Journal of Ayurveda and Integrated Medical Sciences

Introduction

Polycystic ovary syndrome (PCOS) is a condition of androgen excess and oligo - ovulatory or anovulatory cycle. It is the most common endocrine disorder in reproductive age. The Rotterdam criteria classifies as many as 10% of reproductive aged women with PCOS. The challenge for providers and patient is to make the diagnosis of PCOS based on a combination of symptoms, signs & test, because there is no single test can make the diagnosis. Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders. It have been affecting 4 to 12% of women of reproductive age globally, about 3.7 to 22.5% Indian women of reproductive age suffer from PCOS. PCOS often develops due to hormonal imbalance, insulin resistance, obesity, inflammation, and oxidative Stress. PCOS chiefly manifests as menstrual irregularity, weight gain and fertility issues. The prevalence of obesity and infertility in women suffering from PCOS is reported to be 30 to 75% and 70 to 80% respectively. Women with PCOS are at higher risk of suffering from metabolic morbidities including insulin resistance, glucose intolerance, cardiovascular disease, endometrial carcinoma, anxiety and depression. Based on the Rotterdam criteria PCOS is diagnosed with a woman meets two of the following three criteria:

1. Oligo and anovulation

2. Clinical (acne, hirsutism or alopecia) & hyperandrogenism

3. Polycystic ovary morphology on ultrasonography

Pathophysiology of PCOS

PCOS involves metabolic and hormonal disturbance. The endocrine system plays an important role in governing the sleep-wake cycle, it is more likely that PCOS interfere with the sleep - wake cycle. In PCOS, hyperandrogenism and elevated luteinizing hormones (LH) level are majorly responsible for disrupting normal ovarian function. In PCOS, increased gonadotropin - releasing hormone (GnRH) pulse frequency favours LH production over follicle stimulating hormone (FSH). The elevated LH concentration leads to production of androgens in the theca cells, whereas the relative FSH deficit reduces the ability of granulosa cells to convert androgen into estrogen and impair follicle maturation and ovulation, thus giving rise to multiple cysts in the ovary.

didn’t subside. She visited OPD of Dravya Guna Department of Ayurveda Hospital, Chimanganj Mandi, Ujjain.

Menstrual history

Her Menarche was at 15 years, it was regular but is irregular since last 1 one year. Menstruation only used to occur with progesterone challenge test. Currently it is irregular bleeding occurs for days. It is associated with foul smell, clots. she doesn’t complain of dysmenorrhea. She use 2-3 pads per day during menstruation.

Mental state examination - She was normal and cooperative.

Clinical examination - Height - 5.6ft., weight - 68kg, pulse - 70/mint, BP - 130/80 mm of hg.

Systemic Examination - No any abnormality was detected in gastro-intestinal, cardio-vascular, nervous and respiratory examination.

Clinical findings

The patient was medium built with a body mass index of 24 on physical examination, mild hirsutism was observed on her chin region. Ultrasonography (USG) findings suggested multiple ovarian cysts. On blood investigation, the patient had subclinical hypothyroidism with a TSH value is normal and hyperprolactinemia with a serum prolactin level of 16ng/ml. She was chronic patient of PCOD.

Diagnostic assessment

The detailed evaluation of subjective and objective parameters was done through history, physical examination, and investigation. Subjective parameters such as vaginal discharge, the interval of menstrual cycle, and objective parameters including USG findings and blood test such as thyroid function test (TFT), CBC, urine test and serum prolactin were assessed. Based on the investigations, the case was diagnosed as Polycystic Ovarian disease, from the ayurvedic prospective, the disease condition was considered mainly under the term ‘Yonivyapad’. It is difficult to find exact correlation of any specific condition in Ayurveda texts with PCOS. However, the signs and symptoms of condition like Anartava / Nashartava, Arjaska Yonivyapad, Lohitakshaya Yonivyapad, Vandhya Yonivyapa, Sandhi Yonivyapada, Aartava Kshaya and Pushpaghni Jataharini mentioned in Ayurveda closely resemble the features of PCOS.

Table 2: Ayurveda medications & Single drugs combinations after 15 days.

Follow Up and Outcomes

After Shodhan Karma, menstruation is attained with an interval of 30 days. FSH & LH hormones levels come to normal limits.

Results

After 30 days of treatment her menses on regular interval, with normal blood and no pain. Assessment was done on the basis of following points.

Table 3: Assessment criteria and observation.

Discussion

The diagnosis in the present study was based on the medical history and available records of investigations as primary polycystic ovarian syndrome. There is a relationship between the hypothalamic-pituitary-ovarian (HPO) axis. Here, patient with delayed puberty, following exclusion of other causes, should be counselled and reassured, otherwise puberty may be induced using oral oestrogen and progesterone therapy when there is severe delay.

Gross defects in the form of adiposogenital dystrophy or pituitary dwarfism are not amenable to any form of therepy, In mild disorders, it is possible to induce ovulation and menstruation either by treatment with gonadotropin or with GnRH analogs. Individuals with isolated gonadotropin deficiency