EPIDEMIC OF MODERN ERA - POLYCYSTIC OVARY SYNDROME (PCOS) WITH SCIENTIFIC BURDEN

 ABSTRACT   

Polycystic ovary syndrome (PCOS) is a new gynecological epidemic. It is the most common endocrine disorder among women of reproductive age groups 12-45 years. It is thought to be one of the leading causes of female subfertility and the most frequent endocrine problem in women of reproductive age. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management of PCOS.

 

INTRODUCTION 

PCOS is a complex, heterogeneous disorder of uncertain etiology, but there is strong evidence that it can to a large degree be classified as a genetic disease. Polycystic ovary syndrome (or PCOS) is common, affecting as many as 1 out of 15 women and is diagnosed in women in their 20s or 30s. Treatment can help control the symptoms and prevent long-term problems. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has symptoms similar to those of polycystic ovary syndrome. Polycystic ovarian disease (PCOD) is currently considered as possibly the most frequent cause of female infertility. It is prevalent in younger reproductive age women (20-30%).Polycystic ovaries may be seen in about 20% normal women. World Health Organization (WHO) estimates that PCOD has affected 116 million women (3.4%) worldwide in 2012.Globally, prevalence estimates of PCOD are highly variable, ranging from 2.2% to as high as 26%.In India, experts claim 10% of the women to be affected by PCOD. The most frequent presenting symptoms associated with PCOD are obesity, hirsutism, amenorrhea or anovulation, dysfunctional uterine bleeding, irregular menses, and infertility.

CAUSES

PCOS is a complex, heterogeneous disorder of uncertain aetiology. There is strong evidence that it is a genetic disease. The symptoms of PCOS are caused by changes in hormone levels. There may be one or more causes for the hormone level changes. PCOS seems to run in families, so chance of having it is higher if other women in a family have PCOS, irregular periods, or diabetes. PCOS can be passed down from either mother's or father's side. The clinical severity of PCOS symptoms appears to be largely determined by factors such as obesity.

WHAT ARE HORMONES, AND WHAT HAPPENS IN PCOS?

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:

· The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause to stop ovulating, get acne, and grow extra facial and body hair.

· The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases chance of getting diabetes.

CLINICAL PRESENTATION

Symptoms tend to be mild at first. Women may have only a few symptoms or a lot of them. The most common symptoms are:

· oligoovulation and/or anovulation 

· Acne.

· Weight gain and trouble losing weight.

· Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.

· Thinning hair on the scalp.

· Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.

· Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).

· Depression.

Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.

DIAGNOSIS

Not all women with PCOS have polycystic ovaries (PCO), nor do all women with ovarian cysts have PCOS; although a pelvic ultrasound is a major diagnostic tool, it is not the only one.

Standard diagnostic assessments includes

· History-taking, specifically for menstrual pattern, obesity, hirsutism, and the absence of breast development. A clinical prediction rule found that these four questions can diagnose PCOS

· Gynecologic ultrasonography, specifically looking for small ovarian follicles. These are believed to be the result of disturbed ovarian function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition.

· Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the ovary. 

· Serum (blood) levels of androgens (male hormones), including androstenedione and testosterone may be elevated. 

·  Dehydroepiandrosterone sulfate levels above 700-800mcg/dL are highly suggestive of adrenal dysfunction because DHEA-S is made exclusively by the adrenal glands. The free testosterone level is thought to be the best measure.

· Some other blood tests are suggestive but not diagnostic. The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone), when measured in international units, is greater than 1:1 (sometimes more than 3:1), as tested on Day 3 of the menstrual cycle.

Common assessments for associated conditions or risks are

· Fasting biochemical screen and lipid profile

· 2-hour oral glucose tolerance test (GTT) in patients with risk factors (obesity, family history, history of gestational diabetes) may indicate impaired glucose tolerance (insulin resistance) in 15–33% of women with PCOS. Insulin resistance can be observed in both normal weight and overweight patients, 50–80% of PCOS patients may have insulin resistance at some level.

· Fasting insulin level or GTT with insulin levels (also called IGTT). Elevated insulin levels have been helpful to predict response to medication

· Glucose tolerance testing (GTT) instead of fasting glucose can increase diagnosis of increased glucose tolerance and frank diabetes among patients with PCOS according to a prospective controlled trial.

· Pregnancy test (serum HCG)

· Prolactin level

· Thyroid function tests

GENERAL MANAGEMENT

· Patients should be reassured and taught not to be panic

· Regular exercise, healthy foods, and weight control are key treatments for PCOS. Medicines to balance hormones may also be used. Getting treatment can reduce unpleasant symptoms and help prevent long-term health problems.

The first step in managing PCOS is to get regular exercise and eat heart-healthy foods. This can help lower blood pressure and cholesterol and reduce the risk of diabetes and heart disease. It can also help to lose weight if need to.

· Try to fit in moderate activity and/or vigorous activity on a regular basis. Walking is a great exercise that most people can do.

· Eat a heart-healthy diet. In general, this diet has lots of vegetables, fruits, nuts, beans, and whole grains. It also limits foods that are high in saturated fat, such as meats, cheeses, and fried foods. If have blood sugar problems, try to eat about the same amount of carbohydrate at each meal. A registered dietitian can help to make a meal plan.

· Most women who have PCOS can benefit from losing weight. Even losing 4.5 kg may help get hormones in balance and regulate menstrual cycle. PCOS can make it hard to lose weight, so work with family doctor to make a plan that can help to succeed.

· If have habit of smoking, consider quitting. Women who smoke have higher androgen levels that may contribute to PCOS symptoms.1Smoking also increases the risk for heart disease.

HOMOEOPATHIC MANAGEMENT:

· Management of PCOD primarily involves prescribing a constitutional Homeopathic remedy capable of working on the ovaries and the entire endocrinal system.  This approach usually helps in correcting the pathology associated with PCOD.

· There are numerous remedies capable of influencing this condition. The remedy prescribed is chosen after carefully understanding your entire constitution, which includes:

o Presence of any genetic predisposition

o Physical makeup (obesity)

o Peculiarities of menstrual cycle

o entire physical and personality characteristics

· Homeopathy for PCOS or PCOD should be continued for a significant duration of time as the appearance and normalization of the menstrual cycle as well as decrease or absence of cyst formation are the only means by which improvement can be monitored

· Homoeopathy offers good prognosis to cases of PCOS. Medicines like Lachesis, Sepia, Graphites, Caulophyllum, Lycopodium, Nat.Mur, Silicea etc are often found indicated in cases of PCOS.

Indicated Remedies	Indications
Lachesis	Pain in ovaries, especially left sided relieved by discharges from uterus, Labour like pain in uterus, Os feels open
Sepia	Irritability is marked in the patient. Cannot tolerate the sight of children. Periods are early and profuse. Backache more on washing.
Graphites	Very useful to correct the menstrual irregularities and to cure pre-menstrual related problems. Patient has induration of ovaries with aversion to opposite sex. During periods severe nausea and constipation. Good medicine for obesity also
Caulophyllum	useful to women with a history of irregular periods, discomfort during periods and pain in the pelvic region
Lycopodium	which may relieve sweet cravings, insatiable appetites, extended periods, bloating, indigestion, constipation, insomnia and anxiety
Iodum	Ovarian cysts and dropsy, with great bearing down pain, induration and enlargement; pain commencing in the right ovary, passing down the broad ligaments to uterus. Pain in ovaries and back during menses
Pulsatilla nigricans	Catamenia too late and scanty, or suppressed, particularly by getting feet wet, and painful menstruation with great restlessness, tossing in every possible direction, and changeable characteristics in the flow of the menses, viz., they stop, and flow, stop and flow again etc, also the menorrhagia
Nat. Mur	which may reduce inflammatory skin conditions such as eczema and vertigo, and may alleviate PMS
Calc-carb	Periods too early, profuse and long lasting. Least amount of excitement brings the flow. Before periods mammary tenderness, sweating on forehead and external genitalia
Silicea	Chilly and desirous of warmth, has milky white leucorrhea, increased flow of menses with icy coldness of body. Nipples sore and are drawn in, vaginal and ovarian cysts with hard lumps in breasts.
Myristica	A very good antiseptic. It hastens suppuration hence can be used when the condition is highly inflammatory.
Platina	With severe gastric irritation and increased sexual urge; patient will be always with delusion of grandeur.
Oophorinum	Usually helpful in climateric states. Ovarian cysts in young girls.
Medorrhinum	Should be used as a Miasmatic remedy. Has offensive flow with difficulty in washing. May or may not be associated with warts on genitalia. Left ovary more painful, breast tenderness with dysmenorrhoea.
Apis	Thin walled multi locular ovarian cyst with tenderness in lower abdomen. Menorrhagia after a long gap of amenorrhoea. Aggravation by heat and touch and > cold.
Ova tosta	Ovarian cyst especially of left side, bearing down sensation, Backache and pain in left hip, Cannot tolerate tight bands on waist.
Folliculinum	She can become aggressive then depressed, put on weight without overeating, gain up to seven pounds before periods, or get into compulsive eating and have huge food cravings, especially before periods but it can be at any time. There can be both fat and water retention. Especially, obstinate cases of acne that aggravate before and during menses are another clinical keynote of this remedy.

 

 

Conclusion

With reference to the current scenario prevalence of PCOS is increasing. Homoeopathy treats the individual in disease and not the disease alone and holistically helps the patient in need. Thus by striking at the root of the problem patient can be relieved from further remission of suffering.