Ayurvedic Management of Secondary Uterine Hypoplasia (Arthava Kshaya): A Case Study

Background: Secondary uterine hypoplasia is a rare, acquired condition marked by regression or incomplete development of the uterus after normal growth. It often leads to amenorrhea and infertility. In Ayurveda, it correlates with Arthava Kshaya - a state of diminished or absent menstrual flow arising from Vata–Pitta imbalance, impaired Agni, and inadequate nourishment of Rasa–Rakta dhatus. Conventional hormone therapy shows only modest benefits.
Case Presentation: A 29-year-old woman presented with an 8-month history of secondary amenorrhea, weakness, abdominal pain, burning sensations, and anxiety. Baseline investigations revealed anemia (Hb 9 g/dL), ultrasonography findings (small uterus, thin endometrium, small ovaries), and suppressed gonadotropins (FSH 1 mIU/mL, LH 0.5 mIU/mL). Thyroid function was normal.
Intervention: Treatment was delivered in two phases: Virechana with Avipathi Choornam followed by Samsarjana Krama, and subsequent Shamana therapy with Gandharvahasthadi Kwath, Sukumara Ghritham/Kwath , Dhanwantharam Gulika, Evecare, Iogen Syrup, and a sesame–bharangi–trikatu decoction. Maintenance therapy included Abhayarishtam and Ashwagandhadi Lehyam. Dietary corrections were emphasized throughout.
Outcomes: Within seven months, menstruation resumed and became regular. Hemoglobin increased from 9 → 12.5 g/dL, weight from 45 → 50 kg, FSH from 1 → 4.8 mIU/mL, and LH from 0.5 → 2 mIU/mL. Ultrasonography confirmed normalization of uterine size (66 × 27 mm) and endometrium, with active ovaries. No adverse effects were reported.
Conclusion: This case highlights the potential of a structured Ayurvedic approach integrating Shodhana, Shamana, and Rasayana to reverse secondary uterine hypoplasia. Objective evidence of structural and hormonal recovery suggests Ayurveda may complement conventional care in reproductive medicine. Controlled trials are needed to validate these findings and assess fertility outcomes.