INTRODUCTION

• Described in 1935 by Stein and Leventhal as a syndrome manifested by amenorrhoea, hirsutism, and obesity associated with enlarged polycystic ovaries.
• Characterised by excessive androgen production by the ovaries/ adrenals 
• Excessive androgen  interferes with growth of the ovarian follicles thus results in chronic anovulation.
• Patients have a steady state of relatively high estrogen, androgen, and LH levels rather than the fluctuating condition seen in ovulating women.

Pathology

• Ovaries are enlarged 2-5 times the normal size. 
• Stroma is increased and the capsule is thickened and pearly white in colour.
• Multiple follicular cysts about 8-10 mm in diameter are crowded around the cortex.
•  Patients may present with features of diabetes mellitus (insulin resistance)

Clinical features

✓Increasing obesity

✓ Menstrual abnormalities in the form of oligomenorrhea, amenorrhoea,or DUB (dysfunctional uterine bleeding) and infertility

✓ Hirsutism

✔ Acanthosis nigricans- skin changes due to insulin resistance, skin is thickened and pigmented. Common sites are nape of the neck, inner thighs, and axilla.

✔HAIR-AN Syndrome- patients with PCOS – hyperandrogenism, insulin resistance, and acanthosis nigricans.

✔ Internal examination- bilateral enlarged cystic ovaries may not be revealed due to obesity.

Investigations 

1) Sonography

➤Transvaginal sonography in obese patients shows enlarged ovaries in volume and increased number of peripherally arranged cysts.

2) Serum values

➤ LH level is elevated and or ratio LH: FSH is >3:1

➤ Raised serum insulin level (insulin resistance) or the ratio of fasting glucose: fasting insulin is vo<4.5

3) Laparoscopy

➤ Bilateral polycystic ovaries. 

Pathophysiology

1. Hypothalamic-pituitary compartment abnormality
2. Androgen excess
3. Obesity and insulin resistance
4. Anovulation

Long term consequences of PCOS 

1. Risk of developing diabetes mellitus due to insulin resistance
2. Risk of developing endometrial carcinoma and carcinoma of breast due to persistently elevated level of oestrogens. Oestrogen effects are not opposed by progesterone because of chronic be bo anovulatory state.
3. Risk of hypertension and cardiovascular disease due to abnormal lipid profile.

POLYCYSTIC OVARIAN SYNDROME (PCOS) – AYURVEDIC VIEW

PCOS is basically a disease of arthavavahasrotus. Avarana is the main pathogenesis in PCOS. Kapha – Medo related dosha- dooshyasammurchana is seen here. Sthoulya samprapti and Kaphajapramehasampraptis are the key areas to be explored.

In PCOS kapha dominant grandhis are seen in ovary. Grandhis develop when there is the sanga in Srotus with guru and snigdhavikalpa of kaphadosha. This grandhis with a strong kapha platform inhibits the arthava pravruthi leading to arthavarodha.

As a systemic effect of Kapha – medo samsarga there can be srotho upalepatha leading to prameha in such cases. Dhathushaidhilya is the later manifestation.

FRAME OF SAMPRAPTI

A) Dosha

• Kapha dosha with Guru, snigdha and mandagunavikalpa

B) Medodhatu is the main dooshya. Rasa and Rakta are also involved

C) Srotus

• Arthavavaha Srotus and Medovaha Srotus are involved mainly. Sanga is the main type of srothodushti.

D) Agni

Status of agni is manda at koshta and dhatu level

PCOS- BEFORE YOU PRESCRIBE BE SURE OF THE FOLLOWING…

1. Kaphaja prameha
2. Medo aavrutha vata 
3. Sthoulya 
4. Kaphavrutha apana
5. Kaphaja grandhi
6. Grandhi arthava dosha

TREATMENT PROTOCOL 

➤ Dhatwagni Deepana 

➤ Kapha- Medoprasadana 

➤ Sthoulyachikitsa

ROLE OF PANCHAKARMA

A) Vamana – For kaphachedana and removing Avarana

B) Virechana – For creating vatanulomatha in koshta and arthavavahasrotus.

C) Lekhana Vasthi – For minimising kapha related grandhis in ovary.

Ayurvedic Specialty Treatments

Ayurveda takes a holistic approach to health, addressing not only the physical symptoms of #PCOD but also the emotional and mental aspects. It is essential to consult with a qualified Ayurvedic practitioner to create a personalized treatment plan tailored to your unique constitution and needs.

 If you or someone you know is struggling with PCOD, consider exploring the holistic and natural approach of Ayurveda for effective and sustainable management. Our Ojas Herbal Ayurveda & Panchakarma  is here to support you on your journey to better hormonal health and overall well-being.

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