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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 9-13

A clinical study to assess the efficacy of satavari yoga in perimenopausal syndrome


Department of Ayurveda Samhita and Siddhanta, Government Ayurveda Medical College and Hospital, Mysore, Karnataka, India

Date of Submission15-Sep-2020
Date of Decision27-Oct-2020
Date of Acceptance04-Nov-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
K Rinku Kuwar
Department of Ayurveda Samhita and Siddhanta, Government Ayurveda Medical College and Hospital, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_94_20

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  Abstract 


Introduction: In Vedas priority has been given to women in all her walks of life. Women lifespan can be broadly categorized into 3 phases based on the reproductive function i.e. Kanya (stage prior to menopause), Patni or Mata (active reproductive stage) and Vridhavastha (menopausal stage). The Matrutva or Motherhood of women is well appreciated in Bharatvarsh. A mother who cares, protect and bring up a small life into a capable citizen needs the same care and protection in her old age. After 40 years women body undergoes physiological changes. In some women these physiological changes goes without a notice and in some women, it results in the manifestation of group of symptoms i.e. Perimenopausal syndrome which need Medical attention using HRT. Looking at the adverse effect of HRT and lack of scientific evidence to support or refute claims that the commonly used botanical product offer Therapeutic benefit in Perimenopausal syndrome Satavari-yoga was selected for the present study. Aims and Objective: Aim and objective of the study is to assess the efficacy of Satavari choorna in Perimenopausal syndrome. Method: The Present study is a single group, open label, clinical trial with pre-post follow up test design. Totally 36 subjects were diagnosed as Perimenopausal syndrome based on STRAW Scale and MRS (Menopausal rating scale), Subjects were intervened with Satavari yoga (Satavari choorna along with Gruta and Madhu) as mentioned in Kasyapa Samhita for the duration of one month with dose of 4 grams TID before food. Its effectiveness was assessed before treatment (0th day) and after treatment (31st day) and after follow up (61st day) using MRS. Results: The efficacy of Satavari-yoga was assessed based on the parameters provide in MRS. Before the intervention with Satavari yoga, mean was 17.61 and after intervention mean it reduced to 5.28 and After follow up (in absence Satavari-yoga) mean was raised to 10.19. This increasing and reducing of mean was highly significant with p value <0.001. Conclusion: Satavari yoga is highly beneficial in Perimenopausal syndrome.

Keywords: Perimenopausal syndrome, Dosa Dhatu- Mala Vriddhi and Ksaya Laksana, Satavari Yoga


How to cite this article:
Kuwar K R, Chate VA, Shrivathsa. A clinical study to assess the efficacy of satavari yoga in perimenopausal syndrome. J Ayurveda 2021;15:9-13

How to cite this URL:
Kuwar K R, Chate VA, Shrivathsa. A clinical study to assess the efficacy of satavari yoga in perimenopausal syndrome. J Ayurveda [serial online] 2021 [cited 2021 Apr 13];15:9-13. Available from: http://www.journayu.in/text.asp?2021/15/1/9/311923




  Introduction Top


Perimenopause, also called menopausal transition, refers to the period around menopause (40–55 years). Perimenopause is a physiological process where the estrogen level decreases due to depletion in the ovarian follicular activity. Even though it is a physiological condition, decreased estrogen secretion in the circulating system results in a group of symptoms termed perimenopausal syndrome. Symptomatology includes irregular menstruation, hot flushes, insomnia, night sweating, palpitation, headaches, irritability, anxiety, lethargy, forgetfulness, low libido, vaginal dryness, etc., Perimenopausal symptoms can be classified as shown in [Table 1].
Table 1: Classification of perimenopausal symptoms

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Disturbance in menstrual pattern

The menstrual cycle is the cyclic events that take place in a rhythmic fashion during the reproductive period of women's life. The duration of the menstrual cycle is 28 days. The following patterns can be observed before menopause, i.e., abrupt cessation of menstruation (rare) or gradual decrease in both amount and duration or irregular with or without excessive bleeding.[1] (The role of Satavari choorna in disturbance of menstrual pattern is not included in the present study as it is purely physiological event).

Early perimenopausal symptoms

Early perimenopausal symptoms include:

1. Vasomotor symptoms:

A vasomotor symptom includes hot flashes, excessive sweating, night sweat, and palpitation. Hot flash is the sensation of warmth spreading from the trunk to the face. Hot flashes are characterized by a sudden feeling of heat, followed by profuse sweating.[2] It can be associated with symptoms of palpitation, fatigue, and weakness. Sleep disturbances include both difficulties in falling asleep and frequent waking episodes. Again, the cause remains vasomotor disturbances include a vicious cycle of hot flashes, which are more frequent in night times resulting into night sweats and ultimately alter the sleep patterns and often may lead to insomnia also. Sometimes, psychological changes such as anxiety, depression, tension, fear, and headache also cause sleep disturbances.

2. Psychological symptoms[3]

The prevailing rate of psychological symptoms is more in perimenopause when compares to postmenopause. Females are more affected than males. A prospective cohort study showed that the risk of depression is 3 folds more in perimenopause women when compared to pre- or postmenopause. About 84%–88% of middle-aged women experience feeling depressed and feeling anxious.

3. Urogenital symptoms:

Urogenital symptoms are further classified into urinary symptoms and vulvovaginal symptoms. Urinary symptoms include urgency, dysuria, and recurrent urinary tract infections, and stress incontinence. Vulvovaginal symptoms include vaginal dryness, bleeding (trauma), dyspareunia, vaginal infection, pruritus, and leucorrhea.[4]

4. Musculoskeletal symptoms:

Perimenopause is characterized by an increase in bone reabsorption and reduction in BMD.[5]

Management

Hormonal replacement therapy (HRT) is the drug of choice for menopausal symptoms.

HRT is useful in treating vasomotor symptoms, sleep disturbances, and genitourinary symptoms and less efficient in treating psychological symptoms, therefore along with HRT antidepressant drugs are prescribed, as psychological symptoms are more prevalent in perimenopause. HRT is associated with the risk of endometrial cancer, breast cancer, venous thromboembolism, Coronary Heart Disease, dementia etc.[6] Further, it results in limitation uses of HRT. In alternative medicine, various drugs show phytoestrogen properties, but fail to reduce menopausal symptoms. Looking at the adverse effect of HRT and lack of scientific evidence to support or refute claims that the commonly used botanical product offers therapeutic benefit in perimenopausal syndrome Satavari yoga was selected.

The present study was undertaken to assess the efficacy of Satavari choorna in the management of Perimenopausal syndrome.

Objective of the study

The objective was to assess the efficacy of Satavari Yoga in perimenopausal syndrome.


  Materials and Methods Top


The present clinical trial has been cleared by the Institutional Ethics Committee with reference no. 01SS/IRC-EC dated on March 24, 2018 and also the present clinical trial was registered in CTRI (Clinical Trial Registry of India), CTRI registration number is CTRI/2019/03/018171.

Study design

The source of data was selected from the OPD and IPD of GAMC, Mysore. Single group, open label, clinical trial with pre-post and follow test design. A total of 40 subjects were registered, there were 4 dropouts. The study was completed in 36 subjects and data of 36 subjects were collected.

Inclusion criteria

  • Including diagnosis criteria of STRAW[7] scale (hormonal parameter were excluded) and Menopause Rating Scale (MRS)[8]
  • Subjects between the age group of 35–50 years
  • Woman complaining of irregular menstrual cycle with or without other symptoms of Menopausal Rating Scale
  • Subjects with irregular menstrual cycle with other symptoms of Menopausal Rating Scale
  • History of amenorrhea within 12 months.


Exclusion criteria

  • Subjects who are in the premenopause and postmenopausal stage
  • Subjects who have undergone hysterectomy
  • Subjects with systemic diseases which intervene the study intervention
  • Subjects having menorrhagia with organic pathology of reproductive system like carcinoma, fibroid cyst, etc.
  • Subjects diagnosed having DUB and premature ovarian failure.


Intervention

About 36 subjects with the above-mentioned inclusion criteria were intervened with Satavari choorna of 4 g TID before food along with Gruta and Madhu (in unequal proportion) for the duration of 30 days.[9] Data were collected before intervention (0th day) and after treatment (30th day). Follow-up data were carried on the 60th day.

Assessment

Data were collected before starting the treatment, after treatment, and after follow-up period.

Duration of the study 30 days

  • Preassessment on 0th day
  • Postassessment on 31st day and follow-up on 61st day.


Assessment parameter

The findings were subjected to analysis before, after treatment, and follow-up using MRS scale. MRS is composed of 11 items [Table 2] and divided into three subscales, i.e., somatic, psychological, and urogenital symptoms. The severity of symptoms varies from 0 to 4 (none), 5–8 (mild), 9–15 (moderate), and 16+ (severe) as shown in [Table 3].
Table 2: Menopause rating scale and its 11 components

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Table 3: Showing overall severity score of MRS

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Statistical methods

The results of the present study were analyzed statistically by applying descriptive statistics, inferential statistics, and other relevant statistical methods. The software used is SPSS Version 16.0.


  Results Top


Distribution of subjects based on severity of overall symptoms of MRS before treatment, after treatment and after follow up as shown in [Table 4].
Table 4: Percentage change in overall symptoms of menopause rating scale before treatment, after treatment, and after follow-up

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Before treatment

Out of 36 subjects, 24 (66.7%) subjects were affected severely with MRS symptoms,

11 (30.6%) subjects were affected moderately with MRS symptoms, and the remaining 1 subject was affected mildly with MRS symptoms.

After treatment

Out of 36 subjects, 19 (52.8%) subjects reported absence of MRS symptoms, 14 (38.9%) subjects had mild MRS symptoms, 2 (5.6%) subjects had moderate MRS symptoms, and only 1 (2.8%) subject reported severe MRS symptoms.

After follow-up

Out of 36 subjects, 6 (16.7%) subjects reported absence of MRS symptoms, 7 (19.4%) subjects reported mild MRS symptoms, 21 (58.3%) subjects reported moderate MRS symptoms, and remaining 2 (5.6%) subjects reported severe MRS symptoms. The result was significant with P < 0.001.

Descriptive statistics: General linear model

Before treatment, the mean was 17.61 and after treatment, the mean was reduced to 5.28, and after follow-up (in absence of medicine), the mean was raised to 10.19. This increasing and reducing of mean was highly significant with P < 0.001.


  Discussion Top


Discussion on effect of Satavari choorna on severity of overall symptoms

Satavari yoga provided relief from both somatic and psychological symptoms experienced during perimenopause. Satavari yoga was highly significant both at the clinical and statical levels with P < 0.001. Even though it is effective in all the symptoms of MRS, at the clinical level, relief of symptoms was more toward somatic and psychological symptoms when compare to urogenital symptoms. In graph [i.e. [Figure 1]], the mean of after treatment was increased in follow-up from 5.28 to 10.19 because symptoms reoccurred when subjects stop taking Satavari choorna.
Figure 1: The increasing and reducing of mean graphically which was highly significant with P < 0.001

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Probable mode of drug action

Hot flashes and sweating

Hot flash is manifested due to the vitiation of Vata and Pitta Dosa. Satavari's Rasapancaka, i.e., Sita Vīrya, Madhura Rasa, and Madhura Vipaka suppress the Vata-Pitta Dosa.[10] Satavari contains properties which are in Viparita Guna to hot flashes. Therefore, based on Viparita Guna Siddhanta, hot flashes are reduced by Satavari. Further Satavari contains Sita Guna and Kasaya Rasa[11] which has Stambana properties. Ati sweda or Sweda vriddhi is reduced due to Stambana Karma of Kasaya Rasa. Hot flashes are produced due to Estrogen deficiency, Satavari contains phytoestrogen in it.

Palpitation

Palpitation is caused due to Dhatu Ksaya (specially RasaDhatu) and secondly due to Vata Vriddhi. Satavari increase oja and Bals due to the presence of Madhura Rasa and Sita Virya. Gruta does the Karma of Agni Vivardhanam results in Dhatu Posana and decreases vitiated Vata Dosa. Satavari and Madhu itself are indicated as Hrdaya and its cardioprotective action has been proved. Therefore, Satavari relives palpitation.

Disturbed sleep

Satavari contains Guru and Snigdha Guna and Sita Virya in it which counteracts Laghu, Ruksa, and usna vitiated Guna in perimenopause subjects. Similar mechanisms can be seen in Mahisi Kshira which also contains Guru, Snigdha, and Sita Guna in it which is described as best Nidrajanaka. 1 (2.8%) subject complained of disturbed sleep even after taking Satavari choorna. This subject was having Vata Pradhana Prakruti and history of less sleep since childhood. Due to increasing Vata Dosa in Vata Pradhanya Kala, Vata Pradhana Prakruti and with history of less sleep all these factors indicated that the subject was having Swabhavatah Nidranasa.[12] Cikitsa is not fruitful in Swabhavaja Vyadhi. Thus, Satavari choorna failed to improve the Nidra of this subject, as the subject was suffering from Swabhavatah Nidranasa.

Joints pain

Asthi Utaptti cycle is once again started due to the presence of Prutvi, Teja, and Vayu component.[13] Prutvi Mahabhuta Amsa is present in Kasaya Rasa and Teja Mahabhuta Amsa is present in Tikta Rasa. Satavari contains both Kasaya and Tikta Rasa. Thus, the cycle of Asthi utpatti starts which reduces further Asthi Dhatu Ksaya.

Psychological symptoms

Satavari choorna along Gruta and Madhu results in Prasannata for both Manas and Sarira. Medhya, Madhura Rasa of Satavari, Gruta, and Madhu results in Indriya Prasadana and due to adaptogenic activities and antidepressant activities of Satavari, psychological symptoms are reduced.[14]

Urogenital symptoms

Urogenital symptoms are urinary incontinence, vaginal dryness, and sexual-related problems. Among 36 subjects, 33 subjects reported urogenital symptoms among them 27 subjects reported urogenital symptoms after treatment only 6 subjects showed minute improvement. Satavari choorna was statistically non-significant with p value 0.206. Satavari choorna was statistically nonsignificant with P value 0.206. These problems need Sthanika Cikitsa for better results. Thus, Satavari choorna along with Gruta and Madhu is less effective in urogenital problems of perimenopause.


  Conclusion Top


Satavari yoga was highly significant both at the clinical and statistical level with P value with P < 0.001. Satavari yoga was capable of relieving the symptoms by Viparita Guna Cikitsa, Vatapitta dosa Prasamana karma, and promoting dhatu Posana (due to Rasayana and Vrusya properties).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Dutta's DC. Textbook of Gynaecology Including Contraception. 6th ed. Jaypee Brothers Medical Publishers (P) Ltd: New Delhi India; 2013. p. 59.  Back to cited text no. 1
    
2.
Freedman RR. Menopausal hot flashes: Mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol 2014;142:115-20.  Back to cited text no. 2
    
3.
Gersak K, Gersak ZM, Turcin A. Reproductive Aging: Perimenopause and Psychopathological Symptoms, Sex Hormones in Neurodegenerative Processes and Diseases, Gorazd Drevenšek, IntechOpen, DOI: 10.5772/intechopen.74159. Available from: https://www.intechopen.com/books/sex-hormones-in-neurodegenerative-processes-and-diseases/reproductive-aging-perimenopause-and-psychopathological-symptoms. [Last accessed on 02 May 2018].  Back to cited text no. 3
    
4.
Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am 2015;44:497-515.  Back to cited text no. 4
    
5.
Lo JC, Burnett-Bowie SA, Finkelstein JS. Bone and the perimenopause. Obstet Gynecol Clin North Am 2011;38:503-17.  Back to cited text no. 5
    
6.
Dutta's DC. Textbook of Gynaecology Including Contraception. 6th ed.; 2013. p. 62  Back to cited text no. 6
    
7.
Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al. Executive summary of the Stages of Reproductive Aging Workshop+10: Addressing the unfinished agenda of staging reproductive aging. Climacteric 2012;15:105-14.  Back to cited text no. 7
    
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Heinemann K, Ruebig A, Potthoff P, Schneider HP, Strelow F, Heinemann LA, et al. The Menopause Rating Scale (MRS) scale: A methodological review. Health Qual Life Outcomes 2004;2:45.  Back to cited text no. 8
    
9.
Tiwari PV, editor. Kashyapa Samhita of Vriddhajeevaka, Kalpa Sthana. Satapushpashatavari Kalpa Adhyaya. 1st ed., Ch. 5., Ver. 10. Varanasi: Chowkamba Vishwabharati; 1996. p. 349.  Back to cited text no. 9
    
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Charak Samhita, Sutra Sthanam, Annapanavidhimadhyaya, 27/42 (231-233). Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 18 Mar 2021].  Back to cited text no. 10
    
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Tiwari PV, editor. Kashyapa Samhita of Vriddhajeevaka, Kalpa Sthana. Satapushpashatavari Kalpa Adhyaya. 1st ed., Ch. 5., Ver. 7-8. Varanasi: Chowkamba Vishwabharati; 1996. p. 348.  Back to cited text no. 11
    
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Susruta Samhita , Sutra Sthanam, Veda Utpatti Adhyaya 1/34 (25/4). Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 18 Mar 2021].  Back to cited text no. 12
    
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Charak Samhita, Sutra Sthanam, Cikitsa Sthanam, Grahanidosa Cikitsitam. 15/13 (23-31). Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 18 Mar 2021].  Back to cited text no. 13
    
14.
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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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