Dysmenorrhoea in Ayurveda: Therapeutic Approaches

Dysmenorrhoea, characterised by painful menstruation, is a common gynaecological complaint that can adversely affect physical functioning, psychological well-being, academic performance, and occupational productivity. Globally, approximately 90% of adolescent females and more than 50% of menstruating women have been reported to experience dysmenorrhoea, with 10-20% describing severe symptoms.

In Ayurveda, painful menstruation is referred to as Kashtartava and is understood primarily through the involvement of Vata Dosha. Various dietary recommendations, lifestyle modifications, herbal formulations, and therapeutic procedures have been described for its management. Their clinical application should be guided by individual assessment and consideration of the available evidence.¹ 

Understanding Kashtartava in Ayurveda 

The term Kashtartava is derived from Kashta, meaning painful or difficult, and Artava, referring to menstrual flow. The expression Kashthena Muchyati Iti Kashtartava describes menstruation that is expelled with considerable difficulty and pain. Similarly, the term dysmenorrhoea is derived from Greek roots denoting difficult or painful menstrual flow. 

Although Kashtartava is not consistently described as an independent disease in classical Ayurvedic texts, menstrual pain has been discussed under conditions such as Kukshishoola (abdominal pain), Vatala Yoni, and Udavartini Yonivyapad. According to Acharya Charaka, the involvement of vitiated Vata Dosha is considered fundamental to the pathogenesis of gynaecological disorders. Suppression of natural urges (Vegavarodha) and inappropriate lifestyle practices are believed to aggravate Apana Vayu, causing its abnormal upward movement and obstructing the normal downward flow of Raja (menstrual blood). Pain and discomfort during menstruation are consequently attributed to this disturbance. 

Clinical classification and risk factors 

Dysmenorrhoea is classified into primary and secondary forms.  

• Primary dysmenorrhoea occurs without identifiable pelvic pathology, usually developing within 1-2 years of menarche as ovulatory cycles become established. Cramping suprapubic pain generally begins shortly before or after menstrual bleeding starts and lasts approximately 48-72 hours. Associated symptoms may include lumbosacral backache, pain radiating to the anterior thighs, nausea, vomiting, diarrhoea, and, occasionally, syncope. 

• Secondary dysmenorrhoea is associated with underlying pelvic pathology. Pain may begin 1-2 weeks before menstruation and continue for several days after bleeding ends. Endometriosis is a leading cause, followed by adenomyosis and intrauterine device-associated pain. 

• Risk factors reported in epidemiological studies include younger age, low body mass index, smoking, early menarche, prolonged or irregular menstrual bleeding, premenstrual symptoms, pelvic infections, psychological distress, genetic predisposition, and a history of sexual abuse. Dysmenorrhoea may contribute to recurrent school absenteeism and reduced workplace productivity.  

Ayurvedic therapeutic approaches  

Ayurvedic management is based on the principle of restoring equilibrium among Vata, Pitta, and Kapha, with particular emphasis on correcting Vata aggravation. Treatment is individualised according to the patient's constitution, symptoms, and associated Dosha disturbances.  

Dietary and lifestyle recommendations  

Pathya Ahara (recommended dietary practices) and Pathya Vihara (recommended lifestyle practices) are incorporated into traditional management.  

Medicated water and selected root or rhizome preparations are also mentioned in classical recommendations. Daytime sleep, intermittent fasting (Langhana), and betel-leaf consumption have been described in traditional sources; however, these practices should not be routinely prescribed without considering individual health needs and contemporary clinical evidence.  

Medicines and therapeutic procedures 

Traditional interventions include Snehana (oleation), Swedana (fomentation), and selected medicated enemas.  

• Traivrita Sneha, prepared using ghee, oil, and animal fat, has been described for oleation and certain therapeutic applications. Milk processed with Dashmula and meat broths are also mentioned in classical management. 

• Anuvasana Basti and Uttara Basti have been described using selected medicated preparations. Local applications, including Yoni Pichu (medicated vaginal tampon), have been recommended with oils prepared from ingredients such as Kushta, Devadaru, Tagara, Vartakini, and Saindhava Lavana.

• Other formulations include Saindhavadi Taila Pichu, Dhatakyadi Taila Pichu, Mushaka Taila Pichu, and Guduchyadi Taila Pichu.  

These procedures require particular caution because intravaginal administration may cause irritation, introduce infection, or delay appropriate diagnosis. They should not be attempted without qualified clinical supervision.  

Classical pharmaceutical formulations  

Several formulations have been described for the management of Kashtartava. 

Additional preparations include Rasna Swadamstradi Ksheerapakam and Pachottikoovaladi Kashayam. Selection should be based on individual assessment, product quality, contraindications, and evidence of safety and efficacy. 

Yoga and Pranayama  

Halasana, Sarvangasana, Bhujangasana, Ardhamatsyendrasana, and Shavasana, along with Nadi Shodhana Pranayama, have been recommended as supportive practices. Gentle physical activity, relaxation, and breathing exercises may help improve well-being and symptom coping, although specific claims regarding hormonal regulation or improved reproductive-organ circulation require further clinical validation.²  

Conclusion 

Ayurvedic management of dysmenorrhoea centres on correcting Vata imbalance through dietary regulation, lifestyle modification, selected pharmaceutical formulations, and traditional therapeutic procedures. Yoga and stress-management practices may provide additional supportive benefits. Nevertheless, evidence for individual Ayurvedic interventions varies, and their safety and effectiveness require further high-quality clinical investigation. Persistent, severe, or progressively worsening menstrual pain should be evaluated for secondary causes, particularly endometriosis and adenomyosis. An individualised approach that integrates appropriate diagnostic assessment with evidence-based treatment can help improve menstrual health and daily functioning.³  

References: 

1. Goel M, Singh R, Bidhoodi U. Therapeutic aspects of Kashtartava (dysmenorrhea) in Ayurveda: a review. J. Indian Syst. Med. 2022;10(2):111-119. doi:10.4103/jism.jism_90_21 https://www.ovid.com/jnls/jism/fulltext/10.4103/jism.jism_90_21~therapeutic-aspects-of-kashtartava-dysmenorrhea-in-ayurveda?an=01744280-202210020-00006 

2. Kanchibhotla D, Subramanian S, Singh D. Management of dysmenorrhea through yoga: A narrative review. Front Pain Res (Lausanne). 2023;4:1107669. Published 2023 Mar 30. doi:10.3389/fpain.2023.1107669 https://pmc.ncbi.nlm.nih.gov/articles/PMC10098011/ 

3. Dhiman K. Clinical efficacy of Ayurvedic treatment regimen in the management of Kashtartava (primary dysmenorrhea): a randomized controlled clinical trial. Int J Drug Deliv Technol. 2026;16(77s):852. https://impactfactor.org/PDF/IJDDT/16/IJDDT,Vol16,Issue77s,Article101.pdf