AYURVEDIC MANAGEMENT OF PCOD AND PCOS

PCOD & PCOS

Introduction

l  Polycystic Ovarian Disease (PCOD) and Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women of reproductive age associated with ovaries , that wreaks havoc on hormones and causes physical and psychological damage.

l  Ovarian follicle

u  Fluid filled sac found in ovaries, containing an immature egg or oozyte.

u  Women begin puberty with about 400,000 follicles, each with a potential to release an egg cell (Ovum) at ovulation for fertilization.

u  While several follicles begin to develop each cycle, normally only one will ovulate egg.

u  These ovarian follicles secrete hormone which influences the stages of the menstrual cycle.

u  Functions of ovarian follicle

l  It provides for the maturation and release of fertilized oocyte.

l  It also forms corpus luteum which promotes and maintains implantation of the embryo.

l  PCOD

u  Condition characterized by an Enlarged ovary and small follicular cysts, which have 0.5—1.0 cm diameter.

u  Hormonal imbalance affects the follicular growth during ovarian cycle leading to collection of mature eggs in the ovary, as they cannot be discharged. Thereby causing the affected follicles to remain in the ovary.

u  The retained follicles (immature follicles) forms a cyst with each ovarian cycle, a new cyst is formed leading to multiple ovarian cyst.

u  These immature follicles are called as cysts. This is a vicious cycle, some cysts leads to more cysts and this cycle goes on.

u  Although reasons were from person to person, but insulin, diet, hormonal disturbances and stress are some cause, which leads to PCOD.

u  Sing and symptoms

l  Irregular periods

l  Hair pattern which resembles male patterns

l  Storage of fat at abdominal area

l  Infertility.

u  FSH and LH levels are important for the diagnosis of disease along with pelvic ultrasound.

u   PCOD does not exactly mean infertility, many women can bear child even with this disease. For the treatment of PCOD, patients are given progesterone pills, which help in balancing the hormones.

l  PCOS

u  PCOS is another condition of ovaries, when patient is affected in more than one ways. In this condition, more than twelve follicles are produced every month, but as they all are, immature so no ovum is released and as a result, ovaries starts producing higher level of testosterones, which leads to hormonal imbalance.

u  Polycystic ovarian syndrome (PCOS) is a condition in which a woman's levels of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries). PCOS can affect a women's menstrual cycle, fertility, cardiac function, and appearance.

u  One forth population of women are having multiple follicles in ovaries, but only 10% women suffer from PCOS.

u 

u  Symptoms for this syndrome include 

u  It is associated with enlarged polycystic ovaries.

u  Androgen levels are often elevated, increasing the risk of metabolic syndrome and causing hirsuitism. Over long term androgen excess increases the risk of cardiovascular disorders including hypertension.

u  Estrogen levels are elevated, increasing risk of endometrial hyperplasia and eventually endometrial cancer

u  It is one of the leading causes of infertility in women.

l  Symptoms usually begin during puberty but worsens with time.

l  Typical symptoms are,

l  Mild obesity

l  Irregular periods or Amenorrhoea

l  Some women have other signs of virilization such as Acne and Temporal balding,

l  Difficulties in pregnancy

l   Thinning of hair

l  Areas of thickened, darkened skin (Acanthosis nigricans) may appear in the axillae, on the nape of the neck and in skin folds, the cause is high insulin levels due to insulin resistance.

u  But symptom vary from person to person which usually develop in late twenties.

u  Blood tests and ultrasound scan are the two methods to diagnose the disease.

u  Examination usually detects abundant cervical mucus, reflecting high estrogen levels.

Differences and Similarities

u  PCOD and PCOS are the conditions associated with malfunctioning of ovaries.

u  Symptoms like irregular periods are common in both cases, but PCOS leads to thinning of hair whereas in PCOD a female develop hair pattern like males.

u   Both are caused by hormonal imbalance but for PCOS there is no exact known reason for this disease but we can link it with inheritance, like PCOD.

u  PCOD is not very serious if we compare it with PCOS, which is more severe form of this syndrome.

u   Both contribute to the infertility.

Diagnosis

u  Clinical criteria

u  Serum testosterone , Follicle stimulating hormone , prolactin and Thyroid stimulating hormone levels.

u  Pelvic ultrasonography.

Ayurvedic view of PCOD and PCOS

v  Not explained as a single disease entity

v  Can be considered as a Yoni Vyapat

v  Also as a Pushphagni Revati - Charakacharya

v  Now correlating the signs and symptoms of PCOD and PCOS with that of the Yoni Vyapat or Artava Vyapat,

l  Menstrual irregularities eg Ammenorrhoea condition ( Described under Arthava Vyapat)

l  Annovulation is included under Vandhya (Infertility)

l  Obesity - sthoulya - Santarpanajanya Vikaras

l  Acne - Mukha dushika

l  Baldness - Khalithya

l  Hyperinsulinemia - Type 2 Diabetes mellitus - described under Prameham - also manifested as a complication of Sthoulya.

Scriptures speak of two conditions in relation to PCOS

ü  In the first, menstruation does not appear in the proper time and it s delayed (Prolonged inter menstrual period)

ü  There is scanty menstruation and it does not last for 3 days.

ü  It is associated with the pain in the vagina.

ü  In the second, the doshas like Vata and Kapha obstructs the passages or orifices carrying the menstrual blood (Arthava)

Samprapti:

²   Apana Vata Dushti happen

l  Apana Vayu does “Vata Vit Mutra Sukra Garba NISHKRAMANADI kriya”.

²  Kaphavruta Vata condition happens

l   Kapha Dosha is cold and dense. With its Guru and Sheeta Guna Kapha dosha nourishes the development of the tissues that forms and support the reproductive system.

l  This Kapha Dosha also supports the growth of the follicles during the ovarian cycle.

²  PCOS occurs when Kapha blocks the other two doshas Vata and Pitta.

²  Hormonal Dishormony caused by Kapha

l  Pitta is responsible for the hormonal play. When pitts gets blocked the hormones that carry the energy of transformation are unable to function.

l  The energy transformation here, refers to the power of function of Pitta which helps to shift from the menstrual cycle to the ovarian cycle which is governed by hormones.

l  Thus the movement of ( release of) the mature ovum and the menstrual blood is obstructed, due to the sticky kapha and the transformation process is suppressed.

l  This deranged Vata mixed up with Kapha vitiates the Mamsa Shonitha and Medas.

l  The accumulated Kapha is thus expressed in the formation of cysts in the ovary. I.e they likely to prioduce circular, raised and knotted inflammatory swellings called Granthi.

l  This type of glandular swelling has been compared with the modern terminology ‘cyst’ which means an abnormal closed epithelium- lined cavity in the body, containing liquid or semisolid material.

²  In PCOS, development of follicles has been arrested at one or any level and  remained as it is. The cysts are follicles at varying stages of maturation and  atresia. So, these cysts are not destined to ovum. Thus, this pathology is compared with granthibhuta artava dushti  i.e. cyst, as in PCOS, the follicles becomes cysts instead of developing up to mature ovum.

²  The different symptoms of PCOS including obesity, insulin resistance, irregular periods, acne, hirsuitism, are the expressions of the different factors occuring inside the body due to the aggrevation of the Kapha Dosha.

Line of Treatment

²  Vata Kaphahara Chikits - Apanavatanulomana chikitsa

²  Sthoulya Chikitsa - Medhohara Chikitsa

²  Vandhya Chikits - Rajah and Stri Beeja Poshana Chikitsa.

²  AvaranaHara Chikitsa - Correcting the Ama Dosha, Acheving Koshta Shuddhi and Tridosha balance.

²  Agnivardhaka Chikits - for treating Agnimandhya - Deepana Pachana Chikitsa - improving the Jataragni and Dhatwagni

²  Srothoshodhana Chikitsa - Panchakarma and Rasayana prayogam

²  Artava Chikitsa - Vishamarthava Chikitsa, Arajaska Chikitsa, Ksheena Arthava Chikitsa, Granti Artava Chikitsa, Pushpagni Chikitsa

²  Overall treatment is based on -

Atipravrutti - Rakta pittahara Chikitsa

Stambhana Chikitsa

Brimhana Chikitsa

Apavrutti - Deepana, Pachana and srothoshodhana.

List of Medicines

Kashaya Kalpana

l  Chitraka Grantyadi kashayam

l  Trayantyadi Kashayam

l  Gandharvahastyadi Kashayam

l  Chiruvilwadi Kashayam

l  Patolamuladi Kashayam

l  Saptasaram Kashayam

l  Guggulu tiktaka Kashayam

l  ASmruthotharam Kashatyam

l  Nisaamalakyadi Kashayam

l  Varadi Kashayam

l  Varunadi Kashayam

l  Kaudaja Triphala

Gulika/Vati Kalpana

l  Chandraprabha vati

l  Kanchanara Guggulu

l  Hinguvachadi pills

l  Vyoshadhi vatakam

l  Dushivishari gulika

l  Kankayana Vati

l  TA Tab

l  Vilwadi gulika

Lehya Kalpanas

l  Dasamula Hareetaki Lehyam

l  Kalyanaka Gudam

l  Sukumara Rasayanam

Choorna Kalpanas

l  Hinguvachadi Choornam

l  Avipathi Choornam

Arishta Asava Kalpana

l  Dantyarishtam

l  Abhyarishtam

l  Kumaryasavam

l  Lodharasavam

l  Puthikasavam

l  Helmolite syrup

Gritha Kaplana

l  Varunadi Gritam

Taila Kalpana

l  Sukumara Eranda Tailam

l  Ghandarvahastyadi eranda tailam

Kriyakramam

l  Udwarthanam

l  Swedam

l  Nasyam

l  Mrudu Vamanam

l  Matra Vasti

l  Doshahara Vasti

l  Anuvasana Vasti

l  Yoga

l  Physiotherapy

Pathyapathyam

  Guluchyadi toyam + nisha kathakadi toyam

 Wheat + cheru payaru + methi - kanji 3 times /day

  Avoidance of kaphkara ahara and vihara