A CASE STUDY ON PCOS

A case study on PCOS

ABSTRACT: Polycystic ovarian syndrome is also known as Stein-Leventhal syndrome. Incidence of this condition is growing amongst women in their reproductive life. Its occurrence is nearly 1 in 10 women suffering from PCOS. Its incidence is increased in recent era due to sedentary life, change in life style, excessive intake of junk food, stress. It is characterized by amenorrhoea/ oligomenorrhoea/ hypomenorrhoea, obesity, hirsutism. There is chance of occurrence of Diabetes mellitus (insulin résistance), malignancies of endometrium and breast in later stages who suffered with PCOS. Therefore the present study was carried out for clinical evaluation of efficacy of ayurveda treatment on PCOS. The treatment was conducted for duration of 3 months the response of treatment was recorded by parameters. The result revealed that PCOS can be cured successfully by using shaman and yapana vasthi.

KEY WORDS: PCOD, Lifestyle disorder, Endocrine disturbance, shaman chikitsa, yapana vasthi

INTRODUCTION:

PCOS is a heterogenous multisystem endocrinopathy in women of reproductive age with ovarian expression of ovarian metabolic disturbance. It is associated with chronic anovulation,, menstrual abnormalities, obesity, minor insulin resistance and hyperandrogenism.

It is common problem amongst adolescents developing soon after puberty. Some of women who develop cardiovascular disease, hypertension, endometrial cancer and type 2 diabetes later in life appear to have suffered from PCOS earlier years. 

For PCOS modern line of treatment is to suppress action of LH hormone on ovary. So that it reduces production of testosterone and thus regularizes menstrual cycle. For such purpose hormones are advised in modern system of medicine which has many side effects. Ayurveda yapana vasthi and shaman chikitsa helped a case of delayed periods with acanthosis nigricans. Its result strengthened role of ayurvedic medicine in management of PCOS. 

ETIOLOGY AND PATHOGENESIS:

Initially the ovaries were set thought to set the changes in endocrine pattern. Genetic and familial environment factors (autosomal dominant inherited factor) were added as etiological factor in the development of PCOS. The environment factor may function in utero or in early adolescent life, manifesting clinically a few years later as PCOS. CYP21 gene mutation has been discovered in this connection. Familial occurrence has been reported. Hyperandrogenism and resulting anovulation was initially thought to arise primarily in ovaries. Now the cause is traced to insulin resistance. Insulin induces to cause thecal hyperplasia and secrete androgens, testosterone and epiandrosterone. Epiandrostenedione is converted in to peripheral fat to oestrone. This leads to rise in oestrogen and inhibin level. These in turn cause high LH surge.Whereas oestrone level increase, oestradiol level remains normal with result oestrone and oestradiol ratio rises. Hyperandrogenism lowers the level of hepatic sex hormone binding globulin (SHBG) so the level of free testosterone raises leading to hirsutism. Androgen also lowers the growth of dominant follicle and prevents apoptosis of smaller follicle which are normally desired to disappear in the late follicular phase.

PCOS may set early adolescent life but clinically manifest in the reproductive age with long term implications of diabetes, hypertension, dyslipidaemia and cardiovascular disease. This cluster of disorders is known as ‘X Syndrome’.

  Stress, lifestyle, obesity -->   Drugs, steroids,aging -->  Insulin -->Genetic predisposition--> Resistance --> Hyperinsulinemia--> LH/FSH ratio-->  Androgen secretion by ovary--> Hyperlipidemia -->PCOS      Oligomenorrhoea, amenorrhoea-->  Infertility, hirsutism, acne

 Later life --> Diabetes II, Hypertension, CVS disorder

CASE REPORT:

26 years old unmarried female consulted to clinic at Hyderabad. She complained of irregular periods with scanty menstruation since 2 years. She has sedentary mode of life style. Her weight is 65 kg. No history of functional thyroid abnormalities. Jihwa (tongue) examined and noted as sama condition. In sroto parikshan else was normal. She had complaint of agni mandhya and mala vibaddhtha. We sent her for USG, reports suggestive of PCOD. She was previously taken progesterone pills for withdrawl bleeding about 4 months. She was hirsuit and has acanthosis nigricans. (hyperpigmentation on nape of neck).

MEDICATIONS:

We first started with Arogya vardhini vati 500mg BD, Hingwastaka churnam 5gms BD, Kumari asava 15ml BD, Kanchanara guggulu 500mg BD, Triphala churnam 5gms BD for 3 months.

Along with 3 consecutive cycles of yapana vasthi with 350ml of goksheera, 100ml of sahacharadi tailam,50ml of makshika,10gms of shatapushpa for 7 days in each cycle.After 3 complete months treatment, helped her to get regular menses with normal flow. Later USG revealed there is decrease in volume of ovaries. And there is no typical cystic apperance.

 Patient had been followed up after up 15 days for 8 months. She had regular menses with normal flow. Shaman chikitsa continued for 3 months.

DISCUSSION:

Ayurveda classifies PCOS as kapha vata pradhana roga. It is due to sanga of artava dhatu. All the 3 doshas are involved in its pathogenesis. Avalambaka kapha, pachaka and brajaka type of pitta and prana, samana vata, apana vata vitiation results in to this type of disorder. Rasa & medha dhatu, raktha and artava vaha srotas. The given treatment worked to improve hormone utilization & regulates overall hormone balance.

Exposure to kapha vata vardhaka ahara vihara vitiation of prana,samana and apana vata, pachaka pitta and avalambaka kapha vitiation of agni(dhatwagni,jataragni )  impaired digestion ama formation rasa vikruthi

 influence uttarotara dhatu(raised stree shukra)

AROGYA VARDHINI VATI: It has pradhana dravya as katuki(55%). It is drug of choice yakrit roga. It stimulates liver to produce more SHBG, resulting to decreasing level of testosterone. This in turn increases female hormone to act on ovary to regularize cycle. It is agni pravartakam (PCOS by agni mandhya, srotho avarodha ) and causes artava vriddhi. It has action over insulin resistance too owing to its tikta rasa pradhana dravya.

HINGWASATAKA CHURNAM:

Hingwastaka churnam is deepana, pachana i.e agni pravartana . Artava is agneya. It helps in artava vriddhi basing on samanya guna. Hingu has property of artava pravartakam. It is srothoshodhanam owing to its teekshna guna. It improves body metabolism.

KUMARI ASAVA:

 It causes agni, bala vardhana. It helps in treating vata roga (H-P-O axis regularisation), meha (insulin resistance)

KANCHANARA GUGGULU:

 It is drug of choice in granthi. It cures ovarian cysts. It pacifies kapha. It is also useful in management of obesity. 

TRIPHALA CHURNAM:

It is rasayana and causes anuloma. It helps in proper functioning of apana vayu. It increases iron binding capacity and also helps in maintenance of normal sugar levels.  

Vasthi is considered as paramoushada in management of vata.

Probable mode of action:

Gut is sensory organ consisting neural,immune & sensory detectors (Enteric nervous system),  cells and provide direct input to local (intramural) regulatory systems and information that passes to CNS or other organs. Basthi stimulate ENS & then can influence CNS and bodily organs. Basti may act on neuro hormonal system of body by stimulating CNS through ENS, by restoring the physiology at molecular level and also can act on hormone protect by its various contents (after their absorption). The drug retained in rectum through which part of rectum is connected to superior rectal vein, that drains in to inferior mesenteric vein (part of portal circulation).

Hypothesis on action of taila: 

Oestrogen is steroid harmone and oil is anabolic steroid. Sesamum oil has phytooestrogen activity. It has protein - helpful in formation of peptide hormone (Gonadotropes). 

It has lipids - Steroid hormones are generated in cholesterol. Leptin (adipocyte protein hormone) is linked to nutrition and play important role in the control of hypothalamic pitutary ovarian axis. The drug reached to circulation reaches blood brain barrier. This BBB allows lipid soluble substances to enter easily in to target organ (hypothalamus).

CONCLUSION:

Thus in our case we saw relieving of symptoms of PCOS. Also the ovarian volume decreased leading deceasing in size of ovaries. There is remarkable decrease in weight, normalizing hormones, regular menses.