(POLYCYSTIC OVARIAN SYNDROME) With the changing life style of 21st century polycystic ovarian syndrome is emerging as one of the common causes of infertility. For a woman regular menstruation is an indication of normal functioning of her reproductive system. Irregular menstruation, which is a main symptom of polycystic ovarian syndrome, is very distressing for a woman. Infertility is the outcome of polycystic ovarian syndrome in 80% of cases and sometimes leads to psychiatric problems like mental depression in females. Polycystic ovarian syndrome is defined as the presence of chronic anovulation and hyperandrogenism. Chronic anovulation means that a woman is not ovulating, or releasing an egg, monthly. This typically leads to "missed" or "skipped" periods. Hyperandrogenism seen in polycystic ovarian syndrome is an excess of "male" hormones (androgens) such as testosterone and androstenedione. Increased androgens can be detected by elevated levels in the blood, or by clinical manifestations of polycystic ovarian syndrome that include Hirsutism and / or acne.
According to modern medical science polycystic ovarian syndrome is described as a constellation of clinical and biochemical features, for which the etiology remains poorly understood. It is usually thought to be a female hormonal imbalance. Polycystic ovarian syndrome often affects several family members and is aggravated by obesity. Current theories indicate that above normal anterior-pituitary LH secretion leads to over stimulation of the ovarian theca cells, causing excessive androgen production (predominantly testosterone and androstenedione). Low FSH levels mean that ovarian granulosa cells fail to adequately convert these androgens into oestrogens, leading to ovulatory impairment and the development of unruptured cysts. Associated hyperinsulinaemia causes dyslipidaemia and increased plasminogen activation, thought to increase the risk of intravascular thrombosis. However, recent research has cast doubt on the presence of increased cardiovascular risk among sufferers of the syndrome once the effect of diabetes and obesity has been excluded.
In Ayurveda it has been clearly mentioned that the irregularity of any function of the body is mainly caused due to vitiated / provoked Vata Dosha. Ayurvedic texts contain no description of disease like polycystic ovarian syndrome but a couple of Yonivyapada resemble clinically with polycystic ovarian syndrome in their presentations.In Ayurveda Acharayas have described that vitiated Vata Dosha is responsible for all Yonirogas. Acharya Charaka has quoted following four causative factors for Yonivyapada-
• Mithya Aahara vihara ( Improper Dietary habits )
• Aartava Dushti (Menstrual Disturbances- Anovulation )
• Beeja Dosha ( Genetic factors )
• Daiva (Divine Factors)
Vata Dosha gets vitiated by excessively consuming dry (Ruksha) ,cold (Sheeta),light (Laghu) food also indulgence in insufficient quantity, excessive sexual intercourse(Ati vyavaya), keeping awake at nights for long periods (Ati Prajagrana), administration of inappropriate therapeutic measures (Vishama Upachara), excessive loss of Doshas and blood, excessive fasting(Langhana), swimming (Plavana), long journeys on foot (Ati adhva),excessive physical exercises (Ati Vyayama), excessive worry (Chinta),and suppression of natural urges (Vega Dharana).Thus vitiated Vata Dosha precipitates various systemic diseases like polycystic ovarian syndrome or disorders localized to a part of body.
Symptoms of polycystic ovarian syndrome are infrequent menstrual periods, no menstrual periods, and/or irregular bleeding, infertility or inability to get pregnant because of non ovulating, increased growth of hair on the face, chest, stomach, back, thumbs, or toes, Acne, oily skin, or dandruff, Pelvic pain, Weight gain or obesity, usually carrying extra weight around the waist, Type 2 diabetes, High cholesterol, High blood pressure, Male-pattern baldness or thinning hair, Patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs and Skin tags, or tiny excess flaps of skin in the armpits or neck area
In Ayurveda Acharya Sushruta has mentioned Bandhya (SuUT38/10) a type of yonivyapada whose symptom is amenorrhoea or oligomenorrhoea. Similarly Acharaya Charaka has described Arajasaka (ChChiS30/17), a Yonivyapada indicating Amenorrhoea
A combination of classical history, close observation of patient and the following investigations are important tools to confirm a case of polycystic ovarian syndrome -
FSH & LH levels with ratio The levels of FSH & LH vary according to the stage of menstruation, but the ratio should always be <2. In POLYCYSTIC OVARIAN SYNDROME a ratio of around 4 and above may be noted.
o Pelvic ultrasound USG shows a honeycomb of partially developed follicles coating the ovaries.
As it has been mentioned earlier that vitiated Vata Dosha is the main cause of Yonivyapada, so the medicines and therapies regulating aggravated Vata Dosha, are of great help in treating the patients of Yonivyapada.
Before administering medicines orally condition of Aamavastha should be looked for. If Aamavastha is there, Panchakol churna or Trikatu churna or Ajmodadi churna in the dose of 1gm-2gm with lukewarm water should be administered for Aampachana for at least seven days.
Kostha shudhi is mandatory for polycystic ovarian syndrome patients,because aggravated and vitiated Vata Dosha causes Koshthabaddhata and for the free flow of Vata Dosha, Koshtha shudhi with Haritaki churna or Triphala churna or some other Virechaka churna in the dose of 2gm-3gm with lukewarm water for couple of days, at bed time is essential.
SHODHAN THERAPY (Panchakarma)
Sarvanga Snehana and Swedana: Sarvanga Snehana in the form of Abhyanga with Mahanarayana Taila, Mahamasha Taila, Dashmoola Taila, Bala Taila, Mahavishgarbha Taila can be recommended in polycystic ovarian syndrome because Sneha is opposite to the Ruksha property of Vata Dosha, which helps in controlling aggravated Vata Dosha and in treating polycystic ovarian syndrome.
Uttara Basti- It is the process in which lukewarm oils like Bala Taila, Saindhavadi Taila, Guduchayadi Taila or Dhatkyadi Taila is administered in uterus through vagina which should be retained there for at least 30 minutes. . Duration of this therapy may be from 7 to 21days.
Matra basti- It is a type of standard Anuvasana Basti (oil based enema) which can be used as a routine measure without any complications. Because of its standard composition it can be administered in all seasons. In this procedure 30-50 ml of medicated oil, as mentioned in Abhyanga therapy, is administered through anal orifice.
In Guggulu preparations Medohara Guggulu, Triphala Guggulu, Mahayograja Guggulu
Can be given in dose of 500 mg - 2 gm in two or three divided doses with Anupana of Lukewarm water
In Vati preparations Kumarika Vati, Vijayadi Vati, Raja pravartini Vati, KasisadiVati can be given in dose of two tablets (500 mg) twice a day with Anupana of Lukewarm water
In Rasa Aushadhi Nashtapushpantaka Rasa, Pradrantaka Rasa, Tapyadi Lauha in dose of 125-250 mg with Honey, Lukewarm water or with any other Anupana as advised by Physician
In Kwatha & Asava /Aristha preparations Rajapravartaka Kwatha, Dashmoola Kwatha, Devdarvyadyarishta, Kumaryasava, Sarasvatarishta in dose of 20-40 ml in divided doses with plane Water
Yoga Chikitsa: Following Asanas can be helpful for managing a patient of polycystic ovarian syndrome but they should be done under the supervision of Yoga specialist
Sarvagasana, Matsyasana, Ardhmatsyendrasana, Paschimottanasana, Surya namaskar, Ushtrasana and all backward bending asana, are recommended.
Recommended diet Ghee, Taila, New Sesame, Wheat, Basmati Rice, Urada, Drumstick, Brinjal, Pomegranate, Garlic, Ripened Mango, Lemon, Orange, Amla, Sprouted wheat, Munakka, Milk, Coconut water and meat soup.
Recommended lifestyle Swimming, Body Massage, Avoid exposure to strong winds, Heavy apparels made of wool or leather, To sleep on the ground or floor, Hot water bath and Exposure to heat.
Contraindicated Diet Gram, Peas, Kodo, Arhara, Munga, Jamuna, Karela, French Beans, Leafy vegetables, Bitter things and contaminated water.
Contraindicated lifestyle Anxiety, Tensions, Sadness, Remaining awake till late nights, Holding the natural urges, Excessive physical work, Excessive Fasting, Excessive sexual intercourse, Excessive elephant & horse riding and Sedentary habits.
1. M.D (Ay.) Scholar,P.G Deptt. Of Kaya Chikitsa,
2. Asst. Prof, P.G Deptt. Of Kaya Chikitsa,
3. Prof &Head P.G Deptt. Of Kaya Chikitsa, N.I.A Jaipur