Polycystic ovarian syndrome, also known as Polycystic ovarian disease or PCOD is a very common female health complaint. The word “Syndrome” is used to describe PCOD because, it is a complex manifestation involving many factors and organs such as – obesity, insulin resistance, irregular menstrual bleeding (in most cases, excessive menstrual bleeding), abnormal menstrual periods & cycle, lack of ovum production (anovulation) etc.
PCOS is a common female endocrine disorder affecting approximately 5- 12% of women.It causes worry as it is commonly found in reproductive age; also it is thought to be one of the leading cause of female infertility.
Organs involved in Polycystic Ovary disease are
1. Ovary – the female gonad organ, present at either side of the uterus.
2. Adrenal glands – The glands which are placed just above both the kidneys.
3. Pancreas – Gland that produces insulin in our body.
4. Pituitary gland – the gland just below the brain, which is responsible for all the hormonal control.
What happens in PCOD?
There is increased production of Androgen (a hormone) by the ovaries, which suppresses the maturation of ovarian follicles (ovarian follicles lead to ovum). So, ovum does not get properly formed and released (anovulation). Remember that ovum meets with the sperm during intercourse leading to conception. So, in the case of PCOD, the lady usually will be having a problem with conception.
How frequent is the problem of PCOD?
The incidence varies between 0.5 – 4 per cent, more common amongst infertile women. It is prevalent in young reproductive period.
What happens inside the body?
Typically, the ovaries are enlarged two to five times the normal size (PCOS – Ovarian cysts). Stroma is increased. The capsule is thickened and pearly white in colour. Ovary which is normally oval in shape will have many cysts within it.
Histologically there is thickening of tunica albuginea. The cysts are follicles at varying stages of maturation and atresia. There is theca cell hypertrophy (stromal hyperthecosis). The patient may present with features of diabetes mellitus (insulin resistance).
A careful survey concludes that the biggest lifestyle contributor to PCOS is a poor diet. Young women with PCOS tend to eat far too much sugar or carbonized drinks and highly refined carbohydrates which causes an unhealthy rise in insulin levels. According to world fame Jerilyn Prior, insulin stimulates androgen receptors outside the ovary, causing typical PCOS symptoms which also play a role in blocking the release of ovum from the follicle. This type of diet will cause obesity and thus aggravates PCOS.
Also, in stressful women, as they eat more food that is high in fat, sugar and carbohydrates in response to stress, the body stores more fat, thus, contributing in the development of obesity-linked PCOS. Thus we can deduce that the modern stressful lifestyle and food- habits are linked and contribute or accelerate many diseases, PCOS being one among them.
Signs and symptoms
Clinically PCOS often manifest itself at menarche with some form of menstrual irregularity, but not essentially. The principal signs and symptoms of PCOS are related to menstrual disturbance and elevated levels of male hormones (androgens).
The patient approaches the physicians with symptoms like menstrual irregularities, androgenic features such as hirsutism, acne, alopecia etc, obesity and infertility caused by improper ovulation etc.
Patient complains of increasing obesity, menstrual abnormalities in the form of less menstrual bleeding, absence of menstruation, or abnormally high and irregular bleeding and infertility. There may be abnormal growth of hair at different places of the body. The patient may not always be obese.
In some patients, due to insulin resistance, a dark coloured band like skin lesion may be developed at the back of the neck, inner thighs and axilla, called Acanthosis nigricans.
Internal examination reveals bilateral enlarged cystic ovaries which however may not be revealed due to obesity.
The assessment and diagnosis of PCOS is mainly based upon clinical presentation together with
USG – Ultra Sonography findings and hormonal profile appropriate to the mode of presentation.
OVERALL VIEW OF PCOD –
1. Hypothalamic-pituitary compartment abnormality:
Stimulation of GnRH leads to increased secretion of LH (Leutinizing Hormone) and a decrease of FSH (Follicle Stimulating Hormone) – This way, Hormonal imbalance is triggered in PCOD.
2. Androgen excess – in some patients there is excessive production of Androgen by ovaries and adrenal glands. Excessive androgen production is partially influenced by excessive LH. Increased insulin levels also result in androgen excess.
3. Anovulation (absence of ovum production)
Because of low levels of Follicle Stimulating hormone, follicle growth inside the ovary is arrested leading to an absence of ovum production (anovulation ) further leading to infertility.
4. Relationship between obesity, insulin production and PCOD
Obesity is recognized as an important contributory factor. It also induces insulin resistance and increased levels of insulin in blood, which in turn increases the androgen production.
Insulin resistance means that the body cells will not respond to the effect of insulin. So, though the body is trying to compensate by producing more and more insulin, leading to high levels of insulin, but thus produced insulin will be inefficient to metabolize the glucose in the body. So, the body becomes resistant to insulin, which means that the body will not respond to insulin.
Long term consequences in a patient suffering from PCOD –
Excess androgens (predominantly androstenedione) leads to thickening (hyperplasia) of the inner layer of the uterus (endometrium).
Risk of developing diabetes mellitus due to insulin resistance.
Risk of hypertension and abnormally high lipid profile.
Treatment of PCOD needs individualistic approach because not all the symptoms might be seen in all the patients.
It depends on the presenting symptoms, like menstrual abnormalities, infertility, obesity, hirsutism or combined symptoms.
Biochemical abnormalities to be corrected –
Hypersecretion of LH (correction of hormonal balance),
High levels of insulin &
Low Follicle stimulating hormone (again related to hormone imbalance management.)
Weight reduction in obese patients is the first line of treatment. Body mass index (BMI)< 25 improves the menstrual abnormalities, hirsutism and infertility.
Ayurvedic herbal remedy for PCOD –
Ayurvedic treatment is by applying a multi-pronged approach towards –
– correcting the hormonal imbalance,
– treatment to obesity and avoiding high cholesterol levels,
– treatment for insulin resistance.
1. Correcting hormonal imbalance:
There are many herbs useful in correcting the hormonal imbalance. Ashoka (saraca asoca), Dashamoola (a group of ten herbal roots) a group of herbs useful in the preparation of Sukumara Kashaya like Ashwagandha, Eranda, Shatavari etc. are useful in correcting the hormonal imbalance.
2. Treatment for obesity:
Treatment for obesity and specifically against cholesterol can be achieved by using Ayurvedic herbal remedy plus diet and lifestyle changes.
3. Treatment for insulin resistance:
Treatment for insulin resistance involves a time-consuming approach with effective Ayurvedic treatment and diet and lifestyle changes including exercise.
The PCOD or PCOS is a common complaint in women, which can be effectively managed using Ayurvedic herbal remedies and herbal medicines.
A multi – pronged approach taking care of different organs and glands is necessary.
Not all the symptoms are manifested in all the cases of PCOD but irregular periods is seen commonly in many.
In Ayurveda this condition is not explained as a single disease entity; but it can be considered under the heading of Yoni Vyapat(utero vaginal disorders). Also, Pushpaghni Rewati, mentioned by Acharya Kashyapa bears some similarity with the symptoms of PCOS.
Ayurvedic perspective of PCOS
In Ayurveda, the balanced state of doshas is mainly responsible for health and any derangement to this will lead to disease.
This dosha-vaishamya is directly connected to symptoms and the relation between doshas and lakshanas are permanent.
By the outlook of the symptoms of PCOS as per modern description, it becomes clear that even though they are not compiled as a syndrome in Ayurveda, most of them have been described as features of separate diseases or conditions.
The symptoms commonly found in these conditions can be summarized as below-
- Menstrual irregularities have been described under artava vyapads or Yonirogas (uterine disorders).
- Anovulation is included under Vandhya (infertility).
- Obesity is the condition described as Sthoulya, a santarpanajanya vikara.
- Acne and Baldness have been described as Mukhadooshika and Khalitya, two independent pathogenesis.
- Hyperinsulinemia leads to type 2 Diabetes mellitus, and is described under prameha. It is also manifested as a complication of sthoulya.
- Since menstrual irregularities including anovulation and obesity are the commonly seen symptoms these two have to be taken care with due attention.
Pathology or origin of diseased condition:
When the deranged vata etc. vitiates the mamsa, shonita and meda mixed up with Kapha; they produce circular, raised and knotted inflammatory swelling called ‘Granthi’. 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.
In PCOS, development of follicles may be arrested at any level and remains 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.
Line of treatment
As PCOS is primarily concerned with Rajah and Stri beeja formation and to some extent medodhatu, much attention should be given to these while treating the conditions.
Treatment modalities mainly aim at providing comprehensive care by correcting the ama dosha, achieving koshta shuddhi and regularizing tridoshas.
The management approach to PCOS should concentrate on:
- Treating agnimandya at jataragni and dhatwagni levels (Deepana-carminatives and Pachana-digestives)
- Alleviating sroto avarodha-Samshodhana -purificatory therapies based upon the grade of doshic vitiation and site of affliction) followed by Rasayana drugs (free radical scavenging agents)
- Regularization of apana vata(vatakaphahara medicaments)
4.Nidan parivarjana :Avoidance of kaphakara ahara and vihara.
- Yogas – Asanas – Lifestyle:
- Pranayama, Kapalabhati etc
- Shavasana, Sarvangasana, Matyasna etc
iii. Compatible and timely intake of a balanced diet, regular physical exercises and a healthy lifestyle will support the therapeutic measures to curb PCOS.
Single herbs usage
Below mentioned are single herbs that are useful in PCOS.
(Click on the herb names to know more about them)
- Varuna- Crataeva nurvala– helps to clear the channels and reduces the size of the cyst.
- Hareetaki- Terminalia chebula –Due to laxative effect it reduces the body morbidity and contributes significantly.
- Pippali- Long pepper-Piper longum –Being a potent rejuvenator, carminative and free radical scavenging agent curbs the pathology in a significant manner.
- Bilva- Aegle marmelos-Reduces the size of the growth by its potent digestive effect.
- Agnimantha- Premna integrifolia- like Bilva it acts as a digestive.
- Guduchi- Tinospora indica-Due to its rejuvinative effect and bitter principles it imparts its benefits in breaking the patho-physiology.
- Punarnava- Boerrhavia diffusa-diuretic benefits and smoothening effect reduces the size of the growths.
- Chitraka- Plumbago zeylanica- potent digestive and carminative.
- Shunthi- Ginger – quick penetrative and digestive.
- Anjani- Memycylon indicum-proven efficient in reducing the cysts and breaking the pathology.
Ayurvedic medicines for PCOS management:
(Click on the medicine names to know more about them)
- Chitrakadi vati – used in Ayurvedic treatment of anorexia and indigestion. It improves digestive power. It is one of the widely used Ayurvedic tablets.
- Varunadi kwatha – Useful in reducing the size of cyst and also in obesity management
- Panchakola choorna
- Arogyavardhini vati
- Triphala guggulu
- Varunadi louha
- Phalatrikadi kashaya
- Punarnavadi kashaya
- Navayasa louha
- Navakarshika guggulu etc
You need to include exercise in your lifestyle. Otherwise, you may develop glucose intolerance and diabetes. Please do exercise / yoga / dance / outdoor games – at least half an hour per day.
Please avoid / restrict non veg, white sugar, oily food and sweets.
Please take food and sleep at regular intervals.
Wholesome and unwholesome foods
Food to avoid –
White Sugar in all forms. Avoid it even in coffee or tea.
Food with high glycaemic index – white rice, potato, muffin, cakes.
Avoid milk. salted nuts, candy,
Avoid soya products
Limit salt intake – If you take excess salt, it can cause water retention, and cause weight gain, which is not desired.
Foods to include –
Green leafy vegetables,
Moderate quantity of fish / meat (if you are okay with non veg food)
Healthy fat like ghee (in very little quantity)
Olive oil, canola oil, corn oil
Almonds, walnuts, beans, nuts, pecans, flax seeds, sunflower and pumpkin seeds.
Buttermilk – Fat-less buttermilk improves digestion strength.
beans, tomato, corn, beets, lentils, spinach, asparagas, avocado, cooked broccoli, orange, liver, avocado, almonds, legumes, sunflower seeds, soyabeans, parsley, peanuts, flax seed, walnuts, cauliflower, orka, celery, spearment
Home remedies for PCOS include –
1 pinch of turmeric along with a teaspoon of Amla powder (Indian gooseberry) – 2 times a day after food.
Triphala powder – 1 teaspoon at bed time.
How long do PCOD women have to depend on medicines for periods?
Till the weight loss is achieved, till the woman gets accustomed to low oil, low fat, nil white sugar diet, till the woman starts exercising regularly, or in case of infertility, till conception, medicines to correct periods might be required.
Essentially PCOS should be taken care in its beginning itself. But most of the time it is diagnosed only in a later period or else it is neglected that it is a minor health complaint or simple menstrual irregularity. Early detection and immediate attention will help to curb the disease as well as to avoid the complications like infertility.
Article by Dr MS Krishnamurthy and Dr Hebbar