A Narrative Review on Raktapradara (Menorrhagia): Classical Concepts, Contemporary Evidence, and the Therapeutic Potential of Punarnava

Abstract

Background: Raktapradara, the Ayurvedic correlate of menorrhagia, is a common gynecological
condition affecting reproductive-age women worldwide. Objective: This narrative review synthesizes
classical Ayurvedic concepts with current scientific evidence on the burden, pathophysiology, and
management of Raktapradara, with special emphasis on Punarnava (Boerhavia diffusa). Methodology: A
systematic literature search was conducted in PubMed, Google Scholar, Scopus, and IndMed from
inception to December 2024 using keywords including “Raktapradara,” “menorrhagia,” “Boerhavia
diffusa,” “Punarnava,” and “Asrigdara.” Classical Ayurvedic texts were accessed through published
translations and commentaries. Original research, systematic reviews, and preclinical studies on
pharmacological mechanisms were included. Results: Epidemiological data show that menorrhagia
affects approximately 30% of reproductive-age women and accounts for 20% of gynecology visits. The
FIGO PALM-COEIN classification provides a structured etiological framework. Modern pharmacotherapy
includes tranexamic acid (45-50% blood loss reduction), NSAIDs, and hormonal agents, but each has
limitations. Several Ayurvedic formulations (Pushyanuga Churna, Darvyadi Kwatha, Gokshuradi
Guggulu, etc.) have shown positive outcomes in preliminary clinical studies, though methodological
quality is variable. Punarnava demonstrates classical indication for Raktapradara, with punarnavoside
identified as an antifibrinolytic agent that reduces IUD-induced bleeding without affecting systemic
coagulation. Anti-inflammatory and antioxidant actions further support its therapeutic
potential. Conclusion: Raktapradara remains a significant health burden. While Ayurveda offers
promising interventions, particularly Punarnava, the lack of rigorous randomized controlled trials is a
major evidence gap. High-quality clinical studies are urgently needed to establish efficacy, safety, and
optimal dosing.