Reversing Hormonal Imbalance with Ayurveda: A Case Report on PCOS and Hypothyroidism treated with Virechana

Neha Malik; Khushbu Kashyap; Swathi C; Venkata Ratnakar L

doi:10.21760/jaims.9.12.45

PCOS and hypothyroidism are two most commonly prevalent endocrine disorders that greatly affect the reproductive and metabolic health of women. This case report discusses the effective management of a 37-year-old female suffering from PCOS and hypothyroidism with an integrative approach to Ayurvedic management. The female patient had menstrual cycle increasing intervals along with scanty flow occurrence over the last two years, ultrasonography for PCOS, and diagnosed hypothyroidism three years back. Treatment approaches for Shodhana as Virechan and Shamana therapies were applied to favor the harmonization of hormones with metabolic functions. It showed significant improvements with a loss of 10kg, menstruation became regular, and thyroid functions became normal. The follow-up showed ultrasonography indicating a complete reversal of PCOS. This case shows how well these Ayurvedic therapies could help these women manage PCOS and hypothyroidism holistically and non-invasively while yielding promising results.

Corresponding Author

How to Cite this Article

To Browse

Neha Malik, Post Graduate Scholar, Department of Prasuti Tantra and Stri Roga and Ayurveda, Sri Jayedra Saraswathi Ayurveda College and Sri Chandrashekhraendra Saraswathi Viswamahavidalaya, Chennai and Kanchipuram, Tamil Nadu, India.
Email:

Malik N, Kashyap K, Swathi C, Ratnakar L V, Reversing Hormonal Imbalance with Ayurveda: A Case Report on PCOS and Hypothyroidism treated with Virechana. J Ayu Int Med Sci. 2024;9(12):335-338.
Available From
https://jaims.in/jaims/article/view/3841

Manuscript Received

Review Round 1

Review Round 2

Review Round 3

Accepted

2024-11-04

2024-11-14

2024-11-25

2024-12-04

2024-12-18

Conflict of Interest

Funding

Ethical Approval

Plagiarism X-checker

Note

None

Nil

Yes

13.38

Introduction

Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrinopathy affecting 4-8% of women of reproductive age. It is an ovarian cause of secondary amenorrhoea which hampers normal menstrual cycle but also has marked affliction on the fertility of females.

The common features found in PCOS are menstrual disorders (Amenorrhoea or Oligomenorrhoea); Hirsutism, Obesity, Anovulation & Infertility. Diagnosis is based upon the presence of any two of the following three criteria.^[2]

1. Oligo and/or anovulation
2. Hyperandrogenism (Clinical and/or biochemical)
3. Polycystic Ovaries

According to Ayurveda PCOS can correlate with several conditions described in Ayurvedic literature. i.e., Granthi, Artavkshayam, Nashtartavam/Anartavam, Pushpagni, Jataharini, and Arajaska, Ksheenartava.

Nashtarthava/Anartava is a condition which is described by Acharya Susrutha. According to Dalhana commentary, either Kapha or Vata alone or Kapha Vata together may cause Aavarana (obstruction).

The doshas obstruct the passage or orifices of channels carrying Artava (Artavavaha Srotas), thus Artava is destroyed. Though Artava is not finished completely, yet it is not discharged monthly.^[3]

Case Study

A married patient aged 37 years attended the OPD of PTSR at SJSACH. She has been married for 5 years. She presented with complaints of Anxious to conceive for 3 years and irregular menstrual cycle for two years and her last menstrual cycle was 11 months back.

She also had dry skin on her bilateral legs, mood swings, severe fatigue, severe hair fall for a year, and complained of continuous weight gain. She was a known case of hypothyroidism and her USG was suggestive of PCOS.

Treatment Schedule

On her first visit on 08/2022, the following treatment was prescribed:

Date

Clinical Event

Treatment

8/10/2022

LMP - 26/09/2023
The patient got her menses; menstrual bleeding was for 6 days. From day 1 to day 4 she used 3 pads which were fully soaked, on day 5th and 6th 2 pads were used.

Treatment was discontinued due to some accidental injury.

23/11/2022

Came for regular follow-up.

The same medicines were continued as of the first visit.

10/03/2023

LMP - 24/02/2023
Only for 1 day menstrual flow was present

Kanahshatavdi Kashayam 20ml BD after food
Vayu Gulika 1TDS

01/04/2023

LMP - 29/03/2023
Spotting present.

The same medicines as above along with these Hingutriguna Oil 5ml with Kashaya and was added for 15 days

19/04/2023

The patient was advised for Virechana procedure

Day 1 to Day 3: Udvartana with Kolkulathadi Churnam followed by Bashpa Swedan
Day 4 to day 7: Tailpana with Dhanwantaram Tail in gradual increasing dosage till Samyak Snigdha Lakshana was observed.
Day 8 to day 10: Abhyang and Bashpa Swedana
Day 11: Trivrit Leha 55gm along with 5 gm of Trikatu Churnam was administered.
Diet - Mugadha Yush and Kanji during the treatment.

	Before Treatment	After Treatment
Weight (kg)	94	84
BMI (kg/m2)	36.7	32.8
USG	Uterus - Anteverted 8.5×3.8×4.9 cm Endometrium Thickness - 9.3 mm Ovaries - Right Ovary - 4.0 × 2.9 × 4.4 volume - 26.5 cc Left Ovaries - 3.0 × 3.1 × 3.5 volume - 17.6 cc Impression - Both ovaries appear enlarged and show multiple peripherally placed follicles. Bilateral polycystic ovaries	Uterus - Anteverted 5.4×2.6×3.7 cm Endometrium Thickness - 6 mm Ovaries - Right Ovary - 2.4 × 1.7 × 2.7 volume - 6.10cc Left Ovaries - 2.2 × 1.9× 2.3 volume – 5.43 cc Impression - Normal Uterus and right ovary. Normal ovaries with small follicles of less than 1cm were noted in the left ovary
Thyroide Profile	T3 - 1.09 ng/ml T4 - 7.60 mg/dl FT3 - 2.61 pg/ml FT4 - 1.03ng/dl TSH - 10.99 mIU/ml	T3 - 1.6 ng/ml T4 - 6.8 mg/dl FT3 - 3.1 pg/ml FT4 - 2.45 ng/dl TSH - 6.57 mIU/ml

Changes in symptoms

Symptoms	Before treatment	After treatment
Menstrual cycles	Increased interval between two menstrual cycles	Regular menstrual cycles for three consecutive months from 05/2023 to 07/2023
Skin	Dry	Normal
Fatigue	Present	Absent
Weight changes	Continuous weight gain	Weight loss noticed of 10 kg after Virechana treatment
Hair fall	Present severely	Reduced to some extent
Mood changes	Mood swings	Improvement in mood changes

Discussion

PCOS is not directly addressed in Ayurveda, however, it may be linked to several disorders such as Vandhya, Nasthartava, Aratava Kshaya, Pushpaghni Jataharini, and others, as well as by considering the specific Sroto Dushti, Avarodha, Agni, Ama, and others. Anartava is a Tridoshaja Vyadhi, even though the major derangement is of Vata. Swanidana Prakopaka Aharatamaka, Viharatmaka, and Manasika Hetu are the causes of Tridosha vitiation. Menstrual flow is considered to be governed by Apana Vata, whereas Rasarakta Chankramana is governed by Vyana Vata. Apana and Vyana Vata vitiation impairs their proper function. Tridosha vitiation impairs Agni's natural function, resulting in the inadequate formation of Rasa Raktadi Dhatu and Upadhatu Artava.

The ultimate goal of the treatment was to relieve the obstructed Vata and enable it to function properly in the Koshta, especially in the Garbhasaya. The obstruction was caused by accumulating Kapha in the Vata pathways, especially in the Arthavavavaha Srotas. The medications used in treatment, such as Rajapravrtini Vati and Hinguvachadi Gulika, include Agneya Dravyas - Teekshna and Ushna Gunas of Agneya Dravya is Arthavajanana, and it also clears the Strotas and does Amapachana.

Due to obesity, the patient was encouraged for Udvartana with Kola Kulathadi Churna as it helps in balancing Vata, Meda Pravilayana thereby alleviating and performing Agni Deepana with Kola, Kulatha, Tila, and other ingredients taken in equal parts.

Thailapana^[4] is specially indicated in Sleshmamedomaruthajanya Roga. In the present study for Snehapana Dhanwantaram Taila^[5] was selected as it contains Dashamoola, Bala, and Jeevaniya Gana Dravyas which help in controlling and balancing the vitiated Doshas. Also, this oil has been indicated in Yoni Rogas.

Abhyanga done in the patient helped in alleviating the Srotorodha of the Doshas. Bashpa Swedana helped the Prakupit Dosha to move to the Koshtha which will ultimately help in elimination of the Dosha by Virechana in the later phase.

PCOS symptoms have features comparable to those of Bahudoshavastha. Sanshodhana is the main line of treatment in Bahudoshavastha likewise, therefore Virechana was planned. It removes metabolic waste, accumulated toxins, and vitiated Dosha from the body. Trivrutta Avlehaeha was used for Virechana as the patient was mainly Sukumara, and Pittaja Prakruti. After the Dosha collection in the Koshtha, it mainly targets on expulsion and liquefication of the excreta, Mala, and the Dosha even if it is in Pakva or Apakva. Being Sukha Virechak in nature, the Dosha expelled from the body does not cause any fatigue or tiredness in the patient as it does not strain the body and the digestive organs for the expulsion.

Sanshodhana works on internal pathology correction. Changes in the USG after Shodhana, such as a decrease in ovarian volume and a drop in the number of non-dominant follicles, are encouraging.

Conclusion

Ayurvedic therapy has been shown to be useful in PCOS, particularly in normalizing menstrual intervals, reducing ovarian volume, and lowering BMI due to its Kaphavatahara, Srothoshodhahara, and Vathanulomana characteristics. A strict dietary and physical exercise had a significant influence in improving the clinical state.

Case Report

PCOS

Journal of Ayurveda and Integrated Medical Sciences