Polycystic Ovary Syndrome - A Case Report

Introduction

Acne vulgaris is a chronic inflammatory disease of pilosebaceous units. It is one of the most common conditions affecting adolescents. The pathogenesis of acne is multifactorial and complex.¹ Seborrhea or increased sebaceous gland activity, dependent on and rogenic sex hormone is mainly of adrenal or ovarian origin.² The polycystic ovarian syndrome (PCOS) has the highest prevalence in acne.³ It is a heterogeneous condition which is defined by the presence of two out of three criteria i.e., anovulation, polycystic ovaries, hyperandrogenism.4 In recent years, the clinical definition of PCOS has changed and includes manifestation of hyperandrogenism, chiefly acne vulgaris, hirsutism, alopecia and acanthosis; acne is a common manifestation.⁵

Acharya Kashyapa explained about Pushpaghni Jaataharini, where the women present with anovulatory regular cycles and increased facial hair.⁶ These symptoms can be related with PCOS. The present case study is an evidence which helps us to understand how an Ayurvedic purification therapy can regulate hormone levels.

Case Study

A 22 year old female patient gradually developed pimples over face, chest and upper back, with associated pain, discharge and increased facial hair since five years. Associated complaints were nasal block, cold with running nose and headache since three years. The pimples initially presented with pain, which remained for a week, later followed with the purulent discharge. After the discharge and healing, the remnant would be as a small hardened mass. The appearance of pimples was aggravated during her menstrual cycles and when she consumes oily, junk food.

General Examination

Height – 155 cm

Weight – 62 kg

Body mass index – 27

Systemic Examination

Dermatological examination – Site – face, upper part of chest, back.

Type of eruption is papulo-pustular, sometimes nodular.

Duration of lesions is 7 – 12 days (More recent is 3-4 days).

Increased facial hair 

Previous Medications

Aragwadhadi Kashayam⁷ - 15 ml twice a day before food for 7 days.

Thiktakam Kashayam⁸ - 15 ml twice a day before food for 7 days.

Sukumaram Kashayam⁹ - 15 ml twice a day before food for 15 days.

Shivagutika¹⁰ – 1 tab twice a day for 21 days.

Kaishora Guggulu¹¹ - 2 tab twice a day after food for 15 days.

Eladi Gana Choorna¹² - for external application with rice washed water. 

Marmani Gulika¹³ - for external application with egg white.

Menstrual History

Menarche – 12 years

Bleeding duration - 4-5 days

Menstrual cycle - 28-30 days

Pattern - regular

Clots - absent

Investigations

Blood routine - normal

USG abdomen reported bilateral polycystic ovaries

Criteria for Diagnosis of PCOS¹⁴

Diagnostic Assessment Based on the symptoms presented and the investigation conducted, the diagnosis was made as PCOS (Pushpagni Jataharini) (Table 1)

Therapeutic Intervention

Line of treatment adopted – Ayurvedic purification therapy (Vamana) (Table 2). Table 3 presents the assessments carried out before and after the treatment along with the follow up.

Discussion

Pushpagni Jathaharini is a condition where there is anovulatory regular cycles with increased facial hair. As the patient presented the same complaints, this case was diagnosed as Pushpagni Jataharini. Acharya Sushruta has given the description of ‘Granthi’, which is caused by vitiation of Kapha, Vata. This deranged Doshas vitiates the Rakta. Mamsa, Meda, to produce knotted swelling called ‘Granthi.’¹⁵ This can be correlated with cystic swelling in ovaries occurring in PCOS. Here, by considering Kapha with Rakta Dusti, Vyakta Sthana is Urdwabhaga, Vamana has been adopted.¹⁶ After a course of Deepana and Pachana, patient was advised Snehapana with Sukumaragritha.¹⁷

The pathogenesis of PCOS has been related to altered luteinizing hormone (LH) action, insulin resistance, and a possible inclination to hyperandrogenism.^18-22 One theory states that primary insulin resistance exacerbates hyperandrogenism by suppressing synthesis of sex  hormone–binding globulin and increasing adrenal and ovarian synthesis of androgens; thereby, increasing androgen levels. These androgens further lead to irregular periods and manifestations of clinical signs and symptoms of hyperandrogenism.²³ In this patient, the clinical signs of facial hair were noted, which reduced gradually over period of one month. Before the treatment, patient had thick and dark hair covering the cheeks and chin, and on the anterior part of neck. After a follow up of one month, the hair thickness reduced over cheeks and chin, and disappeared on the anterior part of neck. The patient also noticed a remarkable reduction of pimples over the cheeks by 14^th day and no reoccurrence was noted on further follow up.

A polycystic ovary is defined as an ovary containing 12 or more follicles (or 25 or more follicles using new ultrasound technology), measuring 2 to 9 mm in diameter (or) an ovary that has a volume of greater than 10 mL on ultrasonography.^24-26 In this case, a follow up report of USG abdomen reported normal ovaries with single or no cysts, which provided a clinical evidence of the effect of treatment.

Discharge Medicine

Varanadi Kashayam – 30 ml - 2 times a day for 15 days.

Haritaki tab – 1 tablet - 3 times a day for 15 days.

Eladi Gana Choorna – external application with rice washed water for 15 days.

The presented case study was a documentary evidence of successful management of Pushpaghni Jaatahaarini (PCOS) through Ayurvedic purification therapy (Vamana). Significant changes in clinical signs and symptoms with respect to reduction in facial hair, absence of pimples and absence of cysts in ovaries were observed. As PCOS manifests in different forms, physician should observe the symptoms in patients and correlate with the symptoms explained and accordingly the treatment can be adopted. Further research studies and trails are required to clarify the multifaceted pathophysiology of PCOS. Finally, patients with PCOS are susceptible to metabolic disorders, such as cardiovascular disease, but their impact on mortality is not clear. Therefore, more potential epidemiologic studies on the topic are necessary.