Excessive bleeding, prolonged bleeding or frequent appearance of menstruation in spite of coming at regular time is called atiyog of artava or atyartava. It also called rakta pradar. There are four types of Atyartava:

1. Atyartava: (menorrhagia): Excessive bleeding from the uterus which occurs at the regular times of the menstrual periods but the bleeding is heavier than usual and may last longer than usual.
    
2. Polymenorrhoea or epimenorrhoea: In polymenorrhoea or the epimenorrhoea, the menstrual cycle is reduced from the normal twenty-eight days to a cycle of two or three weeks and remains constant at that frequency. The frequent menstruation is usually associated with excessive and prolonged bleeding.
    
3. Metrorrhagia: Metrorrhagia is defined as irregular, acyclical bleeding from the uterus. The bleeding may be intermittent or continuous. The addition of acyclical bleeding to normal menstruation results in a pattern of haemorrhage. Thus, it is difficult or impossible to distinguish the pathological bleeding from that of the normal period. It is called asrigdaar in Ayurveda.
    
4. Dysfunctional Uterine bleeding: Dysfunctional uterine bleeding (DUB) is heavy or irregular menstrual bleeding that is not caused by an underlying anatomical abnormality, such as a fibroid, lesion, or tumour. DUB is the most common type of abnormal uterine bleeding. The cause of this is emotional imbalance.

Bleeding which appears may be of thin or thick consistency, can be in form of clots or pieces. Its colour can be bright red or bluish.

Nidan (Causes of Menorrhagia)
Menorrhagia is essentially a symptom and not a disease. According to Ayurveda, it is caused by an aggravation of pitta dosha and low vata dosha. Pitta symbolizes heat or fire. Increased pitta dosha causes increase of hot temperament in the body.  Decreased vata dosha causes decrease of cold temperament in the body. Menstrual blood is analogous to pitta dosha. Thus high pitta dosha or high hot temperament leads to increase of menstrual blood.

The causes can be divided into

Constitutional factors: Thrombocytopenic purpura, severe Anaemia, immature and poorly developed reproductive system, bleeding disorders (e.g., Von Willebrand's disease; leukaemia) All these diseases aggravae the pitta dosha in the body, which leads to high flow of menstrual blood. In such cases it is very important to treat the root cause.

Along with these psychological disorders, emotional imbalance, matrimonial disharmony and a state of anxiety are important factors. Prolonged menstrual loss provides a specious excuse to avoid a sexual relationship that has become tedious or distasteful. In a patient who dreads a pregnancy for any reason, this is one method of escaping the risk of matrimonial duties.

Local factors: In many cases, menorrhagia is caused by local diseases in the pelvis such as fibroids, adenomyosis, polyps, endometriosis, pelvic infection, and pelvic cancer. Sub involution of uterus, prolapse or inversion could be some of the causes. Other causes include spontaneous or induced abortions, incomplete abortion, and trauma to uterus, ectopic pregnancy (the fertilised egg lodges in the slender fallopian tube instead of the uterine lining,) leading to Menorrhagia.

Iatrogenic: Intrauterine devices and Anticoagulants, use of contraceptives.
Endocrine Disturbance: In hyperthyroidism, Menorrhagia is occasionally seen in the early stages. But in advanced cases, patients usually have Amenorrhoea. In Myxoedema, (hypothyroidism marked by dry skin and swellings around lips and nose as well as mental deterioration), particularly in women over age of 40, Menorrhagia is not uncommon.

Other factors that lead to Menorrhagia include

1. Diseases like typhoid, malaria or measles
2. Rajas and pitta aggravating lifestyle like reading books or seeing pictures, which aggravate sexual feelings, lethargy lifestyle
3. Rajas and pitta aggravating diet - excessive spices, vidahi foods, hot in nature, pungent, acidic, or salty foods
4. Excessive use of chemical medicines
5. Improper way of doing virechan
6. Doing physical and mental work beyond one's stamina
7. Excessive intercourse
8. Improper way of intercourse
9. A woman with many children
10. Women who live in hot climates are more prone to this disease

Kinds of Menorrhagia

1. Functional: It is mainly due to emotional disturbance. Ayurveda has effective herbal combinations to deal with this.
2. Sympathetic: It is the result of chronic and complicated physical pathology.
3. Organic: It occurs due to pathology in the genital organs.

Symptoms of Menorrhagia include

• Heavy blood loss during the menstrual period
• Bleeding or spotting between periods
• Cramping and pain in the lower abdomen and sacral region
• Fatigue
• Headache
• Feeling of heaviness in the body
• Constipation
• Tenderness in breast
• General debility
• Indigestion
• Anaemia

Samprapti (Pathogenesis)
As explained above, various factors can create an imbalance of the pitta dosha. Pitta is analogous to rakta or blood. Aggravated pitta causes contamination of rakta dhatu. Contaminated blood or rakta moves towards the pelvic region and causes imbalance of apana vata dosha. Apana vata dosha controls the flow of the menstrual blood through artavavahi srota. Low apana vata and contaminated blood increase menstrual blood, which leads to Menorrhagia.

Premenstrual Tension Syndrome - PMT - PMS
Most women are aware of some changes that occur in their body before the onset of a period. These symptoms may start a few hours or a few days before the period. They are natural and normal and there are women who notice nothing at all. The premenstrual syndrome (PMS) is when these symptoms are more severe.

PMS is more common in women over the age of 30 years and tends to cease with the menopause. PMS also cease in women who have an operation to remove both their ovaries.

These symptoms can be divided into physical and emotional symptoms that start up to 2 weeks before the period.

Physical symptoms include

1. Breast tenderness and enlargement.
2. Women may put on weight, retain fluid and get abdominal distension.
3. Headaches may occur and migraine may be worse in women prone to such attacks.
4. Feeling of pelvic congestion.
5. Intercourse may be uncomfortable.
6. Constipation is common.
7. Back or lower abdominal pain

The emotional and personality changes may be very profound

1. Depression can be severe enough for suicidal feelings
2. Irritability or aggression
3. Anxiety
4. Mood swings
5. Tiredness
6. Poor concentration
7. Short-tempered and strike out verbally and physically at her family
8. Less desire for intercourse

A more severe form of PMS is called Premenstrual Dysphoric Disorder (PMDD), in which the emotional symptoms, such as depression, mood swings, anxiety and tension are particularly serious. It occurs in only a small percentage of women with PMS.

Nidan (Causes of PMS)
The cause of PMS is aggravated apana vata. As discussed above, apana vata controls menstruation. At the commencement of menstruation, apana vata is naturally aggravated in each woman. In some women, it is aggravated beyond its natural levels, which leads to these symptoms. Some women are more sensitive to aggravated vata dosha and this causes these symptoms. Importantly, PMS is psychosomatic. It often affects the highly-strung, introspective and neurotic woman.

The other doshas involved in PMS are prana vata, sadhak pitta, samana vata and pachak pitta.

Factors, which aggravate vata dosha:

Our lifestyle, diet, and drugs predispose us to an aggravation of vata dosha. Factors that contribute to this include:

Contraceptive Pill: By design the contraceptive pill increases apana vata.

Hormone disrupting chemicals: Chemicals in pesticides, plastics, industrial compounds, and some pharmaceutical drugs increase apana vata.

Meat / dairy products: Non-organically farmed animals are often fed hormones to promote growth and to maintain lactation, which causes an imbalance of the doshas in our body.

Constipation: Constipation also aggravates vata dosha.

Toxicity / impaired liver function: Increased toxicity in the body and / or impaired liver function causes imbalance of the vata dosha.

Consumption of excessive coffee, tea, chocolate and cola increases apana vata.

Samprapti
As we can see, apana vata is aggravated before commencement of the menstruation cycle. Pain is a symptom of an aggravated vata. Aggravated apana vata leads to pain in the back or lower abdomen before menstruation. Aggravated apana vata moves upwards and causes imbalance of other doshas such as samana vata and pachak pitta. These doshas stay in the digestive gut and control digestion. Constipation, digestive disturbances, flatulence are the various symptoms of imbalanced samana vata and pachak pitta. When Apana vata moves above the digestive system, it causes imbalance of the next dosha whose site is in the head and the brain. This is prana vata. It controls our nervous system. Aggravated prana vata leads to symptoms such as mental imbalance, depression, anxiety, mood swings, insomnia. Sadhak pitta is also imbalanced by an aggravated apana vata. Sadhak pitta stays in the heart and controls our emotions. Imbalanced sadhak pitta causes low mental stamina.

Imbalanced vata also causes aggravation of kapha dosha, which increases extra-cellular water throughout the body, causing water retention in some patients.
All imbalanced doshas cause weakness of body tissues and women feel tired during this time.

Treatment

Diet
Sour foods, fried foods, and beans should be avoided during menstruation and one week before menstruation. Foods that cause constipation or aggravation of vata should not be consumed. Vegetables like potato, mushroom, cauliflower, peas and eggplant should be excluded from the diet. Cold drink, frozen foods, ice creams should be avoided. Papaya, cucumber, squash, pumpkin and zucchini are recommended. Foods should be garnished with spices like black pepper, cinnamon, coriander, cardamom, fennel, ginger, cumin, black pepper, fenugreek, clove, celery seed, salt, soya seeds, mint and mustard seed. Warm vegetable soups garnished with spices are also very good during this period. Khichari, rice, mung dal are also easily digestible and good for eating.

Alcohol and smoking should be strictly avoided

Herbal teas are recommended. Milk should be boiled with ginger powder, fennels seeds powder, cardamom powder and black pepper powder. Such spices make milk easily digestible. Spiced warm milk pacifies vata dosha.

Lifestyle
A lifestyle that will pacify vata dosha should be followed. Regular physical exercise for the whole month is a must for coping with these symptoms. During the menstrual period, bed rest, remaining active is advised. Heavy physical works should be avoided during this period. Fast jogging, sports should be minimized as they increase the vata dosha in the body. Walking is especially good for alleviating cramps. Simple stretching is recommended. Keeping your body warm is very important. In winters, cover your head, feet and pelvic region properly.

Contraceptive pills, excessive chemicals should be avoided. Stress, tension and negative mental feelings increase vata dosha. Hence, relaxation is the best treatment. Yoga and meditation should be added to your daily routine. Taking purgatives (laxatives) for 2 days before the scheduled start of menstruation can alleviate disturbed vata.