Dr. Bharti Arora, MD (Hom.), BHMS (Silver Medalist), Co-Founder: Vivid Homeopathy
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In This Issue
- Polycystic Ovarian Syndrome (=PCOS or PCOD)
- Common Age of Onset
- What is PCOS
- Important terms
- How it happens
- Clinical Presentation
- Types of PCOS
- Differential Diagnosis
- Some Important facts
- Role of Homeopathy in PCOS
- Recommended Scientific Reading
Polycystic Ovarian Syndrome (=PCOS or PCOD)
Polycystic Ovarian Syndrome or commonly called PCOS or PCOD (disease) is one of the rising endocrine disorders affecting millions of reproductive age group females. It is not only a disease which affects ovaries but may result in reproductive, metabolic, and psychological consequences.
Common Age of Onset
- Common age of onset is adolescence.
- Common time of diagnosis: 2nd to 4th decade of life.
- Some symptoms may appear starting at menarche or post menopause.
What is PCOS
The first consensus definition of PCOS arose from the proceedings of an expert meeting in April 1990 in USA (1990 NIH criteria). It defines PCOS as the combined presence of:
- Oligoovulation and
- Exclusion of related disorders such as Cushing’s syndrome, hyperprolactinemia, and congenital adrenal hyperplasia.
However, in today’s scenario, an increasing awareness about PCOS suggests that the clinical expression of PCOS are broader than that specified by the 1990 NIH criteria.
- Hyperandrogenism = Androgen excess = excessive levels of androgens (male sex hormones such as testosterone).
- Oligoovulation: Infrequent or irregular ovulation (usually defined as cycles of ≥36 days or <8 cycles a year).
- Anovulation: is absence of ovulation when it would be normally expected (in a post-menarchal, premenopausal woman).
How it happens
The exact cause of PCOS is still unknown. It is believed that the hormonal imbalances and genetics play important role in its pathogenesis.
- Females with PCOS often struggle with higher-than-normal production of androgens.
- This affect the development and release of eggs during ovulation.
- In many cases excess serum insulin may cause high androgen levels.
The type and severity of symptoms varies from individual. Hyperandrogenism is a primary hallmark of PCOS. PCOS may cause women to develop certain characteristics, such as:
- Abnormal growth of hair on the face, chest, stomach, thumbs, or toes (hirsutism),
- Weight gain
Other symptoms/signs include:
- Deeper voice
- Decrease in breast size
- Thin hair
- Pelvic pain
- Anxiety or
Along with PCOS a female may have other concurrent health problems, such as diabetes, hypertension, and high cholesterol. These are linked to the weight gain typical in PCOS patients.
Types of PCOS
PCOS may express in following subtypes:
- HYPERANDROGENISM, normal cycle, PCO IN ULTRASOUND.
- Normal androgens, OLIGO-ANOVULATION, normal
- HYPERANDROGENISM, OLIGO-ANOVULATION, normal
- HYPERANDROGENISM, OLIGO-ANOVULATION, PCO IN ULTRASOUND
- It affects approximately 5-10% of the female population in developed countries
- In India it is approximately reported in 9% of the adolescent females.
- Between 15-35 years of age it is commonly prevalent in around 6 – 13% of females
PCOS is diagnosed clinically, but certain investigations are advised to diagnose it completely, such as:
- Androgen level: free testosterone, DHEAS and androstenedione.
- Sex hormone binding globulin (SHBG): usually low in PCOS.
- Fasting insulin: elevated in PCOS.
- Fasting glucose or 2-hour post-prandial glucose: elevated in PCOS.
- LH/FSH Ratio: PCOS is associated with high LH with normal FSH. Normally, the ratio of LH: FSH is 1:1, but in PCOS, this ratio can get altered to 2:1 or even more.
- Cholesterol levels: Impaired lipid metabolism may occur together with impaired blood sugar metabolism leading to an increase in both HDL and LDL.
- Ultrasound to check for the presence of ovarian cysts in a typical pattern.
- Premature ovarian failure
- Pituitary adenoma
- Late-onset congenital adrenal hyperplasia
- Congenital adrenal hyperplasia
- Androgen-producing tumor of the ovary or adrenal gland
- Discontinuation of oral contraceptives
- Rapid weight loss
Untreated PCOS may be associated with
- Increased risk for cardiovascular disease
- Menstrual irregularities like amenorrhea, dysfunctional uterine bleeding
- Permanent hirsutism
- Persistent acne and
- In some cases increased risk for endometrial cancer, endometrial hyperplasia and, breast cancer.
Some Important facts
- This disorder was first identified in 1935 by Stein and Leventhal who noticed a condition in women characterized by irregular menstruation, obesity, and hirsutism, in addition to cysts on the women’s ovaries.
- Genetic and environmental factors when combined with ovarian dysfunction, hypothalamic pituitary abnormalities, and obesity can accentuate PCOS.
- Hormones imbalance involves estrogen, progesterone and androgens, such as testosterone.
- The syndrome has major metabolic as well as reproductive morbidities. Reproductive problems may include infertility and various pregnancy complications and clinical signs of androgen excess.
- Since it is reflected as hormone imbalance, there are instances where metabolic problems are also seen such as insulin resistance, metabolic syndrome, impaired glucose tolerance etc.
- It is a psychological stress to a female and may result in lack of confidence, poor quality of life, poor self-esteem, depression, anxiety, and possibly eating disorders.
The management of PCOS has four thumb rules:
- Education: The PCOS and its causes must be taught to the patient. Many times it may be due to an underlying risk factor such obesity or stress.
- Understanding: PCOS and its pathophysiological understanding is a must. Its present form, how much it is going to trouble a patient, what would be the probable outcome in future etc. must be understood.
- Treat the Cause: As a thumb rule we need to identify the underlying cause of the PCOS, thus the treatment must aim at considering the root cause and not superficial symptoms only.
- Eat Healthy Live Healthy: It is now an established fact that PCOS is related to poor life-style, stress and genetics. We can’t modify genetics but we can modify body’s expression and health status. Involment in health activities and treatment is the key rule. The patient is advised to take active interest and participation in timely medication, exercise, and dietary restrictions. Activities may include controlling cholesterol levels, reducing obesity, maintaining blood pressure etc.
Role of Homeopathy in PCOS
Homeopathy heals holistically!
- Treat the Cause: Homeopathic system of medicine is a therapeutic system of symptoms similarity which is safe, effective, affordable and within reach. It takes into account the holistic approach i.e. person as a whole. This means that we treat every patient on the basis of individualization. During this process prescription is based upon the many factors such as symptoms, sign, causation, history, family history, mental status and inherent nature of the person, likings, disliking etc. This is synonymous with term Constitutional Medicine.
- The PCOS has been termed as a syndrome as it affects many systems of the body. Therefore, it may be considered as a constitutional problem rather than a local disease.
- Homoeopathic intervention aims at halting the progress, providing symptomatic relief and curing the patient.
- Homeopathic medicines stimulate the hypothalamic-pituitary-ovarian axis thereby strengthens the immune system and trigger the natural release of hormones.
The homeopathic treatment of PCOS is divided into three major parts:
- Initial stages (detected early): Constitutional treatment and/or specifics to control the symptoms.
- Developed stages: Specific medicines to control symptoms and to regularise the body’s hormonal imbalance.
- PCOS with other morbidities: Specific medicines are repeated too often and given for longer duration. The aim is to control the situation and improve quality of life of patients.
Homeopathic medicines can be taken safely along with other/conventional medications (ADD-ON Therapy).
- The patient is asked to maintain a gap of approx. 30 mins between different medications.
- The key point of treating PCOS is holistic healing and not hormonal or ultrasonography normalcy only.
Following medicines are commonly used frequently in homeopathy as constitutional or specific or both:
- Apis mellifica
- Natrum muriaticum
- Pulsatilla (both in potency and mother tincture)
- Thuja occidentalis
- Senecio aureus
- Jonesia Asoca
As a common myth, mother tinctures are not always superior to potencies. The right potency may be mother tincture, trituration or a dilution depending on severity and presentation of the case.
Recommended Scientific Reading
- Azziz R, Carmina E, Dewailly D, Diamanti – Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. Feb 2009;91(2):456-88. [Medline].
- Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. AJOG 1935; 29(2):181-191.
- Garad, R., Teede, H. J., & Moran, L. (2011). An evidence-based guideline for Polycystic Ovary Syndrome. Australian Nursing Journal, 19(4): 30.
- Heidi A. Polycystic ovary syndrome (PCOS) in urban India. Manlove University of Nevada, Las Vegas. Available from: http://bit.ly/1Dq1fbP [Last accessed on 26 April 2015].
- Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol 2011;24:223‑7.
- Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of Polycystic Ovarian Syndrome in Indian Adolescents. Journal of Pediatric and Adolescent Gynecology 2011; 4: 223–27.
- Polycystic Ovary Syndrome: Current and Emerging Concepts. Springer. Lubna Pal 2014. London
- Burghen G.A., Givens J.R., Kitabchi A.E. (1980) Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab 50: 113–116
- Jeffcoate, William et al. Diabète des femmes à barbe: a classic paper reread. The Lancet , Volume 356 , Issue 9236 , 1183 – 1185
- Kierland RR, Lakatos I, Szijarto L. Acanthosis nigricans: An analysis of data in twenty-two cases and a study of its frequency in necropsy material. J Invest Dermatol 1947:9:299-305
- Brown J, Winkelmann RK. Acanthosis nigricans: a study of 90 cases. Medicine 1968 47:33-51
- Kahn CR, Flier JS, Bar RS, Archer JA, Gorden P, Martin MM, Roth J 1976 The syndromes of insulin resistance and acanthosis nigricans. N Engl J Med 294:739–745
- Hughesdon PE 1982 Morphology and morphogenesis of the stein-leventhal ovary and of so-called “hyperthecosis.” Obstet Gynecol Surv 37:59–77
- Roe AH, Dokras A. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Reviews in Obstetrics and Gynecology. 2011;4(2):45-51.
- Legro RS. Polycystic ovary syndrome: current and future treatment paradigms. Am J Obstet Gynecol. 1998;179:S101–8.
This article does not intend to replace the in-person consultation. The facts are for general purpose and public awareness only, and must not be taken as Medical Consultation in any form. For consultation, treatment and specific queries you need to contact your healthcare professional.
Not for Medico-legal purposes.
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