With the boomer generation heading into their late fifties and sixties, there are more menopausal and post-menopausal women around than ever before. Our understanding of this important phenomenon and of how to support women in all stages of menopause is thus an essential aspect of Ayurveda practice today. Yet menopause is a more difficult topic to approach because menopause is not an illness. Every woman, however healthy, will go through menopause sometime in her mid-forties to mid-fifties. This seemingly obvious point is key, if only because in allopathic medicine today, menopause is seen as a deficiency disease and is typically treated with hormone replacement therapy, a phraseology that pathologizes this natural process.
Within Ayurveda there are two fundamental traditions, which I like to call the father lineage and the mother lineage. The Father lineage, contained in the sutras and in the traditions of vaidya families, contains a wealth both of theoretical and philosophical teachings as well as specific approaches to every known pathology. The Mother lineage, held for generations by the grandmothers of the Indian subcontinent, includes recipes and home remedies that particularly address the support of natural processes such as pregnancy, birth, and menopause. Both lineages are of great value in menopausal support, depending whether actual pathology has entered into the process or not. For a healthy menopause, home remedies such as CCF Tea (cumin, coriander, and fennel) are of great value. Where dosha imbalances are affecting the progress of menopause, proper chikitsa must be applied.
What is a healthy menopause?
In an ideally healthy menopause process, a woman of the age of forty-five or over will begin skipping menstrual periods. She may notice some hot flashes or night sweats, particularly if she is pitta-predominant. Gradually her flow will become lighter, the number of days of menstrual bleeding will diminish, and menstrual periods will spread out and eventually cease. Once a woman has not experienced menstrual bleeding for a full year, she is said to have attained menopause. Although this picture of the menopause process is one of health rather than disease, we should still note that menopause is termed in common speech as "the change." In Ayurvedic terms, for even the healthiest woman, it is a vata process. Indeed, the menopause process announces the transition between the pitta and vata time of life. Typical vata symptoms include vaginal dryness, indecisiveness, insomnia, and a sudden onset of age-related mental decline—the famous "senior moment."
Supporting a Healthy Menopause
Support of a healthy menopause includes gentle rejuvenation of artava dhatu, the female reproductive system, as well as lifestyle measures for vata management. Women's Support is a good all-around formula that can be of value to women of any prakriti type. In addition, vata can be managed by self-massage using the indicated oil for the woman's constitution—Vata, Pitta, or Kapha Massage Oil. A weekly bath using dry ginger powder and baking soda will also help to calm vata. CCF tea contains natural phyto-estrogens that support healthy hormonal balance, while tea made from tulsi will ease the tendency toward “senior moments,” stress, and indecisiveness. For vaginal dryness, she can use a ghee medicated with shatavari, which can be applied locally to enhance lubrication. A gentle vata-soothing yoga practice is also of great help.
A woman going through menopause should be advised to shift her diet to focus on foods that provide positive nourishment. In general, there are three kinds of food we can put into our bodies—those that are good for us, those that are not harmful but not positively good, and those that are bad for us. A menopausal or post-menopausal woman can be counseled to focus on high-quality nutrition, emphasizing foods and teas that are wholly beneficial.
Perhaps the greatest support of all can be derived from women circling together to support and understand their body's process of change. Since ancient times, the new moon has been an occasion for women to gather to honor the cycles and seasons of their bodies. A women's menopause support group, accompanied by Ayurvedic teas and sesame snacks laced with shatavari, would be a wonderful addition to any Ayurveda practice.
Menopause with Vata Imbalance
Looking back on my own menopause, I can recall bursting into tears in the grocery store because I was unable to make a decision on what food to purchase for my cat! Adrenal stress is a typical feature of vata-imbalanced menopause. A woman whose menopause is affected by vata imbalance may also experience earlier onset of menopause (before age forty-five), clinically significant insomnia, impaired short-term memory, and emotional debility, as well as osteoporosis or osteopenia.
Supporting Menopause with Vata Imbalance
With the onset of vata menopausal symptoms, it will be beneficial to use either Women’s Natural Transition, or another formula that contains vidari, such as Women’s Support, Tranquil Mind, or I Sleep Soundly. For adrenal stress, impaired short-term memory, and indecisiveness, a tea made from equal parts tulsi and brahmi/gotu kola can be very beneficial, as can Mental Clarity. To support sleep, a teaspoon of ashwagandha in a cup of warm milk at bedtime will help ensure sound sleep. The soles of the feet can be massaged with Brahmi Oil at bedtime. Daily self-massage using Vata Massage Oil is essential, while regular basti using dashamula tea will help alleviate vata symptoms. Diet should be moist, well-cooked, and meal times should be regular.
Menopause with Pitta Imbalance
Pitta-imbalanced menopause can manifest with a range of symptoms from annoying to serious or even life-threatening. The most common symptoms are hot flashes and night sweats. Although hot flashes are not dangerous in any way, at their height they can be quite disruptive. My mother describes with horror an unforgettable hot flash that she experienced when driving—it was so severe that she had to pull over on the shoulder of the road. Night sweats are also troublesome because they can disrupt sleep, leading to fatigue and impaired functioning.
The next most common is a typical pitta peri-menopause pattern, where menstrual periods become more frequent, spacing to as little as twenty-one days apart. This estrogen-dominant pattern has an inherent danger in that it leads to more periods and a greater opportunity of developing deeper seated conditions. It can also lead to iron deficiency anemia, as the body does not have a chance to make up its iron reserves before bleeding begins again. Many pitta women also suffer from an apparent personality change. As levels of progesterone and then estrogen drop, the relative level of testosterone becomes greater. Hence a pitta-provoked menopausal woman may experience levels of anger, aggression, and a fighting spirit that are quite unfamiliar to both her and her partner. At worst, a pitta-imbalanced menopause may destroy a hitherto satisfying life partnership, although at best it can lead to a healthy integration of a woman's more assertive masculine aspect. Menorrhagia and uterine hemorrhage are the most life-threatening aspects of a pitta-imbalanced menopause, leading to iron deficiency anemia, protein deficiency and fatigue, and possible hospitalization and blood transfusion.
Supporting Menopause with Pitta Imbalance
As soon as a pitta woman notices indications of the onset of menopausal changes, she would be well advised to start using both Women's Support and Shatavari Kalpa (recipe below).
A pitta-soothing diet is essential at this stage, especially avoiding acidic foods such as eggplant and tomato sauce, as well as hot spices. These measures will help with regulation of the menstrual cycle to a more normal length and will ease hot flashes and night sweats. Pitta-soothing yoga such as Standing Forward Folds, Shoulder Stand, and Savasana will also be supportive. For anger and irritability, brahmi/gotu kola tea can be taken three times daily.
It can also be tremendously helpful for a woman in pitta-imbalanced menopause to have her own room to sleep in, especially if her moods are putting a stress on her relationship. During pitta menopause, she may well be up during the pitta time of night, both because of hot flashes and because of flashes of inspiration that lead her to journal, draw, and write poetry. It is helpful to have the space to follow her own altered rhythms at this time. For excess menstrual bleeding, a good choice is hibiscus tea with a little cinnamon. Ashoka is a star herb in any formula for excess menstrual bleeding since it is astringent, cooling, and pitta soothing. It is essential to give supplemental iron in menorrhagia, since low serum iron causes the blood vessels in the uterus to lose their capacity to constrict, further increasing menstrual bleeding. One method for supplementing iron is to make a paste from half a teaspoon of triphala and place it overnight in a cast iron vessel where it will absorb the iron. Triphala, in turn, will support iron absorption in the gastro-intestinal tract.
Shatavari Kalpa Recipe
Roast 1 ounce of shatavari with 1–2 tablespoons ghee in a cast iron pan until light brown. Then add 2 tablespoons of sucanat or turbinado sugar, 2 pinches saffron, and a pinch of cardamom, and eat 1 teaspoon three times daily.
Menopause with Kapha Imbalance
Although most women gain about ten pounds during the menopause process, kapha imbalanced women may gain significant amounts of weight, becoming overweight or obese. Their thyroid function may be affected by the hormonal changes of menopause, resulting in lowered metabolism and an inability to lose weight. Fibrocystic changes may occur in the breasts during peri-menopause, while fluid retention may also be an issue.
Supporting Menopause with Kapha Imbalance
Nutritional counseling is essential for any kapha woman over forty, for weight once gained will be hard to lose. Most essential is avoidance of starchy foods during the kapha time of the evening. Dinner should consist of soup, vegetables, or salad. To make this work, a good lunch is needed, although even at lunch, kapha must understand that a portion of rice or other starchy foods should be half a cup. Refined sugars should also be avoided, and a kapha-soothing diet implemented. Exercise is essential and is particularly useful during the kapha time of morning—a good time for yoga, as well as the kapha time of night, when a brisk walk is in order. Women's Support will help maintain hormonal balance while Trim Support will enhance and support the thyroid function. For swollen, painful breasts, or fibrocystic changes, it is helpful to support the breasts with daily breast massage with Breast Balm. Punarnava is a great herb for supporting normal fluid retention and overall kapha balance.
Embracing the Transition
Menopause is a time of death and rebirth. The childbearing years are over and the season of elderhood is on its way. Women in the menopause process need the opportunity to mourn their lost youth and fertility, a process that is particularly painful for a woman who has not had children or has lost pregnancies. Brahmi/gotu kola tea may be of great support in the grieving process that accompanies this death and rebirth. Ritual is also of great benefit.
Although it may seem embarrassing to some to have a "menopause party," a fiftieth birthday celebration can be turned into a ritual honoring the transition from the mother to grandmother stage of life. Even age-related mental decline may not be what it at first appears. One kind of functioning diminishes to make way for another, in this case a more reflective and intuitive way of thinking. Women elders may not be as quick as when they were younger, yet great wisdom can be harvested from an elder's mind. Our thinking becomes less linear and more holistically oriented. A good practitioner will help women not only mourn what they are losing but also celebrate what they are embracing. Menopause is a natural process for the good of the whole, because women elders and their unique wisdom are needed to guide the human community.