The moon, the tides of the ocean and woman, these three cycle together each month. A woman’s monthly bleeding sets her apart from all other females, none of whom have menstruation as part of their reproductive physiology. Mysterious and powerful, a woman’s cycle is a source of her deep connection to the moon and the cycles of nature. Yet all too often, her cycle is experienced as troublesome and painful rather than as enriching. One of the most important things an Ayurvedic practitioner can do in the care of a younger woman is to help her have a positive experience of her menstrual cycle. PMS and menstrual cramps rob a woman of the potential richness of this experience and can lead to her feeling negative about her femininity. This in turn can create worse problems such as malignancies in the reproductive system. 

Vata PMS
Vata type PMS manifests in stress, anxiety, insomnia, low back pain and constipation occurring during the week or ten days before the onset of menstruation. This condition is best dealt with by gentle vata soothing measures such as regular self abhyanga using organic sesame oil or Vata Massage Oil, and sweat therapy in a tub with one third cup of ginger root powder and one third cup of baking soda mixed in the warm water.  A basti using Dashamula tea can be done one week before menstruation, to ease both vata type PMS and vata dysmenorrhoeaTHis basti is best preceded and followed by oil basti.  For insomnia and anxiety, a good remedy is a teaspoon of Ashwagandha in a cup of warm cow’s milk or almond milk at bed time. For constipation, it may be sufficient to add a teaspoon or two of ghee to the Ashwagandha milk. An alternative choice is a half teaspoon of Sat Isabgol in warm water or milk at bed time.  Below are typical instructions we give out for home sweat and Dashamula basti.

Ginger/soda bath:

• 1/3 cup each of dried ginger & baking soda for each bathtubful of tolerable hot water (avoid excessive heat). Total amounts needed: dried ginger 1/3 cup baking soda1/3 cup
• Be sure the bathroom is warm—avoid getting chilled at any time.
• Have extra “oil” towels available.
• Soak after oiling and then get out when begin to sweat.
• Cover with towels and continue to sweat in the warm bathroom until you are beginning to cool down.

Basti

• At 7 pm or sunset time, instead of dinner prepare the recommended basti for that day,
  • Day 1 : 4 oz sesame oil, blood heat temperature (body temperature)
  • Day 2: Dashmula tea: 1 ½ pints pure water & 2 Tablespoons Dashmula tea. Simmer with lid on for 10 min. Then strain really well, through a silk cloth or coffee filter. Do not use the roots/powder portion in the enema bag, ONLY use the strained liquid. Then add ½ cup of warm sesame oil, mix & put in enema bag at blood heat temperature.
  • Day 3: 4 oz sesame oil again, blood heat temperature
• Prepare & warm up the bathroom or other location where you will be administering the basti.
  • Have towel handy for “diaper”, if needed to safely get to toilet.
  • Be sure you have a comfortable, cushioned place to recline during the basti. There may be some leakage while administering the enema, so have appropriate old towels etc under you (ie. Not your favorite blanket). Most people arrange a “nest” in the bathroom or bathtub.
  • You will want to have a place to hang up the enema bag – most have a hook or loop on the top which you can use directly on something or can put on a clothes hanger & then hook onto a towel rack or shower head, etc.
• After preparing the basti put it in the previously cleaned & air-dried enema bag
• Check the action of the bag while doing the previous cleaning – how to release the clasp; letting air out of the nozzle before insertion
• Lubricate the nozzle (part to be inserted in the anus) with sesame oil. Also lubricate your anus with sesame oil .Do not use KY jelly even if this is indicated in the instructions that come with your enema kit. ( KY jelly is a petroleum product.)
• Lie on your left side. Gently & slowly insert the nozzle (if it’s uncomfortable try another angle inward) Release the clasp holding the liquid in and allow it to flow slowly into the rectum. Lie on the left side for 10 minutes. Then move to lie on the back for 10 minutes. Then turn & line on the right side for 10 minutes. Trying to retain the enema for 30 minutes is ideal. If you feel like you aren’t retaining it, oil your belly and massage counter-clockwise for five minutes to help keep the basti in.
• When it has emptied from the bag, slowly remove the nozzle from your anus
• When the urge arises after 30 minutes, use the towel “diaper” under you to avoid leakage, and go to the toilet. Relax for awhile.
• It is not unusual for no oil to come out, especially with the first oil enema, and for vata people or situations. Do not be alarmed. The oil will be beneficial if your body has chosen to absorb it. You can just carry on with your day- maybe keeping a little pad or toilet paper in your underwear in case oil leaks out.
• Usually the tea enema will lead to some results. If not, inform your practitioner for further consultation. You can continue with the 3rd enema if s/he hasn’t gotten back to you yet, and stay on kitcheree until after talking with her/him.
• After the results, clean the toilet as needed and then take a shower
• Eat a small amount (1/2 -1 cup of very soupy kitcheree) with plenty of ghee, to keep the vata moving downward
• After 1 ½ to 2 hrs (when kitcheree has gone past stomach digestion) go to bed for the night

Pitta PMS
Pitta PMS can be a devastating problem that destroys lives and marriages. In its most severe form, it may be diagnosed as premenstrual mood disorder, also known as PMDD—premenstrual dysphoric disorder. Affecting 5% of women, PMDD expresses in moodiness or out of control anger outbursts during two weeks or before menstruation.  Depression, mood swings, suicidal thoughts, irritability and cravings for sweets and chocolate are typical pitta symptoms that mark this disorder. Matters are only made worse when the woman blames herself or experiences blame from family members. One woman says, “Only after menopause did I fully realise the devastating impact PMDD had exerted on my life. Once my hormones were no longer cycling I realised that I was in fact a very patient and well balanced person who had been blamed for a physical ailment that did not reflect my true personality.” PMDD is a serotonin-related imbalance treated in Western medicine with SSRI anti-depressants. Hence it will respond well to either Brahmi or Bacopa, both of which elevate serotonin levels. In addition, the underlying pitta condition can be managed with Shatavari Kalpa.  Roast an ounce of Shatavari with one or two tablespoons ghee in a cast iron pan until light brown and add two tablespoons of sucanat, rapadura or turbinado sugar, two pinches saffron and a pinch of cardamom. A teaspoon of this recipe can be taken in the morning to prevent tikshnagni and provoked pitta. For tender breasts, another typical symptom of pitta PM S, breast massage with Organic Coconut Oil or Breast Balm can be extremely helpful.

In addition to these herbal remedies, a strict pitta-pacifying diet should be followed, with especial care to avoid nightshades such as eggplant and tomato sauces.   PMDD may be a result of our unnatural indoor lifestyle which does not expose us to natural alternations of light and dark.  Moon bathing and moonlight strolling can be helpful for this condition. If possible, the woman should place the head of her bed near a skylight or large window so she can get exposure to moonlight and be influenced by the moon’s cycle while sleeping, as her ancestors were.

When PMDD manifests as a significant illness, pancha karma will help speed the rate of recovery. An appropriate PK regime for pitta should be followed, including abhyanga with Pitta Massage Oil, virechan (purge) with either castor oil or a larger-than-usual dose of Amlaki and basti with Guduchi in place of Dashamula

Kapha PMS
Bloating, fluid retention, crying, weepiness, fatigue and lethargy characterise kapha PMS. This condition can be helped by a kapha soothing diet with emphasis on salt reduction, and by Punarnava, half a teaspoon twice daily mixed in honey, which will have a mild diuretic effect and will in addition soothe kapha. Triphala or Bibhitaki will also be of help in balancing kapha, reducing toxins and limiting fatigue.

Vata Dysmenorrhoea
Vata dysmenorrhoea consists of intense cramps which occur before the onset of bleeding or when the bleeding is still only light. Such cramps can be severe and disabling. Yogaraj Guggulu is an excellent remedy for this condition and should be taken daily throughout the cycle as the intention is not just for immediate relief of pain but to pacify the underlying vata. Alternatively, and more suitable for an underweight vata, a combination of Ashwagandha and Vidari will help to reduce menstrual cramps and regulate the menstrual cycle. Again, this remedy should be taken all month long as the intention is to calm vata systemically rather than to act as an alternative to Ibuprofen.  As mentioned in context of vata PMS, Dashamula basti can be done a week before the onset of menstruation and can help calm the vata so that cramps are lessened. At that time, it can also be helpful to do a Dashamula douche with some of the same decoction. This can help remove vata from artava dhatu. Supported supta vajrasana is an excellent yoga pose for menstrual cramps. With adequate support, it is possible to remain in this position for as much as twenty minutes, with great relief. A woman who suffers every month from intense cramps will be likely to get significant relief by doing pancha karma, with emphasis on internal oleation, abhyanga with Vata Massage Oil  and sesame oil and Dashamula bastis. 

Pitta Dysmenorrhoea and Menorrhagia
 Pitta dysmenorrhoea and menorrhagia go hand in hand as manifestations of excess pitta in the system. Because of the sara (creeping)nature of pitta, excess ranjak pitta can overflow from the liver and collect in the pelvic cavity, causing excess menstrual bleeding and pitta type cramps. Symptoms of pitta dysmenorrhoea include tenderness and cramps which occur when the flow is at its heaviest. Symptoms of menorrhagia include soaking through a pad or tampon each hour or less or needing to use double protection, passing large clots, being woken at night by excess flow, and feeling breathless or dizzy during the flow as a result of excess bleeding.  Causes of menorrhagia can be complex and multifactorial. Sometimes HRT can provoke pitta causing excess bleeding. EDS, a genetic disorder in which the mridu (soft) quality of pitta is in excess can lead to heavy menstrual bleeding as well as easy bruising. Vitamin K deficiency can be caused by pitta provoking medication such as aspirin as well as by malabsorption conditions such as celiac syndrome. Von Willebrands disease is a little known bleeding disorder characterised by excess menstrual bleeding, easy bruising and frequent and prolonged nosebleeds. Iron deficiency is both an effect and a cause of menorrhagia since when serum iron is low the blood vessels are unable to constrict effectively to stop the bleeding.

Aloe vera is the anupan of choice for pitta dysmenorrhoea and menorrhagia. Guduchi will help address the root cause of menorrhagia in the excess ranjak pitta, Shatavari will support healthy balance of hormones and reduce pitta throughout the system, Ashoka is an excellent remedy for excess bleeding and menstrual cramps and Rose is astringent and reduces excess bleeding. Hibiscus will also balance the female reproductive system and reduce pitta, so Rose and Hibiscus tea with a touch of cinnamon, a warming emenogogue, can be an excellent beverage for pitta menstrual symptoms.  Musta is an herb of choice for pitta PMS and pitta cramps and will also help with yeast infections. Containing many of these pitta soothing herbs, Women’s Support is a good all purpose women’s formula that can bring relief for dysmenorrhoea and menorrhagia.

Moon salutations, shitali and gentle forward-bending poses can help bring relief for pitta dysmenorrhoea, menorrhagia and indeed for PMDD. The women cited earlier in context of PMDD notes that, “Although I had no choice about being irritable and upset, I still had a choice of how to deal with it. Eventually I learnt to run into another room before I yelled, and to do some shitali until I felt calmer. Then I could have some hibiscus tea or some warm milk with cardamom. These small victories gave me a sense of self respect and achievement even in the face of the mood disorder.”

Kapha Dysmenorrhoea
A dull ache, heavy, congested feeling, lethargy and fogginess characterise kapha dysmenorrhoea.  The kapha woman should avoid dairy products such as milk and cheese during her menstrual period and should concentrate on light, kapha reducing food such as fruits and vegetables. Unlike vata and pitta, who need to rest during menstruation, the kapha woman needs gentle, low impact exercise at this time, including flowing vinyasa and walking. This will stimulate circulation which will relieve much of the sensation of heaviness. As during kapha PMS, Punarnava in honey is an herb of choice. She can also try some emmenogogue teas such as Hibiscus tea, without the rose and with more cinnamon and a little ginger powder. Women’s Support may be very beneficial, especially if she has heavy bleeding or clots.  Hot packs such as castor oil packs or ginger packs can also give great relief to the feeling of congestion.

Ayurvedic support in terms of diet, yoga, home remedies and herbs offer women the life-changing opportunity to experience their moon cycle as life-giving rather than as negative. Even a devastating condition such as PMDD can be relieved by appropriate pitta soothing measures and nervine herbs. By reducing the amount of ill health and pain experienced before and during menstruation, the Ayurvedic practitioner can make a significant impact on a woman’s overall wellbeing and that of her family.

All products mentioned in this article are available from www.banyanbotanicals.com

Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at 303-786-7437 or by email at: info@alandiashram.org.

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