Management of PCOS:Ayurvedic

perspectiveDr.shailesh s phalle M.D.(K.C)

Ayusanjivani ayurveda ,kharadiwww.ayusanjivani.com

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 heterogenous disorder characterised by -amenorrhoea, -hirsutism -obesity - associated with enlarged polycystic ovaries

Introduction :

Among the total female population 6% About 50% cases seen within the age of 20

to 30 years 60 % presents with anovulation 90 % presents with hirsutism 80 % with Obesity. 30 % with infertility

INCIDENCE :

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 ,sedentery lifestyle,improper diet,lack

of workout

ETIOLOGY :

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 

Pathophysiology :

ABNORMALITY OF HPO AXISHypothalamus

Increased frequency of GnRH

Increasepulse frequency of LH compared to FSH

Increased pituitary sensitivity of GnRH

LH : FSH

Hyperinsulinaemia arising from receptor dysfunction

Reduced shbg

Insulin receptor dysfunction

Hypothalamus

Pituitary

Follicle

Pancreas

Hyperinsulinemia

Adrenal Liver Stroma

Abnormal regulation of the androgen forming enzyme (P450C17) is thought to be the main cause for excess production of androgens from the ovaries and adrenals.

Sources of Androgens – 1) Ovary 2) Adrenal

3) Systemic Metabolism Alteration

3) Hyperandrogenemia : ( adrenal/Ovarian)

A genetic basis that is both multi-factorial and polygenic is suspected, as there is well documented aggregation of the syndrome within families.

Specifically, prevalence has been noted between affected individuals and their sisters and mothers.

Familial condition possibly autosomal dominant, however PCO gene as such has not been identified.

4) Genetic inheritance :

Menstrual irregularities Anovulation Hirsutism Acne Obesity Acanthosis Nigricans –thickend and

pigmented skin –insulin resistance HAIR-AN Syndrome: (HA-hyperandrogenism IR_insulin resistance ,AN- Acanthosis

Nigricans)

CLINICAL FEATURES :

Sonography :Trans vaginal sonography in obese patients shows

enlarged overies in volume and increase no of peripheraly arranged cyst.

INVESTIGATIONS :

Polycystic ovary

Normal Ovary

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 repeating

“PCOS” though a syndrome can not be correlated to a particular disease.

An exact correlation is not possible. No specific Yonivyapad with the above said

features is noted. 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. 

AYURVEDIC CONSIDERATION :

धु्रवं चतुर्णाम् सन्नि�ध्यत् गर्भः स्यत् विवन्नि�पूवकः ऋतुक्षेत्रम्बुबीजनं समग्र्यङ्कुशे य� (सु. सु.२/३३)

 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.

PUSHPAGNI JATAHARINI :

Vrutha Pushpam – Anovulation,Fruitless/without conception

Yathakalam prapashyayti – Mentruating regularly

Sthula- obesity Lomasha ganda – Hairy chin/ Hirsutism

VANDHYATVA W.S.R. TO ABIJOTSARGA (ANOVULATION)

1.Aartava dushti: Acharya have mentioned that Ashtartava dushti if remains

untreated or not properly treated then it causes Abeejata i.e. unable for prajotpadana (Su. Sha. 2/3). Acharyas have not described any specific etiology of these eight menstrual disorders.

Vata get aggravated and causes „Dhatu- Kshaya‟. Because of this Dhatu Kshaya Rasa Dhatu decreases and that ultimately causes the Kshaya of its Upadhatu i.e. Artava Kshaya (Anovulation).

  2) Avarana: In the concept of artavanasha, Sushruta and Vagbhatta has

described that both vata and kapha when aggravated, obstruct the path, thus artava is destroyed (A.S. Su.1/13). Here artava can be taken as Antapushpa. Here we can take as anovulation. The Artava Vaha Srotas is obstructed by the Kapha and Vata due to which Artava is not visible (Ovulation does not occur). It is also a Sanga Pradhana Vikara.

 

(3) Asrikdosha: (Ch. Sha.2/7) : Word Asrik refers to Ovum and menstrual blood.

abnormalities of ovum and ovarian hormones produce infertility.  (4) Dietetic habit (Ka. Sa.) : Besides all these reasons dietetic habits also causes

anovulation as mentioned in Kashyapa Samhita Kalpa Sthana. Due to ati Ushana veerya annapana

artava, beeja becomes upchita or vitiated.

Pcos is basically a disease of artav vah shrotas. Aavarana is the main pathogenesis in PCOS. Kapha Medo related dosha dushyasamurchana is

seen here. Sthoulya samprapti and kaphaja prameha

samprapties are the key areas to be explored. In pcos kapha dominant granthis are seen in overy. Granthis devloped when there is the sangha in

srotas due to snigdha and guru guna of kapha. Thease granthis with strong kapha platform inhibits

the aartav leading to artav rodha.

Ayurveda perspective :

Dosha: kapha- (guru,snigdha,manda guna) Dooshya –Medodhatu,rasa,rakta Strotus :artavvahashrotas,medovahastrotas Strotodusti -sangha Agni -manda at kostha and dhatu level.

Frame of samprapti :

Pcos ayurveda co relation : Kaphaja prameha Sthoulya Medoavrutha vata Kaphavrittha vata Kaphaj granthi-granthi aartav dosha.

Sthoulya chikitsa : Dhatwagni deepan Kapha medo dusti chikitsa

Treatment protocol :

1.Vaman:-for kapha chedan and aavaran chikitsa

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

Virechan with erandam tailam 25 ml with milk

Virechan with 50 gm trivrutha lehyam Virechan with kalyana gulam 25 gm

Role of panchakarma :

For minimising kapha related granthis in overy

Erandamuladi shodhan basti- Lekhan basti – Uttarbasti – Falghrutam,kasisadi tailam,sahachar

tailam,bala tailam.

Basti

Lekhan basti –1 Lekhan basti 2

Makshika -200 ml,saindhav -15 gm,morchit tailam -200 ml,yavanyadi kalkam-30

gm,triphala kashay-300 ml,dhanyamla-200 ml,yavakshara-10 gms

triphala kashay-150 mlKulatha kashay -150 mlMakshika -150 mlSnehan -100 mlKalkam-hinguvachadi-

30 gmLavan-10 gmYavakshar -10 gm

Bahiparimarjan chikitsa : Udwartan – kapha medoshamana by

kolkulathyadi choornam avagahasweda-pakwashyavata shaman shirodhara shiropichu Adviced as per patient prakruti

Lasun erandadi kashay :lasuna ,erand,punarnavaRemoves avarana and useful for reduction in circulating

androgensSukumar kashay : acts on pakwashay,corrects apan

vaigunyaVaranadi kashay : varun ,saireyak,shatawari,chitrak-

removes avaran,useful in insulin resistance.Rajaha pravarthini vati -kumari ,kasis,hingu-

aartavpravrthakKanchanar guggulu –indicated in granthiKuberaksha vati - lasuna,latakaranj -indicated in granthiPhal ghruta – corrects harmonal imbalance,regularies

arthav

Shaman chikitsa :

CONCLUSION It is inaccurate to state that PCOS is the most common cause

of anovulation, because PCOS does not cause anovulation; rather, PCOS is the consequence of chronic anovulation, which can result from a wide variety of causes.

PCOS is now firmly established in our scientific and clinical lexicon, it is important to emphasize that PCOS is not a discrete or specific endocrine disorder having a unique cause or pathophysiology.

PCOS is a condition involving disorder of ovary associated with deranged metabolism of lipids and carbohydrates and multiple harmonal involvment.

Researches are required for understanding the correct pathophysiology of PCOS in Ayurveda causing infertility.

By proper investigations, diagnosis and management we can fight against PCOS and can bring new glow to women’s life.

Extensive studies needed. 

PCOD PCOS

Overies are reeling under pressure and filling the burnt of the disturbences in your body and generally not functioning at that pick efficiency.

Hyper androgenic obese anovulation . High lh to fsh ratio. Ovaries large with evidance of

homogenous polyfollicular enlargement with thickal hyperplasia.

Necklace pattern on usg

Thease disturbences are now no longer just in the overies but are also manifestating in other parts of the body as acne,body hair,irrguler periods,obesity,insulin ensitivity,high

ammount of male harmones,irritability,oily kin,thinning of hairs.

Normoandrogenic,normoestrogenic lean,Anovulation

No significant alteration in harmones.

Bilateral active overies with no evidance of follicular dominancy or ovulation.

An 31 yrs female patient with primary infertility with h/o pcos since 12 yrs.

Patient having irreguler periods since menarche. Newly diagnosed with hypothyrodism since 2 yrs. Acne,hirsutism and lean lady.Improper Diet and life style,lack of exercise Investigation report :

CASE STUDY

tsh lh amh Prolactine

Progesterone

Testesterone

Before treatment

7.8 32 35 11 Not done

78

Aftertretment

3.2 10.76 16 10.6 0.18 36