Ayurveda & PMS: Ayurvedic Management of Premenstrual Syndrome & Menstruation

The Luteal Storm: Understanding Premenstrual Syndrome (PMS) through the Lens of Ayurveda

Premenstrual Syndrome or PMS is often dismissed as a routine inconvenience of the female reproductive cycle, yet for millions of women worldwide the physical discomfort, mood swings, bloating, breast tenderness and emotional turbulence in the week or two leading up to menstruation can significantly impair daily function, relationships and professional life; approaching premenstrual syndrome (pms) through the lens of Ayurveda reveals that these cyclical disturbances are not merely random or solely biomedical but reflect underlying imbalances in the doshas—particularly aggravated vata and pitta with occasional kapha involvement—and that each woman’s experience is shaped by her unique prakriti (constitutional type), seasonal influences and lifestyle patterns. From this perspective, symptoms are meaningful signals that guide a holistic response: gentle vata-pacifying routines (regular sleep, warm oil massage, grounding foods), pitta-soothing cooling diets and herbs (amla, coriander, brahmi where appropriate), and kapha-lightening activity when necessary, combined with targeted herbal formulations like ashwagandha, shatavari or manjistha under professional supervision, specific yoga postures, pranayama and mindfulness practices to regulate the nervous and endocrine systems, and seasonal or cycle-based Panchakarma therapies to detoxify and restore balance. By emphasizing individualized assessment, noninvasive daily rituals, dietary adjustments, stress reduction, and careful use of traditional remedies, the Ayurvedic approach offers practical, sustainable strategies to reduce symptom severity, improve resilience across the menstrual cycle and support long-term reproductive and emotional wellbeing.

PMS in the Modern Context:

Physiological and Psychological Aspects

In contemporary medicine, PMS is defined as a collection of recurring symptoms that manifest during the luteal phase (post-ovulation) and resolve shortly after the onset of the menstrual flow.

Premenstrual syndrome (PMS), also described as premenstrual tension (PMT) is a psycho neuro endocrine disorder of unknown etiology, often noticed just prior to menstruation. There is a cyclic appearance of a large number of symptoms during the last 7-10 days of the menstrual cycle.

The Physiological and Chemical Basis

The root cause of PMS is linked to the dramatic cyclic changes in ovarian hormones- specifically estrogen and progesterone that occur after ovulation. While hormone levels may be technically "normal," the body's sensitivity to their fluctuations is believed to trigger a cascade of effects.

Neurotransmitter Fluctuations: 

The drop in progesterone and estrogen impacts brain chemicals like serotonin (linked to mood, appetite, and sleep) and GABA (a calming neurotransmitter), contributing directly to mood and sleep disturbances.

Fluid and Inflammatory Changes related to symptoms of PMS:

Physical Signs: Abdominal bloating, weight gain (fluid retention), headache, joint and muscle aches, significant breast tenderness, and cramp.

Digestive Issues: Constipation or diarrhea can occur due to intestinal sensitivity.

The Significance in Present-Day Life

The emotional component is often the most debilitating aspect of PMS, sometimes escalating into the severe form known as Premenstrual Dysphoric Disorder (PMDD). It is included as a psychiatric disorder in the 5th edition of the Diagnostic & Statistical Manual for mental disorders (DSM-5)

Emotional Symptoms: Profound mood swings, heightened irritability and anger, anxiety, depressed mood, and difficulty concentrating ("brain fog").

Lifestyle Impact: This monthly wave of intense symptoms affects productivity, strains personal relationships, and can significantly reduce the quality of life, demonstrating that PMS is a complex psycho-physiological event that requires comprehensive management.

The Ayurvedic Perspective: A Tale of Imbalanced Doshas

Ayurveda does not identify PMS as a single disease entity but rather interprets the symptom complex as a manifestation of imbalanced Doshas-primarily Vata and Pitta-during the Ritu Vyatita Kala (the time past the appropriate season/phase), leading to disruption in the flow of Apana Vayu and vitiation of Rasa Dhatu (the tissue responsible for plasma and reproductive health).

The Role of Apana Vayu

The menstrual cycle is largely governed by Apana Vayu, the sub-categorization of Vata Dosha responsible for downward movement (elimination, urination, and menstruation). Stress, poor diet, and irregular lifestyle disrupt the natural, downward flow of Apana Vayu, causing it to move upward or obstruct its channels (Srotas). This is similar to the concept of Udavarta (upward movement of Vata), which leads to symptoms lodging in the head and upper body, exacerbating psychological symptoms.

PMS Symptom Classification by Dosha

The specific type of PMS a person experiences depends on which Dosha is predominantly aggravated.

Vitiated dosha	Rupa (The presenting symptoms)	Modern comparison
Vata	Anxiety, restlessness, insomnia, mood swings, severe lower back pain, bloating, constipation, dry skin, light menstrual flow	PMS- A
Pitta	Irritability, anger, Craving for spicy sour food items, hot flashes, headaches, acne, breast tenderness, hyperacidity, heavy/bright red flow	PMS - H /C
Kapha	Lethargy, heaviness, depression, excessive sleepiness, fluid retention, weight gain, congestion	PMS -D

As the etiology of PMS is unknown so it is treated mostly empirically and symptomatically. Management of premenstrual syndrome can incorporate both pharmacological and non-pharmacological interventions along with dietary supplements. Non-pharmacologic interventions for PMS include patient education, supportive therapy, and behavioral changes.

Ayurvedic Management: Line of Treatment (Chikitsa)

The goal of Ayurvedic treatment is not merely symptom suppression but to regulate the hormonal sensitivity, normalize the direction of Apana Vayu, and strengthen the Rasa Dhatu.

Shamana therapy (palliative internal medicine), along with Yogasanas,  Pranayama, and proper Rajaswalacharya, will help the patient to recover from the symptoms that were bothering her day-to-day activities. Shamana therapy includes the drugs that have Agnideepana properties,  which correct the Ama  Dosha, thereby   removing Srothorodha,   which can act on Manovaha   Srothas, thereby correcting Manasika Vikaras, which can correct HPO axis thereby balancing level of hormones.

Line of Treatment Principles

1. Vata Anulomana: Correcting the direction of Vata to ensure proper downward flow.

2. Pitta Shamana: Pacifying the heat and inflammation associated with Pitta.

3. Agni Deepana&Ama Pachana: Kindling the digestive fire and clearing accumulated toxins (Ama) which cause Srotas (channel) blockages.

Internal Medicines (Aushadha)&Herbs

Ayurveda utilizes specific herbs (known as Rasayanas for the reproductive system) to modulate the cycle:

Single drugs	Key actions
Shatavari (Asparagus racemosus)	Cooling (pitta pacifying), nourishes rasa dhatu
Ashoka (Saraca indica)	Uterine tonic,  regulates menstrual flow and discomfort
Ashwagandha (Withania somnifera)	Adaptogen, lowers cortisol, reduces stress and anxiety, improves sleep, and helps manage psychological symptoms.
Brahmi (Bacopa monnieri)	Nootropic calms the nervous system and improves mental clarity
Jatamamsi (Nardostachys jatamansi)	Reduces anxiety and pacifies vata, relieves insomnia
Lodhra (Symplocos racemosa)	Astringent, helps in reducing heavy bleeding and balancing hormones.

Panchakarma & External Therapies

An Ayurveda physician can intervene in PMS multidimensionally. Apart from internal medicines, dietary regulations, and lifestyle modifications, a Vaidya can direct those suffering from PMS to some external Ayurvedic treatment modalities with due consideration to the Dosha involved.

·       Abhyanga- i.e. oil massage with medicated oils can help to regulate the flow of Vata and thus manage PMS.

·       Basti (Medicated Enema): Excellent for relieving Vata localized in the pelvic region, treating symptoms like bloating and constipation.

·       Shirodhara: Pouring warm oil on the forehead to deeply relax the Manas (mind) and nervous. System, especially beneficial for anxiety and irritability.

Some Yoga Asanas can also be prescribed along with medicines like Ushtrasana, Gomukhasana,

Bhujangasana and Pavanamuktasana. Pranayamas like Nadi Shodhana and Anulomaviloma are also helpful in a Vata imbalance, serving as effective breathing exercises. Naukasana and Dhanurasana yoga postures and Sheetali pranayama can be used in a Pitta imbalance. Suryanamaskaras and spinal twists, Bastrika and Kapalbhati can be adopted in a Kapha imbalance to manage symptoms of PMS. 

Pathya Apathya for Menstrual Harmony

The most crucial intervention involves lifestyle and diet modification (Nidana Parivarjana).

Pathya (the do’s To follow)	Apathya (The don’ts To avoid)
Ahara (Diet) : Warm, cooked, nourishing foods. Increase intake of ghee, milk, cooked grains, and root vegetables. Add more of cumin, coriander, and fennel in food to help manage symptoms of PMS.	Ahara (Diet) : Cold, raw, dry foods. Excessive spicy, salty, sour or deep-fried foods. Refined sugar, caffeine, and alcohol.
Vihara (activities) : Maintain a consistent daily schedule (dinacharya). Gentle movements, restorative yoga, meditation, and pranayama can alleviate symptoms of PMS. Ensure 7 to 8 hours of sleep.	Vihara (activities): Staying up late at night (rathri jagarana), intense and exhausting exercises during luteal phase, suppressing natural urges, excessive stress and anger.

By harmonizing the Doshas, particularly calming the mobile Vata and cooling the intense Pitta, Ayurveda offers a sustainable path to transforming the "luteal storm" into a natural, subtle shift, empowering women to reclaim their well-being throughout their monthly cycle.

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by,

Dr.Anjali C.V. BAMS,MD(Ayu)

Consultant,

Aryavratha ayurveda clinic, Nellayi, Thrissur.