The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research






Lake Mary Clinic, Gerson Ayurvedic Spa, and Panchakarma Facility: at 635 Primera Blvd. Lake Mary, Florida 32746

Jupiter Medical Center at The Calcagnini Center for Mindfulness
1210 S. Old Dixie Highway, Jupiter, Florida 33458, Suite M-117.2




 Telephone: (561) 263-MIND (6463); option 2 (407) 549-2800

The Ayurvedic Management of Menopause

Menopause is a normal part of a woman's natural aging process and occurs as hormone levels in the body decline. It marks the end of a woman's menstrual periods and her ability to become pregnant without assistance from technology. Menopause is a process that usually occurs between the ages of 45 and 55 and begins 2 to 5 years before (perimenopause) a woman's last menstrual period. It is considered complete (postmenopause) when 1 full year has passed without a menstrual period.

The symptoms of declining hormone levels can occur before menstrual periods have ended. This 2 to 5 year period of declining hormones is called the climacteric or perimenopause. Perimenopause can last several years and often includes irregular menstrual periods and other symptoms, such as hot flashes, vaginal dryness, and mood swings.

The term menopause is used to describe the period between the beginning (perimenopause) and end (postmenopause) of symptoms. A woman who has not had a menstrual period for 1 year or longer is postmenopausal. The confusing term 'menopause' is most often used to include both the perimenopausal and postmenopausal periods.

A woman may say she is “in menopause” when she is:

  • Still having menstrual periods but also has symptoms of approaching menopause, such as hot flashes, vaginal dryness, mood changes, libido changes, etc.
  • No longer having menstrual periods but continues to have other symptoms, such as hot flashes, vaginal dryness, mood changes, libido changes, etc.
  • No longer having menstrual periods or any menopausal symptoms.

What Causes Menopause?

Menopause is caused by the natural declining function of the ovaries, which gradually produce lower and lower levels of the hormones estrogen, progesterone, and testosterone. This causes the total serum levels of these hormones to also decline in the woman's body. Decreasing levels of estrogen cause many of the long-term health problems, such as osteoporosis and heart disease that can occur after menopause.

Menopausal Symptoms

Although some women have very few noticeable symptoms of menopause besides the cessation of her menstrual periods, most women will have some degree of other symptoms. Symptoms may come and go, and more may develop, over the course of the menopausal years. They include:

  • Hot flashes
  • Night sweats
  • Vaginal changes (atrophic vaginitis)
  • Difficulty concentrating/memory loss
  • Emotional changes (depression, anxiety)
  • Sleep disturbances (insomnia)
  • Changes in sexual desire (increased or decreased libido)
  • Rapid, irregular heartbeat (heart palpitations)
  • Generalized itching
  • Joint and/or muscle pain
  • Headaches
  • Urinary changes (urinary frequency)

Many women report an increase in many of these symptoms following surgical menopause (hysterectomy or oophorectomy), and in these women the symptoms tend to be more severe.

Diagnostic Evaluation of Menopause

A diagnosis of menopause is usually made based on your age, history of menstrual periods, symptoms, and the results of a pelvic exam. Additional exams and tests may be needed if symptoms are severe, if other conditions are suspected, or if other concerns make a diagnosis difficult.

Vasomotor instability (i.e. hot flashes), irregular menses, insomnia, decreased libido, and mood swings are among the most common symptoms that prompt perimenopausal women to seek an Ayurvedic medical consultation. Generally, the modern Ayurvedic physician will include the following in his initial diagnostic evaluation:Determination of the individual’s prakriti and vikriti (constitutional type and doshic imbalances)Complete medical historyAppropriate physical examination including pertinent physiological testing (i.e. EKG, pulmonary function, etc)Laboratory measurement of hormone levels (blood tests)Baseline evaluation of lipid profile, glucose tolerance test, and bone mineral density (DEXA)

Ayurvedic physicians will always observe the woman’s posture for early signs of osteoporotic compression of the spine as well as her gait, muscle tone, coordination, general nutritional status (i.e. dhatuksaya), flexibility, hearing, eyesight, and emotional status. Some studies show a decline in the number of anterior horn cells in the spinal cord after age fifty, which leads to muscle weakness, atrophy and loss of lean muscle mass.

Besides this set of age-old diagnostic observations, the principle laboratory test for diagnosing menopause is the serum follicle stimulating hormone (FSH) level. As ovarian function declined, the serum FSH level rises. At menopause it is usually greater than 40 mIU/ml. In perimenopausal women who are still menstruating, an FSH level greater than 12 mIU/ml on the second or third day of bleeding is considered elevated. Remember that oral contraceptives suppress FSH and thus should be discontinued for 48-72 hours before FSH levels are measured.

Determining levels of estrogen (estradiol), progesterone, testosterone, and thyroid stimulating hormone are sometimes included in the evaluation but their precise usefulness is unclear. However, if the estradiol level is low (< 30pg/ml) and the FSH is high (> 40 mIU/ml) fertility is very unlikely. Progesterone levels may be useful in documenting ovulation in perimenopausal women. Thyroid function tests can effectively rule out hypothyroidism, a common condition in peri- and postmenopausal women. Obviously, every woman should have a papanicolaou smear annually and should discuss the need for mammography with her primary care physician.

Management of Menopausal Symptoms

Menopausal symptoms may not require treatment of any kind if they are not severe and do not bother you. If symptoms of menopause do not bother you, discuss them with your health professional at your next regular visit. Often, Ayurvedic home treatments and herbal medications can be used for mild to moderate symptoms. The only current conventional medical treatment available for menopausal symptoms is hormone replacement therapy.

Risks and benefits of Hormone Replacement Therapy (HRT) as of October 2004

If you are considering using HRT for your menopausal symptoms, it is important to consider all the risks and benefits of short-term therapy.

The benefits of short-term hormone therapy may include:

  • Full or partial relief of menopausal symptoms, such as hot flashes and sleep disturbances.
  • Maintenance of muscle tone and integrity of the vaginal mucous lining

The risks of short-term hormone therapy include:

  • A small increase in the rate of breast cancer (see box below)
  • A small increase in the risk of blood clots causing deep vein thrombosis and pulmonary embolism.
  • A small increase in the risk of heart attack

Every form of hormone usage is laden with risks, from weightlifters using steroids, to runners using insulin, to insomniacs using melatonin, to the aging using growth hormone and DHEA supplementation. Furthermore all of the risks for every type of hormone replacement therapy are still not known.

Ayurvedic Management of Menopausal Symptoms

Treatment (chikitsa) in Ayurveda means the set of interventions, which can remove the causative factors and reestablish doshic equilibrium. Generally, there are two broad groups of treatments: measures calculated to maintain the health of healthy people, and measures which focus on the cure of specific diseases

In both approaches, the therapeutic effect of any particular therapy on any particular patient will depend on correct dosage, prevailing climate, the dosha(s) involved, the strength of the patient,the strength of the disease, the patient’s age, prakriti (constitution), emotional status, and finally the experience of the physician.

Treatment should be strictly individualized and target the doshas and so completely different diseases can sometimes have a single therapy; also, a single disease is often treated differently in different patients. In menopause, lifestyle factors play an important role.Positive lifestyle changes can have an enormous impact on conditions, which involve the immune system and the endocrine system. Both of these complex and interrelated systems represent the highest degree of physiological evolution that characterize the human being. Endocrine function, in particular, is affected by input from the nervous system, emotions, thoughts, internal electrolyte balance, climate, and diet, including both foods and herbal medicines. A customized lifestyle modification strategy is therefore an essential component in a woman’s approach to ameliorating the symptoms of menopause. These lifestyle choices include nutrition, exercise, stress reduction, weight management, and intelligent herbal supplementation.


A diet low in saturated fat, moderate in mono- and unsaturated fats, and high in properly cooked whole grains, fruits, and vegetables and which includes some dairy will contain more than adequate vitamins, minerals, and trace elements to promote strong and healthy tissues. Ayurveda recommends that we adjust our lacto-vegetarian diet according to our most dominant dosha. Please refer to any good introductory book on Ayurveda to obtain these dosha-specific diets. Women who have reached perimenopause and beyond, in addition to these guidelines, have specific nutritional considerations which can greatly modify the chances of developing osteoporosis and heart disease as well as other menopausal symptoms.

The risk of heart disease can be lowered by greatly reducing the amount of saturated fats in the diet. This is particularly true of the trans-fatty acids found in some processed foods. Cook with olive oil or canola oil instead of butter or margarine. It is important to also limit the amount of caffeine, salt, and alcohol in the diet. The latter should be no more than ¾ glass (6 oz.) of wine per day, three days per week…maximum. The diet should include five or more servings of fruits and vegetables daily. A definite conscious effort to include soy products in the diet should be made.Soy is both a source of phytoestrogens (see below) as well as a modest cholesterol-lowering food.

A balanced and individualized diet is required to maintain the structural and functional integrity of the various bodily tissues. For example, the amino acids hydroxyproline and glycine are needed for collagen production, B12 is needed for nervous function and hemoglobin production, and hundreds of other examples exist. Osteoporosis risk, as we all know, can be averted by an adequate intake of calcium starting as a teenager. Along with adequate dietary protein, calcium builds bone density, mass, and tensile strength which peaks in the mid-20’s. This bone density then decreases by about 0.5% per year. As women reach menopause it is still vitally important for there to be adequate calcium in the diet. It is recommended that postmenopausal women consume 1200 to 1500 milligrams of elemental calcium daily. The average American women aged 50-65 currently averages about 700 mg/day. Calcium is best obtained from low-fat dairy products (milk, cheese, yogurt) unless it cannot be tolerated for some reason. Although green leafy vegetables do contain some calcium, it is generally unrealistic to expect to get the full 1500 mg from that source alone. If sufficient calcium is not found in the diet, a calcium supplement is an excellent idea. Taking up to 1500 mg of calcium in the carbonate or citrate form in divided doses with meals will not increase the risk of kidney stones, but adequate water intake is certainly advised. Do not take calcium together with food containing high fiber or iron content.

Vitamin D also is important for incorporating the calcium into the bones. Ayurveda advises 15 minutes of sun exposure daily to at least 15% of the skin area. This is equivalent to the face and arms. Postmenopausal women need about 400 to 600 IU daily; for those who are never in the sun, the larger dose (600 IU/day) is better.


A sedentary lifestyle is an established risk factor in many common conditions including: obesity, diabetes, hypertension, heart disease, insomnia, low back pain, and certain forms of cancer (including breast). Adequate exercise, like proper nutrition and clean water and air, is essential for optimal health but is often lacking in the daily life of the modern woman. Exercise need not be a complicated or time consuming affair; it can be in the form of brisk walking, jogging, bicycling, aerobics, dancing, tennis, weight-training, rollerblading, ice-skating, or even gardening. Any activity which raises the heart rate and/or works against gravity can help maintain a healthy heart, skeleton, muscle tone, immune system, and body weight.

Adequate exercise is also a potent modifier of many menopausal symptoms. Exercise can promote more restful sleep, reduce depressive thoughts, retard osteoporosis, ameliorate hot flashes in some women, and improve cognitive function. The single, most important key is to develop an enjoyable, realistic exercise plan appropriate for your individual constitutional type, which is conducive to long-term compliance.

There are three general types of exercise and most women should try to incorporate examples of all three: (1) aerobic, (2) anaerobic (or weight-bearing), and (3) flexibility exercises. A recent study published in the Journal of the American Medical Association found that 30 minutes of moderate exercise five times a week was sufficient to help reach ideal body weight and decrease the risk of breast cancer. A brisk two-mile walk would satisfy this requirement. In addition, however, exercise is known to have a modest effect on reducing postmenopausal bone loss if it is anaerobic (weight-bearing in nature. Fifteen to thirty minutes of light weight-training on machines or with free weights three times a week would be recommended for most women. The flexibility component is comprehensively addressed through a daily yoga practice of 15-30 minutes. Your physician or healthcare professional can help determine the appropriate initial level of exercise for you. Then its just a matter of making exercise a permanent part of your daily life.

Weight Management

Obesity, or sthaulya, is a multifactorial complex of imbalances affecting both an individual’s physiology and psychology which results in an increase of body weight to more than 30 per cent above “normal”. This increase is due to the systemic accumulation of fat throughout the body

Overweight and obesity are associated with virtually all of the most common diseases which have been on the rise over the past 50 years: type-2 diabetes, high blood pressure, hyperlipidemia, coronary heart disease, polycystic ovary disease, hyperandrogenism, gallstones, osteoarthritis, infertility, fatigue, low back pain, shortness of breath, esophageal reflux, depression, colon cancer, postmenopausal breast cancer, and endometrial cancer. One recent survey showed that approximately 55% of Americans are overweight and, even more distressing, 22% suffer from obesity. (Kuzmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among U.S. adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA 272:205, 1994.).

Human beings have the extraordinary physiological machinery to use the energy from our foods to meet our immediate requirements and store the remainder for later. We can do this by virtue of an internal rechargeable battery, which we all are created with: our body fat. We recharge and replenish this stored energy depot every time we eat more than we need and we drain it every time we need additional biological energy. On the average, most of us store enough energy in our fat tissues for us to jog New York City to Chicago without consuming a thing.

What gives us the ability to store and release food energy as required? The answer lies in the complex and counter-regulatory hormones, enzymes, and neurochemicals which have evolved to create the human neurohormonal system. We now know that insulin and glucagon are the chief hormones involved in these processes. But there are many other substances with equally important effects on our fat stores, and hence our weight: lipase, l-carnatine, cortisol, adrenocorticotropic hormone (ACTH), NADPH, NADH, acetyl coenzyme A, adenosine diphosphate and many others.

Being overweight means you have developed an imbalance in one or more of these physiological enzyme/hormone pairs in the direction which favors energy storage. This unhealthy shift in one’s metabolism is known to accelerate during menopause. Simply losing weight will not correct this imbalance and the amount of weight loss will always be limited because the underlying problem has not been corrected.

Ayurveda offers a program which combines general principles of hygienic living with specific individualized constitutional guidelines. Overweight conditions are effectively addressed by understanding these conditions for what they truly are--an accumulated toxin with both physical and mental roots which are unique for each person. The molecular structure of human fat which deposits in different individuals may be identical, but the unhealthy habits, attitudes, misconceptions, and stored emotional experiences which promulgate obesity are unique and singular. These weight loss measures are presented succinctly in The Ayurvedic Approach To Diet and Weight Loss: The Sattva Program, S. Gerson, 2002, Lotus Press.

Panchakarma Chikitsa

Panchakarma (“five therapeutic actions”) chikitsa (“treatment”) are physical therapies that thoroughly cleanse and purify the physical and mental impurities from the body and mind. Normally the body has the innate ability to efficiently process and remove these waste materials, including the vitiated doshas. However due to one's repeated dietary indiscretions, hormonal changes, poor exercise patterns, lifestyle, and genetic predisposition, the digestive enzymes, metabolic cofactors, hormones, and agnis which regulate the body's internal homeostasis become disorganized. This can lead to the accumulation and spread of toxins throughout the physiology-resulting in disease.

Although most reasonable individuals recognize the value in maintaining a clean internal physiology, modern medicine has yet to accept this idea as a central tenet of healthcare and has therefore provided no practical guidance for detoxification therapies. The result is that few of us give the same care and attention to our internal organs and tissues that we confer on our vacuum cleaners or cars. However, recently more and more men and women are becoming aware of the dangers of living in environmentally toxic, over-populated, and over-stressed conditions.

The general purpose of the Panchakarma Therapies is to loosen, liquefy, and remove the vitiated substances and doshas from their abnormal sites in peripheral tissues via their natural pathways of elimination.

Unlike many health-promoting recommendations of Ayurveda, these are not self-administered therapies. These procedures must be administered by specially trained therapists in a definite sequence for a specified period of time. In addition, although Panchakarma is for the most part a delightful and comfortable spa-like therapy, there can be periods of discomfort associated with the profound release of toxins which does occur. It is therefore essential that the therapy be supervised by a knowledgeable expert who can recognize the signs of properly and improperly administered Panchakarma.

Panchakarma detoxification is perhaps the "missing link" to restoring optimum function of our cells and tissues in the postmenopausal years. Whether undertaken to prevent or treat disease, most women who avail themselves of authentic panchakarma chikitsa every two to three years will feel physically and mentally revitalized with a commensurate amelioration in many of the symptoms of menopause and premature aging. Following the physical panchakarma therapies, women are advised to take a special category of herbal preparations known as rasayanas, for several weeks or months. Rasayanas are tonic medicines which, when given to an individual who has undergone panchakarma cleansing, increase the strength, vitality, and function of all the tissues of the body.

Herbal Preparations


Modern medicines are usually one or more synthetic chemical compounds designed to alter a specific metabolic biochemical process. They interfere with, or in some cases simulate, a natural biochemical process somewhere in your body. Taking estrogen or taking an aspirin are good examples; they may reduce certain symptoms but this is possible only because the synthetic drug overpowers the internal human chemistry. Estrogen, aspirin, and all modern medicines are designed to artificially produce or inhibit a specific metabolic reaction, when something in body is going the other direction. Sure the hot flash or the fever may be diminished, but the underlying cause is not set right. The disease process remains; only its full expression is camouflaged by the apparent reduction of one or two bothersome symptoms.

Ayurvedic preparations are completely different in their intention and their action. They mixtures of natural substances which can correct an underlying imbalance. They promote an energetic adjustment which is at a level of intelligence higher than the molecular level. Reestablishing balance at this subtle energetic (i.e. doshic) level of human function removes the push at the physical (i.e. molecular) level toward discomfort and the symptoms are eliminated at their root.

Ayurvedic preparations are made from various materials in Nature: roots, rhizomes, seeds, flowers, stems, leaves, barks, minerals, resins, and even some metals. We are taught in high school science that the Animal and Plant Kingdoms are two separate universes. If a high school student asked the teacher about a possible similarity between a tulip and a human tumor cell, this would be dismissed as ridiculous. However, one of the seminal truths discovered by the Ayurvedic scientists of ancient times is that there are common basic energetic threads which connect the Animal, Plant, and Mineral worlds. Thus a specific quality (guna) or set of qualities can be present in both a tulip (plant) and a tumor cell (animal). This is because both Plants and Animals arise from a more fundamental all-encompassing natural source. Interestingly, we have accrued volumes and volumes of books and periodicals on plant biology and perhaps even more on human biology. But in our pursuit of these highly specialized academic compartments, we have lost all knowledge of how these two biologies interrelate.

Most Ayurvedic preparations are combinations of several different materials, sometimes up to fifty. Each root, leaf, or mineral component can be thought of as an “information bit” and when combined together form an “information bundle”. Applying the correct information bundle for your energetic imbalance in the proper dosage, at the right time, and for the correct duration, is the key to rebalancing your physiology. Although to accurately determine which herbal medicines are precisely indicated requires a full knowledge of both the patient and the condition (rogarogi pariksha), knowing a woman’s constitutional type (prakriti) allows us to choose some basic therapeutic materials. Many of the plants below contain one or more phytoestrogens. Phytoestrogens are plant-derived substances whose chemical structure is similar to endogenous human estrogens. They are categorized into four main groups: isoflavones, lignans, coumestans, and resorcylic acid lactones (although the latter is not a true phytoestrogen). The formulas below can include all or some of the listed ingredients.

Herbal Formula For Vata Types

  • Ashoka (Saraca indica)
  • Lodhra (Symplocos racemosus)
  • Musta (Cyperus rotundus)
  • Black Cohosh (Cimicifuga racemosa)
  • Ashwagandha (Withania somnifera)
  • Shatavari (Asparagus racemosus)
  • Yastimadhu (Glycyrrhiza glabra)
  • Sveta musali (Asparagus adscendens)
  • Nagbala (Grewia hirsuta)
  • Guduchi (Tinospora cordifolia)
  • Jiraka (Cuminum cyminum)
  • Bala (Sida cordifolia)
  • Vidari (Pueraria tuberosa)
  • Nilotpala (Nymphoae stellata)
  • Makaradwaja
  • Asparagus adscendens (Sveta musali)

Herbal Formula For Pitta Types

  • Shatavari (Asparagus racemosus)
  • Lodhra (Symplocos racemosus)
  • Sariva (Hemidesmus indicus)
  • Sveta musali Asparagus adscendens
  • Gokshura (Tribulus terrestris)
  • Ashoka (Saraca indica)
  • Black Cohosh (Cimicifuga racemosa)
  • Brahmi (Bacopa Monniera)
  • Hibiscus rosa senesis
  • Mandukaparni (Centella asiatica)
  • Prisniparni (Uraria picta)
  • Rakta chandana (Pterocarpus santalinus)
  • Shivalingi (Byronopsis laciniosa)
  • Vanga Bhasma

Herbal Formula For Kapha Types

  • Ashoka (Saraca indica)
  • Musta (Cyperus rotundus)
  • Mahat Panchamula (the 5 large roots: bilva, agnimantha,synonaka, patala, kasmarya)
  • Black Cohosh (Cimicifuga racemosa)
  • Guduchi (Tinospora cordifolia)
  • Guggulu Commiphora mukul)
  • Shankhpushpi (Evolvulus alsinoides)
  • Satapushpi (Peucedanum graveolens)
  • Sweta Chandana (Santalum album)
  • Jatamansi (Nardostachys jatamansi)
  • Arjuna (Terminalia arjuna)
  • Shatavari (Asparagus racemosus)
  • Abhraka bhasma
  • Shilajitu


Women around the world are now living approximately one third of their lives after they reach menopause. Every women can benefit during these years from a balanced diet tailored to her specific constitution, an appropriate form of regular exercise, intelligently selected plant-based Ayurvedic preparations, and additional dietary calcium and vitamin D. Most women will also derive great benefit from Panchakarma therapies followed by rasayana therapies every 2-3 years. Depending on one’s risk factors, women should have a Pap smear and mammogram every 1-2 years and check her thyroid function, lipid profile, and have a colonoscopy every 3-5 years.