Introduction

Polycystic ovary syndrome (PCOS) was originally delineated in 1935 by Leventhal and Stein.^[1] PCOS is one of the most common endocrine disorder of women in their reproductive period manifested by irregular menstrual cycle and polycystic ovaries; excess unwanted hair and baldness, although not all patient have all these features. The term ‘polycystic’ means ‘many cysts’ and PCOS gets its name because of the clusters of small, pearl size cysts in ovaries. These cysts are fluid filled bubble (called follicle) that contains eggs that have not yet been released because of the hormonal imbalance. Many women with PCOS demonstrate challenges of feminine identity and body image due to obesity, acne and excess of unwanted hair; also infertility and long-term health related concerns that compromise the quality of life and adversely affect mood and psychological well-being.

PCOS is a heterogeneous endocrine disorder that affects about 5% of women worldwide.^[2] The prevalence is 9% and average age of onset of depression is 31.9 year in Nepal.^[3] Up to 40% of women with PCOS develop either impaired glucose tolerance of type 2 diabetes by age of 40.^[4] Large amount of testosterone is secreted in PCOS which possibly prevent ovaries from releasing an egg each month, thus causing infertility, which may be the result of high levels of insulin that stimulate ovaries to produce excess testosterone. High testosterone levels can also cause excessive hair growth, stimulating male pattern baldness and acne. In patient with PCOS, insulin resistance causes fat deposition and excessive production of testosterone.^[5]

The cause of PCOS is unknown, but studies suggest a strong genetic component that is affected by gestational environment, lifestyle factor or both. Women who have PCOS are at an increased risk of cardiovascular disease, diabetes and pre-diabetes, endocrinal cancer, heart attack, hypertension, high level of low density lipoprotein and low levels of high density lipoprotein.^[6]

In Ayurvedic classics there is no direct mentioning of this disease rather, symptoms are found under various diseased conditions at various references i.e., menstrual irregularities are described under broad heading of Ashtoartavadushti, while descri-ption of infertility due to anovulation is scattered.

Personal history

Her appetite was good. She drinks 3-4 glass of water daily. Tongue was mildly coated and dry (Alpa Sama).

She passes hard stool and there is constipation. Her bladder habit is normal and she is vegetarian. There is no significant addiction.

Treatment History

For the present illness, patient went to allopathic hospital for treatment, but she didn’t find the relief in symptom. So, she visited OPD of Streeroga and Prasutitantra of P.D Patel Ayurved Hospital, Nadiad.

Menstrual History

Her menarche was late at 16 year, it was irregular menstruation.

Mental state examination

She was normal and cooperative.

Clinical Examination

Built - height - 145cm, weight - 45Kg

Pulse - 76/min; BP - 120/80mm/hg

Systemic examination

No any abnormality was detected in gastro-intestinal, cardio-vascular, nervous and respiratory system examination.

Diagnosis

Diagnosis was done clinically by following symptoms as per Rotterdam criteria.^[8]

• Irregular menstrual cycle
• Abnormal menstrual cycle
• Oligomenorrhea
• Poly cystic ovary on USG

According to Ayurveda Samprapti Ghatak:

• Hetu: Divaswapna, Avyayama, Ruksha Ahara Vihara, Abhishyandi Ahara Vihara.
• Dosha: Kapha, Vata
• Dushya: Rasa, Meda, Mamsa
• Strotas: Rasavaha, Medavaha, Artavavaha Strotas.
• Pratyatma Lakshana: Artavkshaya, Staulya.

Changes in Blood investigation and USG

These cysts occur when regular changes of a normal menstrual cycle are disrupted. The ovary is enlarged and produces excessive amounts of androgen and estrogenic hormones. Various drugs that are used in this case are discussed below:

Rajapravartani Vati

Rajapravartanvati has Katu, Tikta, Laghu, Snighdha and Tikshna Guna, Katu Vipaka and Ushna Virya. Tikta Taste and Tikshana properties. This drug will remove the Srotoavarodha and facilitates flow of Vata; Katu Vipaka and Ushna Virya pacifies the aggravated Vata and thus allow the painless flow of Artava.

Dhashamula Kwatha

Most of the drugs are having Tikta, Kashaya Rasa, Ushna Virya Laghu, Ruksha Guna and Vata hara properties which helps in alleviating the diseases of Vata. Also, it acts as Amapachana and removes the Avarana of Kaphadi Dosha. Drugs like Gambhari, Gokshura, Brihati, and possess properties such as Garbhashaya Shodhaka which helps during pregnancy and restores energy in women after delivery. Drugs having Shothahara properties help to alleviate Shotha associated with Vata disorder.

Katuki

Katuki has been widely known and used as hepatoprotective agent. In liver injury mainly kuffer cells cause problems in regeneration process and it here when extract of this plant plays its role by supporting cells. This plant has been currently used in treating liver disease, viral hepatitis, ischemic injury, cirrhosis, radiation toxicity.

Sathapushpa Churna

Shatapushpa have Katu, Tikta and Madhura Rasa. Katu Rasa has Agneya properties and Tikta Rasa has Deepan properties, which improve Jathragni Daurbalya and from Nirama Rasa Dhatu and helps in Artavkshaya. Tikta Rasa also has Lekhana properties due to this it work on Avarana and improve Picchila and Kleda properties of Kapha Dosha. Ushna Virya of Shatpushpa removes Srotoavarodha and increase the blood circulation in the Yoni and Garbhashaya, due to this Garbhashaya gets proper nutrition which helps formation of healthy endometrium and thus menstrual cycle become normal in amount, duration and interval.^[10]