Polycystic Ovary Syndrome (PCOS) or Stein and Leventhal Disease is a very common clinical condition these days for which patients seek the Ayurvedic treatment.
It is characterized by chronic anovulation and hyperandrogenism. Patients usually present with menstrual disturbances, hirsutism, and acne. It is associated with obesity and metabolic abnormality like insulin resistance, dyslipidemias, diabetes and cardiovascular diseases.
Diagnostic Criteria- Rotterdam 2003 criteria for PCOS (Any Two).
1) Ovulatory dysfunction such as amenorrhea or oligomenorrhea.
2) Clinical or biochemical evidence of hyperandrogenism.
3) USG – 12 or more follicles in each ovary and increased ovarian volume.
Clinically PCOS is the combination of anovulation and hyperandrogenism.
Pathogenesis- Insulin resistance is in association with compensatory increase in blood insulin level is the hallmark of the pathology. Increase secretion of LH leads to hyperandrogenism. All of these pathological processes lead to dyslipidemia with increase in the level of LDL, triglycerides and decrease level of HDL. The ration of FSH to LH is decreased due to increase level of LH in relation to FSH. The sex hormone binding globulin is reduced in liver and this leads to increase level of free testosterone.
1) Menstrual Disorders- It ranges from amenorrhea to oligomenorrhea. Amenorrhea is usually secondary but may appear rarely primary. It is necessary to monitor the BMI in these patients.
2) Hyperandrogenism- There is the signs of hyperandrogenism like hirsutism, acne and seborrhea.
3) Obesity- 50-70% of the PCOS patients are obese and BMI is the tool by which the obesity can be assessed. The other parameter is considered is the waist to hip ratio. The waist circumference > 80 cm is considered significant for the South Asian women.
4) Acanthosis nigricans- Dark blackish velvety discoloration on the back or in the armpits or under the breast is a definite indicator of insulin resistance.
5) Infertility- Infertility is very common in PCOS and the miscarriage chances are also higher due to the increase level of LH.
1) USG Abdomen and pelvis
2) Thyroid function test
3) Prolactin level
6) FSH /LH ratio.
Ayurvedic Aspect of PCOS- Based on the clinical and the pathological aspects the PCOS in ayurvedic perspective may includes the various conditions and they are as follow
1) Apan Vayu Dushti
3) Artav Dushti
Course of Management-Iin the management of these PCOS patients the ayurvedic physicians utilize the management guidelines given under the above mentioned conditions in Ayurvedic classics.
As per the pathological overview one can easily understand the Kapha and Vata Dushti in Apan Sthan.
The symptoms and signs of the condition PCOS mimics with the ‘Bahu Dosha Avastha’ and its features in Ayurvedic Pathology and hence the ‘Shodhan’ mode (Purification) of the therapy is the main course of the management in PCOS.
Hence the ‘Virechan’ ( Therapeutic Purgation) treatment had tried in many patients and proved effective in the most of the patients. Even the problem of infertility was managed effectively after the ‘Virechan’ therapy.
In some patient it has been observed that the menses appear only after the beginning of the ‘Snehapan’ who had amenorrhea for the 3-4 months period in the past. Usually we use the ‘Panchatikta Ghrutum or Triphaladi Oil’for the Snehapan.
Dose of Snehapan- Generally we give the dose of 20,40,60,80 and 100 ml of the Ghrutum and 15,30,45,60 and 75 ml of oil for the Snehapan.
We use either1 tablet of Ichhabhedi Ras ( Baidynath ) or Abhayadi Modak 2 tablets in the morning in between 8.30 to 9 a.m.
We recommend the dietary regimen i.e. ‘Sansarjan Kram’ for the 5 days period.
Considering the ‘Dhatvagnimandya’ we use the ‘Rasapachak and Medopachak Yog’ of Agasti pharma in a dose of 2 tablets twice or thrice with Mustharishtum.
The other medicines we use in our practice as per the requirement in PCOS patients are Arogyavardhini 500 mg TDS, Chandraprabha Vati 500 mg TDS, Kanchanar Guggul, Triphala Guggul, Gokshuradi Guggul.
We also use the the course of 8 Bastis for the three months period and we use Triphala and Dashamool Bharad for Niruha and Sahacharadi Oil for the Anuvasan.
Ayurvedic Patent and Proprietary Drugs- We use the drugs like Yesaka, Ayaskruti , Diabecon DS to reduce the insulin resistance.
We are impressed with the drug OVACID from ‘Brahma Chaitanya Pharmaceuticals Nagpur’. The main ingredients are Sharpunkha,Shatapushpa, Shatavari, Shuddha Tankan &Latakaranj.
The clinical efficacy of this formulation is really encouraging as we have observed the onset of menstruation and reduction in the acne and hirsutism in the course of three to six months period.
The dietary counseling and exercise is also are the important part of our course in the PCOS patients.
We recommend a walk for 40 minutes every day with other aerobic activities. Moderate activities are always preferred than that of vigorous exercise in these patients.