Menopause. from an Ayurvedic perspective

Menopause from an Ayurvedic perspective DevaKhalsa May2012

Table of Contents Introduction. 2 Whatismenopause?... 3 HotFlashes 5 TheDoshas 8 Dhatus.. 10 Herbs. 15 PathologyofMenopause 18 HormoneReplacementTherapy 21 Diet. 25 Conclusion... 27 Endnotes/abstracts. 28 Menopause,DevaKhalsa 1

Introduction Inmypracticeasayogateacher,cleansingfacilitator,AyurvedicHealthEducatorandwoman,hundredsof womenhavecometomecomplainingabouttheirmenopausalsymptoms.theybelieve(orhavebeen taughtbywesternmedicalscience)tochasetheirsymptomswithexternalhormoneswillmakethem happierandsymptomfree.theystronglybelievethattheycannotsurvivewithoutthesehormonesand thatthequalityoftheirlifeimproveswithhormonereplacementtherapy. WhenIwasinmy30 sijustlistened. Nowat47Ihavesomethingtosay.PersonallyIhavenoovertsymptomsotherthanmusteringthe courageat45toleavemyspiritualcommunityof20yearsandmymarriageof16years.thisimplies radicalchangewithin.iamlessapttositbyquietlywhenidon tagreeandamdriventocreatealifeof stressfreehappinessformyselfandmytwosons.beforethisresearchpaper,whenwomentalktome abouttheirpersonalmenopausalexperienceihavepromotedherbaltherapy,slowingdownandstress reductiontechniques. Theintentionofthispaperistoshowtheconnectionbetweenmenopause,rasaandojas,specificallyhot flashes.researchonhotflashesandayurvedawaslimited.thispaperassumesaworkingknowledgeof Ayurvedafromitsreaders. Menopause,DevaKhalsa 2

Whatismenopause? TheAyurvedicancienttext,theAstangaHrdayam,hasaneloquentanswertothisquestion Justasthe lotusclosesattheendoftheday,soalsotheyoniafterthertukala(theperiodsuitableforconception); i1 thereaftershewillnotbereceptiveforsukra(semen) Thiscouldberelatedtotheperiodofthemoon eachmonthandalsocouldbeconsideredthepassageofawoman stimeforprocreationinthegrand schemeofherlife. InanotherancientAyurvedictext,theCarakaSamhita,thetermfordiseasesofthefemalereproductive systemisguhyarogaandgarbharogaisthetermforthediseaseoftheuterus.diseasesofthevaginaare calledyonivyapat. ii Forthispaperthevagina,uterusandfemalereproductiveorganswillbecalledthe yoni. Menopauseisthepermanentendofawoman smenstrualperiods.menopauseoccursnaturally,orit canbecausedbysurgery,chemotherapy,orradiation.naturalproductsormindandbodypracticesare sometimesusedinanefforttorelievemenopausalsymptomssuchashotflashesandnightsweats. iii Perimenopauseisthisperiodoftransitionfromnormalcyclesandlevelsofsexhormonestomenopause. Menopauseiswhenithasbeenayearsinceourlastperiod,anditisdrivenandaccompaniedbymore dramaticchangeswithoursexhormones.perimenopauseisconsideredtolastanywherefromacouple yearstotwelveormorebeforemenopauseandalthoughthisisnotimplicitlystated,thetermtendstobe appliedmoretowomenwhoareexperiencingdiscomfortwiththetransition.progesteronestarts droppingatage35,wecouldarguethatmostwomenenterperimenopauseasthattimeandthatit progressesasoursexhormonesdiminish.themoreimbalancedourhormones,themorelikelyitisthat perimenopausewillbedifficult.ifourhormonesarebalanced,itispossibletogofromage35to55 iv withoutanydiscomfort. Menopause,DevaKhalsa 3

Whenmenopauseisinducedbysurgeryorradiation,whichradicallyalterstheyoniitiscalledartificial menopause.thereareseveralhormonalchangesthatareoccurringasawomanentersherlater reproductiveyearsincludingdecreasesintheproductionofestrogenandprogesterone,decrease receptivenessoftheovariestofsh(folliclestimulatinghormone)andlh(luteinizinghormone)anda decreaseinthepostovulationlevelsofprogesterone.allofthesechangesdecreasefertility. v Symptomsofmenopause Hairloss Digestivedisturbances Cystitis vaginitis vi anxiety,nervousnessanddepression vaginaldryness sweating/hotflashes irregularperiods sorebreasts fatigue,dizziness jointpain headaches fastheartbeat decreasedlibido bladderincontinence vii vaginalatrophy(thinningofthevaginaltissue) viii Menopause,DevaKhalsa 4

Whatarehotflashes? Themostcommonmenopause relateddiscomfortisthehotflash(sometimescalledahotflush). Althoughtheirexactcauseisamatterofspeculation,physiologicallyhotflashesarethoughttobethe resultofchangesinthehypothalamus,thepartofthebrainthatregulatesthebody stemperature.ifthe hypothalamusisunstableandmistakenlysensesthatawomanistoowarm,itstartsachainofeventsto coolherdown.bloodvesselsnearthesurfaceoftheskinbegintodilate(enlarge),increasingbloodflow tothesurfaceoftheskininanattempttodissipatebodyheat.thisproducesared,flushedlooktothe faceandneckinlight skinnedwomen.itmayalsomakeawomanperspiretocoolthebodydown.an increasedpulserateandasensationofrapidheartbeatingmayalsooccur.hotflashesareoftenfollowed byacoldchill.afewwomenexperienceonlythechill. ix Hotflasheshavealsobeenshowntoincrease whenawomanisanxiousortense. x Howlongwillhotflashesgoon? Hotflashestypicallystopontheirownovertime,andmaynotrequireanytreatment.If treatmentisneeded,hotflashescanusuallybereducedoreliminatedcompletely. xi ClaudiaWelchsays, ourpopularculturehascaughtonthatmenopauseisnotadisease,it sanatural process. xii Duringmenopause,theyangrises.Ourhiddenpower,ourinnerfire,comestothesurface.This firemaygiveustheenergyweneedtobeginanewcareer,remodelourbodieswithafitnessanddietary regime,leaveorinvigorateastalerelationship,developanabandonedtalent,traveltheworld,giveback toourcommunityortotheearth.whateverisitthatyouhavebeenputtingoff,whateverpartofyourself remainsunderdeveloped,whateveryourdreamswhispertoyouatnight,nowisyourtimetoreallylisten andfollowthrough. xiii This isnotadiscretehormonaleventbutacomplexperiodinwomen slivesinwhichhormonalfactors, familyrelationships,workstatus,andself conceptchange.itisimportanttoexaminewhetherthese changesalterqualityoflifeandtodisentanglethespecificpathwaysrelatedtohealth relatedqualityof lifeinmid lifewomen. xiv Thisisatimewhenmanywomenbegintomanifestsomeofthefierceneedfor self expressionthatsooftengoesundergroundatadolescence.mid lifewomenaredangeroustoany forcesexistingthatseektoturnthemintosilentoldladies,dangeroustothedeadeningeffectsof Menopause,DevaKhalsa 5

conventionandnicenessanddangeroustoanyaccommodationsmadethatarestiflingwhotheyarenow becoming.shescrutinizeseveryaspectofherlifeandrelationshipseradicatinganydeadwoodthatheld herbackornolongerservedwhoshehadbecome.womeninmid lifeareataturningpoint,eitherthey continuelivingwithrelationships,jobsandsituationsthattheyhaveoutgrown achoicethathastensthe agingprocessandthechancefordiseasedramatically ortheycandothedevelopmentalworkthattheir bodiesandhormoneslevelsarecallingoutfor. xv Atmenopausethereisamoredrasticchangeinourlevelsofsexhormones,butthisisn tnecessarilya problem. xvi Theprevalentmedicalbeliefthatfallingestrogenlevelsaresolelyresponsibleforallthe symptomswecurrentlyattributetomenopauseisamistake.whilethereisaverydefinitedropin estrogenandprogesteroneduringperimenopauseandmenopause,womenintheirfortiesandfiftiesare showingothersignsofagingthatmayhavebeengoingonfordecades. xvii Menopausalsymptomsaredueinparttochronicdepletionofwomen smetabolicresourcesduringthe perimenopausalyears.theeaseoftransitionintothisstagedependsuponthestrengthofawoman s adrenalsandthestateofhergeneralnutrition.inahealthywoman,theadrenalglandswillbeableto graduallytakeoverhormonalproductionfromtheovaries.manywomen,however,approachmenopause inastateofemotionalandnutritionaldepletionthathasaffectedoptimaladrenalfunction.underthese conditionsawomanmayrequirehormonal,nutritional,emotionalandothersupportuntilherendocrine balanceisrestored. xviii Sincewenolongermakeandbearbabies,wenolongerneedtomaintainthepotentialtonourish anotherbeing.westillrequirenourishmentourselves,however,andprovidedwehavenotconsumedtoo muchyin xix (author snote:yinandojasareusedinterchangeablyinthispaper)inourearlieryearsby plowingthroughlife sobstacles,ourbodiescanstillprovideuswithwhatweneed.postmenopausal womenstillproduce40 60%oftheirpremenopausallevelsofhormonesandestrogenfallsonly40 50%at menopauseandthatwehavetheabilitytosynthesizesexhormonessufficientforournatural postmenopausalneedsviatheadrenalglandsandourvariousbodilytissues. Tomakeestrogen,weneedestrogenprecursorsandaromatase theenzymenecessarytoconvert precursorsintoestrogen andwomenhavebothofthesejustabouteverywhereintheirbodies,even Menopause,DevaKhalsa 6

aftermenopause.sowehavegreatpotentialtosynthesizesufficientestrogen.thisiswhynotallolder womenhaveosteoporosisordeficientestrogenorprogesterone.manywomennavigatemenopausewith minimaldiscomfortandhaveneverhadhormonereplacementtherapyofanysort.theyhike,bike,swim, gardenandwalkupastormandhavehealthyheartsandstrongbones. Estrogendeficiencymaysimplybeduetoalong termexcessofstresshormonesdrainingsexhormones. Addingmoreestrogenviahormonereplacementtherapywithoutcalmingthestressislikepouringwater intoabucketwithaholeinit.stressrendersherlessresponsivetonormalamountsofhormonesand prettymuchensureshormonalimbalance.forexample,awomanwithexcesscortisolbutnormal amountsofestrogenmaygethotflashesorothersymptomstypicallyassociatedwithestrogendeficiency. Ifthiswomanweretotreatthesesymptomswithestrogenreplacementtherapyshewouldpossiblythen developestrogen dominantsymptomssuchasweightgain,waterretention,andmoodswings. Bythetimewomenreachmenopause,manyhavealreadydrainedtheirreservesofyinsexhormones (depletedourojas).nowwhenherovariesareproducingasmallerquantityofsexhormones,heradrenal glandsaresupposedtokickinandproducemoreofthehormonesandhormoneprecursorsneeded.but whatiftheseglandsarealreadyburntoutfromproducinglotsofstresshormonestomanagestressful livesoverthelast20ormoreyearsandbyproducingthedhearequiredtoassuagetheeffectsofexcess cortisol?theywillbetappedandtiredoutandunabletodeliverpostmenopausalhormonal requirements. InWesternterminologythistranslatesashighorlowcortisollevels(lowwhenthey vebeenhightoolong andcrash),adeficiencyofsexhormones,thyroidproblems,adrenalburnout,andahostofother imbalances.theresultcanbeamenopauseaccompaniedby: Insomnia hotflashes moodswings compromisedimmunesystems osteoporosisandheartdisease Menopause,DevaKhalsa 7

Hotflashesareagoodindicatorofhormonalimbalance.About80%ofmenopausalwomen(Dr.Halpern cites75%inhistextbookofclinicalayurvedicmedicine)willexperienceatleastonehotflash,makingthis asignificantsymptomaccompanyingmenopause.generallythemoreintensethesymptomsof menopausethemoreoutofbalancethehormonesare. xx THEDOSHAS Disturbanceinthedoshasliesattherootofmostmidlifesymptomsofmildintensityandonceawoman hasdeterminedwhichofherdoshasisoutofbalanceshewillbeabletocorrecthermildersymptomsfor asmoothsymptomfreetransition. xxi ToBeginwith, withouttheaggravationofvata,thevaginadoesnot getdisorderedinwomen;hencethisshouldbewonoverfirstandtheotherstreatednext. xxii InrelationtothismidlifetransitionVatagovernsthesecretionanddeliveryofhormones(reproductiveor other)fromtheirglandsoforigintotheirorgansofdestination:brain,vagina,skin,liver,bones.vataalso keepstheevery cyclingbiologicalrhythmsinbalanceandattunedtothecyclesofthemoonandseasons. Vataisprimarilyresponsibleforguidingthebody sadjustmenttochange. xxiii And AsMenopauseisassociatedwiththemovementintooldage,theVatastage,symptomsare primarilyofhighvatawithincreasednervousness,anxiety,insomniaanddepression. xxiv Therearethreetypesofmenopause: Vata Type Menopausalsymptomsare precipitatedandaggravatedbyvatavitiatingregimenssuchascold,dryand lightfoodsandahigh stress,fast pacedlifestyle.thisconditionisfurtheraggravatedwhenawomandoes notembracethechangeoflifeandattemptstocontinueonwiththeresponsibilitiesofthepittatimeof life.childrearingandprofessionalaccomplishmentduringthevataphaseoflifeisoutofharmonywith life srhythms. ThesymptomsofVataimbalanceduringmenopausewhilequitevariablearegenerallythoseofdepletion. Hotflashesarethemostcommonsymptom.Additionalcommonsymptomsincludevaginaldryness, atrophicvaginitis,insomnia,irritability,anxiety,palpitations,tachycardia,cystitis,urinaryincontinence andconstipation.vataaccumulatesandbecomesaggravatedinthepurishavahasrota.itoverflowstothe Menopause,DevaKhalsa 8

rasaandraktavahasrotas.relocationtotheartavavahasrotacausesvaginaldrynessandpossible atrophicvaginitis.relocationintotheannavahasrotasharplydisturbssamanavayuleadingtohotflashes. Relocationtothemutravahasrotaresultsinpossiblecystitisandincontinence.Relocationintotheorigin oftherasavahasrotaresultsinpalpitationsandtachycardia.relocationtotheashtivahasrotaleadsto osteoporosis.whenvatarelocatestothemanovahasrotawomenmayexperienceemotionalinstability, insomnia,irritabilityandanxiety. xxv TheactualstimulusofmenopauseisVataenteringtheshukradhatuoftheartavavahasrotapreventing maturationofthefollicles.thisisnormalduringthisstageoflifeandrequiresnotreatmentinandof itself.symptomsthatarepresentarecausedbyanaggravationofapre existingvataimbalanceora concurrentvata vitiatinglifestylewhichismadeworsebythechangesoflife. xxvi Tonictherapyatthistimeoflifeslowstherateofdepletionallowingagradualtransitiontotakeplace. Dr.HalpernrecommendsRejuvenativetherapiestobuildthedhatusandrestoreojas:Abhyanga, shirodhara,anuvasanabastiandchakrabastioverthesvadhisthanachakra. xxvii Indiseasesofthevaginaofvataorigin oleation,sudationandenema,whichmitigatevataarehighly valuable,especiallyinthosewhicharecausedbyvata. xxviii Regularroutinesarealwaysimportantfor supportingvatadoshaandareparticularlyimportantforstabilizingsamanavayu xxix Vata/Pitta Type Ingeneral,thePittadoshaisresponsibleforkeepingdigestionstrong,metabolismbalancedandweight normalinthefaceofchanginghormones.pittaguidesthechemicalreactionsthatoccurwithinthecells afterhormonalstimulation.pittaprovidestheheatofhotflashes. xxx AsthetransitionvitiatesVatadosha, thedisturbanceinairfansanalreadyvitiatedfireincreasingpittadosha.asaresulthotflashesaremost intensewithapittanature.additionalcomplicationsincludegreaterinflammationandburningasoccurs incystitisandvaginitis.emotionallythereisgreaterangerandintensitywhich,likethehotflashescomes andgoes. xxxi Pittatypemenopauseappearsasanger,irritabilityandshorttemper,withmorefrequent orpronouncedhotflashes. xxxii Vata/Kapha Type Menopause,DevaKhalsa 9

AwomanwithaKaphanatureorimbalanceoftenenterstheVatatimeoflifewithfewersymptomsthan thosewithamorevataorpittanatureorimbalance.thisisduetothemoiststableandcoolnatureof Kaphawhichnaturallyantidotesthecondition.WomenwithaKaphaimbalanceoftenfindthatVata pusheskaphafurtheroutofbalance.thiscausesasteadyriseinbodyweightthatisaccompaniedby lethargyandmelancholy.thequalitiesofimbalancepresentinmostvata/kaphaimbalancesareheavy, coldanddry.oftenthebodyissluggishbutthemindisactiveunlessthereismorevatathenamore mobilemind.whileisitmostimportanttopacifyvataduringthemenopausaltransition,the managementofkaphashouldnotbeignored. xxxiii Kaphainvolvesfeelingofheaviness,sleepiness,lackofmotivation,weightgainorholdingofwater. xxxiv Aftermenopause,Kaphadoshaisresponsibleforkeepingawoman sjoints,skin,eyesandvaginaltissues moistandlubricated,alsoprovidingstrengthandstaminatoemotions,behaviorandtheimmune system. xxxv Doshasandthehotflashes Thehighlyirregular,unstablepatternoftemperaturecontrolreflectsVata squalityofirregularity.the heatfactor(pitta)ofhotflashesisasecondaryphenomenon.butvataiscoolandpittaishot.ayurveda seekstotreattheprimarycausefirst, xxxvi whichreinforcestreatingvatafirst. DHATUS Thedhatusarethebasictissueelementsofthebody.Theyareseveninnumber,namely,(1)rasaorchyle orplasma,(2)raktaorthered bloodcorpuscles,(3)mamsaormuscletissue,(4)medasorfattissue,(5) asthiorbonetissue,(6)majjaorbonemarrowand(7)sukraandrajasorthespermandovumwhichare responsibleforprocreation.thesedhatusorbasictissueelementsremaininaparticularproportioninthe humanbodyandanychangeintheirequilibriumleadstodiseaseanddecay.theirfunctionsaredescribed indetailinayurvedicclassics.diseasesareproducedonly whenthedoshasinteractwiththesedhatus andthishappensonlywhenthereisdisturbanceintheirequilibrium.ifthereisanychangeinthe equilibriumofthesedhatuscertainsignsandsymptomsaremanifestedinthebody.fromthesesignsand symptoms,thephysiciancanascertainthemahabhauticrequirementofthebodyforthecorrectionofthe Menopause,DevaKhalsa 10

disease,anddrugsareselectedaccordingly. xxxvii RasaDhatu Rasadhatuistheclearserumportionofthebloodandinmenopausecanexperiencethesesymptoms: verydryskin,prematuregrayingorwrinklingoftheskin,mildoroccasionalvaginaldryness,excess mucousorrespiratorycongestion,feelingofweaknessandtiredness,lackofstamina,ovarianorbreast cystsnoworinthepast(fluid filledonly). xxxviii Iron deficiencyanemiaisacommonproblemforperimenopausalwomenwhohaveheavybleedingwith theirperiods.ifherdigestionisweak,herbloodmaynotbeabletoabsorbadequateironfromherdietto meetherbody sneeds.thismeansherbloodplasma(rasa)willbedeficientiniron,whichisessentialfor thenexttissueinline,theredbloodcells(rakta).withoutenoughiron,herredbloodcellswillbesmaller thannormalandthereforecarrylessoxygen.thenexttissuedowntheline,themuscles(mamsa)willbe undersuppliedwithoxygenandbecomeeasilyfatigued.thisishowweak(rasaandrakta)translatesto tiredmuscle(mamsa)lessexercisetoleranceandstamina,andagenerallyrun downcondition. xxxix Dr.Ladsaysthatexcessheaviness,waterretentionandswellingareallkaphasymptomsassociatedwith rasa.thesearesymptomsofmenopause. xl Oneofmyfavoriteteachers,MaryThompsonfromtheCaliforniaCollegeofAyurvedaheldamenopause workshopinjanuary2012.shesaidthatduringmenopausethebodynolongerhasestrogentobuildthe rasadhatusothenaperimenopausalwomancannotstabilizerasaandheatinthebody.sherecommends arasatea.rasateahelpseliminatehotflashes,migrainesandconstipationduetodehydration. Thompsonsays thethickertheteathemorerasathatgetsbuilt. RASA TEA 1 Tbsp Fenugreek or slippery elm or Shitavari (cut and sifted) 1 Tbsp Flax or chia seeds 1 Tbsp Fennel Seeds 1 Tbsp Marshmallow root Pour one quart of hot water over the herbs in a quart size mason jar. Steep up to 30 min. and drink as it cools. Astragalus root is an adaptogen and can be added as well in equal parts in Menopause,DevaKhalsa 11

weight. xli RaktaDhatu Raktadhatuistheredbloodcellsandbileandinmenopausewomencanexperiencetheseimbalances: severehotflashesorfrequentfeelingofexcessiveheat,veryheavybleeding,frequentorchronicskin rashes,acne,pustulesorhives,gallstonesnoworinthepast,bleedinghemorrhoids,constantthirst MamsaDhatu Mamsadhatuisthemuscletissueandinmenopausecanexperiencetheseimbalances:constantmuscle achesoreasilyfatiguedmuscles,chronicallyswollentonsilsorlymphglandsintheneck,itchyearcanals oreczemaofearcanalorexcessearwax,fibroidsoftheuterus(noworinthepast),fibrousorglandular lumpsinthebreasts,severelydry,crackinglips. MedasDhatu Medasdhatuisthefat,hormoneandcarbohydratemetabolismandinmenopausecanexperiencethese imbalances:weightgain(10poundsormore)orinabilitytoloseweight,highbloodsugar,high cholesterol,chronicsweatorbodyodor,fattycystsundertheskinorscalporinthebreasts,thyroid disorder,frequentnightsweatsorsweatsduringthedayassociatedwithhotflashes. AsthiDhatu Asthidhatuisthebone,cartilage,hairandnailtissuesandinmenopausecanexperiencethese imbalanceslowbonedensity,hairbreakingorhairverydryandlackingluster,problemswithteeth (breakingeasilyormanycavities),nailsbreakingfrequently,constantjointpainsorarthriticconditions, deeppainsinthebones. xlii Exerciseisbesttreatmentforosteoporosis.Inresponsetostressplaceonbones,naturehasdesigned ourbodiestoincreasebonedensity.hence,dailyexerciseisimportant.weightbearingexerciseisthe mostimportantformofexercise.thuswalkingismorebeneficialthanswimming. xliii Standingyogaposes arealsobeneficial. Duringmenopause,asthiagnibecomeshyperactivebecausethebodyproduceslessestrogen.Whenless estrogenispresent,asthiagnibecomesoveractiveinanefforttocompensateforthatlackofestrogenin Menopause,DevaKhalsa 12

anefforttocompensateforthatlackofestrogenandtheagniitcontains.theresultcanbeosteoporosis. Eatingavataprovokingdietwillworsenosteoporoticchanges. xliv TheAyurvedictextsstatethatabhyangahelpstopreventosteoporosisandincreasebonestrength.The skinisoneofthemainsiteswhereestrogenisformedinthebodyaftermenopause.dr.lonsdorfthinks thattheabhyangaenhancesproductionofestrogenbytheskincells,helpingthebodymakeupforless hormoneproductionbytheovaries.takingafewminuteseachmorningtodoaself massagewithoilwill helpcounteractthespaciness,dryness,anxiety,stiffness,achesandpainsthatcomefromvatarisingin thebodyandmind.thecharakasamhitatellsusthatonewhodoesabhyangaregularlywillnotinjureas easilyandifinjuredwillhealmorequickly.recentresearchhasshownthatsesameoilhasantiinflammatorypropertiesaswellasantibacterialandanticancereffectsontheskin. xlv MajjaDhatu MajjaDhatuisthecentralnervoussystemtissueandinmenopausecanexperiencetheseimbalances: frequentorrecurringinfections,excesssecretionsoftheeyes,drynessofskinonuppereyelids,constant spaceyanddistractiblefeeling,inabilitytofocusorconcentrate,paininthetendons,easilyinjured tendonsorrecurrenttendonitis,frequentfeelingoffaintnessordizziness. ArtavaDhatu Artavadhatuistheovumanditssupportivetissuesandinmenopausecanexperiencetheseimbalances: absenceoflibido(nosexdrive),severevaginaldryness,overalllackofsexualattractiveness,dull,unclear eyes,historyofmorethanonemiscarriage,infertility. xlvi Artavavahasrota(femalereproductivesystem)includesthefallopiantubes,ovaries,uterus,cervix,vulva andvaginalpassage.thefunctionsofartavavahasrotasincludemenstruation,ovulationandconception. Thecessationofartavahappensduringmenopause. xlvii OJAS Ojasis themostrefinedandsubtleessenceofthephysicalbody.whenfullyactivated,ojasisthebliss factorthatgoesbeyondgoodhealthtokeepyoufullyimmuneandstrengthenedagainalldisease.ojasis thesuperfluidslidethatlinkstheunderlyingintelligenceofnaturetoitsexpressionsinyourmindand body.ojasisasupremelyrefinedhealthgivingelixirresultingfromperfectdigestion,whichpermeates Menopause,DevaKhalsa 13

everycellwithlife givingenergy.ojasisresponsibleforkeepingallthecellsofyourbodyfunctioning coherentlytogether,muchastheconductorofasymphonyorchestrakeepsalltheinstrumentalists playingasacoordinatedwhole,inperfectharmony.whenyourojasisenlivened,youhaveahealthyglow onyourface,andthelightinyoureyesburnsbrightly.yourhormonesarecommunicatingtheright messages,attherighttimes,intherightamountstoyourcellsanddna.whenojasishighduetoamafreedigestionandmetabolism,menopausesymptomsareminimalandyourbodyadjustseasilytoits innershifttohormones. xlviii Menopause,DevaKhalsa 14

HERBS HerbsforVata HerbsforVatashouldbeutilizedandformulaspreparedshouldbecoolinginnatureanddipanasshould beaddedtoformulasthatpacifybothvataandpittasuchasfennel,cumin,coriander,peppermint,and chamomile.burningwhenpresentisbesttreatedwithsweetdemulcentherbssuchasshitavari,asweet, cooldemulcentthatisalsoareproductivetonicprovidingestrogenicsupport.forthemind,thebest herbsforpacifyingbothdoshas(vp )arebrahmiandshankpushpi. xlix Menopausetreatmentrequiresspecialherbsforstrengtheningorrejuvenatingthefemalereproductive system,alongwithherbstohelpregulatethehormonesandcalmtheemotions.thegeneraltreatment forvatatypemenopauseissimilarlyanti Vata.Frawleyrecommendsherbswhichtonifythefemale reproductivesystem,includingaloegel,shitavari,saffron,kapikacchu,ashwaghandatakeninmilk decoctions(swamisadashivatirthaaddssaffronandmyrrhtothislistforvataherbs) l,ifpossible,orin theirdifferentpreparationslikeshitavaricompound.chinesetonicherbssuchasdongquai,rehmannia, whitepeony,lyciumandwomen spreciouspillsaregood.aloegelisspecificformaintainingthe youthfulnessofthefemalereproductiveorgans. li Dr.AlakanandaDevitaughtmeaShitavarikulpainJanuary2012inSantaFeatapulseworkshopwith AmadeaMorningstar. ShitavariKulpa 1cupShitavari 1/3cupturbinadosugarorcoconutsugar 2Tbspghee ½tspcardamom Pinchofsaffron Simmeronlowinacastironfryingpanuntilgoldenbrown. Menopause,DevaKhalsa 15

Thisformulaincreasesthedemulcentpropertiesthroughoutthebodybuildingrasaandrakta.Dr. AlakanandaDevirecommendseatingwithaspoonformenopausalwomenthatarehotandbothered. Shesuggestsitistooheavyforkaphathough. HerbsforPitta TreatmentforPittatypemenopauseisanti pittaincludingaloeveragelandshitavaritonicsorasaffron milkdecoctionorshitavaricompound. HerbsforKapha TreatmentforKaphatypemenopauseisanti kapha.hotspicesareusedlikethetrikatuformulaalong withaloegel. lii MoreherbsrecommendedforKaphaarepippiliandginger liii Lekhanastosupport weightlossincreasethemedagniincludeguggul,chitrak.nervinestimulantscanbetakentopacifykapha inthemajjadhatuaswellasthemanovahasrotareducingbothlethargyandmelancholyrepectively, calamus,bayberry,andtulsi. liv AccordingtoAyurveda,awomanshouldtakenaturalherbalestrogenthatispresentinShitavariand otherherbalremedies.shitavariiseffectiveinpreventingosteoporosisduringmenopausalage. lv Estrogenpromotingherbsareoftenusedinthetreatmentofmenopausesymptoms.Commonherbs thataregenerallyacceptedtomimicestrogenincludemotherwort,redcloverandsawpalmetto. Motherworthasthestrongesthistoryforuseintreatingfemalereproductivecomplaints.Otherherbs suchasdongquai,vitex,bluecohosh,blackcohosh,wildyamandlicoricehavealsobeenfoundtohave estrogenlikeeffectsthoughtheyareweakerthanthosepreviouslynoted.themostcommonoftheseare dongquai,vitex,wildyamandblackcohosh.inindiathemostcommonherbusedisshitavariwithits estrogenlikeeffects.theseherbsaremosteffectiveinthetreatmentofhotflashesandvaginaldryness. Fordryvaginitisandpainfulintercoursetheseherbscanbepreparedinamedicatedgheeandapplied topically. Inthemanagementofpost menopausalpalpitations,inadditiontotheestrogen promotingherbs, circulatorytonicssuchasbalashouldbeused.thesenourishtherasadhatuwhilestrengtheningand regulatingtheheartbeat.arjunaandhawthornberriesmayalsobebeneficial. lvi Dr.Halpernrecommends patientsshouldtaketheherbsuntilmenopauseiscompleteandthengraduallyreducethedosagewith Menopause,DevaKhalsa 16

thehopeofgettingofftheherbsaltogether. Whileherbscaneasethetransition,occasionallysymptoms returnwhenthepatientgoesoffoftheherbs. Menopause,DevaKhalsa 17

PathologyofMenopause Stage Evidence Dosha Subdosha Dhatu Srota Category Twoex. VATA A/A Possible,mild, Vata Apana Rasa Purishavaha Demulcents Licorice,shitavari, dry,hardstools aloevera andstraining Cooldipanas Fennel,cardamom, Constipation coriander andgas O Mild,Transient systemic Vata Vyana Rasa Rasavaha Demulcents Licorice,shitavari, slipperyelm dryness O Mild,Transient Feelingcold Vata Vyana Rakta Raktavaha Circulatory stimulants Cinnamon,ginger, blackpepper RMD Vaginaldryness Vata Vyana Rasa Artavavaha Demulcents Shitavari,Licorice, aloevera RMD Atropicvaginitis Vata Udana Mamsa Artavavaha Muscletonics Shitavari, ashwaghanda,bala RMD Emotional Vata Prana,Vyana, n/a Manovaha Nervine Ashwagandha, instability, samana sedatives& jatamamsi,brahmi insomnia, tonics shankapushpi irritability, Ashwagandha, anxiety brahmi,shitavari RMD Hotflashes Vata Samana n/a Annavaha Dipanas Fennel,cumin, coriander RMD Cystitis Vata Vyana Rasa Mutravaha Demulcents Shitavari,aloevera Gokshura, Menopause,DevaKhalsa 18

Urinarytonics RMD Incontinence Vata Udana Mamsa Mutravaha Urinary muscletonics punarnava Gokshura, punarnava RMD Palpitations/ Vata Vyana Rasa Rasavaha Demulcents Licorice,shitavari, tachycardia slipperyelm Cardiactonics HawthornBerries, arjuna,bala RMD Osteopenia/ Vata Apana Asthi Asthivaha Bonetonics Ashwagandha, osteoporosis bala,haritaki RMD Endocrine Vata n/a Shukra Artavavaha Endocrine Shitavari,vitex, imbalanceuntil tonics dongquai,wild ovariesstop yam,vidarikand producingova* *Onceovariesstopproducingova,notreatmentisrequired Itisimportanttonotethatthispathologyarticulatedaboverepresentsimbalancescreatedbymenopause. Dr.Halpernsaysthatthemostimportantherbsarereproductivetonicsastheseeasethehormonal transitionandallrelatedsymptoms.additionalherbsshouldbegivenasneededforspecificsymptoms. lvii However,andIwanttoemphasizethis,thepractitionershouldnotattempttotreateachandevery symptomifmanyarepresent.itisbesttochoosethemostsignificantsymptomdirectlywhilecorrecting theunderlyingdepletion. lviii SebastionPolerecommendsabeautifulredfruitfamedforitstasteaswellasbeingafertilitysymboland balancingestrogen!hegoesontosay, pomegranatesareusefulformaintaininghealthylevelsof oestregenastheycontainsmallamountofestrone. Polerecommendseatingthefreshfruit,juiceofthe seedsregularlyduringmenopauseandthatthesweetflavorcanhelptocoolsensationsofburningand flushing. lix FordhatuimbalancesDr.LonsdorfrecommendsaddingtheseherbsdescribedbelowtoCCF(cumin, coriander,fenneltea).use¼tspofeachcumin,corianderandfennel.cuminhelpsabsorbanduse Menopause,DevaKhalsa 19

nutrients,corianderhelpseliminatetoxicchemicalsandwastesthroughyourkidneysandfennelhelps reducegasandbloatingandnormalizesdigestions(agni). Rasa~1/8tspajwanseeds(skipifhavinglotsofhotflashesthoughastheyaresometimesheating) Rakta~¼tspmanjistha Mamsa~1/8tspIndiansarsaparilla Medas~1/8tspblackcardamomseedsor3greenpodsofwholecardamom Asthi~¼tspmarshmallowroot Majja~¼tspbalaroot Artava~¼tspShitavari lx Menopause,DevaKhalsa 20

HORMONEREPLACEMENTTHERAPY Studieshavereportedthatwomen sattitudes,beliefs,andvaluesprimarilyinfluencetheirdecision makingonmanagementstrategiesformenopausalsymptoms.womenwithmorepositiveoroptimistic outlooksaboutmenopause(forinstance,thosewhoconsideredmenopausenotillnessbutpartofthe normalagingprocess)werelesslikelytousehormonereplacementtherapy(hrt)totreatsymptomsand wereabletotoleratesymptoms.incontrast,apessimisticappraisalofmenopausewassignificantly relatedtoincreasednumbersofsymptoms.inthisstudy,thefindingsonmanagementstrategiesforand themeaningofsymptomsshowedthatmidlifewomenacrosstheethnicgroupsconsideredmenopausal symptomsasignofagingandaresultoftheirnormallifespandevelopment.mostwomenchose no management asamanagementstrategy,andonlythosewhohadserioussymptomstookhrtfor temporaryrelief.interestingly,manyasiansadoptedmindcontrolstrategiessuchas tryingtobe optimistic and tryingtocalmdown tomanagesymptoms.thefindingsalsosupportedthatethnicity wasasignificantpredictorofthetotalnumberorseverityofsymptomsacrossethnicgroups,andthat levelofacculturationwasasignificantpredictorofthetotalnumberoftotalsymptomsamongasian women,whichagreeswithpreviousstudies.severalstudiesdemonstratedreducedfrequenciesof menopausalsymptomsamongasianwomenethnicdifferencesinmenopausalsymptoms. Therewasastatisticallysignificantethnicdifferenceinthetotalnumberofsymptomsexperiencedduring themenopausaltransition;physicalsymptoms,psychologicalsymptomsandpsychosomaticsymptoms. HispanicsandWhitesreportedsignificantlylargernumbersoftotalsymptoms,physicalsymptoms,and psychosomaticsymptomsthanasians.africanamericansreportedasignificantlylargernumberof psychosomaticsymptomsthanasians.therewerestatisticallysignificantethnicdifferencesinthe frequenciesof41individualsymptoms. lxi Incross sectionalstudies,perimenopausalwomenreportgreaterbodilypainandrolelimitationsdueto physicalhealthoremotionalproblems,poorerperceivedhealth,andmorephysicalorsomaticsymptoms thandopremenopausalwomen. Thesestudiesarebasedondiversepopulations,includingwomenfrom Menopause,DevaKhalsa 21

England,Holland,Taiwan,Chile,France,Sweden,andtheUnitedStates,wherewomenofJapanese, Chinese,Hispanic,African,andEuropeanoriginhaveparticipated.Severalstudiesalsosuggestthat womenwhochoosetousehrtduringthemenopausehavepoorhealth relatedqualityoflife. Several studiessuggestthatstatisticalcontrolsforemotionalsymptomsremovetheeffectofmenopausalstatus onsomaticsymptoms. Stateddifferently,womenwhoreporthighlevelsofanxiety,depression,andother emotionalsymptomsarethewomenwhoreportpoorqualityoflifeduringmenopause.thisisconsistent withdatashowingthatwomenatotherlifestageswhoreportemotionalsymptomsalsoreportapoor qualityoflife. lxii Women sabilitytomanagesymptomsassociatedwiththisnormallifetransitionhasbeenreportedto greatlyinfluencetheirqualityoflifeandimposephysical,psychological,andeconomicburdens.hence, strengtheningwomen sabilitytomanagesymptomsduringthemenopausaltransitioninculturally competentwaysisimperativeforthehealthandwellbeingofmorethan40millionmidlifewomeninthe U.S. lxiii AboutPhytoestrogens Phytoestrogensoccurnaturallyinplantsandactlikeestrogensinsometissues,includingboneand cardiovasculartissue.somebotanicalproducts,suchassoyandredclover,containphytoestrogens.plants richinphytoestrogenshavebeenstudiedfortreatingmenopausesymptoms.however,muchremainsto belearnedabouttheseplantproducts,includingtheireffectsinthehumanbody.doctorscautionthat certainwomenneedtobeparticularlycarefulaboutusingphytoestrogens,especially: Womenwhohavehadorareatincreasedriskfordiseasesorconditionsthatareaffectedbyhormones, suchasbreast,uterine,orovariancancer Womenwhoaretakingmedicationsthatincreaseestrogenlevelsinthebody,suchasbirthcontrolpills; menopausalhormonetherapy;oratypeofcancerdrugcalledselectiveestrogenreceptormodulators (SERMs),suchastamoxifen. ThompsonsaidthatwhenawomanistakingHRT,thebodywillconfuseHRTandthyroidhormonehence therewillbemorethyroidfloatingaroundintheblood.thyroidhormonewillbeoverabsorbedbecause thereceptorsiteisthesameforthyroidhormoneandestrogen.shealsobelievesthatthisproblemwill Menopause,DevaKhalsa 22

self correctinsixmonthsasreceptorsitesdecrease.initiallythiscouldaccountfortheweightgainand fatigueofawomanonhrt.shesaidathyroidglandularfromanimalsforthefirst6monthswouldhelpto counteractthisissueandbegintoproducet3andt4inhersystem.shealsosuggestedkelp,whichisrich iniodinetosupportthethyroidglandtoproducemorehormones. lxiv DHEA DHEAisanaturallyoccurringsubstancethatischangedinthebodytothehormonesestrogenand testosterone.dheaismanufacturedandsoldasadietarysupplement.afewsmallstudieshave suggestedthatdheamightpossiblyhavesomebenefitforhotflashesanddecreasedsexualarousal, althoughsmall randomizedcontrolledtrialshaveshownnobenefit.becauselevelsofnaturaldheainthe bodydeclinewithage,somepeoplebelievethattakingadheasupplementcanhelptreatorprevent conditionsrelatedtoaging;however,thereisnoscientificevidencetosupportthisnotion. ConcernshavebeenraisedaboutwhetherDHEAissafeandeffective.Itslong termeffects,risks,and benefitshavenotbeenwellstudied,anditremainsunclearwhetheritmightincreasetheriskforbreast orprostatecancer.thereisthepossibilitythatevenshort termuseofdheasupplementsmighthave detrimentaleffectsonthebody.beforeusingdheaforanypurpose,peopleshouldtalktotheirhealth careprovideraboutpotentialbenefitsandrisks. lxv Eachwoman smenopauseexperienceisdifferent.thegreatestdifferencesobservedarebetween womenwhohavenaturalmenopauseandthosewhosemenopauseisearlyorinduced,whichtypically requiresspecializedcare.manywomenwhohavenaturalmenopausereportnophysicalchangesatall duringtheperimenopausalyearsexceptirregularmenstrualperiodsthateventuallystopwhen menopauseisreached.inadditiontoirregularmenstrualperiods,somewomenexperiencesymptomsof hotflashes,difficultysleeping,and/orvaginaldryness.theseverityofthesechangesvariesfromwoman towoman,butforthemostpart,theyareperfectlynaturalandnormal.infact,someexpertsandwomen prefernottocallperimenopausalchanges symptoms, atermusuallyreservedtodescribediseases. lxvi Menopause,DevaKhalsa 23

HRTforhotflashes Hotflashesareoneofthemajorreasonsthatwomenturntoestrogen replacementtherapyorhormone replacementtherapywhichisacombinationofestrogenandprogestin. lxvii Thebesttreatmentdependsonhowseverethehotflashesare,howmuchtheyinterferewithawoman s qualityoflife,herpersonalphilosophyandpreferences,andherhealthprofile.iftreatmentisneeded,hot flashescanusuallybereducedoreliminatedcompletelywithlifestylechanges,nonprescriptionremedies, andprescriptiontherapies.systemicestrogentherapyistheonlytherapyapprovedbytheu.s.foodand DrugAdministration(FDA) andhealthcanada fortreatinghotflashes. lxviii Someexpertssuggestthattakingestrogenasatherapymaynotcreatethesamebeneficialeffectsasthe estrogenproducedbyyourbody.continuousexposuretohrt,takenatthesamedosedayafterdaycan leadtoadesensitizationofthetargetcells,thecellscanclosetheirdoorstomoreestrogenenteringby decreasingthenumberofestrogenreceptorsavailable,anaturaladjustmentcalleddown regulation.we canunderstandthisasthebody sinnerintelligencetellingitthatthisamountofhormoneisunnatural andunhealthyandthecellsadjustaccordingly. lxix Ifyougiveawomansyntheticestrogen,hermenstruationcanreturn,orshemaydeveloppitta symptoms,becauseestrogenispittaprovoking.inaddition,thereisthepossibilityofcancer.itismore balancingtousenaturalherbalestrogen,whichispresentinshitavari,gaduchiandaloeveraastheseall decreasepitta. lxx Recently(Dr.Lonsdorf s2004book)ultralow doseestrogen(1/4oftheusualdose)wasfoundto significantlyincreasebonedensityinpostmenopausalwomenwithoutanyreportedsideeffectsinthree years.whetherthatwilltranslatelong termintofewerfracturesandanabsenceofsideeffectsisyetto bedetermined.inwomenwithovariesintact,anyamountofestrogentakenastherapyisstillmorethan thebodyismakingnaturally asetupforlongtermsideeffects. Menopause,DevaKhalsa 24

DIET TheAstangaHrdayamclaimsthattwentydiseasesofthevaginaarisebecauseofconsumingbadfood. lxxi IntribalandruralIndia,womenlivingsimple,low stresslivesrarelyhavemenopausalsymptoms.physical exertionandadietoffreshfoods(especiallywildyam),grainssuchasquinoaandamaranth,andspices withestrogeniceffectsallhaveamodulatingorbalancingeffectonfluctuatinghormonelevels. lxxii AMA&HotFlashes Ifawomanhasmoderatetoseveresymptoms frequenthotflashes,insomnia,jointpains,painful vaginaldryness,extrememoodswings andthenitspossiblethatshehasblockagesthatarecausingher symptoms.theseblockagesaretheresultofamaormetabolicwastesandtoxinsthathavebuiltupinthe tissues. lxxiii Whendigestionfailstobreakdownyourfoodcompletely,largerthannormalfoodparticlesare permittedtoenterthebloodstreamandcirculatetotissues.thesemisshapenfoodparticlesare permittedtoenterthebloodstreamandcirculatetothetissuesuntiltheylodgeinnarrowpassageways andgetstuck,cuttingoffchannelsthatwouldotherwisecarrynutrientsandhormonesintoyourcells. Thisblockingofhormonedeliveryandnutrientsisanimportantwayinwhichamaleadstomoreextreme symptomsofmenopauseandtodegenerativeconditionsinlaterlife.thehormonescannotreachorbind withtheappropriatecells.thisiswhysoyproductsandevenhormonereplacementtherapydoesnot relieveawoman shotflashesorothermenopausalsymptoms.thesoyorhormonemoleculesjustnever connectwiththecellsthatneedthem.thisisindicativethatcleansingisnecessary. lxxiv OneofDr.Lonsdorf smentorsdescribeshotflashesinthisway:whenthechannelsarecloggedwith wastes,thepittafrommetabolismbuildsupinthetissues.theexperienceisaflashingofthesudden surgeofheatandflushingasthebodytriestodissipatethebuildup.tocoolthisdown,pittaneedstobe pacifiedbutthetissuesalsoneedtobeclearedofchannel obstructingamasotheheatcanflowout.the mentorrecommendedapure,simplecleansingdietandherbstocleartheamaandresolvethesymptoms quickly. lxxv Menopause,DevaKhalsa 25

VataDiet Vatapacifyingdietemphasizestheuseofthesweettasteasitistonicandhelpstosupportallofthe dhatusandojas. lxxvi Vatadietwouldconsistofmainlywarm,cooked,wholesomefoodsateachmeal.Reservesaladsandraw vegetablesforthesidedishes.avoidcolddrinksandiceddesserts. lxxvii Thompsonrecommendsheavy, moistdensefoodstopacifyvataandtobuildrasadhatu.shealsorecommendsincreasingoilssuchas flax,sesameorgheeupto1tbsppermealinadditiontothecookingoil.thompsonsaysthatshemust havejataragni(goodtissuedigestivefire)orcannotdigesttheoilsandwillgetmoreamainthe system. lxxviii PittaDiet ThebesttasteforbothVata/Pittaisthesweettaste.Thisiscool,moist,heavyandstabilizing allquantities thatbenefitthiscondition.thebittertastethoughcooling,shouldbeavoidedastheairandetherthat makeupthetastefurtheraggravatevatadosha. lxxix Pittadietwouldbetoavoidprocessedfoods,cheese,yogurt,junkfoods,redmeat,hotspices,alcohol, caffeine,vinegar,sugarandfriedfoods.eatorganicwholesomefoodswithlotsoffreshvegetables,sweet, juicyfruitsanddrinkplentyoffreshpurewater. lxxx KaphaDiet AVata/Kaphapacifyingfoodprogramemphasizeswarm,spicyfoodthatincreasesagni(digestivefire)and improvesdigestion.sweet,nourishingfoodspreparedwithwarmingspicesshouldbetakeninsmall quantitiesonaregularbasis3 5Xperdaywillresultinslowweightloss.Inordertoraiseagni,stronger spicessuchastrikatucouldbetakenwithmeals. lxxxi Delicioushome cookedmealsforkaphawithplentyoflegumes,wholegrainslikebarleyandcooked vegetablesspicedgenerouslywiththyme,basil,mint,oregano,cumin,turmeric,freshgingerandblack pepper.avoidredmeat,dairy,colddrinksandsugar. lxxxii MaryThompsonrecommendsmenopausalwomentoeatinaccordancewiththeirappetiteandnotwith theirhistory.watchportionsizewillhelppreventover eating.toaskherselfthisquestion;whatisthe rightamountoffoodforthisbody? Menopause,DevaKhalsa 26

CONCLUSION ClaudiaWelchputsitperfectly; Wecanhaveamuchsmoothermenopauseifwehaveestablished healthyhabitsearlier. lxxxiii Headingintomenopausealreadydepletedisacausativefactorofhotflashes plusothermenopausalsymptoms.cleansingalsoplaysalargeroleinreducingandpossiblyeradicating menopausalsymptoms.oneofthedoctorsinmyresearchmakesacorrelationbetweenpmsand Menopausalsymptoms.Increasingojas,strengtheningthebodywithdoshicappropriatediet,good healthyroutinestogroundvatainthistimeoftransitionandreducingamawithcleansingcanhelpto reducesymptoms. Mygoalinwritingthispaperwastoshowtheconnectionbetweenmenopause,rasa,ojasandhotflashes. Iwasabletofindabundantinformationontheconnectionbetweendepletedojasandhotflashes. Researchondepletedrasaandhotflasheswaslimited. Menopause,DevaKhalsa 27

Endnotes i Pro.K.R.SrikanthaMurthy,AstangaHrdayamVolI,(GovernmentCollegeofIndianMedicine,Bangalore, PublisherKrishnadasAcademy,Varanasi,1995),section2,verse21b 22ap.363 ii P.V.Sharma,CarakaSamhitaVolII(chowkambaka),Ch.XXX,p.502,verses1 40 iii NationalCenterforComplementaryandAlternativeMedicine,MenopausalSymptomsand ComplementaryHealthPracticeshttp://nccam.nih.gov/health/menopause/menopausesymptoms iv ClaudiaWelch,p.115 v Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine(SixthEdition),Vol.II(GrassValley,California CollegeofAyurveda,2008)p.6 35 vi Welch,p.113 vii Dr.SatDharamKaur,ND,Dr.MaryDanylak Arhanic,MD,Dr.CarolynDean,ND,MD,TheComplete NaturalMedicineGuidetoWomen shealth(toronto:robertroseinc.publishingco.,2005),p.274 viii ChristianeNorthrup,M.D.,Women sbodies,women swisdom,(newyork:bantambooks,2006),p. 551 ix Dr.ClaudiaWelch,MSOM,BalanceYourHormones,BalanceYourLife(Cambridge,DaCapoPress, 2011),p.115 x ChristianeNorthrup,M.D.,Women sbodies,women swisdom,(newyork:bantambooks,2006),p.574 xi TheNorthAmericanMenopauseSociety,ExpertAnswerstoFrequentlyAskedMenopauseQuestions. http://www.menopause.org/expertadvice2.aspx#hotflashes xii Dr.ClaudiaWelch,MSOM,BalanceYourHormones,BalanceYourLife(Cambridge,DaCapoPress, 2011),p.115 xiii Dr.SatDharamKaur,ND,Dr.MaryDanylak Arhanic,MD,Dr.CarolynDean,ND,MD,TheComplete NaturalMedicineGuidetoWomen shealth,(toronto:robertroseinc.publishingco.,2005),p.274 xiv KarenA.Matthews,Ph.D.andJoyceT.Bromberger,Ph.D. SymptomsandHealth RelatedQualityof LifeandtheMenopausalTransition (Bethesda:NIHState of the ScienceConferenceonManagementof Menopause RelatedSymptoms,March21 23,2005WilliamH.NatcherConferenceCenter,National InstitutesofHealth),p.39 xv ChristianeNorthrup,M.D.,Women sbodies,women swisdom,(newyork:bantambooks,2006),p. 549 xvi Dr.ClaudiaWelch,MSOM,BalanceYourHormones,BalanceYourLife(Cambridge,DaCapoPress, 2011),p.116 xvii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page6 xviii ChristianeNorthrup,M.D.,Women sbodies,women swisdom,(newyork:bantambooks,2006),p. 551 xix Dr.ClaudiaWelch,MSOM,BalanceYourHormones,BalanceYourLife(Cambridge,DaCapoPress, 2011),p.116 xx Dr.ClaudiaWelch,MSOM,BalanceYourHormones,BalanceYourLife(Cambridge,DaCapoPress, 2011),p.117 xxi NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page7 xxii Pro.K.R.SrikanthaMurthy,AstangaHrdayamVol.III,(GovernmentCollegeofIndianMedicine, Bangalore,PublisherKrishnadasAcademy,Varanasi1995)section6,chapter33,verse23,p.320 xxiii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page46 xxiv Dr.DavidFrawley,AyurvedicHealing,AComprehensiveGuide(SaltLakeCity:PassagePress,1989)p. 208 xxv Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008)p.6 39 xxvi Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),p.6 37 Menopause,DevaKhalsa 28

xxvii Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),p.6 39 xxviii Pro.K.R.SrikanthaMurthy,AstangaHrdayamVol.III,(GovernmentCollegeofIndianMedicine, Bangalore,PublisherKrishnadasAcademy,Varanasi1995)section6,verse22,p.320 xxix Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),p.6 39 xxx NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page46 xxxi Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),p.6 39 xxxii Dr.DavidFrawley,AyurvedicHealing,AComprehensiveGuide(SaltLakeCity:PassagePress,1989)p. 208 xxxiii Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),p.6 39 xxxiv Dr.DavidFrawley,AyurvedicHealing,AComprehensiveGuide(SaltLakeCity:PassagePress,1989)p. 208 xxxv NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page47 xxxvi NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page51 xxxvii VaidyaBhagwanDash,MateriaMedicaofAyurvedaBasedonAyurvedSaukhymaofTodarananda (NewDelhi,NaurangRaiConceptPublishingCo.1980),p. XXXIX XLintroduction xxxviii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page100 xxxix NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page86 xl Dr.VasantLad,M.A.Sc.,TextbookofAyurveda,AcompleteGuidetoClinicalAssessment,Vol.2 (Albuquerque:TheAyurvedicPress,2006),p.239 xli MaryThompson,FemaleReproductiveHealthlecture,CaliforniaCollegeofAyurveda,January25,2012, webex xlii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page101 xliii Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),p.6 39 xliv Dr.VasantLad,TextbookofAyurveda,FundamentalPrinciplesofAyurveda,(Albuquerque:The AyurvedicPress,2002),p.148 xlv NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page68 xlvi NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page101 xlvii Dr.VasantLad,M.A.Sc.,TextbookofAyurveda,AcompleteGuidetoClinicalAssessment,Vol.2 (Albuquerque:TheAyurvedicPress,2006),p.314 xlviii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page97 98 xlix Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),P.6 39 l SwamiSadaShivaTirtha,TheAyurvedaEncyclopedia(Bayville,NY:AyurvedaHolisticCenterPress,1998) p.508 li Dr.DavidFrawley,AyurvedicHealing,AComprehensiveGuide(SaltLakeCity:PassagePress,1989)p. 207 8 lii Dr.DavidFrawley,AyurvedicHealing,AComprehensiveGuide(SaltLakeCity:PassagePress,1989)p. 207 8 liii SwamiSadaShivaTirtha,TheAyurvedaEncyclopedia(Bayville,NY:AyurvedaHolisticCenterPress, 1998)p.508 liv Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),p.6 39 Menopause,DevaKhalsa 29

lv Dr.VasantLad,TextbookofAyurveda,FundamentalPrinciplesofAyurveda,(Albuquerque:The AyurvedicPress,2002),p.148 lvi Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008)p.6 39 lvii Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008)p.6 39 lviii Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008)p.6 38 39 lix SebastionPole,AyurvedicMedicine,ThePrinciplesofTraditionalPractice(Philadelphia,PA:ElsevierLtd, 2006),p.242 lx NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page109 110 lxi Eun OkIm,BokimLee,WonshikChee,AdamaBrown&SharonDormire, MenopausalSymptoms AmongFourMajorEthnicGroupsintheU.S WestJournalNursRes.(2010June)32(4):540 565 lxii KarenA.Matthews,Ph.D.andJoyceT.Bromberger,Ph.D. SymptomsandHealth RelatedQualityof LifeandtheMenopausalTransition (Bethesda:NIHState of the ScienceConferenceonManagementof Menopause RelatedSymptoms,March21 23,2005WilliamH.NatcherConferenceCenter,National InstitutesofHealth)p.38 lxiii Eun OkImmBokimLee,WonshikChee,AdamaBrown&SharonDormire, MenopausalSymptoms AmongFourMajorEthnicGroupsintheU.S WestJournalNursRes.(2010June)32(4):540 565 lxiv MaryThompson,FemaleReproductiveHealthlecture,CaliforniaCollegeofAyurveda,January25, 2012,webex lxv NationalCenterforComplementaryandAlternativeMedicine,MenopausalSymptomsand ComplementaryHealthPracticeshttp://nccam.nih.gov/health/menopause/menopausesymptoms lxvi TheNorthAmericanMenopauseSociety,ExpertAnswerstoFrequentlyAskedMenopauseQuestions. http://www.menopause.org/expertadvice2.aspx#hotflashes lxvii Dr.ClaudiaWelch,MSOM,BalanceYourHormones,BalanceYourLife(Cambridge,DaCapoPress, 2011),p.117 lxviii TheNorthAmericanMenopauseSociety,ExpertAnswerstoFrequentlyAskedMenopause Questions.http://www.menopause.org/expertadvice2.aspx#hotflashes lxix NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page170 lxx Dr.VasantLad,TextbookofAyurveda,FundamentalPrinciplesofAyurveda,(Albuquerque:The AyurvedicPress,2002),p.148 lxxi Prov.K.R.SrikanthaMurphy,AstangaHrdayamVol3(KrishnadasAcademy),Ch.33,verses27b,p.310 lxxii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page7 lxxiii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page82 lxxiv NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page86 lxxv NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page89 lxxvi Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),P.6 38 lxxvii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page60 lxxviii MaryThompson,FemaleReproductiveHealthlecture,CaliforniaCollegeofAyurveda,January25, 2012,webex lxxix Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),P.6 39 lxxx NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page60 lxxxi Dr.MarcHalpern,TextbookofClinicalAyurvedicMedicine,(SixthEdition)Vol.2(GrassValley,CA: CaliforniaCollegeofAyurveda,2008),P.6 39 lxxxii NancyLonsdorf,MD,TheAgelessWoman,(MCDCenturyPublications,2004),page60 Menopause,DevaKhalsa 30