Nastapushpa/Nashtaarthava (Premature Ovarian Failure)

Written by: Vaidya Vibhuti Rao

Early menopause is not accepted by many women. Specially for women who are trying to conceive this diagnosis is not less than a nightmare. Nashtapushpa is a disease mentioned in Ayurveda where a woman has stopped having periods or ovulation or both of them together. Pushpa here means- menstrual blood or egg formation. Surprisingly, we are seeing many young women with POF. Suddenly they stop having periods or their cycle become irregular and they get periods only with hormones. Women as young as 21 years old are having this. The bad genes, sedentary lifestyle, increased stress level, poor immunity and toxin environment are to be blamed. Are we are losing a generation? 

What modern medicines says- 
Medically, POF/POI- Premature Ovarian insufficiency is a clinical syndrome defined by loss of ovarian activity before the age of 40. In this woman has menstrual disturbances (either no periods from pasr 4 months or very less frequent periods). In laboratory tests she has raised gonadotropins (FSH more than 25 IU/l)  and low estradiol. ​Women think that POF means menopause has occurred and now, there is no cure for it.Remember, menopause is a natural process and not the abnormal one. Around 45-50 years women’s ovarian hormones fall. So, if you stop having periods or ovulation before the age of 40 years, its not menopause but an abnormal ovarian function. In a Korean study, low socio-economic status was related to high number of POF cases. In a recent research review, it was suggested that there are chances (2-14%) to fall pregnant with POF if the women is of age 30 years.

For menopause there is no reason as it is a normal process of body, similarly to the way you get your first periods -you get your last periods too. But POF, has reasons and is not expected to happen before your menopausal age.

You don’t have enough follicles in your ovaries- In POF your FSH hormone levels increases significantly because of low estrogen in the body. Low estrogen is caused by low/no follicles in the ovaries. Less follicles in the ovaries- less estrogen levels-high FSH levels

There are disturbances in ovarian functions- There is a possibility that you may have follicles in your ovaries but they are not working well due to various reasons. They have stopped listening to your brain. If you have any autoimmune problems such as autoimmune thyroid issues or rheumatoid issue etc, there are chances that you may be suffering with ovarian dysfunction.

How can you avoid POF?
There are lot of reasons of POF. Out of them some are not in your control such as environment toxins, Pollution, genetics etc. But there are some factors you can certainly avoid and avoid having POF. Such as-

• Having a healthy lifestyle
• Being physically active
• Having a routine
• Buying organic and non-GM foods.
• Growing your own vegetables and fruits.
• Following meditation or mindfulness practices
• Eating green leafy vegetables
• Eating in moderation and eating all variety of food
• Avoid use of chemicals in toothpaste, shampoo, soap, foods, deodorants, paints, beauty products etc.

How do you know if you have POF?
A patient had come to me a while ago saying that she has PCOS and have been suggested for laparoscopic surgery to remove those cysts. She was on fertility treatment- injections and hormones intake form last one year and also had tried IUI. There was no success. After seeing her reports, I came to know that it is not PCOS, and likely to be nastapushpa. She was getting her periods for one year as she was on hormones. Before that her periods were irregular. Now after stopping hormones, again her periods are not coming in time and coming once in 2-3 months. She compliant of vaginal dryness, itching, loss of libido, mood swings and hot flushed at night.  These were not PCOS symptoms. I checked her FSH levels which came very high and very negligible AMH levels (0.01ng/ml.)

I explained her that she needs an expert opinion on this. After two weeks, she came back to me saying that her diagnosis of PCOS was wrong and she has been diagnosed with POF. And doctors are suggesting donor egg IVF. She was devastated. She asked me “will I never get my periods back? Will I never have my own baby?”. Looking at her age (she was 28 years old) I suggested to undergo Ayurveda treatment and have healthy lifestyle. Either she could sit at home and cry with this diagnosis or she can get up with head high and take treatment for it. 

She wanted some hope. She wanted to fight with her problem. As a doctor, I told her that we should never leave hopes of recovery even if we know that it is impossible. And Ayurvedic medicines works wonder when given and taken properly. So many at times, the diagnosis is not done properly. Do not self-diagnose yourself. Got to an expert and know your condition. It is better to act when you start having irregular cycles. After one year of treatment, she had a spotting on regular interval (monthly) and flow also increased slowly. She feels better about herself- those menopause symptoms are very less. She still has not conceived but I am hoping to continue her treatment and help her further. Her hormones are looking better also. But it has a long way to go for conceiving. I have other patients with similar problems and saw quick results compared t other patients.  So it depends on case to case.

How Ayurveda may Help-
Yes, Nastapushpa is a challenging problem. Ayurveda has suggested a treatment line for it, if a woman come to Ayurvedic doctor in initial stage of her problem rather than coming very late. She may have to take the treatment for a longer duration (at least more than a year) with regular counselling sessions and lifestyle changes.
Panchakarma- Depending on the condition of the disease and patient, it is recommended to conduct 5 cleansing procedure before starting nay treatment. Vamana-Virechana- Two types of Basti and Nasya Karma, all these have special role to play in helping women. You need to consult your local Ayurvedic doctor and undergo these procedures. Basti karma is highly important and may be given frequently along with Nasya karma.

Ayurveda lifestyle-

• Regular oil massage is suggested.
• Avoid caffeine
• Avoid use of plastic
• Use all 6 taste food and eat at regular interval
• Eat easily digestible home cooked food only
• Moderate exercise is suggested. Avoid going to Gym.
• Practice Yoga and meditation
• Have a sound sleep

 
Ayurvedic medicines –

• Fennel seeds
• Cumin seeds
• Garlic
• Sesame seeds
• Rasayana drugs- guduchi, ashwagandha, shatavari, Kumari, Gugglu formulas may be effective if taken for longer terms.

Final words: I know it is hard. I have seen broken marriages or relationships because of such cases and I have seen strong marriages too. It depends on you how to take your diagnosis. Chose a path which leads you to your success. Never be dishearten. Take care and you will win over your problem.
Namaskara,
Vaidya Vibhuti Rao
References: 
https://webofproceedings.org/proceedings_series/ALSMB/ICBSIS%202019/ICBSIS1904.pdf
https://www.sciencedirect.com/science/article/abs/pii/S0378512218306832
https://www.rbmojournal.com/article/S1472-6483(19)30396-7/abstract