PCOS – Poly Cystic Ovarian Syndrome.

  • Poly - denotes multiplicity, several or more 
  • Cystic - an abnormal sac containing gas, fluid or semi-solid material,    containing cysts. 
  • Ovary - one of the two reproductive glands in the female containing germ cells or ova.
  • Syndrome - a set of symptoms

It was first described in 1935 by Stein and Leventhal and called as Stein - Leventhal Syndrome for many years. 

It is a heterogeneous disorder characterised by 

  • Amenorrhoea,
  • Hirsutism
  • Obesity
  • Associated with enlarged polycystic ovaries

Incidence:

  • Among the total female population: 6% 
  • About 50% cases seen within the age of 20 to 30 years
  • 60 % present with anovulation
  • 90 % present with hirsutism
  • 80 % present with Obesity
  •  30 % present with Infertility

Causes :

 According to modern science :

  • Uncertain
  • Hypothalamic-pituitary gonadal disturbance, associated with elevated follicular phase LH levels causes PCOS.
  • Abnormal Ovarian Steroidogenesis 
  • Genetic and Affected families. 
  • Stress, sedentary lifestyle, improper diet, lack of workout 

Pathophysiology :

Not clearly understood, can be discussed under the following headings: 

1) Abnormality of HPO axis 

2) Hyperinsulinaemia arising from receptor dysfunction 

3) Hyperandrogenemia (Adrenal/Ovarian)

 4) Genetic inheritance

SYMPTOMS :

  • Menstrual irregularities 
  • Anovulation 
  • Hirsutism
  • Acne
  • Obesity
  • Acanthosis Nigricans –thickend and pigmented skin –insulin resistance

Diagnosis :

Sonography: Transvaginal sonography in obese patients shows enlarged ovaries in volume and increase no of a peripherally arranged cyst.

PATHOLOGICAL CHANGES :

  LH – Elevated or LH:FSH is 3:1 

 Oestrogen – Elevated 

 Testosterone – Raised (>150ng/dl) 

 DHEAS – Elevated (>3400 ng/dl) 

 Fasting Insulin – Raised (>25µ IU/ml)

  Fasting Glucose – Raised (>119 mg/dl)

  Insulin response at 2 hrs postglucose (75gm) load – 300µ IU/ml (suggests IR)  Total Cholesterol - >200 mg/dl

  HDL Cholesterol - <50 mg/dl

  LDL Cholesterol - >130 mg/dl

  Trigycerides - >150 mg/dl 

 Prolactin >1000 IU/l indicates pituitary adenoma; needs repeating14.  

PCOS AND AYURVEDA :

“PCOS” though a syndrome can not be correlated to a particular disease.  An exact correlation is not possible. 

 Conditions like Vandya, Arajaska, Nashtartava, Artavakshaya and Puspaghni Jataharini to some extent can be related. 

 According to Acharya Sushruta the four essential factors for the conception are similar as the germination of a seed.

 ध्रुवं चतुर्णाम ् सन्निध्यणत् गर्ाः स्यणत् ववधिपूवाकः ऋतुक्षेत्रामणबुबुबानणिणं सणमर्यायणककु शे यिण (सु. सु.२/३३) 1. 

1.Rutu:  Fertile period is more explained by Acharya Dalhana that Rutu means Rajaha Kala i.e.ovulation period. – (Su. Sha 3/6 Dalhana Commentary)  Deposition of the spermatozoa in the upper vagina should be in appropriate time of the female cycle. 

2. Kshetra:  Anatomically and physiologically adequate reproductive organs.

  Vagina must be healthy. 

 Cervix and its secretion are also permitted to pass spermatozoa. 

 The oviduct must be patent and sufficient cilliary movement is present.

  The uterus must be capable of supporting implantation and foetal growth throughout pregnancy. 

3. Ambu

 Proper nourishment to the body, adequate hormonal level and proper nutrition is required for genital organs. 

4. Beeja

 The adequate ovum & spermatozoa and the female‟s ovulatory mechanisms must be normal. 

The male must produce an adequate number of normal spermatozoa. So in the concept of PCOS adequate beeja is not available.

 Pcos ayurveda co relation : 

 Kaphaja prameha 

 Sthoulya 

 Medoavrutha vata

  Kaphavrittha vata

  Kaphaj granthi-granthi aartav dosha.

PANCHAKARMA TREATMENT :

 1.Vaman:-for kapha chedan and aavaran chikitsa 

2. Virechan-for kapha pitta nissaran,vat anuloman,

3. Lekhan basti 

4. Uttarbasti – Falghrutam,kasisadi tailam,sahachar tailam,bala tailam.

5. Bahiparimarjan chikitsa: 

Udwartan – kapha medoshamana by kolkulathyadi choornam

 avagahasweda-pakwashyavata shaman 

 shirodhara 

 shiropichu Adviced as per patient. 

MEDICATIONS :

  • Lasun erandadi kashay: lasuna, erand, punarnava: Removes avarana and useful for reduction in circulating androgens 
  • Sukumar kashay: acts on pakwashay, corrects apan vaigunya
  • Varanadi kashay: varun, saireyak, shatawari, chitrak: removes avaran,useful in insulin resistance.
  • Rajaha pravarthini Vvati: kumari ,kasis,hingu-aartavpravrthak 
  • Kanchanar guggulu: indicated in granthi 
  • Kuberaksha Vati: lasuna, latakaranj -indicated in granthi Phal ghruta – corrects hormonal imbalance, regularizes arthav