Pcod dr. diksha khathuria

UNDERSTANDING &
MANAGEMENT OF
POLYCYSTIC OVARY
SYNDROME
Presented by:
Dr. Diksha Khathuria
Assistant Professor
Stri-Prasuti Vibhaga
M.M.M Govt. Ayu. College Udaipur
4 October
2020

• 1 in 5 women of
reproductive age have
PCOS
• The World Health
Organization estimates
that it affects 116
million women
worldwide as of 2010
(3.4% of women).
One community-based
prevalence study found
that about 18% of
women had PCOS, and
that 70% of them were
previously undiagnosed
4
FACTS AND FIGURES
4 October
2020

INCIDENCE
It affects 4-6 % of women and appears to be on
increase due to change in lifestyle and stress
Most common endocrine disorder of reproductive -
aged women
➢ 75 % of anovulatory women of any cause have
polycystic ovaries and 20-25 % with normal ovulation
have polycystic ovaries in ultrasound
➢ 90 %presents with hirsutism
➢ 80 %with Obesity.
➢ 30 %with infertility.
4 October
2020

DEFINITION
Heterogeneous, multisystem endocrinopathy
in women of reproductive age
Formation of multiple
tiny cysts in the ovary is
called Polycystic Ovary
Syndrome (PCOS).
4 October
2020

4 October
2020
NORMAL MENSTRUAL CYCLE

Diagnostic criteria
❑ Stein and Leventhal (1935)
It is a syndrome manifested by
• Amenorrhoea,
• Hirsutism and
• Obesity associated with enlarged
polycystic ovaries.
4 October
2020

NIH criteria - 1990
1. Oligo / anovulation
2. Hyperandrogenism ( with
the exclusion of related
disorders )
4 October
2020

Rotterdam criteria ( 2003 ) by
ESHRE/ASRM
 presence of two out of following three
criteria
1. Oligomenorrhoea and/or anovulation
2. Hyperandrogenism clinical and/or
biochemical
3. Polycystic ovaries with exclusion of
other aetiologies
4 October
2020

AES (2006)
Menstrual irregularity
 +/- USG - Polycystic ovary
Hyperandrogenism
Exclusion of other etiologies
4 October
2020

What are the causes of
PCOS?
The real cause of PCOS is unknown.
Factors-
▪ Metabolic.
▪ Hormonal imbalance- the ovaries make more
androgens than normal. Androgens are male hormones that
females also make.
▪ Insulin may be linked to PCOS- Excess insulin
appears to increase production of androgen.
▪ Familial tendency and may be autosomal
dominant inherited 4 October
2020

Causes Of Increasing Incidence
 Excess Junk food intake.
 Use of Digital gadgets.
 Lose of difference between day and night.
(Disrupted Circadian Rhythm)
 Sedentary life style.
 Increasing stress.
It is believed that the picture is of a
multigenic etiology in which non-genetic
factors such as diet and exercise have strong
influence on the development of the disorder
4 October
2020

PATHOPHYSIOLOGY
 Hyperandrogenism and anovulation may be
caused by abnormalities in four
endocrinologically active compartments
1. Hypothalamic pituitary compartment
2. Ovaries
3. Adrenal glands
4. Peripheral compartment
• About 25% of patients with PCOS exhibit
elevated prolactin levels
4 October
2020

ABNORMALITY OF HPO AXIS
Hypothalamus
Increased frequency of GnRH
Increase pulse frequency of LHcompared to FSH
Increased pituitary sensitivity of GnRH
LH : FSH
4 October
2020

OVARIES
CYP17
dysregulation
Increased LH
stimulation
Increased
insulin
OVARIES
Hyperandrogenism
Defective
aromatisation
IGF 1
4 October
2020

 Causes for Increased Androgen Level:
❖ Increased frequency of GnRH pulses, so LH rises
❖ Insulin stimulates theca cells with LH to produce
androgens
❖ Insulin also synergistically act with androgens to decrease
hepatic production of SHBG, thus increasing free or
active testosterone
 High androgen concentration inhibit follicular maturation.
Although ovarian theca cells are hyperactive, retarded
follicular maturation results in inactive granulosa cells
with minimal aromatase activity for conversion to
oestrogens.
4 October
2020

ADRENAL GLANDS
Excessive androgen production due to
hyperfunctioning CYP17 enzyme
DHEAS increased in 50% cases
4 October
2020

PERIPHERAL COMPARTMENT
Presence and activity of 5α reductase in
skin determines presence of hirsutism
Aromatase and 17β hydroxysteroid
dehydrogenase activities increased in fat
cells and peripheral aromatisation
increased with body weight.
4 October
2020

ANOVULATION
 Because of low FSH, follicular growth
arrested at different phases of maturation.
 Defective FSH induced aromatisation of
androgens to oestrogens.
 Elevated LH results in increased androgen
production
 Follicular microenvironment – androgenic
 In absence of estrogenic microenvironment,
follicular growth, maturation and ovulation
cannot occur.
4 October
2020

INSULIN RESISTANCE IN PCOS
 It occurs in 50 – 70 % of patients independent of body
weight.
 Hyperinsulinaemia augments stimulatory action of LH on
growth and androgen secretion of ovarian thecal cells
 Inhibits hepatic production of SHBG
 Obesity in PCOS excess adipose tissue
Increase secretion of leptin, adiponectin and cytokines
interfere with insulin signaling pathways in the liver and
muscle insulin resistance and hyperinsulinaemia
4 October
2020

4 October
2020

Pathophysiology:
Chronic anovulation: Steady state LH/FSH.
No progesterone. Irregular bleeding
Increased androgens: LH stimulation of theca cells &
decreased SHBG from liver. Free testosterone rises
(Hirsutism)
Enlarged ovaries: Multiple peripheral cystic follicles
fail to mature an apoptosis ceases due to increased
androgens. Premature follicle atresia despite follicle
stimulation from steady state FSH 4 October
2020

• SYMPTOMS
Dr. Diksha
Khathuria
4 October
2020

Symptoms of PCOS may be
categorized in the three groups-
 Cosmetic Symptoms
 Metabolic Symptoms
 GynecologicalSymptoms
4 October
2020

The common cosmetic symptoms
lead to-
Acne, oily skin, dandruff, skin tags.
Excessive hair growth (Hirsutism) on the face and body.
Often women get thicker and darker facial hair and more
hair on the chest, belly, and back.
4 October
2020

Hatch et al, 1981 Am J Obstet Gynecol 140: 815-30
• Hirsutism - Ask H/o removal of hair - show
pictorial representation of Ferrimman-
Galway ScoringSystem. of  8 is consider hirsute.
4 October
2020

Acanthosis nigricans – Skin is thickened
& pigmented ( grey brown ) and mainly
affects nape of neck, inner thighs, groin
and axilla.
4 October
2020

Male-pattern baldness-
thinning hair.
Male pattern hair growth on
body
4 October
2020

The metabolic symptom leads to-
➢ Weight gain and trouble losing weight.
➢ Android obesity – in 50% cases
4 October
2020

Apple Shape Pear Shape
Obesity
4 October
2020

Gynecological symptom leads
to-
➢ Irregular or absent or profuse periods
➢ Lowback or lower abdominal pain during
Periods
➢ Infertility: Difficulty in getting pregnant
4 October
2020

Reference:Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2014;6:1–3.
Clinical Presentation of Women with PCOS
Obesity
4 October
2020

INVESTIGATIONS
 LH/FSH ratio > 2:1 or > 3:1
 Serum testosterone – more than 150 ng/dl
In ovarian hyperthecosis, values may reach 200 ng/dl
or more
• DHEA-S may be elevated(>3400 ng/dl)
• PRL – usually normal but may be slightly elevated >
40 ng/ml
 SHBG level is reduced
4 October
2020

❑ Thyroid Profile.( TSH increased)
Fasting Insulin – Raised (>25µ IU/ml)
Fasting Glucose – Raised (>119 mg/dl)
Insulin response at 2 hrs post glucose (75gm) load –
300µ IU/ml (suggests IR)
Total Cholesterol - >200 mg/dl
HDL Cholesterol - <50 mg/dl
LDL Cholesterol - >130 mg/dl
 Elevated total cholesterol, triglycerides and LDL and low
level of HDL
4 October
2020

Polycystic
ovary
Normal
Ovary
Ultra Sound examination reveals B/L enlarged
cystic ovaries.
TVS – Multiple cysts are located along the surface
of ovary giving a “necklace appearance”
4 October
2020

Laproscopic view
PEARLYWHITE SMOOTH ENLARGED AND THICKWALLED OVARY ON
LAPAROSCOPY
4 October
2020

USG and Laproscopic Evidences in
Ovary.
 Ovaries enlarged 2-5 times the normal size.
 Capsule is thickened and pearly white in
colour
 Ovarian volume increased > 10 cm3 and
stroma is increased
 Multiple > 12 follicular cysts measuring 2-9
mm in diameter crowded around the cortex
 There is thickening of tunica albuginea
4 October
2020

METABOLIC SYNDROME
 Three of five qualify for the syndrome
1. Abdominal obesity – waist circumference >
88 cm
2. Triglycerides > 150 mg/dl
3. HDL- Cholesterol < 50 mg/dl
4. BP > 130/85 mmHg
5. FBS 110 - 126 mg/dl and 2h glucose from
OGTT of 140 – 199 mg/dl
4 October
2020

Ann N Y Acad Sci. 2008; 1135: 85–94.
4 October
2020

DIFFERENTIAL DIAGNOSIS:
Menstrual Irregularity
Oligo – ovulation or anovulation
HYPERTHYROIDISM TSH decreased
HYPOTHYROIDISM TSH increased
HYPERPROLACTINEMIA PRL increased
HYPOGONADOTROPIC
HYPOGONADISM
FSH, LH, E2 decreased
POF FSH, LH increased and E2
decreased
PCOS LH:FSH > 3:1
4 October
2020

TREATMENT
• Treatment goals are based on only
symptomatic relief.

Goal of management
• Tocure a women with menstrual disorder
• Totreat hirsutism
• Totreat infertility
• Toprevent long term effect of X syndrome in
later life
4 October
2020

Non
pharmacological
Pharmacological Surgical
Management
4 October
2020

Non pharmacological Therapy:
• Weight loss:
– Weight loss of more than 5% of previous weight alone is
beneficial in mild hirsutism
– It restores the hormonal milieu
– It increases secretion of sex hormone binding globulin
from liver thereby reducing testosterone level.
– Reduces insulin level
• Lifestyle modification
4 October
2020

Pharmacological
Tomaintain regular menstruation cycle
– Oral combined pills(Oestrogen-Progestins)
– OC and cyproterone acetate
– OC and spironolactone (spironolactone inhibit 5
alpha reductase so less DHT formation)
– Ketoconazole (200 mg daily of ketoconazole
reduces testosterone secretion)
4 October
2020

Hirsutism:
• Acne can be managed by 1% clindamycin lotion or 2%
erythromycin gel if pustules form
• For severe acne, isotretinoin is used (MUST be avoided in
pregnancy)
– Takes 3-6 months to show the effect effect on hirsutism
• Antiandrogens like cyproterone, spironolactone, Flutamide
can be given for hirsutism
• Dexamethasone (0.5 mg) at bedtime reduces androgen
production
– used in some infertile women with clomiphene if DHEA-S > 5
ng/mL. 4 October
2020

Treatment of Infertility:
4 October
2020

Infertility:
• Clomiphene, 1st line treatment for PCOS with infertility
• Class of drug: Partial Estrogen Agonist
• MOA:
– It induces GnRH secretion in women by blocking estrogenic
feedback inhibition of pituitary. The amount of LH/FSH
released at each secretory pulse is increased. In response,
the ovaries enlarge and ovulation occurs if the ovaries are
responsive to gonadotropins.
• Antagonism of peripheral actions of estrogen results in
hot flushes
• Endometrium and cervical mucus may be modified
4 October
2020

Side Effects of Clomiphene:
• Ovarian enlargement
• Hot flushes, sweating
• Visual disturbances
• Headache, dizziness, allergic skin reactions
• Anti estrogenic in cervical mucus and
endometrium
• >1 year: low grade ovarian cancer
• Ovarian hyperstimulation syndrome
• Multiple pregnancy(10%)
4 October
2020

Contraindications
• Ovarian cyst- the cyst can increase in size
• Chronic liver diseases- metabolized in liver
• Scotoma
4 October
2020

Failure to Clomiphene
• In resistant case: Tamoxifen 20-40 mg daily for 5
days or off-label letrozole (2.5 mg daily for 5 days or
20 mg single dose on day 3) should be tried
• Failure to above therapy: FSH, LH or GnRH analogues
are used
• A woman with insulin resistance requires metformin
in addition
• For raised level of homocysteine, N-acetyl-cysteine
1.2 g may be added to clomiphene therapy
• N-acetyl-cysteine (NAC) is a mucolytic drug and
insulin-sensitizer 4 October
2020

Surgery
• Reserved for
– Medical therapy fails
– Hyperstimulation occurs
– Infertile women
– Previous pregnancy losses
– Surgery comprises laparoscopic drilling or puncture of not
more than four cysts in each ovary either by laser or by
unipolar electrocautery
– Restores endocrine milieu, improves fertility for a year or so.
– Pelvic adhesions caused by surgery may again reduce fertility
rate. 4 October
2020

Disadvantages of Surgery:
• Surgery involves anaesthesia and laparoscopy
• Adhesions may form postoperatively
• Premature ovarian failure due to destruction
of ovarian tissue if cautery is used. For this
reason, many now prefer simple puncture of
the cysts
4 October
2020

COMPLICATIONS IN PREGNANCY
Early miscarriage
Gestational diabetes
PIH
Preterm birth
4 October
2020

AYURVEDIC VIEW
gsrq
fyax
vkS”k/k
4 October
2020

“PCOS” though a syndrome can not b e
correlated to a particular disease.
An exact correlation is not possible.
No specific Yonivyapad with the above said
features is noted.
Conditions like Vandya, Arajaska,
Nashtartava, Artavakshaya and Puspaghni
Jataharini to some extent can b e related.
According to Acharya Sushruta the four
essential factors for the conception are
similar as the germination of a seed.
4 October
2020

1. Ritu:
Fertile period is more explained by Acharya Dalhana that Rutu means
Rajaha Kala i.e.ovulation period. – (Su. Sha 3/6 Dalhana
Commentary)
Deposition of the spermatozoa in the upper vagina should be in
appropriate time of the female cycle.
2. Kshetra:
Anatomically and physiologically adequate reproductive organs.
Vagina must be healthy.
Cervix and its secretion are also permitted to pass spermatozoa.
The oviduct must be patent and sufficient cilliary movement is present.
The uterus must be capable of supporting implantation and foetal
growth throughout pregnancy.
3. Ambu:
Proper nourishment to the body, adequate hormonal level and proper
nutrition is required for genital organs.
4. Beeja:
The adequate ovum & spermatozoa and the female‟s ovulatory
mechanisms must be normal. The male must produce an adequate number
of normal spermatozoa.
So in the concept of PCOS adequate beeja is not available.
4 October
2020

 iq’i?uh tkrgkfj.kh
o`Fkk iq’ia rq ;k ukjh ;Fkkdkya izi”;frA
LFkwyykse”kx.Mk ok iq’i?uh lk·fi jsofrAA
dk- la- d- 6
o`Fkk iq’i & Anovulation
LFkwyx.M & indirectly denotes obesity
ykse”kx.M & Hirsutism
4 October
2020

Aartava dushti and Aartava Kshaya:
Acharya have mentioned that Ashtartava dushti if
remains untreated or not properly treated then it causes
Abeejata i.e. unable for prajotpadana (Su. Sha. 2/3).
Acharyas have not described any specific etiology of these
eight menstrual disorders.
Vata get aggravated and causes „Dhatu- Kshaya‟.
because of this Dhatu Kshaya Rasa Dhatu decreases
and that ultimately causes the Kshaya of its Upadhatu
i.e. Artava Kshaya (Anovulation).
vkrZo {k; &
vkrZo{k;s ;Fkksfprdkykn”kZueYirk ok ;ksfuosnuk pA lq lw 15@12
4 October
2020

Avarana:
In the concept of artava-nasha, Sushruta and Vagbhatta
has described that both vata and kapha when
aggravated, obstruct the path, thus artava is destroyed
(A.S. Su.1/13).
Here artava can b e taken as Antapushpa. Here we
can take as anovulation. The Artava Vaha Srotas is
obstructed by the Kapha and Vata due to which Artava is
not visible (Ovulation does not occur).
It is also a Sanga Pradhana Vikara.
• vukrZo &
nks"kSjko`rekxZRoknkrZoa u';fr fL=;k% A lq-'kk 2@21
4 October
2020

Dietetic habit (Ka. Sa.) :
Besides all these reasons dietetic habits
also causes anovulation as mentioned in
Kashyapa Samhita Kalpa Sthana. Due
to ati Ushana veerya anna-pana artava,
beeja becomes upchita or vitiated.
अति उष्ण पानअन्नतनषेवने | रेिो असृक अंड उपचयश्च दुष्यिे||
का.क 7/
4 October
2020

funku
feF;kpkjs.k rk% L=h.kka iznq’VsukrZosu p A
tk;Urs chtnks’kkPp nSokPp J`.kq rk% i`Fkd~ AA
p fp 30
feF;kpkj & Abnormal lifestyle and diet
nq’V vkrZo & Hormonal imbalance
chtnks’k & Genetic and Familial tendency
nSo & Idiopathic
4 October
2020

u fg okrkn`rs ;ksfuUkkZjh.kka laiznq’;frA p fp 30
 PCOD occur due to vitiation of Vata. It is tridoshaja vyadhi
with vata and Kapha predominance
 Vata is responsible for ovulation so vitiation of Vata causes
anovulation
 Apana vayu vikriti results in amenorrhoea or
oligomenorrhoea
 Pitta – acne, alopecia, hirsutism
 Kapha – obesity, DM
 Aavarana may play a role in pathogenesis o f PCOS.
4 October
2020

➢ Dosha: Tridoshaj
➢ Dooshya –Medodhatu,rasa,rakta
➢ Strotus :artavvahashrotas,medovahastrotas
➢ Strotodusti –sangha mostly sometimes
atipravriti.
➢ Agni -manda atkostha and dhatu level.
4 October
2020

Examination of patient
4 October
2020
PrashanaSparshanaDarshana

Preventive Measure
 Nidana Parivarjana
 Rajaswala paricharya – a mode of living during menstruation is mentioned
various ayurvedic granthas
 it is observed that Aacharyas treated Rajakala as a natural shodhana kala,
leading to agnimandya. According to Ayurveda, menstruation is a naturally
occurring shodhana procedure occurring monthly so it is necessary to follow
pathya and apathya mentioned under shodhana therapy which are similar to the
rajaswala paricharya.
 Aim of this is avoid vitiation of vata and kapha, prevent formation of aama and
restore energy. Thus following rajaswala paricharya women respond healthily to
the physiological and psychological changes by keeping balance doshas, agni
and bala.
 Rajaswala paricharya is best example of nidana parivarjana chikitsa (Prevention
of diseases) so by following paricharya, we can counter the adverse effects of
present life style over reproduction by avoiding menstrual disorders.
4 October
2020

4 October
2020
Diet having following properties
1.Deepana
2.Pachana
3.Vata-anuloman
4.Karshana
5.Stokanna

Treatment protocol
Santarpana
janya
Aptarpana
janya
Santanechhuka
4 October
2020

Treatment protocol in Santarpana-
janya PCOS w.s.r to Insulin Resistance :
It is Amashaya Samutha Vyadhi ( arises from kapha sthana)
 Sthoulya chikitsa.
 Dhatwagni deepan.
 Kapha medo dusti chikitsa / Prameha chikitsa.
 Samshodhana- Vaman, karshan chikitsa, basti.
 The treatment principle is to clear obstruction in the pelvis,
normalize metabolism and regulate the menstrual system
(Aartava Dhatu). Kapha reducing, insulin enhancing and
hormone rebalancing drugs help to the relieve symptoms of Poly
Cystic Ovarian Syndrome.
4 October
2020

Treatment protocol in Apatarpana-janya
PCOS w.s.r to Menstrual irregularity and
Excessive Androgen Production:
It is Pakwashaya samutha vyadhi (arises from pitta sthana)
 Dhatwagni deepan
 Vata anuloman
 Treatment of Dhatukshya (lohitkshaya)
 Rasayana therapy
 Panchkarma- Nasya, Brahun chikitsa and Basti
 The treatment principle is to rejuvinate pelvis, normalize metabolism and
regulate the menstrual system (Aartava Dhatu). Vata anulomak, rakta
vardhaka and hormone rebalancing drugs help to the relieve symptoms of
Poly Cystic Ovarian Syndrome.
4 October
2020

Treatment protocol in Santanechhuka
PCOS w.s.r to Infertility
 After accessing santarpana janya or aptarpana janya pcos
 Panchkarma
 Uttar basti
 Meditation
 Positive environment (somnasya garbhdharnam)
 The treatment principle is to detoxify and rejuvenate body,
normalize metabolism and regulate the ovulation. Stanaya-
Shukra Janana and Shodhan drugs and hormone rebalancing
drugs help to have quality egg and sperm attaining ovulation and
achieving pregnancy with healthy progeny.
4 October
2020

 It is an in-depth Ayurvedic treatment which completely cleanses the
body, mind and emotions from toxins.
 It rejuvenates the body by reducing weight and restores regular
menstruation cycle and ovulation.
 It provides strength to the reproductive organs like uterus, ovaries,
fallopian tubes and vagina and maintains hormonal balance.
 Panchakarma protocol helps to high degrees in clearing much
pathology which inhibits fertility.
 Each person receives a unique combination of five processes according
to their specific health needs.
Role of Panchakarma :
4 October
2020

 Basti – Enema of medicated oil or Decoction is given through rectum which
helps in expelling vitiated vata. As In females oil Basti of “Sahachar Tail” or
“Narayana Tail” improves quality of ovulation within normal days.
 Vaman: It is a cleansing procedure intended mainly for the expulsion of
vitiated ‘Kapha’. This is a painless, drug induced emetic procedure. Vaman
procedure purifies internal toxins and balances hormonal system and
stimulates pancreas to secrete insulin in normal level, so PCOD decreases
accordingly.
 Virechan: It eliminates body toxins like vitiated ‘Pitta’. The process of
cleansing is carried out in the small intestine & other Pitta zones. Here drugs
that stimulate bowel movement are increased for the expulsion of doshas
through rectum.
 Nasya: it is a procedure of giving medicines through nose as it reaches
directly to brain so it helps in balancing of HPO axis.
 Uttarbasti : Uttara basti is the most effective treatment in gynecological
disorders. It helps in purification and clears the AartavaVahaSrotas, pacifies
vitiated ApanaVayu and improves follicular maturity. After proper
completion of uttar basti it has been observed that follicles do rupture
naturally without any hormonal injections.
4 October
2020

Yglqu ,j.डkfn d”kk;: Removes avarana and useful for reduction
in circulating androgens
lqdqekj d”kk; : acts on pakwashay, corrects apan vaigunya
Ok:.kkfn d”kk; : removes avaran, useful in insulin resistance.
Kanchanar guggulu –indicated in granthi
Kuberaksha vati - lasuna,latakaranj -indicated in granthi
Phal ghruta – corrects harmonal imbalance, regularies aartav
Rejuvenative and fertility enhancer………………………..
• fry]’ksyq o dkjoh DokFk $ xqM
• d`".k fry DokFk $ xqM
Shaman chikitsa :
4 October
2020

Commonly used medicines
 prqZcht pw.kZ
 iapdksy pw.kZ
 n”kewy DokFk
 EkgkjkLukfn DokFk
 jt%izofÙkZuh oVh
 pUnzizHkk oVh
 vkjksX;o/kZuh oVh
 u’Viq’ikUrd jl
 iq"i/kUok jl
 dkapukj xqXxqyq
 ;ksxjkt xqXxqyq
 uod xqXxqyq
 dqek;kZlo
 n”kewykfj’V
 v”kksdkfj’V
 ‘krkojh o ’kriq”ik dk
iz;ksx foQy vkrZo esa
crk;k gS& iku] uL;]
Lusgu] vH;ax] ofLr
4 October
2020

Probable mode of action:
v’kksd] n’kewy] v’oxa/kk] ,jaM] ‘krkojh & correct
the hormonal imbalance
dkjosYyd & increase insulin signaling and
peripheral glucose oxidation and decreases
hepatic gluconeogenesis
XkqMekj & overcome insulin resistance
yks/kz & decreases testosterone and cholesterol
Ukxds’kj- overcome hyperandrogenism
4 October
2020

पुनननवा-improves appetite, corrects digestive system,
removes excess kapha, balances kapha and vata, is
antioestrogenic, and corrects anaemia.
 बिल्व- pacifies kapha and vata dosha,is a very good
digestive restorative, it increases sugar tolerance and
decreases insulin resistance. It helps to keep insulin and
blood sugar levels under control.
लहसुन- reduces circulating androgens, optimises ovarian
function, and supports optimal endocrine function.
एरण्ड (castor)-pacifies vata dosha, cleanses the female
reproductive system (uterus), and acts carminative (expels
gas).
 nkSz.kiq”ih- Useful to dissolve the formations of cyst and
tumours.
घृतकु मारी-purifies the blood and stimulates the female
4 October
2020

Jeevaniya gana
Deepaniya gana
Brihniya gana
Lekhaniya gana
Satnaya janan and shodhana gana
Shukra janan and shodhana gana
Praja sthana gana
Aartava janan aushadhiya
Punsawana aushadhiya
4 October
2020

SEED CYCLING IN PCOS
4 October
2020
Calcium
Omega 3 FA
Zinc(fertility mineral)
Increases sperm-egg quality
PCOS fighting nutrients
Reduces risk of miscarriages
Supports good estrogen.
Calcium
Omega 6 FA
Zinc, magnesium
Plant sterols
Vit-E
Anti-oxidants
Controls cell damage
Supports progesterone(prevent LPD)

DIET AND LIFESTYLE
 Ayurveda advices to choose low Glycemic Index (G.I)
foods – such as Barley, cauliflower, tomatoes, onions,
peaches, apples, and grapefruit.
 Food timings must be fixed.
 Avoid all forms of refined sugar
 Salt restriction is another major aspect. Use of natural salt
like Saindhav (Himalayan Crystal Salt) gives more benefit
 Avoid sleeping after lunch or during daytime.
 Dinner should comprise of light foods.
 Avoid late night exposure to artificial lights.
4 October
2020

Yoga
 Relaxation is the key in Polycystic Ovarian Disease.
Posture’s designed for PCOD helps open up the pelvic area
& promote relaxation and strength to the entire reproductive
organs.
 Pranayama (breathing exercises) are powerful techniques
that help calm the mind.
 Yoga has several poses that aids in weight loss, relieves
stress and improves blood circulation to the ovary, thus
naturally curing PCOD. Yoga helps tone up the whole
reproductive system. Avoid stress and tension and gives
plenty of relaxation.
 Some effective asanas & pranayam for Pcod –
Sarvangasana, Padmasana, Ardhahalasana,
SuryaNamaskara , Shalbhasana, Kapalbhati, Anulom-
vilom, Bhramri etc
4 October
2020

Diet and Exercise
• In patients with PCOS who are obese, endocrine-
metabolic parameters markedly improve after 4 - 1 2
weeks of dietary restriction.
• Their SHBG levels rise and free testosterone levels fall
by 2-fold.
• Serum insulin and IGF-1 levels also decrease.
• Weight loss in patients with PCOS who are obese is
associated with a reduction of hirsutism and a return
of ovulatory cycles in 30% of women.
Moran LJ, Pasquali R, et all Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome
Society. Fertil Steril. Dec 3 2008;
4 October
2020

Diet and Exercise
• A moderate amount of daily exercise increases of
levels of IGF-1 binding protein and decreases IGF-1
levels by 20%.
• Modest weight loss of 2-5% of total body weight can
help restore ovulatory menstrual periods in obese
patients with PCOS.
• A daily 5 0 0 - 1 0 0 0 calorie deficit with 1 5 0 minutes
of exercise per week can cause ovulation.
• The AE-PCOS recommends lifestyle management as
the primary therapy in overweight and obese women
with PCOS for the treatment of metabolic
complications.
Moran LJ, Pasquali R, et all Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome
Society. Fertil Steril. Dec 3 2008; 4 October
2020

CONCLUSION
सूत्रस्थानम् 1.sūtrasthānam,-१. दीर्घञ्जीतविीयोऽध्यायः 1. dīrghañjīvitīyō'dhyāyaḥ, (S.-1, Ch.-1, V.-123)
योगमासां िु यो तवद्याद्देशकालोपपातदिम्|
पुरुषं पुरुषं वीक्ष्य स ज्ञेयो तिषगु्तममः||१२३||
Approach of Ayurveda is unique which refers to person-centered
point of view of an abiding health and preventing rather than
treating diseases.
4 October
2020

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