Hahneman Ki AAwaz posted on 13.08.2019
PCOS is the most common endocrine disorder in women. It affects up to 10% of women of reproductive age.1 This disease was discovered by Stein and Leventhal in 1935.2,3,4,5 It is clinically represented by amenorrhea, hirsutism and obesity associated with enlarged polycysticovaries.1,2,3,4,5 The insulin resistance with hyperinsulinaemia initiates PCOS in 50-70 % cases.5
EPIDEMIOLOGY AND PREVALENCE-
Approximately, 10 million women globally suffer from PCOS. 1in every 4 women suffer from PCOS and yet half of these women go undiagnosed; PCOS undiagnosed is because it doesn’t cause pain in most cases.6
In India, one in every 10 women suffers from PCOS, a common endocrinal system disorder among women of reproductive age, according to study by PCOS society. Out of every 10 women diagnosed with PCOS, six are teenagers.7
· Genetic and familial environment factors: the environmental factors may function in utero or in eary adolescent life, manifesting clinically a few years later as PCOS. CYP21 gene mutation has been discovered in this connection.5 A high prevalence of PCOS in first degree relatives is suggestive of genetic influences. In addition greater concordance has been reported in monozygotic twins versus dizygotic twins.8
· PCOS has been attributed to several causes including change in lifestyle, diet, and stress.4 The principal biochemical abnormalities in most patients are excessive production of androgens, and low levels of pituitary follicle stimulating hormone (FSH).3
· The ovaries of PCOS women seems to be particularly sensitive to high blood level of insulin and respond by overproducing androgens.4
· Insulin resistance and hyperantrogenamia are responsible for increased pulse frequency of LH.2 And this LH to cause thecal hyperplasia and secrete androgens, testosterone and epiandrostenedione. Epiandrostenedione is converted in the peripheral fat to oestrone. This level leads to rise in the oestrogen and inhibin level.5
· This over production responsible for hyperandrogenism resulting anovulation was initially thought to arise primaliy in ovaries.2.4,5
· Ovulation does not take place because the egg could not develop properly and the immature egg, instead of being released from the ovary, become a tiny cyst that starts producing its own supply of endrogens.4
· The ovarian volume is increased >10cm3. The capsule is thickened pearly white in colour. Presence of multiple follicular cyst measuring about 2-9mm in diameter.2,3
· The ovaries are usually involved bilaterally and are at least twice the size of the normal ovary.3
· Oligomenorrhoea, amenorrhoea
· Acanthosis nigricans is due to insulin resistance. The skin is thick and pigmented (grey brown). Commonly affected sites are nape of the neck, inner thighs, groin and axilla.2,4,5
PCOS requires the presence of two of the following three features: menstrual irregularity, clinical or biochemical androgen excess, multiple cysts in the ovaries (most readily detected by transvaginal ultrasound.2,4,5
· Ultrasound- Presence of 12 or more cysts of 2-9 mm in subcapsular region.2,4,5
· Biochemical test2,4,5-
a. Elevated Fasting insulin level<30 mu/1
b. Increased Fasting blood sugar
c. Raised total and free testosterone (normal 20-30ng/dl)
d. Decreased Sex hormone binding globulin(16-119)
e. Free androgen index
f. serum prolactin increased(normal<20ng/ml)
g. Thyroid stimulating hormone
h. Lipid profile
· Laparoscopy– Bilateral polycystic ovarian are characteristic of PCOS.1,2
MANAGEMENT- PCOS is usually treated with lifestyle modification and medications.
General management of pcos-
1. Weight loss– It is a very good therapy along with changes in lifestyle and must be initiated as a part of treatment plan for all patients of PCOS. The aim is weight loss 5-10% and BMI of <27.4,5
2. Diet– Diet modification is advocated. Foods recommended are of low glycemic index, limiting simple carbohydrates complex and foods high in poly saturated fatty acids are advised.4
3. Exercise – 30 to 60 min/day, moderate physical activity is required.4
4. Life style- cigarette smoking should be abandoned. It lowers E2 level and raises DHEA and androgens level.4,5
ACONITE NAPELLUS – vagina dry, hot and sensitive, menses too profuse with epistaxis.9Menses suppressed from fright, cold in plethoric subjects. Ovaries congested and painful. sharp shooting pain in womb. Ovaritis from sudden checked menstrual flow.10
APIS MELLIFICA- edema of labia, relieved by cold water. Soreness and sticking pains; ovaritis, worse in right ovary.9 Ovarian tumor, ovarian cysts, with sticking pain. Ovaries numb or congested with suppressed menses. Pain in ovaries worse by sex.10
LACHESIS MUTUS- uterine and ovarian pains , all relieved by the flow. Ovarian tumors. Left ovary, swollen indurated, painful, must lift covers. Nymphomania . leucorrhoea , copious, smarting, staining and stiffening the linen greenish.10 Menopausal troubles like palpitations, hot flushes, hemorrhages, vertex headache, fainting spells.9
LYCOPODIUM- menses of clots and serum, discharge of blood from genital during stool. Vagina dry, burning, worse during and after sex. Cutting pain from right to left ovary, ovarian tumors, dropsy. Dropsy of uterus . menses suppressed for months. 9,10
MAGNESIA PHOSPHORICA- membranous dysmenorrhoea. Mencse too early, dark stringy or tarr, flowing in night leaving a stain. Ovarian neuralgia. Vaginismus. 9,10
MEDORRHINUM- intense menstrual colic, better pressing feet against support. Menses offensive, profuse, dark, clotted, stains difficult to wash out. Drawingin ovaries better pressure. Ovarian pain, worse left side or from ovary to ovary.9,10
PODOPHYLLUM- pain in uterus and right ovary with shifting noises along ascending colon prolapsed uterus.9 Ovarian tumor with pain extending to shoulders. Pain in the region of ovaries, down the crural nerve worse stretching the legs.10
ZINCUM METALLICUM- ovarian pain specially left, can’t keep still, nymphomania of lying in women. Menses too late, suppressed, lochia suppressed menses flow more in night.7 Female symptoms are associated with restlessness, depression, coldness, spinal tenderness and restless feet. All complaints better during menstrual flow. 9,10
1. Davidson S. Davidoson’s principles and practice of medicine. Churchill livingstone Elsevier:Edinburgh;2014.
2. Dutta DC. DC Dutta’s textbook of gynecology. The health sciences publisher: New Delhi;2016.
3. Mohan H. Textbook of pathology. The health sciences publisher: New Delhi;2014
4. Padubidri VG, Daftary SN. Howkins and bourne.Shaw’s textbook of gynaecology; Reed Elsevier: New Dehli;2011.
5. Salhan S. Textbook of gynecology. Jaypee brothers medical publishers: New Dehli; 2011.
6. Over 10 million women suffer from PCOS globally. Times of India [newspaper online] 2018 Sep 20 [cited 2019 Feb 13]. Available from: https://timeofindia.indiatimes.com.
7. Kulkarni G. Of every 10 women with PCOS, six are teenagers. The new Indian express [newspaper online] 2018 Sep 13 [cited 2019 Feb 13]. Available from: www.newindianexpress.com.
8. Sirmans SM, Pate AK. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology. Dove Medical Press limited. 2013 Dec 18 [cited 2019 Feb 14]. Available fromhttp://www.ncbi.nlm.nih.gov.
9. Boericke W. Boericke’s new manual of homoeooathic materia medica with repertory. B. jain publishers: New Dehli; 2000.
10. Murphy R. Lotus material medica .B jain publishers: New Dehli; 2002.
Homoeopathy University, Jaipur
*Corresponding author- Pooja Sharma; [email protected]