In Ayurveda Acharya Sushruta has mentioned Bandhya (Su/UT/38/10) a type of yonivyapada whose symptom is amenorrhoea or oligomenorrhoea. Similarly Acharaya Charaka has described Arajasaka (Ch/ChiS/30/17), 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.
Ayurveda suggests that this is a Vata type disorder (Apan vata), though the involvement of other dosha can be there but in some measure.
Vata predominance manifests with painful menses, severe menstrual irregularity, low weight, coldness
Pitta predominance manifests as hair loss, acne, painful menses, clots, heart problems
Kapha predominance manifests as increased weight, infertility, hirsutism, diabetic tendencies, and coldness
Polycystic ovarian syndrome, also known as polycystic ovarian disease or PCOD is a very common female health complaint. The word “Syndrome” is used to describe the PCOD because, it is a complex manifestation involving many factors and organs such as – obesity, insulin resistance, irregular menstrual bleeding (in most cases, excessive menstrual bleeding), abnormal menstrual periods & cycle, lack of ovum production (anovulation) etc.
PCOS is a common female endocrine disorder affecting approximately 5- 12% of women.It causes worry as it is commonly found in reproductive age ; also it is thought to be one of the leading cause of female infertility.
Organs involved in Polycystic Ovary disease
- Ovary: The female gonad organ, present at the either sides of the uterus.
- Adrenal glands: The glands which are placed just above the both the kidneys.
- Pancreas: Gland that produces insulin in our body.
- Pituitary gland: The gland just below the brain, which is responsible for all the hormonal control.
What happens in PCOD?
There is increased production of Androgen (a hormone) by the ovaries, which suppresses the maturation of ovarian follicles (ovarian follicles lead to ovum). So, ovum does not get properly formed and released (Anovulation). Remember that ovum meets with the sperm during intercourse leading to conception. So, in a case of PCOD, the lady usually will be having problem with conception.
How frequent is the problem of PCOD?
The incidence varies between 0.5 – 4 per cent, more common amongst infertile women. It is prevalent in young reproductive period.
What happens inside the body?
Typically, the ovaries are enlarged two to five times the normal size (PCOS – Ovarian cysts). Stroma is increased. The capsule is thickened and pearly white in color. Ovary which is normally oval in shape will have many cysts within it.
Hystologically there is thickening of tunica albugenia. The cysts are follicles at varying stages of maturation and atresia. There is theca cell hypertrophy (stromal hyperthecosis). Patient may present with features of diabetes mellitus (insulin resistance).
Careful survey concludes that the biggest lifestyle contributor to PCOS is poor diet. Young women with PCOS tend to eat far too much sugar or carbonized drinks and highly refined carbohydrates which causes unhealthy raise in insulin levels. Insulin stimulates androgen receptors outside of ovary, causing typical PCOS symptoms which also play a role in blocking release of ovum from follicle. This type of diet will cause obesity and thus aggravating PCOS.
Also, in stressful women, as they eat more food that are high in fat, sugar and carbohydrate in response to stress, the more fat they store, thus, contributing in the development of obesity- linked PCOS. Thus we can deduce that the modern stressful lifestyle and food- habits are linked and contribute or accelerate many diseases, PCOS being one among them.
Signs and Symptoms
Clinically PCOS often manifest itself at menarche with some form of menstrual irregularity, but not essentially. The principle signs and symptoms of PCOS are related to menstrual disturbance and elevated levels of male hormones (androgens).
Also patient approach the physicians with the features like menstrual irregularities, androgenic features such as hirsutism, acne, alopecia etc ,obesity and infertility caused by improper ovulation etc.
Patient complains of increasing obesity, menstrual abnormalities in the form of less menstrual bleeding, absence of menstruation, or abnormally high and irregular bleeding and infertility. There may be abnormal growth of hair at different places of the body. The patient may not always be obese.
In some patients, due to insulin resistance, a dark coloured band like skin lesion may be developed at the back of the neck, inner thighs and axilla, called as Acanthosis nigricans.
Internal examination reveals bilateral enlarged cystic ovaries which however may not be revealed due to obesity.
Diagnosis: laboratory investigations:
The assessment and based diagnosis of PCOS is mainly based upon clinical presentation together with
USG – Ultra Sonography findings and hormonal profile appropriate to mode of presentation.
OVERALL VIEW OF PCOD –
Hypothalamic – pituitary compartment abnormality:
Stimulation of GnRH leads to increased LH. (leutinizing Harmone). Leading to increased secretion of LH and decrease of FSH (Follicle stimulating Hormone) – This way, Hormonal imbalance is triggered in PCOD.
In some patients the excessive production of Androgen by ovaries and adrenal glands, Excessive androgen production is partially influenced by excessive LH. Increased insulin levels also results in androgen excess.
Anovulation (absence of ovum production)
Because of low levels of Follicle stimulating hormone, follicle growth inside the ovary is arrested leading to absence of ovum production (anovulation) further leading to infertility.
Relationship between obesity, insulin production and PCOD
Obesity is recognized as an important contributory factor. It also induces insulin resistance and increased levels of insulin in blood, which in turn increases the androgen production.
Insulin resistance means that the body cells will not respond to the effect of insulin. So, though the body is trying to compensate by producing more and more insulin, leading to high levels of insulin, but thus produced insulin will be inefficient to metabolize the glucose in the body. So, the body becomes resistant to insulin, means the body will not respond to insulin.
Long term consequences in a patient suffering from PCOD
- Excess androgens (predominantly androstenedione) leads to thickening (hyperplasia) of the inner layer of the uterus (endometrium).
- Risk of developing diabetes mellitus due to insulin resistance.
- Risk of hypertension and abnormally high lipid profile.
Ayurvedic herbal remedy for PCOD
Correcting hormonal imbalance
There are many herbs useful in correcting the hormonal imbalance. Ashoka (saraca asoca), Dashamoola (a group of ten herbal roots) a group of herbs useful in preparation of Sukumara Kashaya like Ashwagandha, Eranda, Shatavari etc are useful in correcting the hormonal imbalance.
Treatment to obesity
Treatment to obesity and specifically against cholesterol can be achieved by using Ayurvedic herbal remedy plus diet and lifestyle changes.
Treatment insulin resistance
Treatment for insulin resistance involves a time-consuming approach with effective Ayurvedic treatment and diet and lifestyle changes including exercise.