Abstract:-
Polycystic ovarian syndrome (pcos) is a common endocrine disorder in women of reproductive age characterized by hormonal imbalance, including high levels of androgens & irregular menstrual cycles or anovulation.
• Introduction :-
- Polycystic ovarian syndrome (pcos) is the most common endocrine pathology in females of reproductive age worldwide. Polycystic ovarian syndrome (PCOS) was originally Described in 1935 by Stein and Leventhal as a Syndrome manifested by amenorrhea, hirsutism and obesity associated with enlarged polycystic ovaries.
- Diagnosis of pcos must be based on 3 criteria: (I) chronic anovulation (II) Hyperandrogenism (clinical and/or biochemical) (III) Polycystic ovaries. Pcos is prevalent in the young reproductive age group (20-30%). Polycystic ovary may be seen in about 20% normal women.
- Homoeopathic medicine, polycystic ovarian syndrome, hirsuitism, high androgen level, infertility, anovulation, amenorrhea
Keywords:
– Homoeopathic medicine, polycystic ovarian syndrome, Hirsutism, high androgen
level, infertility, anovulation, amenorrhea
Abbreviation:
- Polycystic ovary syndrome (pcos), ultrasonography (USG), sex hormone binding globulin (SHBG), follicle stimulating hormone (FSH), luteinising hormone (LH), insulin ratio.
Epidemiology:
-As evidence is growing, PCOS is being recognized as the most common endocrine pathology in reproductive-aged females worldwide, affecting between 5% and 26% of females. More than 80% of women who present with hyperandrogenism have PCOS. Multiple conditions have been associated with PCOS, including infertility, metabolic syndrome, obesity, impaired glucose tolerance, type 2 diabetes mellitus, cardiovascular risk, depression, obstructive sleep apnea (OSA), endometrial cancer, and metabolic dysfunction-associated steatotic liver disease (MASLD). Higher prevalence has been associated with first-degree relatives with PCOS, prepubertal obesity, congenital virilizing disorders, above-average or low birth weight for gestational age, premature adrenarche, and the use of valproic acid as an antiepileptic drug.
Aetiology:
- Genetic causes: Women with PCOS have strong family history with significant hereditary components and are often transmitted from mother to daughter.
- Endocrinal causes: Neurotransmitters produced in higher centre of brain are passed on to hypothalamus and to pituitary through hypothalamic – pituitary axis Psychological causes i.e mental shock, grief, mortification , vexation, anger, suppression of emotion, dreams fears delusions that affect mind. Psychoneuroimmunology and Stress Insulin resistance theory. Insulin is a hormone that the pancreas makes. It allows cells to use sugar, your body’s primary energy supply. If cells become resistant to the action of insulin, then blood sugar levels can go up. This can cause your body to make more insulin to try to bring down the blood sugar level.
Too much insulin might cause your body to make too much of the male hormone androgen. You could have trouble with ovulation, the process where eggs are released from the ovary. One sign of insulin resistance is dark, velvety patches of skin on the lower part of the neck, armpits, groin or under the breasts. A bigger appetite and weight gain may be other signs.
- Lifestyle causes: Obesity can aggravate PCOS because fatty tissues are hormonally active and they produce oestrogen which disrupts ovulation. Lack of Physical activity. Type of food- oily, starchy, spicy, fried.
- Iatrogenic causes: Drug diseases which have an estrogenic effect on ovaries.
Clinical features:
- Irregular periods: Abnormal menstruation involves missing periods or not having a period at all. It may also involve heavy bleeding during periods.
- Hirsutism: Excess facial hair or experience heavy hair growth on arms, chest and abdomen. This affects up to 70% of people with PCOS.
- Acne: PCOS can cause acne, especially on the back, chest and face. This acne may continue teenage years and may be difficult to treat.
- Obesity: Between 40% and 80% of people with PCOS have obesity and have trouble maintaining a weight that’s healthy for them.
- Darkening of the skin: Dark patches of skin, especially in the folds of neck, armpits, groin (between the legs) and under breasts. This is known as acanthosis nigricans.
- Cysts: Many people with PCOS have ovaries that appear larger or with many follicles (egg sac cysts) on ultrasound.
- Skin tags: Skin tags are little flaps of extra skin. They’re often found in the armpits or on the neck.
- Thinning of hair: People with PCOS may lose patches of hair on their head or start to bald.
- Infertility: PCOS is the most common cause of female infertility. Not ovulating regularly or frequently can result in not being able to conceive.
Diagnosis:
- Diagnosis is based upon the presence of any two of the following three criteria, as per the American society for reproductive medicine (ASRM) / European society of human reproduction and embryology(ESHRE), 2003:
-Oligo and/ or anovulation.
– Hyperandrogenism (clinical and/ or biochemical)
-Polycystic ovaries
-In USG it shows Ovaries are enlarged in volume (≥ 10 cm3), Increased number (>12 ) of peripherally arranged cysts (of 2-9 mm in diameter) is seen.
– Ovarian capsule is thickened and pearly white in colour.
– Serum values:
-LH levels are elevated and/ or the ratio LH:FSH is > 2:1.
-Raised fasting insulin levels >25 µIU/ml and fasting glucose to insulin ratio <4.5 suggests IR. Levels of serum insulin response > 300 µIU/ml at 2 hours post glucose (75 gm) load, suggests severe IR.
-Raised level of oestradiol and estrone- the estrone level is markedly elevated.
-SHBG level is reduced.
-Hyperandrogenism- androstenedione is raised.
-Raised serum testosterone (> 150 ng/dl) and DHEAS may be marginally elevated.
Treatment:
– Lifestyle changes:
~ weight loss by a low calorie diet with regular exercise .
~ weight loss upto 5% of the body can improve the pcos .
~ Diet should include plenty of fruit S and vegetables.
Medicinal Treatment:
- Contraceptive pills: Pills that contain both estrogen and progestin decrease androgen production and regulate estrogen. Regulating hormones can lower risk of endometrial cancer and correct irregular bleeding, excess hair growth and acne.
- Clomiphene: It is used in women who are trying to get pregnant because it induces ovulation. Clomiphene works by blocking estrogen receptors in the hypothalamus and pituitary gland, which leads to increased levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones stimulate the growth of ovarian follicles and the release of an egg.
- Metformin: It improves insulin resistance and lowers insulin levels in patients who are suffering from pcos
- Spironolactone (Aldactone) & Eflornithine: It is used to control excessive hair growth ( hirsuitism).
- Acne treatments are also used .
- Statins – to reduce blood cholesterol level.
Complications:
- Infertility
- Gestational diabetes
- Miscarriage
- Metabolic syndrome
- Type 2 diabetes
- Sleep apnoea
- Depression & anxiety
- Endometrial carcinoma
- High blood pressure
- Cardiovascular disease
HOMOEOPATHIC TREATMENT:-
- Pulsatilla nigricans :-
- Pulsatilla is often suited to young girls in whom problem starts at puberty itself.pcod with scanty & late menses.The general temperature of patient is mild & gentle also patient is thirstless and takes little water. A changeable mood is also present. At one time the patient is very happy & next moment she becomes irritable. Menses are suppressed from wet feet ,nervous debility & chlorosis. Tardy menses, too late, scanty ,thick ,dark ,clotted, changeable & intermittent flow . Diarrhoea during or after menses.
- Sepia officinalis:
- The patient is having bearing down pain from the back & abdomen. Sepia is the best Homoeopathic medicine for pcos. There is the feeling of “ball” like sensation in the inner parts of pelvic organs. In some persons menses are too late & scanty and in some persons they are early & profuse. There may be yellowish greenish leucorrhoea.
- Thuja occidentalis:
- A good medicine for Cysto- ovarium. There is inflammation with pain in my left ovary. Pain extends through the left iliac region into the groin and sometimes into the left leg. <from walking or riding, so she has to lie down (during menses); burning pain in the ovary, ovarian affections are worse during menses. Menses are scanty and retarded.
- Conium maculatum:
- Menses are irregular too early and too feeble, or too late and too scanty, of brownish coloured blood. Dysmenorrhoea with pains extending to the left chest; labour like abdominal pains, extending into thighs. Ovaritis; ovaries are enlarged and indurated; lancinating pains. Ill effects of repressed sexual desire or suppressed menses or from excessive indulgence. Breasts enlarge and become hard and painful before and during menses. Induration of cervix and os is present. Rash before menses. Itching around the pudenda. Unready conception (sterility) is present.
- Graphites:
- The menses are too late and scanty. pcos with constipation . hardness may be felt in the Ovarian region. Patients are often of a stout build or is fat. She cannot tolerate cold & is always feeling chilly.
References:
- National Library of Medicine. Metabolic Syndrome and PCOS: Pathogenesis and the Role of Metabolites . Available from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8709086
- DC Dutta , Konar H(ed.)Textbook of gynecology.2016.Jaypee brothers medical publishers (P) Ltd.
- Cleveland clinic : polycystic ovary syndrome (pcos) Available from:
https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos
- Mayo clinic: polycystic ovary syndrome (pcos) available from:
https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
- Boericke W. Boericke’s new manual of homoeopathic materia medica with repertory. 3rd ed. Noida: B Jain Publishers;2019.
- Lilienthal S. Homoeopathic therapeutics. 24th ed. New Delhi: B. Jain publishers (P) Ltd; 2016.
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