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Open Access Full Text Article  Review Article

Unani Perspective on Polymenorrhea (Kathrat-I-Ḥayd): Understanding Etiology and Pathogenesis

¹ Sehba Zaheer *, ² Nida Sultana 

¹ PG scholar, Department of Ilmul Amraz, Faculty of Unani Medicine, AMU Aligarh

² Assistant Professor, Department of Ilmul Amraz, Faculty of Unani Medicine, AMU Aligarh

 

 

INTRODUCTION

Menstrual irregularities are among the most common gynaecological complaints affecting women of reproductive age. Polymenorrhea is defined as frequent menstrual cycles occurring at intervals of less than 21 days ^1,2. In contrast to the average menstrual cycle length of 28 ± 7 days, Polymenorrhea may lead to more than one menstrual episode in a calendar month. Though often benign and transient, recurrent Polymenorrhea can indicate underlying pathology and may lead to complications such as anaemia and infertility ³. It may be caused by hormonal, structural, or systemic factors. Hormonal causes include luteal phase defect (insufficient progesterone), anovulation during menarche or perimenopause, thyroid dysfunction (both hypo and hyperthyroidism), and hyperprolactinemia, which affects ovulatory cycles. Structural causes include uterine fibroids, endometrial polyps, and Adenomyosis. Systemic and iatrogenic factors such as bleeding disorders (e.g., von Willebrand disease), hormonal contraceptive use, chronic illnesses, and stress also contribute to frequent menstruation ^{3, 4}.

Polymenorrhea affects around 5–15% of women of reproductive age and is more common during adolescence and perimenopause due to hormonal fluctuations ³. A study in rural India reported that about 9% of women experienced menstrual cycles shorter than 21 days, often associated with stress, malnutrition, or thyroid issues ⁵. Despite its prevalence, it is frequently underreported due to social stigma and limited healthcare access.

In the Unani system of medicine, this condition is referred to as Kathrat-i-Ḥayḍ, where ḥayḍ (menstruation) is a natural process for tanqiya-i-madda (evacuation of morbid matter), from the body, particularly from the uterus ^6,7.

Classical Unani scholars, including Ibn Sīnā, Rāzī, and Jurjānī, have described Kathrat-i-Ḥayḍ in terms of imbalance of the humors (Akhlāṭ), temperament (Mizāj), and faculties (Quwa) of the uterus. The excessive and frequent flow of menstrual blood is generally due to Sū’-i-Mizāj Ḥārr Raṭb Māddī. (Morbid hot temperament with substance) and Sū’-i-Mizāj Bārid Sāda, (Morbid cold temperament), ghalba-i-dam (dominance of blood), or ghalba-i-ḥarārat (excessive heat) in the uterus, both of which accelerate the excretion of blood ^[8,9]. In addition, impairment in the Quwwat Dāfi‘a (expulsive power) and Quwwat Māsika (retentive power) may alter the natural rhythm of menstrual discharge ^{10, 11, 12}.

ETIOLOGY OF KATHRAT-I-ḤAYḌ

In Unani medicine, the causes of Kathrat-i-Ḥayḍ (Polymenorrhea) are broadly categorised into two main types: one is related to the uterus and the other is related to the blood ^{13, 14}. Uterine causes are numerous and include morbid uterine temperament, either hot and dry or cold and dry, which alters the function of the uterus ¹⁴. Weakness of uterine blood vessels ^{14, 15}, the presence of ulcers or wounds in the uterine lining ^7,11,13,16 and the opening or rupture of uterine vessels due to strong humors ^12,13 are all considered contributing factors. Other uterine causes include uterine trauma, irritation, prolapse or displacement, and conditions such as pruritus uterii or haemorrhoids ^7,17,18. The weakness of Quwwat Māsika (retentive power of the uterus) is also an essential factor in the pathogenesis, making the uterus unable to hold blood properly ^10,11,12.

From a humoral perspective, excess moistness and wet temperament can also stimulate frequent bleeding ^7,9,16. The stretching or contraction of uterine vessels can lead to bleeding ^[12]. Furthermore, although the blood is normal in quality and quantity due to weakness, the body is unable to hold it. ¹⁴. Thin, or light blood or Hiddat khoon, increases fluidity and movement, causing excessive bleeding ^11,15. In some instances, Imtilā’-i-Damawī in the uterus, leading to frequent menstruation ^12,17,18.

In addition to these, several other systemic or external factors contribute to Kathrat-i-Ḥayḍ. Weakness of the body’s defence mechanism (tabi‘at), difficulty during labour, excessive sexual intercourse during menstruation, and injuries caused by physical activities such as jumping or climbing stairs are also causes of excessive bleeding^13,14,18. The consumption of hot and strong substances, liver or kidney atrophy, tuberculosis, and miscarriage further aggravate the condition ^12,17,19. According to Buqrat, Excessive or insufficient menstrual bleeding is harmful. Excessive bleeding can make the liver's temperament cold, while insufficient bleeding can lead to various diseases ^11,16.

Polymenorrhea (Kathrat-i-Ḥayḍ) is a menstrual disorder marked by frequent bleeding at intervals shorter than 21 days, with significant effects on women's physical and reproductive health. In Unani medicine, it is caused by morbid temperament of the uterus, excess dam (blood), and weakness of Quwwat Māsika (retentive power) and strong Quwwat Dāfi‘a of the uterus ^10,14. The condition may lead to anaemia, fatigue, and infertility, along with emotional distress and reduced quality of life ²⁰. While modern medicine relies on hormonal therapies with potential side effects, Unani treatment focuses on lifestyle (Tadābīr), diet (Ghidhā), and natural remedies like qabiz and musakkin drugs^21,22. This review of literature is essential to understand the underlying causes and pathogenesis of Polymenorrhea, which is essential to formulating an effective and appropriate treatment approach.

MATERIAL AND METHOD

A systematic review was conducted using both offline and online sources. Offline sources included Maulana Azad Library (MAL) and Ajmal Khan Tibbiya College Library (AKTC) at AMU, Aligarh, along with the Regional Research Institute of Unani Medicine (RRIUM) and various seminar libraries. Online sources comprised databases like Cochrane Library, PubMed, Scopus, AYUSH Portal, Internet Archive, Google Scholar, Research Gate, and Rekhta Books. Primary sources consisted of original works by renowned Unani scholars, such as Al-Qānūn fi’l Ṭibb, Kāmil al-Ṣanā‘a al-Ṭibbiyya, and Kitāb al-Kulliyyāt. Secondary sources included translated classical texts and books like Kulliyāti-Qānūn and Jame ul Hikmat. Tertiary sources involved journal articles, dissertations, and other relevant publications.

 

 

RESULTS

Table 1: Causes of Kathrat-i-Ḥayḍ

 

 

DISCUSSION

Through a thorough literature review, the general causes of Kathrat-i-Ḥayḍ were classified into Asbāb-i-Maraḍ and Asbāb Sū’-i-Mizāj, as illustrated in Table 1. Such as Asbāb Sābiqa (Remote Causes), Asbāb Wāṣila (Immediate Causes), Asbāb Bādiya (external causes). Among the hot causes (Asbāb Musakhkhina) are hot and dry temperament, heated melancholic humors, and consumption of hot substances ^9,13,14. Cold and dry temperament (Asbāb Mubarrida), excess moisture (Asbāb Muraṭṭiba), or dryness (Asbāb Mujaffifa) are also able to alter the balance of the uterine temperament, which leads to menstrual irregularities ^7,15,16.

The pathogenesis of Kathrat-i-Ḥayḍ (Polymenorrhea) in Unani medicine is associated with an imbalance in the Mizāj (temperament) and derangements in the Quwa of the uterine system. This is shown in Figures 1 and 2. The findings of this study are consistent with classical Unani literature, which states that Kathrat-i-Ḥayḍ can be caused by Sū’-i-Mizāj Ḥārr Raṭb Māddī, wherein Asbāb Wāṣila, Asbāb Bādiya, Asbāb Musakhkhina, and Asbāb Muraṭṭiba contribute to its development. The condition is characterised by an excess of moistness and wetness ^{7,9,13,14,15,16} and an increased quantity of blood within the body^{11,12,13,15,16}, leading to Imtilā’Damawī in the uterus^12,15,17,18. Due to the excess of heat, the blood becomes thinner in consistency ^{[7,9,11,12,13,15,16]}. Since the blood is both excessive in quantity and thin in nature^{7,9,11,12,13,15,16}, the Quwwat Māsika (retentive power) of the uterus becomes overburdened and weakened due to excess of action to retain it^10,11,12. Moreover, as the humour involved is irritant in nature and the blood is present in excess, the Quwwat Dāfi‘a (expulsive power) of the uterus becomes hyperactive ^[10], resulting in the frequent expulsion of blood and ultimately leading to Kathrat-i-Ḥayḍ.

Similarly, Kathrat-i-Ḥayḍ may also be caused by Sū’-i-Mizāj Bārid Sāda, wherein Asbāb Wāṣila and Asbāb Mubarrida play a key role. This condition is associated with a morbid, cold, and dry temperament of the body ^7,14, which leads to weakness of the uterine powers. (as Sū’-i-Mizāj Bārid causes weakness of organs). It causes Weakness in the Quwwat Māsika (retentive power) of the uterus ^10,11,12.  So, due to the weakness of retentive power, blood cannot be retained in the body; it is expelled and leads to Kathrat-i-Ḥayḍ. 

These theoretical insights align with the Unani perspective on temperament imbalance and its contribution to menstrual irregularities. They highlight the significance of assessing both qualitative and quantitative disturbances in blood and temperament when evaluating patients with Polymenorrhea (Kathrat-i-Ḥayḍ). This understanding emphasises the necessity of a comprehensive diagnostic approach that integrates Mizāj based assessment with modern evaluations of hormonal and structural factors. Effective management involves strengthening the uterine musculature through Muqawwī raḥim (uterine tonics), regulating the humor, and promoting overall balance through Tadābīr (Regimenal therapy).

 

 

 

 

 

 

 

 

 

PATHOGENESIS OF KATHRAT-I- ḤAYD

 

FIGURE: 1

FIGURE: 2

 

CONCLUSION

Kathrat-i-Ḥayḍ is becoming more common today due to lifestyle changes, stress, and poor nutrition. It can lead to problems such as infertility, weak bones, delayed physical and emotional growth, and poor overall health. Understanding its causes and mechanisms through the Unani system helps in achieving better diagnosis and treatment.

Unani scholars have explained the causes of Polymenorrhea in great detail. They describe it as resulting from changes in temperament (Sū'-i-Mizāj), imbalance in body humors (Akhlāṭ), weakness in the uterine faculty (Quwa). By identifying the exact cause, treatment can be planned according to Unani principles, which focus on restoring balance in the body naturally.

In modern medicine, many gynaecological problems, such as PCOD, AUB, and premature ovarian failure, still lack clear causes and complete cures. Most treatments rely on hormones, which may have side effects. Unani medicine, with its holistic and temperament-based approach, offers a broader and more natural understanding of the disease process. Therefore, studying the Unani concept of etiopathogenesis can help improve the management of Polymenorrhea and related disorders even in the modern era.

Conflict of Interest: No conflict of interest.

Acknowledgement: None stated.

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