Menopause: A Review of Western Pathology and Ayurvedic Management

By: Mariam Samimi Wiwe
California College of Ayurveda, Nevada City

Abstract

Menopause is the natural and permanent cessation of menstruation that marks the end of a woman’s reproductive life. From a Western biomedical perspective, it results from the progressive depletion of ovarian follicles and the consequent decline of estrogen and progesterone, producing both acute signs and symptoms — including vasomotor symptoms, sleep disturbances, and mood alterations — and long-term health consequences such as osteoporosis and cardiovascular disease. From an Ayurvedic perspective, the same transition — known as Rajonivritti — represents a natural progression into the vata-dominant phase of elder life, understood through the lens of dosha imbalance, srota dysfunction, and dhatu depletion. This paper presents a comparative Review of the Literature examining menopause through both frameworks, drawing on classical Ayurvedic texts including the Charaka Samhita and Sushruta Samhita, the textbook Clinical Ayurvedic Medicine by Marc Halpern, and peer-reviewed research studies. Ayurvedic management of Rajonivritti — including diet, herbal medicine, body therapies, and lifestyle — is presented in detail, with reference to both classical formulations and modern clinical evidence.

Introduction

The female reproductive system includes the vagina, uterus, ovaries, and fallopian tubes, as well as hormones produced by the pituitary gland and the hypothalamus.¹ A woman is born with approximately two million follicles, of which only 400 to 450 will mature and ovulate over the course of her reproductive life, while the remainder degenerate through a process called atresia.² Menopause is the natural cessation of the reproductive capacity of a woman, marked by the end of her menstrual period.³ It is clinically defined as twelve consecutive months of amenorrhea in the absence of other known pathological causes. By 2025, an estimated 1.1 billion women worldwide are postmenopausal, underscoring the profound public health significance of this universal transition.⁴

The average age of onset of menopause is 50 to 51 years; however, it can occur both earlier and later. When menopause occurs before age 40 it is classified as premature menopause, or premature ovarian failure, occurring in approximately 1% of women.⁵ Symptoms of menopause, when present, may last from six months to ten years, with hot flashes occurring in 75% of all women as the most common symptom.⁶

The menopause transition — often referred to as perimenopause — may begin several years before menopause and is characterized by hormonal fluctuations and irregular menstruation. It can last anywhere from one to ten years and represents the transition between the pitta stage of a woman’s life and the vata stage. As vata is rising during this period, and particularly the qualities of the air element, there is greater instability at this time.⁷ The present paper focuses primarily on menopause (Rajonivritti), the stage defined by the permanent cessation of menstruation, examining it through both Western biomedical and Ayurvedic lenses. It addresses both the acute signs and symptoms of the menopausal transition and the long-term health consequences associated with sustained estrogen deficiency in the postmenopausal years.

Western Pathology Of Menopause

Reproductive Aging and Hormonal Mechanism

The female endocrine system operates through a hormonal cascade originating in the hypothalamus, the master endocrine regulator. The hypothalamus releases Gonadotropin-Releasing Hormone (GnRH), also known as Luteinizing Hormone-Releasing Hormone (LHRH), which travels to the pituitary gland and stimulates the release of two hormones: Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). These hormones then travel through the bloodstream to act upon the ovaries.⁸

FSH, released by the pituitary in response to GnRH, stimulates the growth and maturation of ovarian follicles, each of which contains a developing egg (oocyte). LH works together with FSH during follicular development and plays a critical role in triggering ovulation, the release of the mature egg from the ovary.⁹ As the follicle matures, it produces increasing amounts of estrogen. The three major naturally occurring estrogens are estradiol (E2), estrone (E1), and estriol (E3). Estradiol is the most potent and abundant estrogen during the reproductive years. All three are steroid hormones synthesized from cholesterol, primarily within the ovaries.¹⁰ Progesterone is produced in small amounts by the developing follicle and in much larger quantities by the corpus luteum, the temporary endocrine structure formed from the ruptured follicle after ovulation. Progesterone prepares and maintains the endometrium for potential implantation by transforming it into a nutrient-rich secretory lining during the second half of the menstrual cycle.¹¹

As a woman approaches menopause, several hormonal changes occur in her later reproductive years, including decreases in the production of estrogen and progesterone, decreased receptiveness of the ovaries to FSH and LH, and a decrease in post-ovulation levels of progesterone.¹² As the number of remaining follicles diminishes, ovarian estrogen and inhibin production falls. The pituitary, deprived of negative feedback, responds by increasing secretion of FSH and LH — which remain persistently and markedly elevated while ovarian hormone production continues to fall.¹³ The process begins in a woman’s 30s, becomes more pronounced in her 40s, and continues until there is complete cessation of menses.¹⁴

Signs and Symptoms

There is a multitude of possible symptoms of menopause, though symptom-free menopause is also entirely possible. Symptoms, when present, may last from six months to ten years. The most common symptom is hot flashes, which occur in 75% of all women and can last for five or more years.¹⁵ Other common symptoms include insomnia, nervousness, irritability, palpitations, tachycardia, cystitis, vaginitis, urinary incontinence, fatigue, hair loss, and digestive disturbances.¹⁶

Sleep Disturbances and Mood

Sleep disturbance is among the most commonly reported and impactful symptoms of menopause. Reduced estrogen and hormonal fluctuations produce hot flashes and night sweats that directly interrupt sleep architecture, contributing to fatigue, cognitive changes, and diminished quality of life. Mood-related symptoms are equally significant: insomnia, nervousness, and irritability are listed among the core signs and symptoms of menopause.¹⁷ Estrogen’s role in modulating serotonergic and noradrenergic neurotransmission means that its decline also contributes directly to mood lability, anxiety, and vulnerability to depressive episodes in the postmenopausal period.¹⁸

Long-Term Health Consequences

While the acute signs and symptoms of menopause may resolve or diminish over time, the sustained estrogen deficiency of the postmenopausal years carries significant long-term health risks. Two of the most clinically important are osteoporosis and cardiovascular disease — conditions that develop gradually over years and represent the primary drivers of morbidity and mortality in postmenopausal women.¹⁹

Osteoporosis

One of the biggest challenges of the post-menopausal years is accelerated bone loss. This causes osteoporosis, leading to fractures. This condition is worse in women who are sedentary and thin, in those who smoke, and in those taking corticosteroids such as cortisone.²⁰ Estrogen plays an essential role in bone metabolism by suppressing osteoclast activity. Without adequate estrogen, bone resorption accelerates significantly in the years following menopause, making fracture prevention a central concern of postmenopausal health management. A 2023 clinical review of postmenopausal osteoporosis confirms that estrogen deficiency results in increased osteoclast activity, increased bone resorption, and reduced bone formation, with bone loss occurring at a rate of 1–5% annually during the first years following menopause.²¹

From a nutritional standpoint, calcium supplementation can be beneficial in the management of postmenopausal osteoporosis. Calcium citrate is the most absorbable form, while calcium carbonate is the least. Exercise is also a cornerstone of prevention, as stress placed upon bones stimulates the body to increase bone density. Weight-bearing exercise is the most important form, making walking more beneficial than swimming.²²

Cardiovascular Disease

There is a well-documented association between the alteration of hormones at menopause and cardiovascular disease. Postmenopausal women also tend to gain weight and may develop urinary incontinence.²³ Prior to menopause, estrogen exerts cardioprotective effects through favorable modulation of lipid profiles, maintenance of vascular endothelial integrity, and anti-inflammatory actions. Following menopause, total cholesterol and LDL cholesterol rise, and the sex-based cardiovascular advantage that women enjoy during reproductive years diminishes substantially, making cardiovascular disease a leading concern in postmenopausal women.²⁴

Western Medical Treatment

Counseling is advised to assure women that menopause is a normal process and that no disease is present. Cessation of factors that aggravate hot flashes is recommended, including the avoidance of smoking, coffee, spicy foods, alcohol, and hot beverages. Estrogen replacement has long been recommended and will correct most hot flashes, vaginitis, and cystitis. It also helps prevent osteoporosis and protects against cardiovascular disease and colorectal cancer. However, concerns about the side effects of estrogen replacement — including increased risk of aggressive breast cancer and the formation of emboli — have decreased its recommendation except when symptoms are moderate or severe.²⁵

Nutritional approaches often include the use of plant-based estrogens, or phytoestrogens, taken internally or prepared as a skin cream. Soy products have a high amount of these and may be taken internally or applied topically. Vitamin E has also been recommended. In the management of postmenopausal osteoporosis, calcium supplementation can be beneficial, with calcium citrate being the most absorbable form. Praval pishti — a red coral preparation used in Ayurveda — undergoes several stages of purification and modification that may make its calcium more readily absorbable.²⁶

Ayurvedic Classification Of Menopause

Menopause, commonly referred to in contemporary Ayurvedic literature as Rajonivritti, is understood as the age-related cessation of menstruation. The term is derived from the Sanskrit words rajah (artava or menstrual flow) and nivritti (cessation), literally meaning the cessation of menstruation.²⁷

Although the classical Ayurvedic texts do not describe menopause as a separate disease entity, the Sushruta Samhita states that menstruation begins around the twelfth year of life and ceases around the fiftieth year as a consequence of aging (Jara).²⁸ This passage provides the primary classical basis for the Ayurvedic understanding of menopause.

According to Halpern, the female life cycle progresses through three doshic stages: kapha predominates during childhood, pitta during the reproductive years, and vata during the later years of life.²⁹ Perimenopause represents the transition from the pitta stage to the vata stage, while menopause marks entry into the vata-dominant phase of life.³⁰

Within Ayurvedic theory, increasing vata predominance is associated with aging³¹ and progressive tissue depletion (dhatu kshaya³²). Consequently, contemporary Ayurvedic scholars interpret Rajonivritti within the broader framework of aging, declining reproductive function, and vata imbalance.³³

Accordingly, menopause is regarded as a natural physiological transition rather than a pathological condition. As Halpern states, “Menopause is a natural phenomenon and is not in and of itself a disease or imbalance, unless the condition occurs unnaturally early.”³⁴

Ayurvedic Pathology Of Menopause

Menopause as Natural Phenomenon

As discussed previously, menopause itself is regarded as a natural physiological transition. Symptoms arise when underlying doshic imbalances accompany this transition.

Menopause is a condition related to vata. Most imbalances related to menopause are imbalances of vata. Even hot flashes are due to vata vitiation, as this type of heat is transient and irregular. Women with a pitta vikruti are prone to the most intense hot flashes, while women with a kapha prakriti will generally experience a less complicated transition, as kapha’s moist and stable qualities counteract the dryness and irregularity of vata imbalance.³⁵

Nidana (Etiology)

Vata-type menopause is precipitated and aggravated by vata-vitiating regimens such as cold, dry, and light foods and a high-stress, fast-paced lifestyle. Halpern suggests that symptoms may be further aggravated when a woman continues to live according to the demands of the pitta stage of life rather than adapting to the physiological needs of the vata stage.³⁶

Samprapti (Pathogenesis)

Although menopause is understood in biomedicine primarily as a consequence of declining ovarian function and estrogen production, Ayurveda interprets the same transition through the framework of Jara (aging), vata predominance, dhatu kshaya, and artava depletion. The Samprapti of Rajonivritti therefore provides an Ayurvedic explanation for many of the physiological and psychological changes observed during menopause.

Understanding the pathogenesis of Rajonivritti requires tracing the full chain of causation — from the natural aging process through to the manifestation of symptoms — rather than simply cataloguing those symptoms. The following five-step Samprapti presents this chain as described in the classical texts and elaborated by Halpern.

Step 1: Natural Aging (Jara)

The root cause of Rajonivritti is Jara — the natural aging process. As the body ages, agni (digestive and metabolic fire) gradually diminishes, and the srotamsi (channels of the body) become progressively less efficient at delivering nourishment to the tissues. Ayurvedic theory describes aging as a progressive decline in the body’s capacity to nourish and maintain the tissues.³⁷

Step 2: Vata Increase

As Jara progresses, vata dosha—whose qualities of dryness, lightness, mobility, and depletion are inherently associated with aging—becomes naturally predominant. The body transitions from the pitta dominant reproductive years into the vata-dominant elder stage (vriddha avastha). This natural increase in vata contributes to the progressive tissue depletion (dhatu kshaya) characteristic of the menopausal transition and may be further aggravated by vata-vitiating factors such as cold, dry, and light foods, irregular routines, excessive stress, and inadequate rest.³⁸ 

Step 3: Dhatu Kshaya (Tissue Depletion)

The increase of vata combined with diminished agni leads to dhatu kshaya—the progressive depletion of the seven bodily tissues (sapta dhatus). These tissues exist in a sequential nutritive relationship: rasa (plasma) → rakta (blood) → mamsa (muscle) → meda (fat) → asthi (bone) → majja (nerve/marrow) → shukra/artava (reproductive tissue). As agni weakens and vata increases, the quality and quantity of nourishment available to each successive dhatu gradually decline. This progressive depletion ultimately affects the reproductive tissues and lays the foundation for the development of artava kshaya.³⁹

Step 4: Artava Depletion

The upstream depletion of rasa dhatu cascades through each successive tissue until it reaches artava, an upadhatu of rasa dhatu governed in its monthly outward expression by apana vayu. As artava kshaya progresses, the formation and release of artava gradually diminish until menstruation ultimately ceases. Halpern describes the Ayurvedic mechanism of this cessation as vata entering the shukra dhatu within the artavavaha srotas, thereby preventing the maturation of ovarian follicles.⁴⁰ Within this framework, menopause is understood as the natural culmination of Jara, dhatu kshaya, and increasing vata predominance, and therefore does not constitute a disease process in itself.

Because artava represents the final expression of a long sequence of tissue nourishment, its depletion reflects a broader decline in the quality and quantity of the dhatus. As the dhatus become depleted, ojas— the most refined essence of all seven dhatus—may likewise diminish, contributing to reduced vitality, resilience, immunity, and mental stability during the menopausal transition.

Step 5: Manifestation of Symptoms

In the Ayurvedic model, the symptoms of Rajonivritti arise not from the cessation of artava itself, but from the aggravation and relocation of vata. Overflowing from its primary site of accumulation in the purishavaha srotas (the large intestine, the principal seat of vata), aggravated vata relocates into other channel systems throughout the body. As Halpern notes, “Symptoms that are present are caused by an aggravation of a pre-existing vata imbalance or a concurrent vata-vitiating lifestyle.”⁴¹

Each relocation of vata into a specific srotas produces a corresponding pattern of symptoms:⁴²

• Artavavaha Srotas → vaginal dryness, atrophic vaginitis
• Annavaha Srotas → disturbance of Samana Vayu → hot flashes
• Mutravaha Srotas → cystitis, urinary incontinence
• Rasavaha Srotas → palpitations, tachycardia
• Asthivaha Srotas → Asthi Dhatu Kshaya → osteoporosis
• Manovaha Srotas → insomnia, anxiety, irritability, emotional instability

Osteoporosis in Ayurvedic Pathology

From an Ayurvedic perspective, the development of osteoporosis at menopause is understood as the relocation of aggravated vata into the asthivaha srotas (the channel system governing bone tissue) through the action of apana vayu and its associated subdosha. This leads to asthi dhatu kshaya — a progressive depletion of bone tissue — which corresponds directly to the accelerated bone resorption described in Western medicine following estrogen withdrawal.⁴³ The appropriate therapeutic response targets bone tonification through herbs such as ashwagandha, bala, and haritaki, along with weight-bearing exercise to stimulate bone density.⁴⁴

Cardiovascular Changes in Ayurvedic Pathology

The cardiovascular symptoms of menopause—including palpitations and tachycardia—are understood in Ayurveda as the relocation of aggravated vyana vayu into the origin of the rasavaha srotas (the channel system governing plasma, lymph, and the heart). This disrupts the normal rhythmic flow of vyana vayu that governs the heartbeat and circulation.⁴⁵

Beyond these symptoms, menopause is associated with an increased risk of cardiovascular disease, partly due to the loss of estrogen’s protective effects on vascular function, endothelial health, and cardiovascular regulation.⁴⁶

From an Ayurvedic perspective, these broader cardiovascular changes may be understood as disturbances of vyana vayu and dysfunction within the rasavaha srotas, both of which are responsible for circulation and the nourishment of the cardiovascular system. Treatment accordingly involves cardiac tonics such as hawthorn berries and arjuna, which nourish the rasa dhatu while strengthening and regulating the heartbeat, combined with circulatory tonics such as bala.⁴⁷

Sleep and Mood in Ayurvedic Pathology

Sleep disturbances, emotional instability, insomnia, irritability, and anxiety at menopause are understood in Ayurveda as the relocation of aggravated prana vayu, vyana vayu, and samana vayu into the manovaha srotas (the channel system governing the mind and nervous system).⁴⁸ This corresponds to the depletion of majja dhatu (nerve tissue) and ultimately of ojas, the refined vital essence that underlies immune resilience, mental clarity, and emotional stability. As the dhatus undergo depletion through the aging process, less refined essence is available to nourish ojas, contributing to diminished vitality, resilience, and emotional stability during the menopausal transition.⁴⁹

Doshic Presentations of Rajonivritti

Because Rajonivritti occurs against the backdrop of each woman’s unique prakriti (constitutional type) and vikruti (current imbalance), its clinical presentation varies considerably. Halpern identifies three primary doshic presentations in Clinical Ayurvedic Medicine, each requiring a distinct therapeutic approach.⁵⁰

Vata-Type Rajonivritti

The most common presentation. Symptoms reflect depletion and dryness: vaginal dryness, atrophic vaginitis, insomnia, anxiety, palpitations, tachycardia, cystitis, urinary incontinence, and constipation. Even hot flashes in this type have a vata quality — they are transient, irregular, and unpredictable rather than sustained and intense. Women with a predominantly vata or pitta-vata constitution are most susceptible.⁵¹

Vata/Pitta-Type Rajonivritti

Women with a pitta vikruti (current pitta imbalance) entering the vata stage of life will experience both vata and pitta vitiation. The disturbance in the air element fans the already vitiated fire, intensifying pitta dosha. Hot flashes are more intense, prolonged, and inflammatory in quality. Additional complications include greater inflammation, burning sensations, cystitis and vaginitis with inflammatory presentation, and emotionally, greater anger and intensity. Treatment emphasizes both vata and pitta pacification, with cooling herbs such as shatavari, fennel, coriander, and brahmi playing a central role.⁵²

Vata/Kapha-Type Rajonivritti

Women with a kapha constitution generally experience a less turbulent menopausal transition, as kapha’s moist, stable, and heavy qualities naturally counteract many of the dry and depleting qualities of vata imbalance. However, when vata pushes kapha further out of balance, a steady rise in body weight accompanied by lethargy and melancholy may develop. The body is sluggish while the mind may be relatively active. Treatment requires a vata/kapha-pacifying approach emphasizing warm, spicy, light foods, stimulating herbs such as trikatu and guggul, and nervine stimulants such as calamus, bayberry, and tulsi to address lethargy and melancholy.⁵³

Ayurvedic Management Of Menopause

The Ayurvedic approach to the management of Rajonivritti is holistic and individualized. While menopause itself is regarded as a natural physiological transition, the symptoms experienced during this period are understood to arise from underlying doshic imbalances that vary from woman to woman.⁵⁴ As a result, treatment is directed not only toward relieving symptoms but also toward correcting the underlying imbalance, pacifying vata dosha, replenishing depleted dhatus, and restoring the integrity of agni (digestive and metabolic fire).⁵⁵ Tonic therapy at this time of life helps slow the rate of depletion and supports a more gradual and balanced transition.⁵⁶

Diet (Ahara)

The patient should follow a vata-pacifying diet emphasizing the sweet taste, as it is nourishing, tonic, and supportive of both the dhatus and ojas.⁵⁷

For women with combined vata/pitta imbalance, the best taste for balancing the two doshas is the sweet taste, which is cool, moist, heavy, and stabilizing. The bitter taste, though cooling, should be avoided as the air and ether that make up the taste further aggravate vata dosha. For women with vata/kapha imbalance, a vata/kapha-pacifying food program emphasizes warm, spicy foods that increase agni and improve digestion. Sweet, nourishing foods prepared with warming spices should be taken in small quantities on a regular basis — ideally three to five times per day — as small quantities of nourishing foods will result in slow weight loss.⁵⁸

Phytoestrogens — plant-based chemicals that mimic the effects of hormones in the body — play an important nutritional role in menopausal management. Phytoestrogens are present in the highest amounts in soy-based products including soy protein, with tofu having a much higher level than soy milk. Phytoestrogens are also found in very high amounts in flaxseeds. In soy products, the source of the estrogenic factor is flavones; in seeds, nuts, and whole grains, the main proestrogenic factors are lignans.⁵⁹ A high phytoestrogen-based diet incorporating soy, flax, sprouts, nuts, and whole grains has positive health benefits and likely decreases the overall incidence of a wide variety of cancers, heart disease, and post menopausal osteoporosis.⁶⁰ This is supported by a systematic review and meta-analysis of 15 randomized controlled trials by Chen et al. (2014), which found that phytoestrogens appear to reduce the frequency of hot flushes in menopausal women without serious side effects.61 A further systematic review by Chen, Ko, and Chen (2019) examining isoflavone supplementation specifically found that isoflavone supplements produced significant reductions in vasomotor symptoms — with some studies showing over 40% reduction — and may also provide cardiovascular and bone health benefits, though evidence remains variable across preparations and populations.⁶² 

Herbal Medicine (Aushadha)

The most important herbs in the management of menopause are reproductive tonics, as these ease the hormonal transition and all related symptoms. Additional herbs should be given as needed for specific symptoms. However, the practitioner should not attempt to treat each and every symptom if many are present. It is best to choose the most significant symptom directly while correcting the underlying depletion.⁶³

Estrogen-promoting herbs are often used in the treatment of all menopause symptoms. Common herbs that are generally accepted to mimic estrogen include motherwort, red clover, and saw palmetto. Of these, motherwort has the strongest history for use in treating female reproductive complaints. Other herbs — dong quai, vitex, blue cohosh, black cohosh, wild yam, and licorice — have also been found to have estrogen-like effects, though they are weaker than those previously noted. The most common herbs used in treating the symptoms of menopause are dong quai, vitex, wild yam, and black cohosh.⁶⁴

In India, the most common herb used is shatavari (Asparagus racemosus). It also has estrogen-like effects. These herbs are most effective in the treatment of hot flashes and vaginal dryness but may have broader actions as well. In the management of dry vaginitis and painful intercourse, herbs should be prepared as a medicated ghee and applied topically.⁶⁵

The Herb-Hormone Support Chart in Clinical Ayurvedic Medicine summarizes the following herbs as having possible biochemical basis for supporting estrogen: shatavari, dong quai, black cohosh, red clover, licorice, thyme, turmeric, hops, verbena, fo-ti, and lodhra. Wild yam and chaste berry (vitex) have been found to support progesterone, with vitex also supporting estrogen.⁶⁶

In the management of post-menopausal palpitations, circulatory tonics such as bala should be used in addition to the estrogen-promoting herbs. These nourish the rasa dhatu while strengthening and regulating the heartbeat. Arjuna and hawthorn berries may also be beneficial.⁶⁷

For the specific symptoms of emotional instability, insomnia, irritability, and anxiety — arising from vata relocating to the manovaha srotas — nervine sedatives and nervine tonics are indicated. Examples include ashwagandha, jatamamsi, and brahmi as nervine sedatives, and ashwagandha, brahmi, and shatavari as nervine tonics.⁶⁸

A double-blind, multicenter randomized controlled trial published in 2024 evaluated the efficacy and safety of shatavari root extract for the management of menopausal symptoms. The eight-week study found positive and significant effects of the active test ingredient over placebo in terms of reduction in hot flashes, night sweats, insomnia, anxiety, nervousness, vaginal dryness, and loss of libido. The Utian Quality of Life score improved significantly in the test group compared to the placebo group, and no significant adverse events were recorded, suggesting the safety of this formulation.⁶⁹

Pingali et al. (2025) conducted a randomized, double-blind, placebo-controlled trial in 123 postmenopausal women examining the effects of standardized aqueous extracts of ashwagandha (Withania somnifera), shatavari (Asparagus racemosus), or their combination on menopausal symptoms, vascular dysfunction, bone resorption, and markers of inflammation. Results demonstrated that both herbs, individually and in combination, dose-dependently reduced menopausal symptom scores, improved vascular endothelial function, decreased bone resorption markers, and reduced circulating inflammatory and oxidative stress markers. The higher doses of ashwagandha showed the most significant reductions in psychosocial and physical domain scores, while shatavari showed dose-dependent effects on vasomotor symptoms. These findings directly support the combined use of these two classical Ayurvedic reproductive tonics as an effective and safe intervention for postmenopausal health.⁷⁰

Additional clinical support for Ayurvedic management of menopausal symptoms comes from a study by Modi et al. (2012), which evaluated a classical formulation consisting of ashokarishta, ashwagandha churna, and praval pishti in women with menopausal syndrome. After fourteen weeks of treatment, participants demonstrated significant improvements across vasomotor, psychosocial, physical, and sexual symptom domains, with a 77.44% reduction in total Menopause Rating Scale scores. No significant adverse effects were reported, and liver and kidney function remained within normal limits throughout the study, supporting the safety and efficacy of this traditional Ayurvedic approach.⁷¹

Body Therapies

Rejuvenative body therapies should be applied to build the dhatus and restore ojas. Abhyanga (full-body warm oil massage), shirodhara (continuous pouring of warm medicated oil over the forehead), anuvasana basti (oil enema), and chakra basti over the svadhisthana chakra may all be applied.⁷²

Abhyanga nourishes the skin and nervous system, promotes lymphatic circulation, and directly counters the dryness and depletion of vata dosha. Shirodhara is profoundly calming to the nervous system, reduces anxiety and insomnia, and balances both vata and prana vayu. Anuvasana basti — the oil enema — is the primary Panchakarma treatment for vata dosha and directly addresses the dryness, constipation, and pelvic tissue depletion characteristic of menopausal vata imbalance.⁷³

Sensory therapies, including general aroma and color therapy, should be applied for pacifying vata dosha. The most commonly recommended essential oils are clary sage and lavender.⁷⁴

Lifestyle and Yoga Therapies

Exercise is the best treatment for osteoporosis. In response to stress placed upon bones, nature has designed our bodies to increase bone density. Hence, daily exercise is important. Weight-bearing exercise is the most important form of exercise; walking is therefore more beneficial than swimming. Yoga places stress on most of the body’s joints and is likewise beneficial. Standing poses improve bone density in the hips. Downward-facing dog practiced regularly strengthens the bones of the shoulder and wrist. Regular routines are always important for supporting vata dosha and are particularly important for stabilizing samana vayu.⁷⁵ This recommendation is strongly supported by a 2023 updated systematic review and meta-analysis of 80 controlled exercise trials involving 5,581 postmenopausal women by Mohebbi et al., which found that exercise training produced significant positive effects on bone mineral density at the lumbar spine, femoral neck, and total hip, regardless of bone status, menopausal stage, or supervision level.⁷⁶

Meditation can ease any anxiety associated with this transitional phase of life. It can also help a woman to go deeper into her spiritual life, bringing deeper insight and wisdom along with greater satisfaction and peace in her later years.⁷⁷

Conclusion

Menopause is a universal biological transition that marks the end of a woman’s reproductive years. Western medicine understands menopause primarily as a consequence of ovarian follicular depletion and the resulting decline in estrogen and progesterone production, leading to both acute symptoms and long-term health consequences including osteoporosis, cardiovascular disease, sleep disturbances, and mood changes.

Ayurveda understands the same transition as Rajonivritti—a natural progression associated with Jara (aging), increasing vata predominance, dhatu kshaya, and the eventual cessation of artava. Rather than viewing menopause as a disease state, Ayurveda regards it as a normal physiological transition that may become symptomatic when accompanied by doshic imbalance and tissue depletion.

The Ayurvedic framework provides a comprehensive and individualized model for understanding and managing menopause. Through the concepts of dosha, dhatu, srotas, and Samprapti, it offers a coherent explanation for the diverse manifestations of menopause while emphasizing treatment strategies that address underlying imbalance rather than symptoms alone. Dietary modification, herbal medicine, body therapies, exercise, meditation, and lifestyle interventions all play important roles in supporting women through this transition.

The convergence of classical Ayurvedic wisdom with emerging clinical research on Ayurvedic herbs, phytoestrogens, exercise, and integrative menopausal care suggests promising opportunities for a more holistic approach to women’s health. As the global population of postmenopausal women continues to grow, an integrative understanding of menopause may offer valuable tools for promoting health, resilience, and quality of life during the second half of life.

Notes

1. Marc Halpern, Clinical Ayurvedic Medicine, vol. 1, 8th ed. (Grass Valley, CA: California
   College of Ayurveda, 2020), Chapter 5a, p. 5-1.
2. Ibid., p. 5-1.
3. Ibid., p. 5-6.
4. Patrizia Monteleone et al., “Symptoms of Menopause — Global Prevalence, Physiology and Implications,” Nature Reviews Endocrinology 14, no. 4 (2018): 199–215. DOI: 10.1038/nrendo.2017.180. PMID: 29393299.
5. Halpern, Clinical Ayurvedic Medicine, Chapter 5b, p. 5-94.
6. Ibid., p. 5-95.
7. Ibid., p. 5-96.
8. Ibid., pp. 5-2 to 5-3.
9. Ibid., p. 5-3.
10. Ibid., p. 5-3.
11. Ibid., p. 5-3.
12. Ibid., p. 5-94.
13. H.G. Burger et al., “A Review of Hormonal Changes during the Menopausal Transition: Focus on Findings from the Melbourne Women’s Midlife Health Project,” Human Reproduction Update 13, no. 6 (2007): 559–565; Karen A. Matthews and Joyce T. Bromberger, “Symptoms and Health-Related Quality of Life and the Menopausal Transition,” in NIH State-of-the-Science Conference on Management of Menopause-Related Symptoms (Bethesda: National Institutes of Health, 2005).
14. Halpern, Clinical Ayurvedic Medicine, p. 5-94.
15. Ibid., p. 5-95.
16. Ibid., p. 5-95.
17. Ibid., p. 5-95.
18. Burger et al., “A Review of Hormonal Changes during the Menopausal Transition,” 559–565; Matthews and Bromberger, “Symptoms and Health-Related Quality of Life.”
19. SN Lee et al., “Associations between Osteoporosis and Coronary Artery Disease in Postmenopausal Women,” Climacteric 19, no. 5 (2016): 458–462. DOI: 10.1080/13697137.2016.1200550. PMID: 27397609.
20. Halpern, Clinical Ayurvedic Medicine, p. 5-95.
21. Rani J et al., “Postmenopausal Osteoporosis: Menopause Hormone Therapy and Selective Estrogen Receptor Modulators,” Indian Journal of Orthopaedics 57, Suppl 1 (2023): 105–114. DOI: 10.1007/s43465-023-01071-6. PMID 38107817. PMCID: PMC10721581.
22. Halpern, Clinical Ayurvedic Medicine, pp. 5-95 to 5-96.
23. Ibid., p. 5-95.
24. Samar R. El Khoudary et al., “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association,” Circulation 142 (2020): e506–e532. DOI: 10.1161/CIR.0000000000000912. PMID: 33251828; Jaya M. Mehta and JoAnn E. Manson, “The Menopausal Transition Period and Cardiovascular Risk,” Nature Reviews Cardiology 21, no. 3 (2024): 203–211. DOI: 10.1038/s41569-023-00926-7. PMID: 37752349.
25. Halpern, Clinical Ayurvedic Medicine, p. 5-95.
26. Ibid., p. 5-96.
27. Meera Kumari, Mahima Dixit, and N. K. Meena, “Ayurveda and Modern Perspective on Rajonivritti w.s.r. to Menopause: Review Based on Literary Study,” International Research Journal of Ayurveda and Yoga 4, no. 11 (2021): 109–113.
28. Sushruta, Sushruta Samhita, Sharira Sthana 3.8, commentary by Ambika Dutta Shastri (Varanasi: Chaukhamba Samskrit Samsthan, 2006).
29. Halpern, Clinical Ayurvedic Medicine, p. 5-96.
30. Ibid., p. 5-96.
31. Vagbhata, Ashtanga Hrdayam, Sutrasthana 1.8, commentary by Kaviraj Atridev Gupta (Varanasi: Chaukhamba Surbharti Prakashan, 2007).
32. Sushruta, Sushruta Samhita, Sutrasthana 15.9.
33. Halpern, Clinical Ayurvedic Medicine, p. 5-96; Nancy Lonsdorf, The Ageless Woman (MCD Century Publications, 2004), p. 7.
34. Halpern, Clinical Ayurvedic Medicine, p. 5-96.
35. Ibid., p. 5-96.
36. Ibid., p. 5-97.
37. Agnivesha, Charaka Samhita, Vimana Sthana 5.3, with commentary of Chakrapanidatta, ed. Vaidya Jadavji Trikamji Acharya (Varanasi: Chaukhamba Sanskrit Pratishthan, 2004); Sushruta, Sushruta Samhita, Sutrasthana 15.9.
38. Halpern, Clinical Ayurvedic Medicine, pp. 5-96 to 5-97; Vasant Lad, Textbook of Ayurveda: A Complete Guide to Clinical Assessment, Vol. 2 (Albuquerque: Ayurvedic Press, 2006), p. 314.
39. Halpern, Clinical Ayurvedic Medicine, p. 5-97.
40. Halpern, Clinical Ayurvedic Medicine, pp. 5-96 to 5-97; Lad, Textbook of Ayurveda, Vol. 2, p. 314.
41. Halpern, Clinical Ayurvedic Medicine, pp. 5-96 to 5-97; Lad, Textbook of Ayurveda, Vol. 2, p. 314.
42. Halpern, Clinical Ayurvedic Medicine, pp. 5-96 to 5-97; Lad, Textbook of Ayurveda, Vol. 2, p. 314.
43. David Frawley, Ayurvedic Healing: A Comprehensive Guide (Salt Lake City: Passage Press, 1989), pp. 207–208; Vasant Lad, Textbook of Ayurveda: Fundamental Principles of Ayurveda, Vol. 1 (Albuquerque: Ayurvedic Press, 2002), p. 148.
44. Halpern, Clinical Ayurvedic Medicine, pp. 5-96 to 5-97; Lad, Textbook of Ayurveda, Vol. 2, p. 314.
45. Frawley, Ayurvedic Healing, pp. 207–208; Lad, Textbook of Ayurveda, Vol. 1, p. 148.
46. María Fasero and Pluvio J. Coronado, “Cardiovascular Disease Risk in Women with Menopause,” Journal of Clinical Medicine 14, no. 11 (2025): 3663.
47. Halpern, Clinical Ayurvedic Medicine, pp. 5-96 to 5-97; Lad, Textbook of Ayurveda, Vol. 2, p. 314.
48. Frawley, Ayurvedic Healing, p. 208.
49. Agnivesha, Charaka Samhita, Sutrasthana 17.74–75 and 30.6–11, with commentary of Chakrapanidatta, ed. Vaidya Jadavji Trikamji Acharya (Varanasi: Chaukhamba Sanskrit Pratishthan, 2004).
50. Halpern, Clinical Ayurvedic Medicine, p. 5-96.
51. Frawley, Ayurvedic Healing, pp. 207–208.
52. Ibid., pp. 207–208.
53. Halpern, Clinical Ayurvedic Medicine, p. 5-98.
54. Lonsdorf, The Ageless Woman, p. 7.
55. Halpern, Clinical Ayurvedic Medicine, p. 5-98.
56. Ibid., p. 5-98.
57. Frawley, Ayurvedic Healing, pp. 207–208.
58. Halpern, Clinical Ayurvedic Medicine, pp. 5-117 to 5-118.
59. Ibid., pp. 5-117 to 5-118.
60. Ibid., p. 5-119.
61. M-N Chen, C-C Lin, and C-F Liu, “Efficacy of Phytoestrogens for Menopausal Symptoms: A Meta-Analysis and Systematic Review,” Climacteric 18, no. 2 (2015): 260–269. Published online December 2014. DOI: 10.3109/13697137.2014.966241. PMID 25263312.
62. Li-Ru Chen, Nai-Yu Ko, and Kuo-Hu Chen, “Isoflavone Supplements for Menopausal Women: A Systematic Review,” Nutrients 11, no. 11 (2019): 2649. DOI: 10.3390/nu11112649. PMID 31689947. PMCID: PMC6893524.
63. Frawley, Ayurvedic Healing, pp. 207–208.
64. Lad, Textbook of Ayurveda, Vol. 1, p. 148.
65. Halpern, Clinical Ayurvedic Medicine, p. 5-121 (Herb-Hormone Support Chart).
66. Frawley, Ayurvedic Healing, pp. 207–208.
67. Halpern, Clinical Ayurvedic Medicine, pp. 5-96 to 5-97; Lad, Textbook of Ayurveda, Vol. 2, p. 314.
68. Halpern, Clinical Ayurvedic Medicine, p. 5-97.
69. Vani S. Gudise, Meenakshi P. Dasari, and Siva Sai K. Kuricheti, “Efficacy and Safety of Shatavari Root Extract for the Management of Menopausal Symptoms: A Double-Blind, Multicenter, Randomized Controlled Trial,” Cureus 16, no. 4 (April 2024): e57879. DOI: 10.7759/cureus.57879. PMCID: PMC11079574.
70. Usharani Pingali, Chandrasekhar Nutalapati, and Yan Wang, “Ashwagandha and Shatavari Extracts Dose-Dependently Reduce Menopause Symptoms, Vascular Dysfunction, and Bone Resorption in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study,” Journal of Menopausal Medicine 31, no. 1 (2025): 21–34. DOI: 10.6118/jmm.24025. PMID 40347163.
71. Mansi B. Modi, Shilpa B. Donga, and Laxmipriya Dei, “Clinical Evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the Management of Menopausal Syndrome,” Ayu 33, no. 4 (October–December 2012): 511–516, PMCID: PMC3665193.
72. Halpern, Clinical Ayurvedic Medicine, p. 5-98.
73. Ibid., p. 5-98.
74. Lad, Textbook of Ayurveda, Vol. 1, p. 148; Lonsdorf, The Ageless Woman, p. 46.
75. Halpern, Clinical Ayurvedic Medicine, p. 5-99.
76. Ramin Mohebbi, et al., “Exercise Training and Bone Mineral Density in Postmenopausal Women: An Updated Systematic Review and Meta-Analysis of Intervention Studies with Emphasis on Potential Moderators,” Osteoporosis International 34, no. 7 (2023): 1145–1178. DOI: 10.1007/s00198-023- 06682-1. PMID 36749350. PMCID: PMC10282053.
77. Halpern, Clinical Ayurvedic Medicine, p. 5-99.

Appendix: Research Article Abstracts

The following are the abstracts of the six peer-reviewed research studies cited in this paper.

Abstract 1

Gudise VS, Dasari MP, Kuricheti SSK. “Efficacy and Safety of Shatavari Root Extract for the Management of Menopausal Symptoms: A Double-Blind, Multicenter, Randomized Controlled Trial.” Cureus, April 8, 2024. DOI: 10.7759/cureus.57879. PMCID: PMC11079574.

This was an eight-week, multicenter, interventional, prospective, randomized, double-blind, placebo controlled, parallel clinical trial structured to compare the safety and efficacy of Shatavari root extract with placebo in the management of menopausal symptoms and regulation of the hypothalamic-pituitary-ovarian (HPO) axis in pre- and postmenopausal women. Seventy patients were randomized into test and placebo groups. The study outcomes showed positive and significant effects of the active test ingredient over the placebo in terms of reduction in hot flashes, night sweats, insomnia, anxiety, nervousness, vaginal dryness, and loss of libido. The Utian Quality of Life score improved significantly in the test group compared to the placebo group. No significant adverse events were recorded in the test group, suggesting the safety of this formulation. These findings support the use of Shatavari root extract as a well-tolerated and effective intervention for the management of menopausal symptoms. 

Abstract 2

Pingali U, Nutalapati C, Wang Y. “Ashwagandha and Shatavari Extracts Dose-Dependently Reduce Menopause Symptoms, Vascular Dysfunction, and Bone Resorption in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study.” Journal of Menopausal Medicine 31, no. 1 (2025): 21–34. DOI: 10.6118/jmm.24025. PMID 40347163.

This randomized, double-blind, placebo-controlled study investigated the effects of standardized aqueous extracts of shatavari (Asparagus racemosus), ashwagandha (Withania somnifera), or their combination on menopausal symptoms, vascular dysfunction, bone turnover, and serum concentrations of inflammatory and oxidative stress markers in postmenopausal women aged 40–55 years. One hundred and twenty-three women completed the 24-week dietary supplementation period. Participants were assigned to one of six groups: placebo, shatavari 250 mg, shatavari 500 mg, ashwagandha 250 mg, ashwagandha 500 mg, or a combination of shatavari 250 mg and ashwagandha 250 mg, each given twice daily. Improvements in menopausal symptom scores (MENQOL) were dose-dependent. All supplemented groups showed significant reductions in bone resorption markers including CTX-1 and RANKL, with increases in bone-protective OPG. Ashwagandha 500 mg/day produced a higher bone mineral density at the lumbar spine at 24 weeks compared to baseline. All groups showed significant reductions in markers of vascular endothelial dysfunction, inflammation (hsCRP), and oxidative stress. The combination of both herbs demonstrated synergistic effects without adverse interactions. This study provides strong clinical evidence supporting both ashwagandha and shatavari as effective, safe interventions for menopausal symptom management, bone health, and vascular function.

Abstract 3

Chen M-N, Lin C-C, Liu C-F. “Efficacy of Phytoestrogens for Menopausal Symptoms: A Meta-Analysis and Systematic Review.” Climacteric 18, no. 2 (2015): 260–269. Published online December 2014. DOI: 10.3109/13697137.2014.966241. PMID 25263312. PMCID: PMC4389700.

This meta-analysis and systematic review examined the efficacy of phytoestrogens for the relief of menopausal symptoms. The databases Medline, Cochrane, EMBASE, and Google Scholar were searched through September 30, 2013 using keywords including vasomotor symptoms, menopausal symptoms, phytoestrogens, isoflavones, coumestrol, soy, and red clover. Inclusion criteria were randomized controlled trials (RCTs) with perimenopausal or postmenopausal women experiencing menopausal symptoms, with intervention consisting of oral phytoestrogen administration. Outcome measures included Kupperman Index changes, daily hot flush frequency, and side effects. Of 543 potentially relevant studies identified, 15 RCTs meeting the inclusion criteria were included in the meta-analysis. Results demonstrated that phytoestrogen supplementation produces a statistically significant reduction in the frequency of hot flushes in menopausal women. This benefit was achieved without serious side effects. The findings provide clinical evidence for the inclusion of dietary phytoestrogens in the management of menopausal vasomotor symptoms, supporting Ayurvedic nutritional recommendations that emphasize phytoestrogen-rich foods such as soy, flaxseeds, and legumes.

Abstract 4

Rani J, Swati S, Meeta M, Singh SH, Tanvir T, Madan A. “Postmenopausal Osteoporosis: Menopause Hormone Therapy and Selective Estrogen Receptor Modulators.” Indian Journal of Orthopaedics 57, Suppl 1 (2023): 105–114. DOI: 10.1007/s43465-023-01071-6. PMID 38107817. PMCID: PMC10721581.

Postmenopausal osteoporosis is one of the most prevalent and debilitating complications of estrogen deficiency following menopause. Estrogen plays a central role in bone remodeling by suppressing osteoclast activity and promoting osteoblast survival. Following menopause, estrogen deficiency leads to increased osteoclast activity, accelerated bone resorption, reduced bone formation, and a net negative bone balance. Bone mineral density may decline at a rate of 1–5% annually in the first years following the final menstrual period, significantly increasing the risk of fragility fractures at the lumbar spine, femoral neck, and wrist. This review examines the pathophysiology of postmenopausal osteoporosis, including the role of estrogen and related hormonal changes, diagnostic criteria, and management strategies including menopausal hormone therapy (MHT) and selective estrogen receptor modulators (SERMs). The authors discuss the benefits and risks of each approach, noting that MHT remains effective for both vasomotor symptom relief and bone preservation when used appropriately. The paper is directly relevant to the Ayurvedic understanding of osteoporosis as Asthi Dhatu Kshaya — depletion of bone tissue through the relocation of aggravated Vata into the Asthivaha Srotas — and supports the integration of both Western and Ayurvedic management strategies.

Abstract 5

Mohebbi R, et al. “Exercise Training and Bone Mineral Density in Postmenopausal Women: An Updated Systematic Review and Meta-Analysis of Intervention Studies with Emphasis on Potential Moderators.” Osteoporosis International 34, no. 7 (2023): 1145–1178. DOI: 10.1007/s00198-023-06682-1. PMID 36749350. PMCID: PMC10282053.

The aim of this updated systematic review and meta-analysis was (1) to determine the effects of exercise training on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone status, menopausal status, and supervision in postmenopausal women. A comprehensive search of eight electronic databases according to PRISMA guidelines, conducted through August 9, 2022, included controlled exercise trials of at least six months’ duration. BMD changes at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as primary outcomes. A total of 80 studies involving 94 training groups and 80 control groups, with a pooled number of 5,581 participants, were eligible. The inverse heterogeneity model determined standardized mean differences of 0.29 (95% CI: 0.16–0.42), 0.27 (95% CI: 0.16–0.39), and 0.41 (95% CI: 0.30–0.52) for lumbar spine, femoral neck, and total hip BMD, respectively, demonstrating positive, statistically significant effects of exercise on bone mineral density at all three sites. Importantly, no significant differences were observed for exercise effects on BMD between studies with or without osteopenia/osteoporosis, between early and late postmenopausal women, or between predominantly supervised and non-supervised exercise programs. These results provide robust evidence that exercise training is an effective intervention for improving bone mineral density in postmenopausal women across a range of bone health statuses, directly supporting lifestyle recommendations including weight-bearing exercise and yoga as core components of menopausal management.

Abstract 6

Chen LR, Ko NY, Chen KH. “Isoflavone Supplements for Menopausal Women: A Systematic Review.” Nutrients 11, no. 11 (2019): 2649. DOI: 10.3390/nu11112649. PMID 31689947. PMCID: PMC6893524.

Menopausal symptoms are largely caused by declining estrogen levels and affect the quality of life of many women. Conventional menopausal hormone therapy effectively alleviates symptoms but carries risks that lead many women to seek natural alternatives. Isoflavones — the most studied class of phytoestrogens — are plant-derived compounds that bind to estrogen receptors and exert weak estrogenic effects. This systematic review examined clinical trials evaluating isoflavone supplementation in menopausal women. The review found that isoflavone supplementation produced significant reductions in vasomotor symptoms, including hot flashes and night sweats, with some studies reporting reductions of over 40%. Evidence also indicated potential benefits for bone mineral density and cardiovascular risk factors, though findings across preparations and populations were variable. Isoflavones derived from soy and red clover were the most commonly studied. The authors note that the mechanism of action includes binding to estrogen receptor alpha and beta, with preferential affinity for receptor beta, and that the degree of clinical effect may depend on individual capacity to metabolize isoflavones to equol. The findings support the incorporation of dietary isoflavone-rich foods — particularly soy products and flaxseeds — as a component of nutritional management for menopausal women, consistent with Ayurvedic phytoestrogen-rich dietary recommendations.