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