POLYCYSTIC OVARY SYNDROME (PCOS)

• Most common endocrine disorder of women in the reproductive age group
• The disorder is manifested clinically as ovulatory disturbances, hyperandrogenism, and polycystic ovarian morphology on ultrasound
• A multifactorial and polygenic condition
• Up to 50% of PCOS patients have metabolic syndrome which is associated with obesity, insulin resistance, hypercholesterolemia
• PCOS primarily manifests with hirsutism, acne, and virilization
• The most common cause of infertility in women

• Exact etiology of PCOS is not clearly understood
• Evidence supports the hypothesis that decreased peripheral insulin and consequent hyperinsulinemia are pivotal in the pathogenesis of PCOS
• Autosomal transmission related to strong familial clustering
• Possible hypothalamic defect

• PCOS has a broad spectrum of clinical manifestations and associated morbidities
• Menstrual irregularity (unpredictable menses at > 35 days or occur less than 8 times per year; 15 to 40 % presents with regular menses and hyperandrogenism)
• Signs of hyperandrogenism
  • Hirsutism
  • Acne
  • Alopecia
  • Seborrhoea
  • Male pattern baldness
  • Clitoromegaly
  • Deepening of voice

• Obesity
• Acanthosis nigricans – dark, velvety patches in the armpits, nape of the neck, and under the breasts (a definite sign of insulin resistance)
• Infertility
• Anxiety
• Depression
• Impaired glucose tolerance and type 2 diabetes mellitus
• Hyperlipidemia
• Significant cardiometabolic abnormalities and an enhanced risk of coronary artery disease
• During pregnancy – higher risk of recurrent early pregnancy loss, gestational diabetes, pre-eclampsia, foetal macrosomia, perinatal mortality, etc

• History and clinical examination
• Investigations - both biochemical parameters and ovarian imaging
• AE-PCOS Society Criteria 2006
  • Clinical and/or biochemical signs of hyperandrogenism
  • Ovarian dysfunction (Oligo- anovulation and/or polycystic ovarian morphology)
  • Both criteria needed for diagnosis
• Ultrasound – Polycystic ovarian morphology (PCOM): 2 antral follicles (2 – 9 mm in diameter) in either ovary, an ovarian volume of >10 mL in one or both the ovaries
• Hormonal investigations
  • Free testosterone – best marker of ovarian androgen production
  • Dehydroepiandrosterone sulfate (DHEAS)
  • Anti-mullerian hormone (AMH) and 17 –hydroxyprogesterone
  • Thyroid function tests – to exclude thyroid abnormality
  • Prolactin – to exclude hyperprolactinemia
  • Increased LH/FSH ratio

Screening for cardiometabolic risk factors

• Blood pressure
• BMI
• Waist circumference (> 88 cm or 35 inches)
• Lipid profile (Increased total cholesterol, triglycerides and LDL and low levels of HDL) – done every two years, earlier if the woman has gained weight

Screening for Impaired glucose tolerance and Type 2 diabetes mellitus

• Fasting Blood glucose
• 75 Gram GTT – repeated every 1-5 years depending on the patient characteristics
• Glycosylated haemoglobin (HbA1c)
• Glucose-insulin ratio (< 4.5 suggestive of insulin resistance)

• General measures - Diet, exercise, relaxation for stress management, etc.
• Weight reduction in an obese person
• Hormonal contraceptives – first-line treatment of hirsutism, acne, and menstrual irregularity
• Metformin reduces insulin resistance and improves symptoms in PCOS

Ayurvedic Treatment

Internal Medicines

• Saptasara Kashaya
• Kanasatahwadi Kashaya
• Sukumara Kashaya
• Tila Kashaya
• Kulathadi Kashaya
• Varunadi Kashaya
• Lasunaerandadi Kashaya
• Chitrakagrandyadi Kashaya
• Kumaryasavam
• Jeerakarishta
• Pulim kuzhambu
• Hinguvachadi Choorna
• Rajapravartini Vati
• Chandraprabha Vati
• Kanchanara Guggulu
• Kalyana kshara

Procedures

• Vamana 
• Virechana – Misraka sneha
• Vasti –Yoga vasti, Vaithrana vasti, Lekhana vasti 
• Uttara vasti
• Yoni pichu
• Udwartana – Especially in an obese patient
• For Snehapana &Vasti – Varunadi Gritha, Tila taila, Murchita Sarshapa Taila, Pippalyadi anuvasana Taila, Sukumara Gritha 
• Kashaya for Vasti – Erandamoola Kashaya, Dashamoola Kashaya, Saptasara Kashaya, Sukumara kashaya