Ayurveda: The science of life.
Ayurveda, the ‘nectar’ provided for the living being by our eminent ancestors spreads its fragrance through all aspects of our life. This time tested ocean of knowledge offer us one of the basic needs of life- the health. This great science is the outcome of keen observation, generalization and analysis of humans in thousands of years by eminent scholars. It imparts great importance to the reproductive health of females.
Poly Cystic Ovarian Syndrome (PCOS).
Changing lifestyle, calorie rich food stuffs, inactive mode of life and heavy stress are part of everybody’s life nowadays. But women are more prone to be affected by these situations. All these factors influence women in a very negative way so as to challenge her mental as well as gynecological health. The Polycystic ovarian syndrome (PCOS) is thought to be the main disease caused by the altered life style in women.
PCOS is a very common endocrine disorder found in female community. It is thought to be heterogeneous in origin and have a wide range of clinical features. After long years of debate, Rotterdam criteria are now accepted for the diagnosis. Any of the two in three viz. Hyperandrogenism (clinical/ biochemical), Anovulation/ Oligo-ovulation and polycystic ovaries conclude the diagnosis with exclusion of other diseases such as Cushing’s syndrome.
In this condition, cysts on the ovaries prevent the ovaries from performing normally.
Symptoms of Poly Cystic Ovarian Syndrome include
- Amenorrhea or infrequent menstruation,
- Irregular bleeding,
- Infrequent or no ovulation,
- Multiple immature follicles,
- Increased levels of male hormones,
- Male pattern baldness or thinning hair,
- Excess facial and body hair growth,
- Acne/ pimples
- oily skin dark colored patches of skin specially on neck, groin, underarms (Acanthosis
- chronic pelvic pain,
- increased weight or obesity,
- lipid abnormalities,
- high blood pressure.
- Infertility and Subfertility
Infertility is the inability to conceive within one or more years of regular unprotected intercourse. Subfertility is the condition of being less than normally fertile though still capable of effecting fertilization. Women with PCOS usually experience either of these problems.
Fertility problems experienced by women with Poly Cystic Ovarian Syndrome may be related to the elevated hormone, insulin or glucose levels, all of which can interfere with implantation as well as development of the embryo. Increased Luteinizing hormone reduces the chance of conception and increase miscarriage. Additionally, abnormal insulin levels may also contribute to poor egg quality, making conception more difficult.
The basic underlying pathology is thought to be insulin resistance & hyper insulinemia, in the presence of normoglycemia. Women with PCOS have android obesity which is seen as waist to hip ratio greater than 0.85, and an increased BMI (Body Mass Index) (more than 25). It is associated with impaired glucose tolerance, Diabetes mellitus, increased androgen production rate resulting in decreased levels of SHBG and increased level of free testosterone and oestradiol.
The most appropriate correlation to this disease is Pushpaghni-Jathaharini of Kashyapa Samhitha according to Ayurveda. The symptoms are futile menstrual cycles, fleshy and hairy cheeks which resemble a typical PCOS patient. Kapha-vatha avarana( functions of Vatha dosha are blocked by kapha dosha) causing arthava nasa( amenorrhoea) which is explained by Susrutha Samhitha and can also be considered as PCOS. The treatment should be kapha-vatha hara and pithavardhaka (agneya dravya- drugs which promote Pitha dosha action) along with avoidance of causative factors. Life style modification is essential for the effectiveness of treatment.
Jaya Jadav, 32 years/ female/ Dwaraka, got an appointment in the center for her increased weight. At that time her weight was 84.6 kg. On detailed evaluation, it was understood that her menstruation was irregular for the last two years for which she was taking modern medicines including Oral contraceptive pills for the last one year. While taking the medicine menses were regular but experienced putting a lot of weight on. So, she stopped all medicines, then the menses became so irregular that it appeared once in two or three months. One more serious problem she had is that she could not conceive since her marriage 5 years ago. She tried every available treatment including IVF but was futile. So she was so hopeless that she stopped seeking cure for infertility. Her husband’s semen analysis was very normal, also no other physical abnormality were reported. Their sexual life also was normal.
On physical examination Acanthosis Nigricans , acne, facial and chest hair growth are also noted. On inquiry, severe hair fall also been identified. Her BMI was 29.6 which definitely fall under obese category. On nadipareeksha (pulse examination) vatha vitiation is noted. Tongue was coated and slight pallor also noted. Later an Ultra Sound Sonography (USS) was taken, it showed multiple small follicles on both ovaries and increased ovarian volume. Other reproductive organs were normal except a reduced endometrial thickness of uterus. Pouch of Douglas was clear. All these suggested she was suffering from PCOS. She was suffering from infertility as well, might be due to PCOS. The case was diagnosed as Infertility mostly due to PCOS.
Adopted treatment protocol
Kapha vatha dosha vitiation is significant in PCOS development. Apart from the genetic predisposition, ingestion of food that are sweet, sour, salty, oily and fried food can lead to kapha vitiation. Junk food, bakery items, ice creams, increased use of sweets and artificial sweetening agents and other calorie rich food can be considered as the above said materials which were the patient was very fond of. Expression and suppression of natural urges would lead to vatha vitiation. Psychological factors like stress, anxiety, depression etc also cause vatha vitiation. When most of the normal qualities of these doshas get altered, they may cause obstruction to the path of menstruation and can cause amenorrhoea or nashtarthava. The functions of pitha are inhibited. So the treatment here should be done with kaphavata pacifyng and pitha increasing drugs. So the treatment was planned and executed as follows.
- Powder massage- with thriphala choorna- 7 days
- Snehapana/ internal oleation with mahanarayana oil- 5 days
- Abhyanga and swedana – external oleation and sudation- 2 days (oil- dhanwantharam
- Vamana(medicated vomiting therapy)-1 day with milk and madanaphala pippali
- Peyadi krama – gradual increasing of heaviness of food ( 3 days)
- One day rest
- Again external oleation and sudation for 14 days
- Nasya- with anutaila for first 7 days, then with ksheerabala 101 avarthi next 7 days.
- Yogavasti (oil and decoction enema in a special way)- which included 4 decoction enema
and 4 oil enema.
- Uthara vasti- keeping of oil in the vaginal region- with mahanarayana taila-7 days in the
morning and evening.
Pacifying medicines were also given in the proper period. They were,
- Sukumaram kashayam
- Saptasaram kashyam
- Varanadi kashayam
- Arogya vardhini rasa
- Agnikumara rasa
- Amritha guggulu
- Dhanwantharam taila drops
- Brihat thriphala choorna at bedtime
The treatment was over after 33 days, then she was advised to continue with the internal medications for next three months. She was asked to give the follow up visit every month. Strict vegetarian diet and regular aerobic exercises were advised. Specific Yoga exercises like Surya namaskar, Bhujangasana, Noukasana and Shavasana were also advocated to do on a regular basis. In addition, she was advised to indulge in sex every possible alternative day. This was because of uncertainty of her ovulation day. Early to bed and early to rise, to have dinner by 7 pm, no sweets and bakery items, no fried items, no raw vegetables and avoiding stress were the Ayurvedic life style modification advised to her.
Outcome of the treatment
The patient gained her confidence after the treatment. In the first month itself, she seemed to be energetic and hopeful. Her weight has considerably reduced by the second month. BMI reduced to 25.5, she had a normal menstruation in the second month. Her blackish color of back of neck and flexures were reduced. There was no change in facial hair growth. In the third month, there was no menstruation. But on the fourth month she felt tiredness and vomiting tendency. When she underwent a urine pregnancy test it was found to be positive. She was directed to take an Ultra Sound Scan and her pregnancy was confirmed. She stopped all the medicines and started with mahadhanwanthara tablet and bhadradi kshayam along with iron tablets and folic acid.
It was evident that the suggested Ayurvedic treatment, changed life style and diet was effective in treating her infertility issues in this case. As Ayurvedic science recommends specific life style and dinacharya (daily routine) for prevention of disease and healthy living, the life style modifications along with various ayurvedic treatments and specific diet was definitely instrumental to overcome her infertility problem. In this case, she has strictly followed every advice which was given to her and religiously taken all the Ayurveda medicines apart from various treatments she was subjected to. Even though we cannot conclude that Ayurveda will be effective in every infertility case due to PCOS, Ayurveda is a time-tested life-science which can do a great help to those who suffer from problems like infertility due to PCOS, provided they follow strict Ayurvedic diet and regimen along with other suggested treatments.