PCOS as a Burden; Effective Management with Homoeopathy and Complementary Supportive Therapies

Abstract

Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder affecting many women globally, with significant impacts as a burden on physical health, emotional well-being, and quality of life. It manifests with distressing symptoms such as irregular menstrual cycles, excessive hair growth (hirsutism), acne, weight gain, and fertility challenges, which can be emotionally taxing. Treatment typically involves lifestyle changes, medications like birth control pills and metformin, and sometimes fertility treatments, posing challenges due to managing side effects and adherence. 

Homeopathy is considered effective for PCOS often complemented by yoga, exercises, pranayama, and meditation, which collectively aid in managing this complex condition. This article explores the use of homeopathy and supportive therapies for PCOS treatment.

Key Words: PCOS burden, effective management, homeopathy, complementary therapies, hormonal disorder, holistic treatment.

Introduction

Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder that is marked by persistent hyperandrogenism and chronic anovulation, typically accompanied by hyperinsulinemia and insulin resistance. These factors lead to symptoms like menstrual irregularities, infertility, and hirsutism, establishing PCOS as the most common endocrine disorder among women of reproductive age.

Incidence

 It affects approximately 5–10% of the female population in developed countries. The prevalence of PCOS in Indian adolescents is 9.13%.

Pathogenesis of PCOS

PCOS’s heterogeneity of presentation suggests a multifactorial cause. Some genetic studies have identified a link between PCOS and disordered insulin metabolism and indicate that PCOS may be the presentation of a complex genetic trait disorder. 

Genetic factors 🡪 Disordered insulin 🡪 Inability or Insensitivity of ovary 🡪 to LH and FSH stimulation Increased LH secretion 🡪   Ovarian Hyperandrogenism 🡪Obesity and Hyperinsulinemia

Explanation: PCOS: Central condition characterized by heterogeneous symptoms.

 Genetic factors: Influence predisposition to PCOS.

 -Disordered insulin metabolism: Linked to genetic susceptibility, it contributes to PCOS.

– Inability or insensitivity of the ovaries: inappropriate response to LH and FSH from the pituitary gland and hypothalamus.

– Increased LH secretion is a prominent feature in PCOS.

– Ovarian hyperandrogenism results from increased LH secretion.

– Obesity and hyperinsulinemia: common features that exacerbate PCOS pathogenesis.

CLINICAL FEATURES

 ∙ Oligomenorrhoea, amenorrhea, abnormal uterine bleeding (all types of menstrual irregularities are more common in obese patients than in lean patients), normal menstrual pattern.

 ∙ Infertility

 ∙ Obesity 

∙ Hirsutism

 ∙ Acne

 ∙ Virilisation 

∙ Polycystic Ovary in ultrasonography

Other clinical features include decreased breast size, decreased sexual desire, acrochordon(skin tags) (tiny flaps of skin seen on the eyelids, neck, armpits, and groins), High blood pressure, Mood swings, Depression and anxiety Acanthosis nigricans, male-pattern alopecia.

Diagnostic Criteria

Revised 2003 Diagnostic criteria for PCOS-presence of 2 out of 3 of following symptoms (Rotterdam criteria)

1. Oligoovulation or anovulation. 
2. Clinical and/or biochemical signs of hyperandrogenism. 
3. Polycystic ovaries and the exclusion of other etiologies. It is recognized that women with regular cycles, hyperandrogenism, and PCO morphology may be part of the syndrome. 

Androgen Excess Society criteria for diagnosis of PCOS: (AES-1990) Diagnostic criteria for PCOS. The Androgen Excess Society (AES) is an international organization dedicated to promoting knowledge and original clinical and basic research in every aspect of androgen excess disorders.

1. Hyperandrogenism: Hirsutism and /or hyperandrogenemia And 
2. Ovarian dysfunction: Oligo-anovulation and / or polycystic ovaries And
3. Exclusion of other androgen excess or related disorders.

Investigations

 There is no single test diagnostic for PCOS & the number of investigations in unison is useful to confirm the diagnosis.

Management of PCOS

PCOS is a multifaceted condition involving the metabolic, endocrine, and reproductive systems. The primary treatment objective is to achieve regular ovulatory cycles and menstrual patterns, along with improving polycystic ovaries through ultrasound and managing hyperandrogenism.

Homeopathic Management

Homeopathy is a holistic approach to health that aims to treat the individual as a whole rather than just addressing specific symptoms or diseases. The treatment is highly individualized based on the unique symptoms, constitution, and overall health of the person. Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that can manifest in various ways. Here are some common homeopathic remedies that may be considered for managing PCOS

1. Natrium muriaticum:  Face is pale, muddy or shiny as if greased. Itching and eruption of pimples on face and forehead. Affects hair follicles Menses irregular; early and profuse or scanty and delayed. Much bearing down pain and much leucorrhoea, backache generally accompanies this. With the menses there is generally headache, both before, during or after. Sterility with too early and too profuse menses. (Anaemia, Menstrual disorder)                                                                
2. Pulsatilla pratensis: Affection in general of the female genital organs, including menstrual disorder. Menstrual blood black, with clots of mucus, or pale and serous. Catamenia irregular, tardy or premature, of too short or too long duration or entirely suppressed (esp. if produced by getting feet wet) with colic, hysterical spasm in abdomen, pain in loins, nausea and vomiting, shivering and paleness of face, moral affections, and many other sufferings before, during or after period. (Ovaries pain, Ovaries inflammation, Menstruation abnormal)
3. Sepia officinalis:  Paleness and puffiness of the face, with blue circle around eyes. Face emaciated. Bearing pain in the uterus, pressure as if everything will protrude through vulva. Menses too profuse, suppressed, or too feeble, or else too early (appearing only in morning). Colic before menses, during menses; irritability, melancholy, headache, weariness in limbs. Dull, heavy pain in ovaries; esp. lt. Sterility, leucorrhoea in place of menses.
4. Ignatia amara:  It is usually suited to sensitive women, easily excited in nature, dark, mild disposition, quick to perceive, rapid in execution. Rapid change of mental and physical condition, opposite to each other. Menses, black with clots, putrid odour, too early, too profuse, or scanty. During menses great languor, with spasmodic pains in stomach and abdomen. Suppression from grief. Catamenia is premature and violent, every ten or fifteen days. During catamenia, heaviness, heat, and pain in the head, anxiety, palpitation of the heart, and great fatigue.
5. Sulphur: Sulphur patient is stooped, lank, uncured, untidy and unwashed. Menses too late, short, scanty, and difficult; thick, black, putrid odour, acrid, making parts sore. Menses preceded by headache or suddenly stopped. Moroseness and apprehension with uterine pain. Sterility, with too early and profuse menstruation. Excoriation, troublesome itching and burning sensation in genitals; with popular eruption around them.
6. Lachesis mutus:  In females who never get well from the change of life- ‘’have never felt well since that time’’. Pains from ovaries to uterus, with discharge of pus while at stool. Redness and swelling of external parts, with itching and sexual desire. Catamenia feeble, tardy, and of too short duration often accompanied by haemorrhoidal and other sufferings. Before and after menses diarrhoea with violent colic. Swelling, induration, pain and other anomalies of left ovary.(Ovaries affection) 
7. Thuja occidentalis:   Severe pain extending to left ovary and inguinal region. Menses scanty, retarded, polypi; fleshy excrescence. Ovaritis; worse left side, at every menstrual period. Left ovary inflamed agg. at each menstrual nisus; distressing pain, burning when walking or riding insupportable must lie down. Menses: too early and too short; scanty with pain.
8. Apis mellifica:  This medicine is indicated in amenorrhea or menorrhagia of females. There is an inflammation, induration, swelling, and dropsy of the ovaries (right). Weight and pain in either ovarian region, predominantly the right side. The ovaries feel better by lying on the right side. Enlargement of the right ovary with pain which is sharp, cutting, stinging worse during menstruation. Ovarian tumours, with stinging pains like bee-stings. Sudden shrill cries or pains that extort cries. Ovaries numb with cystic tumor. Menses suppressed, with cerebral and head symptoms, especially in young girls. Dysmenorrhoea, with severe ovarian pains. Useful for amenorrhea of puberty. Apis is more a rightside medicine; symptoms proceed from right to left and from above downwards. Patient is Irritable, excitable, jealous, fussy and fidgety or apathetic in nature.

• Yoga and exercise were beneficial in minimizing PCOS risk, as reflected in the risk assessment score. More such interventions, covering different schools, could provide larger health benefit

Exercise 

Exercise is a cornerstone of managing PCOS effectively. Alongside a balanced diet and other lifestyle changes, regular physical activity can significantly improve symptoms, enhance overall health, and increase the quality of life for women with PCOS.

Obese PCOS patients show more difficulty losing weight through exercise than lean PCOS patients. The role of hormonal alterations and PCOS per se in the responsiveness of weight loss to exercise remains to be determined. 

The role of hormonal alterations and PCOS per se in the responsiveness of weight loss to exercise remains to be determined.                                  

• Improving Insulin Sensitivity: Regular exercise enhances insulin sensitivity, reducing insulin levels and mitigating the risk of insulin resistance associated with PCOS.
• Weight Management: Aerobic exercise and strength training help manage body weight by increasing energy expenditure and promoting muscle mass, which is crucial for women with PCOS who often experience weight challenges.
• Hormonal Regulation: Exercise aids in reducing elevated androgen levels, such as testosterone, thereby promoting more balanced hormone levels and improving menstrual regularity.
• Stress Reduction: Physical activity stimulates the release of endorphins, improving mood and reducing stress levels, which can alleviate symptoms exacerbated by stress.
• Enhancing Fertility: Exercise, combined with a healthy diet, supports fertility by regulating ovulation patterns and promoting overall reproductive health.

Type and frequency of exercise, along with consistency, play crucial roles in achieving benefits

Yoga

Incorporating yoga asanas into a routine can support hormone balance, reduce stress, and improve overall physical and emotional well-being for individuals managing PCOS. 

Yoga Asanas for Managing PCOS:

1. Supta Baddha Konasana (Reclining Bound Angle Pose): Opens the hips and stimulates reproductive organs. Improves blood circulation to the pelvic region, promoting relaxation and reducing stress.
2. Bharadvajasana (Bharadvaja’s Twist): Massages abdominal organs, including the ovaries and uterus. Enhances digestion, stimulates the liver, and aids detoxification.
3. Ustrasana (Camel Pose): Stretches the abdomen, thighs, and pelvic region. Stimulates the thyroid and adrenal glands, helping regulate hormone levels. Improves flexibility and reduces stress.
4. Dhanurasana (Bow Pose): Strengthens back and abdominal muscles. Enhances digestion, stimulates reproductive organs, and improves blood circulation. it alleviates menstrual discomfort.
5. Bhujangasana (Cobra Pose): Opens chest and abdomen and strengthens the spine. Stimulates reproductive organs, improves posture, relieves stress, and enhances spinal flexibility.
6. Setu Bandhasana (Bridge Pose):Strengthens the back, buttocks, and thighs. Opens the chest, stimulates the thyroid gland, and improves blood circulation. Alleviates stress and anxiety.

Diet for PCOS

A well-balanced diet plays a crucial role in managing PCOS symptoms and promoting overall health. Research shows that people with PCOS show evidence of all-over inflammation, which is associated with heart disease and other illnesses. 

People with PCOS should avoid these foods that can ramp up inflammation:

• Fried foods (French fries, potato chips, corn chips and fried chicken or fish)
• Saturated fats such as butter or margarine
• Red meat, including hamburgers, roast beef and steaks, processed luncheon meat, and hot dogs
• Processed snacks: cakes, cookies, candy, and pies
• Prepared cereals high in sugar, including instant oatmeal and granola
• Sugary beverages such as sodas, teas, and sports drinks
• Alcoholic beverages
• Refined flour, white bread, rolls, pizza crust, and pasta
• White rice

Best Foods for PCOS:

Substituting whole, unprocessed options for inflammatory items can set the stage for better long-term health.

• Omega-3-rich fish, such as salmon, baked or broiled
• Olive oil instead of butter or margarine
• Beans and other protein-rich legumes instead of meat
• Non-starchy vegetables such as leafy greens (spinach, kale, escarole, endive, lettuce, etc.), tomatoes, mushrooms, peppers, broccoli, cauliflower, snow peas, celery, and fennel
• Whole grains, such as brown rice, barley, sorghum, and others. Breads and pastas made with whole grains can help people with PCOS avoid spikes in blood sugar.
• Whole fruit for dessert. The fiber content in whole fruit helps you feel full, helps your digestion, and slows down the absorption of its sugars into the bloodstream.

Reference 

1.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717472/
2. https://pubmed.ncbi.nlm.nih.gov/22375190/ 
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289164/
4. https://pubmed.ncbi.nlm.nih.gov/22375190/
5. https://www.hopkinsmedicine.org/health/wellness-and-prevention/pcos-diet#:~:text=%E2%80%9CResearch%20shows%20that%20people%20with,address%20inflammation%2C%E2%80%9D%20Stathos%20says
6. Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory: Third Revised & Augmented Edition based on Ninth Edition. New Delhi: B. Jain Publishers; 2010
7. https://www.materiamedica.info/en/materia-medica/john-henry-clarke/index
8. https://www.materiamedica.info/en/materia-medica/henry-c-allen/index
9. Allen H. C. keynotes rearranged and classified with leading remedies of the materia medica and bowel nosodes including repertorial index tenth edition 2005; 33rd impression 2017.
10. STANDARD TREATMENT GUIDELINES IN HOMOEOPATHY, Central Council for Research in Homoeopathy published 10th July 2016.
11.  

Guide 

Dr. Rakesh Sonkusare 

(Asso. Professor) 

Department of Organon of Medicine and Homoeopathic Philosophy,

Government Homoeopathic Medical College & Hospital,

 Ayush Parisar, Near Kaliyasot Dam, Bhopal, Madhya Pradesh, India. 

Dr. Vaishali Saxena

Post Graduate Trainee, 

Department of Organon of Medicine and Homoeopathic Philosophy,

Government Homoeopathic Medical College & Hospital, Ayush Parisar, Near Kaliyasot Dam, Bhopal, Madhya Pradesh, India.