PCOS Treatment in Ayurveda

Other names for this syndrome include polycystic ovary disease, functional ovarian hyperandrogenism, ovarian hyperthecosis, and sclerocystic ovary syndrome and Stein-Leventhal syndrome.  In the present era the erratic lifestyle and diet, increased stress, strain and restlessness have resultantly expanded the spread of hormonal imbalance and menstrual disorders.

PCOS produces symptoms in approximately 5-10% of women of reproductive age (12-45-year-old). It is thought to be one of the leading causes of female subfertility and the most frequent endocrine problem in women of reproductive age. The symptoms and severity of the syndrome vary greatly among the affected women.

Abnormal Steroidogenesis – Excess androgen biosynthesis is a diagnostic feature of polycystic ovary syndrome. The excess circulating androstenedione and testosterone is produced primarily by the ovary. The ovarian theca cells, the site of de novo androgen biosynthesis, are increased in number in polycystic ovaries, and they have increased steroidogenic capacity. The increase in steroidogenic capacity is caused by overexpression of steroidogenic enzymes because of increased transcription and mRNA stability. High concentration of circulating testosterone and dehydroepiandrosterone (DHEA) occur in 60% to 80% and 20% to 25% of women with PCOS respectively.

Insulin Resistance – In the last decade it has been observed that the majority of the women with PCOS presents some degree of insulin resistance even non-obese. Studies suggest the existence of Genetic predisposition which ends up manifesting as a result of lifestyle and obesity. The resulting hyperinsulinemia insulin resistance causes an increase in both the production of androgen as in the biologically active portion. The joint mechanism proposed for this could be the relation to the changes in swimming-insulin receptors and the enzyme that regulates adrenal and ovarian androgen production.

Abnormalities in Pituitary Function – The cluster in the release of gonadotropins: luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary have been implicated in the pathogenesis of PCOS. In most patients with PCOS, the relation of LH/FSH is altered, being higher the LH secretion in relation to FSH, resulting in increased production of androgen by theca cells, and anovulatory cycles. However, more recent studies have shown that these changes in LH levels are secondary event and non-primary. The excess androgen changes the regulation of female hormones, resulting in increased estrogen levels, menstrual irregularity and infertility.

Inflammation – The role of inflammation in PCOS has been the subject of a number of studies, and direct correlation has been found between increased level of inflammation markers (CRP, ferritin, leukocyte TNF-α, IL-18) and the development of PCOS.

NICHD/NIH Definition, 1990

Less inclusive
(1 and 2 needs to be met

1. Hyperandrogenism
Clinical(hirsutism, acne, frontal balding)
Biochemical(high serum androgen concentration)

2. Menstrual irregularity
– Chronic anovulation
– Oligomenorrhea, > 35days

Rotterdam Definition, 2003

More inclusive
2 of 3 needs to be met

1. Hyperandrogenism
Clinical or biochemical

2. Menstrual irregularity
Key difference from NIH

Amsterdam ESHRE/ASRM – 2012

Most recently defined presence of 2 out of 3 criteria
– Menstrual dysfunction and /or polycystic ovary
– Hyperandrogenia and/ or Hyperandrogenism
– The ultrasound showing a polycystic ovary

1) Biochemical evidence of Hyperandrogenism
-Serum Total testosterone

2) USG evidence of PCOS
-12 or more follicles in each ovary measuring 2-9 mm in diameter +/- Inc. ovarian volume(>10ml)

3) Other tests
-FSH & estradiol level
-Prolactin & TSH
-Progesterone in luteal phase to confirm ovulation
-DHEA-S level
-17-hydroxyprogesterone level

4) Physical Examination
-Body mass index
-Acanthosis nigricans – insulin resistant
-Acne/alopecia – androgen excess
-Galactorrhea – hyperprolactinemia
-Blood pressure

DIFFERENTIAL DIAGNOSIS OF PCOS
-Other causes of irregular or absent menstruation and hirsutism such as
Hyperthyroidism,
-Congenital adrenal hyperplasia
-Cushing’s syndrome
-Hyper-prolactinemia
-Androgen secreting neoplasms other pituitary or adrenal disorders.

Vandhya (anovulation leading to infertility) arajaska, nashtartava, lohitakshaya, granthyaartava, ksheenaartava are some of the conditions explained in Ayurveda which simulate the clinical manifestation of PCOS.

Ayurvedic interpretation of disease goes in line with rasapradoshajavyadhi, santarpanotthavyadhi (disease which is derived from excessive nourishing agents like snigdha, madhura, guru, picchila, nava anna, nava madhya, cheshta dwesha, divaswapna, asana sukha) today’s era these causes can be compared with sedentary life style, junk food, improper work schedules, stress etc.

Ahara and vihar causing vata-kapha dushti and medo dushti will be the key factors causing the expression of the syndrome. PCOS is a disorder involving Pitta, Kapha, Medas, Ambhuvahasrotas & Artava Dhatu. Towards the complete manifestation of the disease we can infer the involvement of Vata dosha at its peak.

PCOS pathogenesis can be explained in two different stages

a) PCOS with Anartava and Alpartava (amenorrhea and hypo-menorrhea)

Vishamaaaharvihar causes increase in Kapha dosha which blocks Artava vaha Srotas interfering the normal function of vata by blocking/vitiating the vata functions, which in turn leads to agnimandya leading to apakwata of aadhya rasa (first food essence) leading to the formation of saama rasa (undigested essence) which vitiates the aartava as well as causes kaphavridhi which further leads to srotorodhajanya Apachita medo dhatu vriddhi(undigested adipose tissue) and vataprakopa causing obesity and amenorrhea. Agnimandya leads to the loss of agneya guna (fire quality) of artava. Kapha avarana results in the localized or generalized anabolic changes like obesity, cystic ovaries, endometrial thickening because of the predominance in kapha dosha. Due to the margavara there will be depletion of rasaadi dhatu resulting in amenorrhea, hypo-menorrhea.

b) PCOS with Asrukdhara (excess bleeding and scanty prolonged bleeding)

In Ayurveda this condition is correlated to Asrukdhara, which is bleeding through apathy marga (birth canal). In general excess blood flow shows the increase in pitta dosha [mainly the qualities like sara and laghu guna (flow, light)] whereas in PCOS due to the long term amenorrhea and excessive accumulation of kapha guna’s or qualities like guru, sthira (heavy, stability) resembles the same qualities of pitta i.e. sara and laghu which results in bleeding and scanty prolonged bleeding.

Ayurvedic treatment aim to remove the aggravated dosha from the artava marga thereby restoring and normalizing the function of arthavavaha srotas. Mode of action of the treatment is in the subtle level of causative dosha’s that result in correcting dhatwagni (regain the agneya guna of artava) in which the end result is dhatu poshana leading to proper formation of dhatu. The treatment modalities aim at providing comprehensive care by correcting the ama dosha achieving koshta shuddhi and regulating tridoshas, by this the menstruation is regularized and fertility is restored

The line of treatment adopted is kapha-vatahara chikitsa, avarana vata chikitsa, sthoulya hara chikitsa, granthi chikitsa.

Panchakarma treatments – Udwarthanam, ruksha swedanam,nabhi pichu,avagaha swedam,vamanam,virechnam,matra vasti,lekhana vasti. Benefits are – reduces body weight, decrease insulin resistance, regulates normal hormone secretion, remove the excess kapha from the srotas, corrects body metabolism, promotes fertility.

Internal medication which have the property of- deepana, pachana, srothoshodhana, medohara, lekahana, kshara guna, brmhana will be prescribed. Benefits are – destroys the cyst, stimulates ovulation, induces menstruation, normalize the function of artava and aides conception naturally.

Foods which are acidic, high in saturated fat, food with trans-fat, food with high sodium, foods high in refined sugar, full-fat dairy have to be avoided.
Also, avoid overexertion, fasting for a long period, constant worries, food which is dry in nature, consuming less quantity of food, excessive exposure to heavy wind and the sun, heat, keeping awake at night, anger, fear, grief and sorrow.

Avoid incompatible foods, untimely food, self-medication, habituated use of medicines like painkillers, anti-inflammatory medicines, sleeping pills etc.

Intake food which is easy for digestion, alkaline in nature, fresh, having all six rasas, seasonal foods, timely foods, vitamin-D rich foods, keep hydrating the body, keep mind calm, relaxed and free from worries, intake of more antioxidants rich fruits, green vegetable etc.