Premenstrual Syndrome and Menstrual Irregularities: A Critical Review Through the Lens of Vata Dosha Derangement in Ayurveda

By Sarina Patel

Introduction

Premenstrual syndrome (PMS) and menstrual irregularities are among the most common concerns affecting women of reproductive age. Both the symptoms and their severity  can vary widely. They can affect many aspects of daily activity and quality of life, presenting as fatigue, bloating, irregular cycles, pelvic discomfort, and increased emotional and physical sensitivities before menstruation. Premenstrual syndrome (PMS) is common among women of reproductive age, with approximately 47.8% experiencing clinically significant PMS symptoms, and up to 80-90% report at least one premenstrual symptom.¹ While menstruation is a natural physiological process, menstrual experiences vary greatly from woman to woman. There are several factors that can influence menstrual health, such as hormonal, neurological, and life-style related factors. Chronic stress, haphazard daily routines, excess travel, and nutritional imbalances are among possible contributing factors. Many of these factors may contribute to worsening menstrual symptoms in some individuals.

In PMS, symptoms typically resolve within 4 days of the start of the menstrual cycle. The list of signs and symptoms is lengthy, but most women experience at least one of the following: 

Emotional and behavioral signs and symptoms 

• Tension or anxiety 
• Depressed mood 
• Crying spells 
• Mood swings, irritability or anger 
• Appetite changes and food cravings 
• Trouble falling asleep (insomnia) 
• Social withdrawal 
• Poor concentration 
• Change in libido 

Physical signs and symptoms 

• Joint or muscle pain 
• Headache 
• Fatigue 
• Weight gain related to fluid retention 
• Abdominal bloating 
• Breast tenderness 
• Acne flare-ups 
• Constipation or diarrhea 
• Alcohol intolerance ²

Conventional medical research understands PMS and menstrual irregularities through hormonal fluctuations within the hypothalamic-pituitary-ovarian (HPO) axis and neurotransmitter changes throughout the menstrual cycle.³  While the biomedical model provides a useful foundational understanding of the cycle, it does not fully explain the variations in symptoms between individuals and the occurrence of severe physical and emotional symptoms, despite normal hormone levels and other lab tests. Due to this, there has been a growing interest in integrative approaches that consider the interaction between mind, body and lifestyle factors.

The Ayurvedic approach for PMS adds perspective beyond merely the hormonal lens. It may be the result of long-standing Vata aggravation that eventually disturbs Apana Vata. As the imbalance progresses, secondary Pitta involvement may develop, creating the mixed symptom patterns often seen in women today.

This paper will explore premenstrual syndrome and menstrual irregularities through the lens of Vata derangement in Ayurveda, with a focus on how disturbed Apana Vata may contribute to both physical and psychological symptoms.

Western Pathology

Analyzing PMS from a medical standpoint, one measures a combination of physical, emotional, and behavioral symptoms mostly occurring during the luteal phase. This phase begins after ovulation and ends when menstruation begins. During this period, estrogen and progesterone levels naturally fluctuate as they prepare the body for a possible pregnancy. Though hormonal fluctuations are a normal part of the menstrual cycle, some women have more adverse reactions to them than others. As a result, these women can experience physical and emotional symptoms that can significantly affect their quality of daily life.⁴

Research suggests that PMS is not directly caused by abnormal hormone levels themselves, but rather by the body’s response to normal hormonal fluctuations. These changes can affect neurotransmitters in the brain, like serotonin, which play an integral role in mood regulation, sleep quality, appetite, and emotional regulation. Reduced serotonin levels can lead to many common PMS symptoms, including irritability, anxiety, depression, fatigue, and food cravings.⁵

The communication between the brain and the ovaries is essential for the regulation of female reproductive function. This is known as the hypothalamic-pituitary-ovarian (HPO) axis, which helps control hormones, puberty, and the menstrual cycle. This communication system between these two organs coordinates the production of reproductive hormones and maintains regular ovulation and menstruation. A disruption in the HPO axis results in missed periods, irregular ovulation, and changes in cycle length. Factors such as chronic stress, poor sleep, excessive exercise, nutritional deficiencies, and medical conditions can interfere with normal HPO axis function.⁶

In addition to the HPO axis, the hypothalamic-pituitary-adrenal (HPA) axis, which regulates the body’s stress response, has been recognized as a major contributor to menstrual dysfunction.⁷ Chronically elevated stress levels can alter hormone signaling and interfere with ovulation. Research suggests that PMS is more prevalent among women working outside the home, women with alcohol dependence, and women with higher parity, supporting the hypothesis that chronic stress and demanding life circumstances influence symptom expression.⁸ One study conducted in Ahmedabad, Gujarat determined a significant positive correlation found between high-stress levels and the severity of PMS.⁹  This relationship highlights the connection between the endocrine system, nervous system, and reproductive health. ¹⁰

While modern medicine has improved its understanding of PMS and menstrual irregularities, there is no single cause that explains the variety of symptoms experienced from woman to woman. Western medicine views the various symptoms experienced in PMS as multifactorial, with explanations ranging from hormone fluctuations, neurotransmitter changes, genetics, lifestyle to chronic stress levels. Due to the complex nature of PMS, looking beyond conventional medical practices may be a key to relief from these various symptoms. Ayurveda, a traditional medical science, employs a whole-body approach, offering a different framework for understanding menstrual health. 

Western Treatment

Lifestyle changes such as stress relief, exercise, and better nutrition can alleviate PMS symptoms for many women with PMS. However, in more severe cases, medications may be indicated. Commonly prescribed medications for PMS include: 

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft are indicated for severe PMS or premenstrual dysphoric disorder (PMDD). 
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Advil, Motrin, or Aleve can ease cramping and breast discomfort. 
• Diuretics: Spironolactone can ease some of the symptoms of PMS such as weight gain/swelling/bloating by helping the body shed excess fluid through kidneys. 
• Hormonal contraceptives: These medications stop ovulation, which may bring relief from symptoms.¹¹ 

Ayurvedic Classification

Ayurveda does not view PMS as a distinct disease, rather as a set of imbalances within the body. PMS is often viewed as the result of low Ojas, which is the body’s vital essence- the subtle substance believed to support vitality, resilience, immunity, mental stability, and overall well-being. Low Ojas is triggered by chronic Vata aggravation, caused by stress, irregular routines, and depletion. A long-standing Vata imbalance depletes a woman’s Ojas reserves, which in turn reduces the body’s resilience and can lead to heightened emotional sensitivity, fatigue, and poor recovery from stress. This decreased overall resilience may make physical and emotional symptoms more apparent during the luteal phase of menstruation, as the protective buffer of Ojas is reduced.

There is particular emphasis on Vata dosha in PMS as Vata governs movement and physiological regulation, and the menstrual cycle itself is cyclical in nature. Vata disturbance may present as irregular cycles, dryness, pain, and emotional instability. These disturbances are commonly linked to disruption in Apana Vayu, which governs downward movement, and ultimately enables the flow of menstrual blood. When aggravated Vata is left untreated, combined with diet choices such as processed foods, refined sugars, alcohol, caffeine, and excessive pharmaceutical and environmental toxins, there may be a secondary aggravation of Pitta and/or Kapha, resulting in complex PMS presentations: Vata-Pitta, Vata-Kapha, & Tridoshic. Pitta-dominant PMS symptoms present as irritability, heat, inflammation, and headaches. Kapha-dominant PMS symptoms present as heaviness, swelling, lethargy, and water retention.  

Ayurvedic Pathology

Ayurveda emphasizes identifying the nidana, or underlying causes of imbalance. Long before menstrual symptoms appear, an individual’s lifestyle habits can gradually disturb the body’s balance, aggravating Vata dosha. Factors such as the intake of dry, cold, and light foods, excessive sexual activity, sleeplessness, fasting, swimming, walking, excessive exercise, worry, fright, uncomfortable seats or beds, trauma, suppression of natural urges, indigestion, and injury to vital areas can all aggravate Vata.¹²  

As Vata becomes aggravated, the normal function and direction of Apana Vata is also disrupted.¹³ Apana Vata is one of the five subdivisions of Vata and plays a central role in female reproductive health. Apana Vata is said to be located in the urinary bladder, umbilicus, thighs, inguinal region and anus and it performs the expulsion of either menstrual blood or the fetus.¹⁴ When Vata becomes aggravated through excessive movement, rushing, stress, irregular routines, or inadequate rest, the normal downward direction of Apana Vata gets disrupted. Dr. Marianne Teitelbaum explains that rather than flowing downward, Apana Vata may begin to move upward, interfering with its normal physiological functions.¹⁵ Because menstruation depends on the proper downward flow of menstrual blood, healthy Apana Vata is crucial for maintaining a regular and pain-free cycle. Disturbance of Apana Vata contributes to irregular menstruation, constipation, bloating, and other symptoms associated with PMS. Accordingly, Ayurvedic treatment of PMS prioritizes the restoration of Apana Vata. 

In addition to disturbing Apana Vata, Vata aggravation can interfere with Agni, leading to irregular digestive and metabolic function. Ongoing Vata aggravation leads to a state of Vishamagni, wherein digestion becomes erratic and irregular. In this state, food is digested inconsistently and this improper digestion contributes to the formation of Ama. Ama can further obstruct the body’s channels, or shrotas, which interferes with the normal flow of the doshas. This added layer of weak Agni and Ama accumulation further complicates menstrual function.  

Properly digested food ultimately nourishes the tissues, or dhatus. Rasa is the first of the seven dhatus to receive nourishment from Ahara Rasa and plays an important role in the nourishment of the remaining dhatus.¹⁶ Artava is closely associated with Rasa dhatu and depends on proper tissue nourishment for healthy menstrual function. When Agni is impaired and Ama is present, the proper nourishment of Rasa, and subsequent tissues, may also become compromised. This ultimately affects the quality and function of Artava, further contributing to menstrual irregularities and symptoms associated with PMS.  

The relationship between stress, depletion, and reproductive function is further explored by Dr. Claudia Welch through her discussion of stress and sex hormones. Welch describes stress hormones as having a more activating and catabolic effect, while sex hormones are nourishing, rebuilding, and crucial for proper reproductive function. When the stress response remains chronically activated, the catabolic effects of excess stress hormones outweighs the nourishing influence of the sex hormones, contributing to depletion and hormonal imbalance. From an Ayurvedic perspective, this theory parallels the effects of chronic Vata aggravation, decreased tissue nourishment, and diminished Ojas reserves. This provides a modern framework for understanding how prolonged stress may contribute to menstrual dysfunction and PMS.¹⁷ 

The concept of Ojas provides an Ayurvedic framework for understanding this pattern of chronic stress and depletion. Ojas is depleted by prolonged stress, anger, excess physical exertion, grief, and Vata aggravation.¹⁸ Signs of reduced Ojas include fear, weakness, worry, loss of complexion, instability of mind, cheerlessness, dryness, and emaciation. As Ojas declines, resilience decreases, making women more vulnerable to physical and emotional symptoms during the menstrual cycle.  

Ayurvedic Management 

Ayurveda always treats the underlying imbalance rather than suppressing symptoms. PMS is not a single disease, rather a complex manifestation of chronic Vata aggravation, impaired Apana Vata, weakened Agni, Ama accumulation, impaired tissue nourishment, and depleted Ojas. Chikitsa, or treatment of PMS, aims to reverse each stage of the pathology.  

The first principle of ayurvedic treatment is to remove the nidana, or the causative factors. This would mean that the patient should prioritize a regular routine, an earlier bedtime, and a lifestyle that is slower paced. Additionally, she should avoid fasting, excessive exercise, chronic stress, and a Vata-provoking diet: cold, dry, light, and raw foods. Once the causative factors are addressed, treatment can shift toward pacifying the aggravated Vata dosha.  

If Vata remains aggravated, other therapies are less effective at addressing PMS. A Vata-pacifying diet should be favored, wherein food is warm, cooked, moist, and nourishing. A Vata-pacifying lifestyle that includes a predictable daily rhythm and routine with adequate sleep is also indicated. In terms of exercise, gentle yoga and moderate-paced walks would be preferred over vigorous or excessive exercise, as they help calm Vata without further depleting the body. Stress reduction is essential, which is why sattvic practices like meditation and yoga should be taken up. Heartfulness, a heart-centric meditation practice, has been proven to reduce stress and burnout while improving the well-being of an individual.¹⁹ A breathwork practice, such as Anuloma Viloma, is emotionally balancing. Furthermore, grounding yoga asanas, which focus on opening the pelvic area, can help to mitigate Vata imbalances. Some of these asanas include Malasana, Balasana, and Baddha Konasana. A daily abhyanga practice of applying warm herbalized oil to the body using gentle massage strokes is also beneficial for pacifying aggravated Vata due to its nourishing, warming, and unctuous qualities. Warm baths and minimizing sensory overstimulation further support Vata pacification. 

Once generalized Vata aggravation has begun to settle, treatment can become more focused on Apana Vata, the sub-dosha that is most closely related to menstruation. Given its key role in menstruation, special attention is directed toward restoring its normal downward flow. Drawing from classical Ayurvedic teachings, Dr. Marianne Teitelbaum outlines some “codes of conduct” intended to preserve the natural downward movement of Apana Vata during menstruation. She recommends that women rest as much as possible during their cycle, particularly during the days of heaviest flow, with an emphasis on keeping the feet elevated. She advises against prolonged standing, excessive talking, prolonged bathing, exercising, or engaging in sexual activity during menstruation as all these activities disrupt Apana Vata and interfere with its downward flow. Dr. Teitelbaum also recommends using menstrual pads rather than tampons or cervical cups, as internal menstrual products oppose the natural downward movement of menstrual blood.²⁰ 

Rekindling Agni and removing the body of Ama is the next key component of treatment. The erratic and irregular Vishamagni is corrected with a diet consisting of warm, cooked foods, steering clear of cold, dry, processed and raw foods. Incompatible food combinations should also be avoided, such as combining dairy with fruit, or cold drinks with hot meals. Consistent mealtimes, eating as per one’s appetite, and reducing stress improve this state of Agni as well. Gentle digestive herbs, such as fresh ginger, cumin, coriander, and fennel, are great for Deepana and Pachana. And lastly, Snehana, consisting of internal and external oleation, helps to counter Vata’s dry quality, which also supports Agni. It is important to improve digestion before introducing heavy nourishment, so that the body can properly assimilate more nourishing foods.  

The next phase of treatment shifts toward replenishing the body’s tissues. Healthy tissue formation depends on efficient digestion and proper sequential nourishment of each dhatu. As Rasa dhatu is the first tissue to be formed following digestion, its proper generation is essential for the nourishment of all the subsequent tissues, including Artava, the reproductive tissue responsible for healthy menstruation. At this stage, treatment emphasizes Brmhana (nourishment) and Rasayana (rejuvenation) therapies to rebuild vitality and restore Ojas. Ojas-building dietary recommendations include nourishing and easy to digest foods such as warm spiced milk, ghee, dates, soaked almonds, well-cooked grains, and nourishing soups or broths. As Ojas is gradually restored, many of the features associated with chronic Vata aggravation—fatigue, anxiety, poor stress tolerance, dryness, and menstrual irregularity—begin to resolve, promoting reproductive and systemic health.

After dietary nourishment, herbal treatment is prescribed to further nourish and rejuvenate the body. Female reproductive tonics, such as dong guai, wild yam, shatavari, and vidari kand are rejuvenative for the Artava dhatu. Shatavari has aphrodisiac properties and mitigates all three doshas.²¹ Studies conducted on Shatavari show that it is effective in improving female reproductive health, especially when stress-mediated.²² Nervine herbs, such as Ashwagandha, Shankpushpi, Brahmi and Jatamansi can help treat the PMS-associated anxiety, tachycardia, and insomnia, mitigating Vata. ²³

Rather than suppressing isolated symptoms, Ayurvedic treatment seeks to restore balance by removing the nidana, pacifying Vata, restoring Apana Vata, strengthening Agni, eliminating Ama, nourishing the dhatus, rebuilding Ojas, and supporting long-term resilience through diet, lifestyle, herbal medicine, and rejuvenative therapies. By addressing the root causes of imbalance, Ayurveda aims not only to alleviate PMS symptoms but also to restore healthy menstrual function and improve overall wellbeing.

Abstracts for Premenstrual Syndrome and Menstrual Irregularities: A Critical Review Through the Lens of Vata Dosha Derangement in Ayurveda 

Journal: The Lancet 371, no. 9619 (2008) 

Title: Premenstrual Syndrome 

Author: Kimberly Ann Yonkers, P M Shaughn O’Brien, Elias Eriksson 

Abstract 

Most women of reproductive age have some physical discomfort or dysphoria in the weeks before menstruation. Symptoms are often mild, but can be severe enough to substantially affect daily activities. About 5-8% of women thus suffer from severe premenstrual syndrome (PMS); most of these women also meet criteria for premenstrual dysphoric disorder (PMDD). Mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, are the most distressing, but somatic complaints, such as breast tenderness and bloating, can also be problematic. We outline theories for the underlying causes of severe PMS, and describe two main methods of treating it: one targeting the hypothalamus-pituitary-ovary axis, and the other targeting brain serotonergic synapses. Fluctuations in gonadal hormone levels trigger the symptoms, and thus interventions that abolish ovarian cyclicity, including long-acting analogues of gonadotropin-releasing hormone (GnRH) or oestradiol (administered as patches or implants), effectively reduce the symptoms, as can some oral contraceptives. The effectiveness of serotonin reuptake inhibitors, taken throughout the cycle or during luteal phases only, is also well established.

Journal: StatPearls, National Library of Medicine (July 17, 2023) 

Title: Premenstrual Syndrome 

Author: Pratyusha R. Gudipally and Gyanendra K. Sharma 

Abstract 

This activity is a review of the existing literature on premenstrual syndrome (PMS). It summarizes the management of PMS by outlining the importance of taking a comprehensive history and performing a detailed physical examination and makes a note of necessary diagnostic tests to be done to rule out other conditions that may present with similar symptoms. Moreover, it describes the role of the interprofessional team in the diagnosis and providing the best possible care for the patient. 

Objectives: 

• Outline the spectrum of symptoms associated with premenstrual syndrome. 
• Describes the pathophysiology of the symptoms in premenstrual syndrome. 
• Reviews the management of premenstrual syndrome. 

Journal: Journal of Clinical and Diagnostic Research 

Title: Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study 

Author: Ashraf Direkvand-Moghadam, Kourosh Sayehmiri, Ali Delpisheh, Satar Kaikhavandi  

Abstract 

Background and objectives: Premenstrual Syndrome (PMS) is a common health problem in women in reproductive age. The present study aimed to investigate the prevalence of PMS using meta-analysis method. 

Methods: This meta-analysis systematically reviewed the prevalence of PMS. A search was conducted using keywords Premenstrual Syndrome, PMS, prevalence PMS and symptom of PMS in reliable English articles. The initial search 53 articles were available. After review of full-text articles, 17 articles were selected for analysis. Data were combined using meta-analysis (random effects model). Data were analyzed using STATA software, Version 11.1 RESULTS: Overall, 17 studies met our inclusion criteria. The pooled prevalence of PMS was 47.8% (95% CI: 32.6-62.9). The lowest and highest prevalence were reported in France 12% (95% CI: 11-13) and Iran 98% (95% CI: 97-100) respectively. However, meta-regression scatter plot showed an increasing trend in the prevalence of PMS during 1996-2011 but correlation between prevalence of PMS and year of study was not significance (p= 0.797). 

Interpretation and conclusions: Considering that different tools have been used in studies and many studies have been designed based on a limited sample, therefore, future research needs to consider the prevalence of PMS in different countries of world. 

Keywords: Meta-regression model; Prevalence of Premenstrual Syndrome; Symptom of Premenstrual Syndrome. 

Journal: Obstetrical & Gynecological Survey 

Title: The premenstrual syndrome 

Author: S Lurie, R Borenstein 

Abstract 

PMS is probably a group of entities which include various symptoms that occur during the 7 to 10 days before menstruation and disappear a few hours after the onset of menstruation. The definition of PMS lacks objective criteria. The most common symptoms are irritability, bloating, aggressiveness, mastodynia, and headaches. The prevalence of PMS is estimated at 30 to 40 per cent. PMS is more prevalent among women working outside the home, alcoholics, women of high parity, and women with toxemic tendency; it probably runs in families. The etiology of PMS is no less obscure to us than when it was first described by Frank in 1931. No single theory has been established to explain the entire diversity of PMS symptomatology. The multitude of possible etiologic factors includes psychosocial bases, progesterone deficiency, prolactin excess, thyroid hypofunction, renin angiotensin alternations, antidiuretic hormone excess, decreased colloidosmotic pressure, endorphin activity alternations, serotonin metabolism alternations, prostaglandin action, vitamin deficiency, and such unconventional theories as the ovarian infection or the “yeast overgrowth” theory. A partial resolution of this divergence of hypotheses comes from the biopsychosocial model developed by Keye and Trunnel. According to this model, a biologic, perhaps genetically determined, predisposition to PMS is realized when past and present life experiences, attitudes, beliefs, coping styles, and social forces interact to stress a woman. The diagnosis of PMS is based on establishing a relationship between the luteal phase of the cycle and the symptoms. The evaluation of PMS patients includes the use of a monthly diary to scale the symptoms, a physical examination, and biochemical studies to rule out other disorders. Management includes education, reassurance, and drug therapy.(ABSTRACT TRUNCATED AT 250 WORDS) 

Journal: Cureus 

Title: Impact of Stress on Premenstrual Syndrome 

Among Young Women: A Cross-Sectional Study 

Author: Diya Trivedi, Karan Patel, Kamleshkumar G Jain 

Abstract 

Background and aims: Premenstrual syndrome (PMS) is a common condition affecting young women, characterized by emotional, behavioral, and physical symptoms. Stress is believed to exacerbate PMS symptoms, yet the relationship between stress and PMS remains underexplored in the Indian context, particularly among young women in urban areas like Ahmedabad. This study aims to assess the impact of stress on PMS among young women aged 18-21 years residing in Ahmedabad, Gujarat. Materials and methods: A cross-sectional study was conducted among 473 young women aged 18-21 years in Ahmedabad, Gujarat, using a stratified random sampling technique. Data were collected using a validated questionnaire that assessed PMS symptoms and perceived stress levels. Statistical analysis was performed using chi-square tests to determine the association between stress and PMS. Results: Participants found to have moderate to severe PMS were 167 (35.3%). The most commonly reported symptoms included irritability, fatigue, and breast tenderness. A majority (84.4%) of the participants were having moderate stress. A significant positive correlation was found between high-stress levels and the severity of PMS (p < 0.01). The amount of menstrual flow was found to be associated with PMS in this study. Conclusions: The study highlights the significant impact of stress on the severity of PMS among young women in Ahmedabad, Gujarat. Considering higher percentages of stress levels among participants, there is a need for stress management interventions to alleviate PMS symptoms among the study participants. 

Journal: Stress and Health 

Title: Effect of Heartfulness Meditation on Stress Biomarkers, Burnout and Well-Being 

Author: Mansee Thakur, Sanjana T. Philip, Kunal R. Desai, Kapil Thakur 

Abstract 

The rise in mental health conditions and stress has attracted global attention. Non-pharmacological and traditional approaches like meditative practices are showing promising results. Therefore, the aim of the study was to evaluate the effect of Heartfulness meditation on stress biomarkers, burnout, and well-being. A double-arm prospective randomized controlled study was carried out on 100 participants aged between 18 and 24 years, experiencing moderate to high perceived stress as assessed by the Perceived Stress Scale (PSS-10). These participants were randomized into a study group (meditation) and control group (sham meditation). An intervention of Heartfulness meditation was carried out daily for 12 weeks. Psychometric analysis was carried out to study burnout (exhaustion, cynicism and professional efficacy) and well-being using the standard validated questionnaires- Maslach Burnout Inventory (MBI) and WHO-Well-being Index (WHO-WBI). Biochemical analysis was also carried out to study psychological stress (serum cortisol), and oxidative stress (serum nitrate/nitrite and serum malondialdehyde (MDA) at baseline and post-intervention. Statistical analysis was carried out using the IBM SPSS software version 26.0. p values < 0.05 were considered statistically significant. A significant increase in serum nitrate/nitrite levels, professional efficacy, and well-being, and a significant decrease in measures such as exhaustion, cynicism, and cortisol levels were observed in the study group than the control group post-intervention. A significant negative correlation was also observed between serum MDA and well-being, whereas a positive correlation was observed between MDA and cortisol. The findings from this research suggest the role of Heartfulness meditation in reducing stress and burnout along with improving the well-being of an individual. Therefore, Heartfulness meditation can be used as a potential tool to improve mental health and well-being. However, future studies with a larger number of samples are needed to strengthen our findings. Trial Registration: Clinical Trial Registry of India: CTRI/2023/10/058,423 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=ODIyOTA=&Enc=&userName=CTRI/2023/10/058423). 

Journal: Biomedicine & Pharmacotherapy 

Title: Impact of Stress on Female Reproductive Health Disorders: Possible Beneficial Effects of Shatavari (Asparagus racemosus) 

Author: Ajai K. Pandey, Anumegha Gupta, Meenakshi Tiwari, Shilpa Prasad, Ashutosh N. Pandey, Pramod K. Yadav, Alka Sharma, Kankshi Sahu, Syed Asrafuzzaman, Doyil T. Vengayil, Tulsidas G. Shrivastav, Shail K. Chaube 

Abstract 

Stress is deeply rooted in the society and women are frequently exposed to psychological, physical and physiological stressors. Psychological stress disturbs reproductive health by inducing generation of reactive oxygen species (ROS) and thereby oxidative stress (OS). The increased OS may affect physiology of ovary, oocyte quality and cause female reproductive health disorders. To overcome stress-mediated reproductive health disorders in women, shatavari (Asparagus racemosus) is frequently recommended in Ayurvedic system of medicine. Although shatavari is one of the major health tonics and most popular rasayana drugs to treat reproductive ailments of women, underlying mechanism of shatavari action at the level of ovary remains poorly understood. Based on the existing studies, we propose that shatavari may improve female reproductive health complications including hormonal imbalance, polycystic ovarian syndrome (PCOS), follicular growth and development, oocyte quality and infertility possibly by reducing OS level and increasing antioxidants level in the body. Further studies are required to elucidate the mechanism of shatavari actions at the level of ovary and oocyte that directly impacts the reproductive health of women.