Polycystic ovaries, means that the ovaries develop more follicles than normal every month. Usually about five follicles start to mature during each menstrual cycle and at least one egg-containing follicle releases a mature egg at ovulation. But a polycystic ovary starts maturing at least twice as many follicles than normal, most of which enlarge and ripen but do not release an egg. It is estimated that between 22 and 33 per cent of women have polycystic ovaries. Some women go on to develop polycystic ovary syndrome (PCOS), which means they have other symptoms in addition to polycystic ovaries. Other names for this syndrome include polycystic ovary disease (PCOD), functional ovarian hyperandrogenism, Stein-Leventhal syndrome (original name, not used in modern literature), ovarian hyperthecosis and sclerocystic ovary syndrome.
PROBABLE CAUSES AS PER MODERN DATA
The real cause is still unknown to experts. However, research indicates that the root of the problem is most probably resistance to the hormone insulin, which means you need more insulin than usual to regulate the levels of sugar in the body. The extra insulin causes an imbalance in the hormones that usually make your menstrual cycle run smoothly. Too much luteinising hormone (LH) is produced compared to follicle-stimulating hormone (FSH), which in turn causes the follicles on the ovaries to produce more of the male hormone testosterone than the female hormone oestrogen. The adrenal glands start to produce increased amounts of testosterone as well. Too much testosterone prevents ovulation, along with other symptoms related to the syndrome. Oestrogen is still produced but, because the follicles never get to the point of maturity when progesterone production starts to increase, women with PCOS can be deficient in progesterone. PCOS may be hereditary as well. Studies show that women with a family history of polycystic ovaries are 50 per cent more likely to develop PCOS. SYMPTOMS Irregular, non-existent or infrequent periods within three or four years of starting to menstruate. Light or very heavy bleeding during your period Weight gain Excessive hair growth to varying degrees on your face, chest and lower abdomen Mild to moderate abdominal discomfort during periods Acne Excessive skin growth on your neck or in your armpit, also called as skin tags. Bone pain (Arthralgia) and Hair loss (Alopecia), Thinning of Hair. Constipation, indigestion, flatulence
SECONDRY DISORDERS DEVELOPING DUE TO PCOS
- High blood pressure Dyslipidemia (high level of blood cholesterol , trigylecrides)
- Cardiac disorders
- Liver disorders
- Insulin resistance and type 2 diabetes
- Sleep apnea
- Infertilty and Miscarriage
- Thyroid disorders
TREATMENT BY ALLOPATHY [MODERN MEDICINE]
Allopathy treats the condition on lines of Hormonal imbalance and the major treatment includes HRT (Hormone replacement therapy) where subsequent hormones are administered after proper evaluation of the patient. Diet and exercises are also recommended. Additionally there is a growing belief that PCOS occurs due to malfunction of the hormone insulin which builds up resistance in tissues causing weight gain resulting in estrogen malfunction and henc Diabetic drugs like metformin may also be prescribed by your doctor for the same. Surgery is also an option exercised where the ovary is punctured or the cystic tissue obove the ovary is destroyed for better hormonal gain. All this have their own after-effects , most time irreversible and one must evaluate all options about it by asking your doctor and personally researching . This rule not only applies to Allopathy but also to other streams of medicine as after all its your body.
OVARIAN CYST AND CANCER EVALUATION
Many times in a grown cyst, doctors may order for blood test like CA125, CA15 etc to rule out the cyst turning cancerous. Once found thy may advise to do biopsy of the cyst by taking a sample by laparoscopy or even suggest to do complete hysterectomy . Remember there is no direct evidence that these markers are definitive and hence one must not haste in going for invasive procedures as once done they are non reversible. I have found many ovaries go bust after these procedures. Though i am not generalising this, on must take 2-3 opinions before going ahead unless the diagnosis is definitive. You can try the remedies mentioned below for few weeks to see if there are improvements or consult a good Ayurveda physician to see if this can be reversed naturally. However do exercise all options with proper research and care.
CERTAIN BLOOD TEST RECOMMENDED AND THEIR INTERPRETATION
AMH : to determine ovarian reserves, high value most times indicates PCOS but needs to be checked with other hormones like FSH. Low value may determine path towards infertility)
FSH :Mostly done together on 3rd day of menses to see the response of brain to stimulate growth of follicle.A high FSH score indicates a low or declining egg supply (ovarian reserve).
Estradoil : his test is used to confirm the results of a day 3 FSH. A high estradiol level may artificially lower (or mask) what otherwise would be a higher (potentially abnormal) FSH.
LH : Done during midcycle to determine about ovulation. A midcycle rise is a good indication that ovulation will occur approximately 24 hours later.
FSH/LH ratio (determined to check the proper process of ovulation.)
DHEA-S : high values indicate towards abnormal seceretion of male hormones or androgens which can lead to facial hair
FREE and TOTAL TESTOSTERONE: Total indicates the degree of hyperandrogenism (over production of male hormones) in women. Mild to moderately high levels are associated with conditions such as PCOS or adrenal hyperplasia. Persistently high levels of total testosterone indicate androgen- producing tumors in the ovaries. Free elevation of testosterone levels is a sign of hyperandrogenism (over production of male hormones). It causes an increase in luteinizing hormone (LH) that leads to an increase in the ratio of LH to FSH. An elevated LH:FSH ratio results in major changes to a woman’s cycle and fertility functions.
SHBG :This protein is responsible for binding the majority of testosterone in the blood into a specific complex. Low levels of SHBG indicate insulin resistance and provides an explanation for elevated levels of Free Testosterone a thing found in PCOS
17-OH: Used to identify why an adult female may be infertile or have excess hair growth (hirsuitism). Deficiencies may increase androgen levels leading to masculine characteristics and interfering with ovulation. Many women with PCOS have exaggerated ovarian 17-OH progesterone secretion. It can also be used to identify possible disorders in the adrenal gland such as Congenital Adrenal Hyperplasia (a group of inherited disorders associated with abnormal metabolism of adrenal gland hormones).
S.INSULIN: To determine insulin resistance
Hb1AC: To determine glucose control and utilization
TSH, FT3, FT4: To determine functionality of Thyroid gland
Prolactin : A hormone that stimulates the production of milk in breastfeeding women. Increased prolactin levels in women not breastfeeding may interfere with ovulation and fertility.
CrP: To ascertain levels of chronic inflammation which may cause insulin resistance
Follicular Study: A ultrscan to check the process of Ovulation
Hormone therapy further depletes the already taxed Endocrinal system and puts it to sleep. The hormones that are meant to be naturally released by the body, now provided with artificial means pushes the body into lazy mode. The HRT treatment may provide excellent results period over a short but over time can lead to irreversible metabolic damage. For a good quality of life relief on following lines must be procured
- Gradual Weight loss with emphasis on loosing inches and not number
- Regular menstrual cycle, devoid of cramps, good menstrual flow.
- Cure from prolonged menses , scanty menses, prolonged menstrual flow are common symptom in such disorder
- Alleviation of symptoms like pre-menstrual swelling, hair loss, acne
- Good mental health with freedom from irritability, mood swings, indecisiveness’
- Promotion of fertility with production of healthy eggs and good uterine health
Following are some useful Ayurveda tips in terms of diet, lifestyle and medicines which help in a major way to alleviate this disorder.
Daruhaldi roots (Berberis aristata; entire about 600 gms),
Arjun bark (Terminalia arjuna; about 300 gms)
Divide both of these into 60 equal parts. Now boil 1 part every morning in 3 cups of water (approx 150ml) and reduce to 1 cup. Now filter this mixture and consume empty stomach in the morning. Repeat fresh in evening
Deodara [Cedrus deodar] bark 40 gms
Boil the bark in 500ml of water and reduce it to 50ml. Consume this tea on empty stomach 3 times away. One can use the same bark for all three times or use fresh as per liking. This is very good remedy.
Punarnava [Boehravia repens] root 30gms
Gokshur [Tribulus terresteris] 10 gms
Prepare an herbal tea as mentioned in MEDICINE 2 and consume fresh 3 times a day on empty stomach
IF FAILED TO ACHIEVE MENSES WITHIN 30-40 DAYS
10gms Nagkeshar (Mesua ferra )
10gms crystal sugar (Khadisakhar, Mishri) 10gms
Cow’s ghee (Clarified butter from cow)
Above herbs be mixed and consumed with milk once a day. The above combination is for one day. If the periods do not commence even after this medicine then do not worry. Keep taking the above medicine. Eventually they will come and with proper ovulation. Many women may vomit after taking this medicine which may continue through the day. Do not worry if you vomit its a sign your ovaries are responding. Take the mixture with honey [minus the sugar] or take it once a day or divide into 2 doses.
Hermal seeds [Peganum Hermala]
Take 1gm of powdered seeds with honey and follow it with 1cup of warm cow’s milk. Do not add sugar in milk
CAUTION These seeds can cause dizziness in some and hence discotinue or reduce the dose if symptoms occur.
Boil 5 gms black sesame seeds in 100 ml water and reduce to 50 ml. Filter add organic jaggery and take 2 times a day empty stomach. This simple remedy can be continued till proper menses is achieved and works most of time. However couple this with diet mentioned below or else one may find increase of heat in the body.
PROLONGED MENSTRUAL BLEEDING
Many women who suffer from PCOS suffer from prolonged bleeding once menstrual cycle commences. Pomegranat fruit rind 10gms fresh Prepare a herbal tea as described in MEDICINE 2 and intake 2 -3 times a day
Vasa [Adhatoda vasica] leaves, dry them and powder. Take 3gms with honey 3-4 times a day. This helps arrest bleeding quickly. If fresh leaves are available, steam them and crush and squeeze to express its juice. Take 30-40ml 2-3 times a day. Vasa is also known as Adulsa and is a common hedge plant.
Alum [Turti/ Fitkari]
Alum is an excellent medicine used in Ayurved to stop bleeding. Alum first needs to be purified. Soak and dissolve Alum in water and let the water be for few hours till it evaporates leaving behind alum in purified state. Crush this alum and roast it in an iron vessel which will make it swell and then collapse into a powder form. This alum medicine is now prepared. Take 1/2 gam of this powder with 10gms crystal sugar and 50ml water 2-3 times a day till bleeding stops. This is a very effective remedy i use in my practice. One can purchase purified alum powder from an genuine Ayurved store if required. Adiitionaly soak alum in water medicated by boiling Areca Nut [Supari, 100gm to 1lt water and filtering]. Soak a piece of cotton in this and keep it in vagina which will help
White Silk Cloth Ash
Burn a piece of pure white silk in a closed vessel. Once reduced to ash , take 1pinch of this ash with honey 2 times a day. This helps arrest bleeding. Stop this medicine once bleeding stops.
Apple Cider Vinegar [ACV] with Mother
Take 20ml of the vinegar and dilute with 200 ml of water. Consume this 2 times a day on empty stomach. This is a very good remedy. Please see to it that you buy the ACV with “mother” and not refined one. Also rinse our mouth thoroughly after you consume as ACV can corrode your teeth enamel. You can use straw.
This remedy can also be taken as a maintain dose along with other remedies mentioned above. On empty stomach and at bedtime take 10 ml ACV with 5ml organic unpasteruised honey and 200 ml water. This is very good to dissolve cyst along with other remedies of Ashwagandha or Deodara as mentioned.
Black Strap Molasses [BSM] unsulphered
BSM is another good remedy I have found do dissolve cyst in certain cases. One can combine BSM with ACV by replacing it with honey as mentioned above or one can use BSM. 5 ml with 250 ml of milk 2 times a day. This along with diet mentioned and other herbs is helpful. However do get an USG (sonography, ultrasound) done periodically to check the progress.
This is an allopathic/modern medicine which is a fibronylytic agent [it clots blood]. In cases of emergency when the blood loss is severe or not being controlled one can take this pill 500mg 2 times a day. This is a safe non hormonal option. However do consult your gynecologist or doctor before taking this.
(I will be discussing more simple remedies to tackle thus problems in my other article related to “MENSTRUAL DISORDERS”)
DIET AND LIFESTYLE
- Food timings must be fixed.
- Salt restriction is another major aspect. Prepare food without salt. Add salt while eating in minimal quantities. Use of natural salt like Saindhav (Himalayan Crystal Salt) gives more benefit
- Avoid sleeping after lunch or during daytime. Preferably have you evening meals before sunset or when there is ample sunlight. Avoid eating heavy food after dark. One can have fresh fruits though. Always drink warm water intermittently while having food. This simple practice will help loose weight very quickly.
- Strictly avoid Bakery products, chilies, pickle, yoghurt and vegetable belonging to th Solanaceae family [Brinjals, Broccoli]. These products instantly cause swelling in the reproductive system. With regards to diary products keep it to bare minimum, use cow,s milk only diluted with water and medicated with cardamom to cut down risk.
- Castor oil massage which I recommend to be done regularly. Warm castor by placing bottle in warm water. Massage in circular motion over the ovaries every night. Plus soak a swab in the oil and place it in navel before sleeping. This is very effective. In case of women who have big cyst on a particular ovary can apply castor oil packs. Castor oil packs are different from massage. One can search on the net how to prepare them, hre are plenty of self help videos.
- Dinner should comprise of light foods , lots of carrot and parsley. Salt again must be restricted if not using Himalayan Crystal salt
- Salt and Sugar plays a major role and the minimal usage the better. In my clinical practice I recommend the patient to go on a complete salt restriction for at least 10 days on commencement of treatment and then reintroduce.
- Avoid all forms of refined sugar. Even fruit juices which contain fructose. Have fruits like Papaya, Musk melon etc low on fructose. Reduce your insulin spikes. Do not eat after sunset. If you find cravings for sugar cut coconut rind [entire one with oil in it] and eat. It is highly beneficial
- Stay away from Copper. Do not use any vessels of Copper
- Check your fasting Insulin levels and do Iron studies. Your ferritin levels must be ideally between 40-70 [normal range 15-150] and S.iron must be above 80. If not your mineral imbalance may cause problems. Through Ayurveda Bhasma this is effectively corrected in very short time but supervision is required. Do not self medicate.
The lifestyle modifications are identical to ones I describe in my other articles regarding Thyroid , Breast cancer and Endometriosis the reason being all these disorders have common metabolic anomalies and one must research in the diet to get good control of Estrogen. as these all disorders mostly happen due to Estrogen malfunctions.
For prolonged health care it would be recommended to visit an Ayurveda physician and get a customized health plan evaluated. I am also listing certain generic Ayurveda preparations that may be prescribed for the said disorder
- Ashwagandhaarishta, Ashokasrishta, Kumariasav, Chandraprabhavati, Pushyanug churna, Phalghrita, Raupya Bhasma, Vang Bhasma, Abrakh Bhasma, etc. may be advised by your Ayurveda doctor.These Medicines, their contents and Preparation methods can be checked at the NATIONAL LIBRARY OF AYURVEDA MEDICINE websitehttp://nlam.in/
- Panchakarma techiniques like Basti, Uttar Basti, Vaman, VBirechan, Nasya are also undertaken
Paschimuttanasan, Pawanmuktasan, Shalbhasan in a proper sequence are very helpful. Yoga in all auto-immune disorders helps immensely as it changes glandular and hormonal functions. Yog done without use of Bandhas is of no use and hence I would recommend patients to undertake Yogic exercises under supervision of an Ayurveda consultant as Yoga is a part of ayurveda and it requires proper knowledge of body functions and Marma points. Do not undertake exercises advertised or from word of mouth as testimonials. What works for others may not work for you. More importantly understand what one is trying to achieve and combine it with proper lifestyle and medication under expert guidance so that the overall quality of life increases. As project of NLAM, elite Hatha Yog sequences of therapeutic nature are being taught under the Marma Yog cluster. Yog Teachers who wish to gain the knowledge can know more about it at [www.marmayog.in].
MENSTRUAL SPOT TEST
As a part of my Ayurveda regime, I always recommend each women to do this self test at home to check the menstrual health. During menses on all three days take a small amount of menstrual blood on a clean white cloth and allow to dry. After few minutes wash it with warm water. The blood should wash away without leaving behind any stain in normal hormonal profile. If stains are left than it indicates disrupted or about to be disrupted cycle.
Apart from above remedies, Ayurveda mentions certain protocols to be followed during menses.
- Salt free diet for first 3 days
- Abstain from any physical work
- No bathing or only sponge clean the body with water medicated with Neem [Azadhiracta India], Nirgudi [Vitex app] or Mint [Mentha sp.] leaves
- Light food preferably comprising of watery gruel’s
- On the 4th day have complete head bath and start with normal food
If these protocol is followed especially for women with Hormonal disorders it can rest assure a healthy life ahead. Understand all remedies mentioned , select ones which re easy to follow for you over period of time, create a protocol with diet and follow it religiously to see improvement.
A sample protocol would be
Before sunrise :Daruhaldi/ Deodar remedy
Breakfast 8am : fruits and carrot juice
10 am : Sesame decoction [only till menses regularizes]
12 pm: lunch with minimal salt
4 pm : Daruhaldi/ deodar
6 pm : dinner (bfr sunset)
7pm: Sesame decoction [only till menses regularises]
8pm : rice water
10 pm : Harada[Terminalia chebula] powder 5gms with 1 cup warm water mixed with warm Castor oil [unrefined]. Adjust does as per bowels
During menses continue above but leave salt and take the menses decoction as additional.
Avoid any Yog asan or Pranayam during menses or uncontrolled bleeding
This is just a sample and will help if followed meticulously. For those trying to conceive have maximum intercourse to simulate ovarian function. More than everything keep faith and patience, do not rush and keep changing physician. Ovarian build up and conception take time and must be gradually proceeded with. Of course each person requires individual treatment and some extra medicine which can only be availed by visiting a good Ayurveda physician , hence do so of conditions improve. Also discontinue or consult your physician if conditions do not improve.