, hepatitis, enlarged liver or spleen, herpes, venereal diseases, amenorrhea, dysmenorrhea, menopause, vaginitis, tumors, intestinal worms Precautions: pregnancy, uterine bleeding Dosage: fresh gel, powder (100 to 500 mg) Aloe gel is a wonderful tonic for the liver and spleen, for the blood and for the female reproductive system. Aloe regulates sugar and fat metabolism and tonifies all the agnis (the digestive enzymes of the body), and at the same time it reduces pitta. It is rejuvenative for pitta and for the uterus. Two teaspoons of it can be taken three times a day, with a pinch of tumeric, as a general tonic. It is more palatable mixed with water or apple juice. Three ounces of the gel can be taken from a fresh plant along with three ounces of water and three teaspoons of salt, brought to a boil and combined with one ounce of raw sugar and taken in teaspoonful doses. Makes an excellent anupana (the medium used to carry herbs into the body) for menopausal herbs. Commercial aloe juices are often diluted and combined with other additives that may give them a different effect. As a nutritive tonic, aloe can be combined with shatavari, as a bitter tonic with gentian, and as an alterative and emmenagogue with manjishta. The fresh juice can be applied externally for burns, sores, herpes, etc. Aloe powder is a powerful laxative that must be used in small amounts. The powders taste is nauseating and so it should be used in small amounts. The powder can also cause severe gripping and should be taken with a carminative herb like turmeric or rose flowers. ASHOK (Saraca indica) Sanskrit: Hemapushpa, Kankeli, Shokanash, Karnapurak, Subhag, Smaracivas, Doshahari, Rama Parts used: bark, seeds and flowers Energetics: astringent, bitter/cooling/pungent KP- V? Actions: astringent, hemostat, analgesic, diuretic, anthelmintic Indications: It strengthens the muscles of the uterus and reduces uterine discharge and pain in the uterus, and as such is useful in menorrhagia (excessive duration of menstrual bleeding), leucorrhea (whitish vaginal discharge), and dysmenorrhea (painful menstruation). Good combined with lodhara for excessive bleeding. A decoction of the bark acts as a tonic for the endometrium of the uterus making it useful in many diseases of the uterus. The bark has analgesic and antidotal properties, making the paste useful for pain and poison when applied topically. It has a tranquillizing effect on the nerves, so useful in painful vata disorders. Pacifying to pitta and kapha. Useful for diarrhea, dysentery, dipsia (thirst). Has hemostatic and blood purifying effects. Contains iron. The flowers are used for internal bleeding.

29 Dose: bark (as decoction) 10 to 20 grams; seeds 1 to 3 grams; powdered flowers 1 to 3 grams. BLACK COHOSH (Cimicifuga racemosa; Ranunculaceae) Other names: black snakeroot, squawroot, bugbane, rattletop, richweed, macrotys Part used: root Energetics: bitter, pungent,sweet/cooling/pungent PK-V+ Actions: alterative, emmenagogue, antiseptic, antispasmodic, expectorant, diaphoretic, alterative Indications: Menopausal symptoms including hot flashes, vaginal atrophy, dizziness, ringing ears, palpitations, headaches, irritability, depression. PMS symptoms such as irritability, headache, sleep loss, muscle and joint pains, sore or painful breasts. Useful for preparing the uterus for pregnancy (used during last 3 weeks of pregnancy only; if used earlier in pregnancy, may promote contractions); softens the cervix and strengthens the uterus for better contractions. Used as alternative to hormone replacement therapy; has estrogenic effect. Improves blood circulation and is used in treating delayed and painful menses. Also used for rheumatic and arthritic complaints, it has anti-inflammatory, neuromuscular and bronchodilant effects. Preparation: 2 tsp. of dried root in a pint of water, take 2 or 3 tbsp. 6X daily; tincture, 10-60 DONG QUAI (Angelica sinensis; Angelica polymorpha; Umbelliferae) Part used: root (member of the carrot family) Energetics: sweet, bitter/heating/sweet V-P+KActions: blood tonic, emmenagogue, sedative, analgesic, laxative, antispasmodic Indications: Used for all gynecological complaints; it regulates menstruation and treats dysmenorrhea (painful menstruation) and amenorrhea (absence of menses). Has estrogenic properties. Useful as a reproductive system tonic, and as such is often used in Eastern cultures throughout a womans life. It promotes blood circulation and thus relieves the pain of injuries and pains caused by stagnant blood. Reputed to lower blood pressure, improve digestion, purify/tonify the blood, treat anemia, tinnitus, blurred vision and palpitations. Useful for dryness of bowels causing constipation. Not to be confused with the European Angelica archangelica which has some of the same benefits but is more of a stimulant. Chinese angelica is an antispasmodic (one reason that it is effective for menstrual cramps and stomach cramps), but the Western variety is not. Precautions: Avoid use during early stages of pregnancy and if there is bloating or abdominal congestion. Dosage: 3-15 grams. GINSENG (Pana ginseng; Araliaciae) AMERICAN GINSENG (Panax quinquefolium; Araliaceae) Sanskrit: lakshmana Part used: root Energetics: pungent, bitter,sweet/heating/sweet VPK= PK+(in excess) Actions: tonic, rejuvenative, stimulant, aphrodisiac, demulcent, nervine Indications: old age, senility, debility, emaciation, fatigue, impotence, convalescence, to improve energy Precautions: high blood pressure, fever, inflammatory conditions, high pitta, high ama conditions generally, may overstimulate vata in excess, obesity. Preparation: decoction, milk decoction, powder (250 to 500 mg)

30 Ginseng is one of the best tonic and rejuvenative herbs, promoting growth and revitalization of the body and mind. It works particularly well for vata disorders of tissue deficiency found in old age. Those who are not weak may find it a stimulant, like coffee. It is excellent for promoting weight and tissue growth in the body (including nerve tissue). It strengthens the lungs, nourishes body fluids, counteracts thirst, and calms the spirit. It may be used for shock, collapse, lung deficiency, chronic febrile diseases, and heart weakness. It increases wisdom, promotes longevity and increases resistance to disease. For rejuvenative purposes, it combines well with ashwagandha (which has similar properties) when taken three grams twice a day. With ginger, it can be used to promote digestion and assimilation. It is a good general tonic cooked in milk. American ginseng has similar properties but is said to be cooler in energy. It is a better demulcent and tonic to the lungs, better for pitta individuals, but more likely to aggravate kapha. LODHRA (Symplocos racemosa; Styraceae) Sanskrit: Lodhra Part used: bark Energetics: bitter, astringent/cooling/pungent PK- V+ Tissues: blood Systems: circulatory, menstrual Actions: astringent, hemostatic, alterative, diuretic Indications: excess menstrual bleeding, uterine hemorrhage, inflammatory diseases of the eye, diarrhea, dysentery, edema Precautions: amenorrhea Preparation: powder (250 to 500 mg), decoction Lodhra is an important astringent and menstrual regulator and a significant hemostat, much like manjishta (madder). It helps prevent miscarriages and strengthens the fetus. Lodhra is found in many Ayurvedic womens formulas. A tea made of equal parts Lodhra and sandalwood is good for excessive menstrual bleeding; also combines well with Ashok for excessive menstrual bleeding. Found in many Ayurvedic tooth powders; a mouthwash made of one teaspoon Lodhra powder with a pinch of Alum is good for receding gums and sensitive teeth. MUSTA, NUTGRASS (Cyperus rotundus; Cyperaceae) Sanskrit: Musta Part used: rhizome Energetics: pungent, bitter, astringent/cooling/pungent PK- V+(in excess) Tissues: plasma, blood, muscle, marrow and nerve Systems: digestive, circulatory, female reproductive Actions: stimulant, carminative, astringent, alterative, emenagogue, antispasmodic, anthelmintic Indications: menstrual disorders, dysmenorrhea, menopause, diarrhea, malabsorption, indigestion, sluggish liver Precautions: constipation, high vata Preparation: decoction (low simmer), powder (250 mg to 1 g) Musta is the Indian variety of the common nutgrass found in most marshy areas and river bottoms. It is one of the most important herbs for treating female disorders because it relieves

31 menstrual pain and dispels premenstrual congestion of blood and water. It is one of the most effective menstrual regulators. Musta is one of the best digestive stimulants for pitta constitution and an effective stimulant for the liver. It improves absorption in the small intestine and thereby stops diarrhea, while at the same time helping to destroy parasites. As such it may be helpful in such problems as candida (gastrointestinal yeast infections). It is effective in chronic fevers and for promoting digestion in such conditions as gastritis. RASPBERRY (Rubus idaeus; Rosaceae) Sanskrit: gauriphal Part used: leaves Energetics: astringent, sweet/cooling/sweet PK- V+(in excess) Tissues: blood, plasma, muscles, reproductive Systems: circulatory, female reproductive, digestive Actions: astringent, alterative, tonic, hemostatic, antiemetic Indications: diarrhea, dysentery, intestinal flu, vomiting, dysmenorrhea, menorrhagia, uterine bleeding, prolapse of uterus or anus, hemorrhoids, inflamed mucous membranes, sores, wounds Precautions: American red raspberry has a good reputation for reducing miscarriage but other varieties are known to promote abortion; high vata; chronic constipation Preparation: infusion (hot or cold), powder (250 mg to 1 g), paste Raspberry is an effective anti-pitta herb with affinity to the colon and female reproductive organs, where it has a strongly astringent and mildly tonifying action. It is used to treat irregular and excessive menstruation and is commonly used before childbirth to prepare the womb for birthing. Used around the world as a general hormonal balancer. It raises prolapse, stops hemorrhage, gives tone to the muscles of the lower abdomen, soothes the mucous membranes and allays inflammation. It is very mild and is a safe astringent for sore throats, diarrhea (it is good for children), nausea, heartburn and ulcers. SHATAVARI (Asparagus racemosus, Liliaceae) Sanskrit: Shatavari Part used: root Energetics: sweet, bitter/cooling/sweet PV- K or ama+ (in excess) Tissues: Works on all tissue elements Systems: circulatory, reproductive, respiratory, digestive Actions: tonic (general, reproductive and nervine), nutritive, rejuvenative, demulcent, antacid Indications: debility of the female organs, sexual debility generally, infertility, impotence, menopause, diarrhea, dysentery, stomach ulcers, hyperacidity, dehydration, lung abscess, hematemesis, cough, convalescence, cancer, herpes, leucorrhea, chronic fevers. Precautions: high ama, excessive mucus Preparation: decoction, milk decoction, powder (250 mg to 1 g), paste, medicated ghee, medicated oil. Three grams of the powder can be taken in one cup of warm milk sweetened with raw sugar. Shatavari is the main Ayurvedic rejuvenative for the female and it means hundred lovers in Sanskrit. It is a rasayana for pitta, for the female reproductive system, and for the blood. As such, it can be prepared as a milk decoction along with ghee, raw sugar, honey and pippali. It also soothes and calms vata. It increases milk and semen and nurtures the mucous membranes. It both nourishes and cleanses the blood and the female reproductive organs. It is good food for menopause or for those who have had hysterectomies, as it supplies many

32 female hormones. It nourishes the ovum and increases fertility, yet its quality is sattvic and aids in love and devotion. It is an effective demulcent for dry and inflamed membranes of the lungs, stomach, kidneys and sexual organs. As such, it is good for ulcers, and with its thirstrelieving and fluid-protecting powers it is good for chronic diarrhea and dysentery. Externally, it is an effective emollient for stiff joints, stiff neck and muscle spasm. Western asparagus root has some similar properties but is more diuretic. VIDARI KANDA (Ipomoea digitata; Convolvulaceae) Sanskrit: Vidari-kanda, vidari kand Part used: root, leaves, resin Energetics: sweet/cooling/sweet VP- Ko Tissues: plasma, muscle, fat, reproductive Systems: reproductive, digestive, urinary Actions: nutritive tonic, aphrodisiac, diuretic, galactogogue, alterative, demulcent Indications: Low sexual energy, impotence, childrens debility and emaciation, spleen and liver enlargement, fever, cough, bronchitis, mild laxative. A relative of the sweet potato, it is used similarly to wild yam as an aphrodisiac, galactogogue and nutritive tonic. In fact, it is thought to have stronger properties in this regard. It has been called Indian ginseng. Preparation: Five grams of the powder can be cooked in a cup of milk with ghee, honey and raw sugar to taste, and taken daily as a restorative for seminal debility, deficient lactation or emaciation. VITEX, CHASTEBERRY (Vitex agnus-castus; Verbenaceae) Sanskrit: Nirgundi Part used: the berries Energetics: bitter, pungent, astringent/warming/pungent V-P+KActions: emmenagogue, vulnerary Indications: It is specific to the treatment of PMS and menopause. Many consider it the single most effective PMS remedy for all types of symptoms. It stimulates progesterone production and regulates menses; it does this by stimulating the pituitary to release LH hormone and by inhibiting FSH hormone, which leads to an increase in progesterone relative to estrogen (most PMS symptoms are attributed to low progesterone-to-estrogen ratio). Brings hormones back into balance, regardless of the direction the imbalance has taken. It can be taken long-term for the treatment of ovarian cysts and non-cancerous breast lumps. Inhibits prolactin, which is associated with PMS and with amenorrhea. Has sedative and antispasmodic properties. Many studies show that chasteberry produces PMS relief, menopausal relief, and an increase in lactation with no hazard to nursing infants (according to Herb Research Foundation). Relieves depression, anxiety, moodiness and sleeplessness, although it can take six months to a year to see long-term permanent changes (where improvement is experienced even after taking the herb). Chasteberry is the main female tonic in European herbal medicine used for a wide variety of conditions as well as general tonifying. The pulp of the berries is applied externally to relieve paralysis and limb weakness and pains. In ancient Greece and Rome, the temple priestesses used it to lessen sexual desire. Dosage: 3 to 6 grams, 2 to 6 capsules. As a tea, ounce per day. WILD YAM (Dioscorea spp.; Dioscoraceae) Sanskrit: aluka Part used: root Energetics: sweet, bitter/cooling/sweet VP- K+(in excess) Tissues: plasma, muscle, fat, marrow and nerve, reproductive

33 Systems: nervous, reproductive, digestive, urinary Actions: nutritive tonic, aphrodisiac, rejuvenative, diuretic, antispasmodic, analgesic, cholegogue Indications: impotency, senility, hormonal deficiency, infertility, colic, nervous excitability, hysteria, abdominal pain and cramps Precautions: excess mucous in the body, congestion Preparation: decoction, milk decoction, powder (250 mg to 1 g). Five grams of the powder can be cooked in a cup of milk with ghee, honey and raw sugar to taste, and taken daily as a restorative for seminal debility, deficient lactation or emaciation. Many of the different varieties of wild yam possess strong rejuvenative powers (others do not, so be sure of the particular species). They increase semen, milk and other hormonal secretions, as well as promoting body weight. The American variety also contains many hormones and is an effective tonic for the female reproductive system. It is also used for its nervine and antispasmodic properties. Soothes urinary pain and the nerves in neuralgia, is used for menstrual cramps, is effective for the liver and gall bladder and for digestive problems associated with an imbalance of these organs. It is near-specific for the treatment of chronic flatulence and gas. Some of the oriental varieties, as well as the Mexican variety, are regarded as rejuvenatives for men. Wild yam also has a soothing and harmonizing effect upon the digestive organs. Vidari-kanda is used similarly to wild yam, and is thought to have stronger properties.

34

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