Review Article
Year: 2025 |Volume: 6 | Issue: 05 |Pages: 15-20
An Integrative Case Study on the Clinical Management of Kastartava (Primary Dysmenorrhea) in a Young Female: A Multimodal Approach
About Author
Correspondence Address:
Dr. Archna Pandey Jumle Associate Professor, Department of Sriroga & Prasutitantra, Datta Meghe Ayurvedic Medical College, Wanadongri, Hingna, Nagpur. Email: drarchna.pandey28@gmail.com
Date of Acceptance: 2025-05-24
Date of Publication:2025-06-15
Article-ID:IJIM_380_07_25 http://ijim.co.in
Source of Support: Nill
Conflict of Interest: None declared
How To Cite This Article: Jumle A., Jumle R., Bhadlikar D., Bhadlikar D. An Integrative Case Study on the Clinical Management of Kastartava (Primary Dysmenorrhea) in a Young Female: A Multimodal Approach. Int J Ind Med 2025;6(5):15-20 DOI: http://doi.org/10.55552/IJIM.2025.6503
Abstract
Primary dysmenorrhea is a common gynecological condition characterized by painful menstruation in the absence of underlying pelvic pathology. While nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal therapies remain the mainstay of conventional treatment, increasing interest in complementary therapies such as Ayurveda, acupuncture, and lifestyle modifications is evident. This case study explores a holistic and integrative approach to managing dysmenorrhea in a 19-year-old female, combining conventional pharmacological management with lifestyle modification and Ayuvedic interventions and Panchakarma therapies like basti. The outcome demonstrates improvement in pain intensity, quality of life, and menstrual regularity, highlighting the potential of integrative management in chronic gynecological conditions. Dysmenorrheal affects about 50% of women who are menstruating, and in Ayurveda dysmenorrheal refers to the term Kastartava. Ayurvedic classics mention various dietary modifications, Anuvasana basti, Uttar basti therapies.
Keywords: Dysmenorrhea, Kastartava, Ayurveda, Basti, Pachakarma, NSAIDs, Menstrual health, Integrative medicine.
Introduction
Ayurveda, the ancient system of Indian medicine, has a dedicated branch known as "Striroga” or gynecology. This branch encompasses the diagnosis, treatment, and prevention of diseases related to women, focusing especially on reproductive health, menstruation, fertility, pregnancy, and menopause. It can hinder the flow of Vayu, causing intense pain throughout the menstrual cycle known as Kashtartava[1]. Stressful lives leading to mithya ahar-vihar, overexertion, and malnutrition are the major causes of this disorder. Acharya Charaka has said that vitiated Vata Dosha is a prerequisite for the emergence of all gynaecological problems including dysmenorrhea, which is caused by a poor lifestyle and the repression of natural desires. He said that the entire Yoni (vaginal canal) is occupied by the Apana Vayu (a kind of Vata), which becomes agitated due to Vegavarodha (suppression of Acharya Charaka has said that vitiated Vata Dosha is a prerequisite for the emergence of all gynaecological problems including dysmenorrhea, which is caused by a poor lifestyle and the repression of natural desires. He said that the entire Yoni (vaginal canal) is occupied by the Apana Vayu (a kind of Vata), which becomes agitated due to Vegavarodha (suppression of natural impulses). Menstruation pain and discomfort are caused by the vitiated Apana Vayu, which pushes the Raja (menstrual blood) higher [2]. Numerous prevalence studies report that dysmenorrhea is prevalent globally. Premenstrual symptoms, including sore breasts and nausea, vomiting, headaches, constipation, nausea, vomiting, exhaustion, stomach issues, and fainting, can all be linked to dysmenorrheal. Several formulations are effective in treating Kashtartava (Primary dysmenorrhea). These formulations primarily function as vata anulomana and shoola prashamana[3]. Examples of these formulations are Dashamoola Taila, Phala Taila, Dashamoola Ksheerapaka, Hingwadi Taila, Tila Taila, Trivrutta Taila, Shatapushpa Taila, Sahacharadi Taila, Dhanwantaram Taila, and Mahanarayana Taila. By giving these formulations as matrabasti, the efficacy of treating Udavartini Yonivyapad (primary dysmenorrhea) was determined. Dysmenorrhea, defined as painful menstrual cramps of uterine origin, is categorized as primary or secondary based on the absence or presence of pelvic pathology respectively. Primary dysmenorrhea usually manifests in adolescents and young women and is associated with prostaglandin-induced uterine contractions [4]. It affects up to 90% of menstruating women, significantly impairing quality of life and daily functioning.
Current treatment focuses primarily on non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives. However, non-pharmacological and complementary therapies such as yoga, herbal medicine, acupuncture, and lifestyle interventions are gaining recognition for holistic management.
Case Presentation
Patient Profile
Name: XYZ
Age: 19 years
Occupation: College student
Menstrual history: Menarche at age 12, regular 28–30-day cycles
Chief complaint: Severe lower abdominal pain during menstruation for the past 2 years
History of Present Illness- The patient reported cramping lower abdominal pain starting 4 to 5 hours before menstruation and lasting up to 24 hours. The pain was described as sharp, radiating to the thighs and lower back, accompanied by nausea and fatigue. The patient rated her pain 10/12 on the Visual Analog Scale (VAS).
Medical and Family History
No significant medical history. Mother also experienced dysmenorrhea during adolescence.
Menstrual Characteristics
Duration: 4–6days
Flow: Moderate
Associated symptoms: Headache, irritability, fatigue
Examination Findings
General: Mild pallor, no edema
Vitals: Stable
Abdominal: Mild tenderness in the suprapubic region
Pelvic ultrasound: Normal findings
Clinical Diagnosis
Based on clinical symptoms and history, absence of pelvic pathology, a diagnosis of / KastartavaPrimary Dysmenorrhea was made.
Management Plan
A multimodal integrative treatment plan was developed to address the condition from physiological, hormonal, and lifestyle perspectives.
1. Pharmacological Treatment
NSAID: Mefenamic acid 500 mg TID during the first 2 days of menstruation.
Vitamin E and B1: Daily supplementation to reduce oxidative stress and support nerve function [5].
2. Lifestyle and Dietary Modifications
Increased hydration and intake of anti-inflammatory foods (green leafy vegetables, flaxseeds)
Avoidance of caffeine, fried foods, and junk food. Regular moderate exercise (brisk walking for 30 minutes daily) [6]
3. Ayurvedic Interventions
Yogasana and Pranayama: Daily practice of Bhujangasana, Supta Baddha Konasana, and Nadi Shodhana[7].
Ayurvedic Medications:
Ashokarishta (10 mL BID after meals) – for uterine health and hormonal balance.
Hingvashtaka Churna (3 gm with warm water before meals) – for Vata-pacifying effects [8].
Panchakarma:
Abhyanga (medicated oil massage) and Swedana (fomentation) during the luteal phase
Basti therapy- Anuvasana Basti of 20ml (Til oil- 10ml + Dashmoola oil 10ml) for 15 days. Repeated the 3 basti cycle of 15 days during non-menstrual days to balance Apana Vata [9].
4. Psychological Support
Concealing done about lifestyle changes, menstrual cycle health and hygiene.
Cognitive Behavioral Therapy (CBT) sessions focusing on stress and anxiety related to menstruation [10].
Follow-Up and Outcome
After 1 Month:
Pain reduced to 6/10 VAS
Slight improvement in mood and fatigue
Better dietary compliance reported
After 3 Months:
Pain score reduced to 4/10
Decreased use of NSAIDs
Improved concentration and daily functioning during periods
Regular practice of yoga and pranayama reported
After 6 Months:
Pain score 2–3/10
No school absences due to menstruation
Psychological wellbeing significantly improved
Discussion
As a holistic medical system, Ayurveda provides efficacious treatments for gynaecological illnesses that have been shown to solve problems. Some of the chosen medications have demonstrated their effectiveness throughout time, despite the fact that Ayurveda offers hundreds of methods for therapy [11]. Considering of this, integrating natural the research that have been presented, some tailas have operated at an exponential rate. Because,
individualised medicine into patient treatment is necessary, given the wide range of applications for herbs. In addition to exploring the past, Ayurveda is also attempting to navigate a future in which the foundation of medicine is comprehensive care [12]. Dysmenorrhea management requires more than symptomatic treatment. NSAIDs are effective in reducing prostaglandin-mediated uterine contractions but do not address underlying inflammatory or lifestyle-related contributors. The addition of Vitamin E and B-complex offers antioxidant and anti-inflammatory benefits [13].
In Ayurveda, dysmenorrhea is often related to Apana Vata dushti, leading to obstruction in normal menstrual flow and pain. Interventions such as Ashokarishta[14] and Hingvashtaka[15] Churna pacify Vata, while Basti regulates Apana Vata and removes Ama (toxins). Panchakarma therapies provide systemic detoxification and support tissue balance [16].
Yoga and pranayama not only alleviate physical symptoms but improve autonomic nervous function and reduce stress, which plays a key role in pain perception. CBT helps alter negative perceptions and responses to pain, offering long-term benefits [17].
Increasing evidence supports the use of Ayurvedic interventions in conditions like PCOS, endometriosis, fibroids, and infertility [18]. Integrative approaches combining Ayurveda with allopathy show improved outcomes in chronic gynecological disorders.
The integrative approach in this case led to significant improvement in symptom severity and quality of life, emphasizing the importance of treating dysmenorrhea as a multifactorial condition [19].
Conclusion
Ayurveda offers a comprehensive, individualized, and holistic approach to women's health that balances the body, mind, and reproductive system through natural means. With its emphasis on preventive care, lifestyle discipline, and herbal remedies, Ayurvedic gynecology remains highly relevant in modern times.
Primary dysmenorrhea, though commonly dismissed as a benign condition, can significantly impair quality of life. This case illustrates the success of an integrative treatment approach that combines modern pharmacology with Ayurvedic interventions, lifestyle modification, and psychological support. Early recognition and multidisciplinary management can result in substantial improvement in menstrual health and overall wellbeing.
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