Management of PCOS

PCOS Management Program – through Integrative & Functional Medicine

At WELLBEEING, we offer an integrative and functional medicine approach to treat PCOS. Treatment plan includes an assessment of all of the potential factors contributing to PCOS with in depth screening, post which assistance with dietary intervention, stress management, assessment of possible environmental factors, as well as non-pharmaceutical options are systematically considered. Over all the treatment plan is nurturing, natural and is holistic in its approach to treat PCOS.

The main line of action is to identify your type of PCOS. Are you prone to hormonal imbalance? Then what kind of hormones are you producing in excess? For example, if your body is producing too much testosterone then we know it’s disrupting the development of ovular follicles and causing your irregular menstrual cycles. Therefore, in this case our aim will be to bring down the testosterone levels. But where are these excess hormones coming from? Researches have shown that high levels of testosterone are also likely to be producing excess DHEA hormones. These hormones are mostly produced by the adrenal glands so it gives us an indication of what regions of the body need more attention. You may have to take the female reproductive hormone panel of tests to help identify any irregularities in your ovarian cycle, potential risks for infertility and the effect of birth control pills.

We focus on maintaining a healthy diet in line with functional nutrition guidelines. Essentially, what you eat will trigger the insulin production in your body and the nature of food can either reduce or worsen inflammation. For example, you’ll have to cut down on sugar, skip the fad diets, eliminate gluten and dairy to keep your insulin levels from spiking. Energy boosting diet, more slow-digesting, complex carbs are recommended Based on series of assessments, a well-planned lifestyle interventions are planned and administered:

• We cleanse and purify the body through Ayurveda therapy plan or simple detoxifying food based on individual convenience and compliance.
• Herbal remedies to alleviate and correct Imbalances
• Diet and food to lose weight
• Yoga and stress management treatment plan to maintain weight, and manage stress

All these after thorough screening, evaluating and assessment of the individual. Based on the goal and age, the program is considered for 3 to 5 months. Both on-line and off line programs are available

PCOS (Polycystic Ovarian Syndrome) & Conventional approach

PCOS or polycystic ovarian syndrome is a common health problem caused by an imbalance of reproductive hormones. Between 5% and 10% of women of childbearing age (between 15 and 44) have PCOS. Most women are diagnosed between 20-30 years of age, when they have problems getting pregnant and present to their physicians. However, PCOS can happen at any age after puberty. Every month as part of a healthy menstrual cycle, the ovaries release an egg

In women who have PCOS, the ovaries will develop a thickened outer wall, underneath which many partially stimulated eggs form cysts, hence the name polycystic ovarian syndrome. Normally, the ovaries release a small amount of male sex hormones, called androgens, however, in women with PCOS, the ovaries start making slightly more androgens, which is the reason for masculine symptoms like extra facial and body hair and male pattern baldness.

Traditionally, the diagnosis of PCOS was made when an imaging study revealed multiple cysts on the ovaries, however, not every woman diagnosed with polycystic ovarian syndrome has visible cysts on her ovaries. Polycystic ovarian syndrome can still be diagnosed if the majority of other common symptoms are experienced and/or they have the common endocrine abnormalities associated with PCOS

Types:

• Insulin-resistant PCOS: Insulin resistance means having high insulin. It’s also called metabolic syndrome or pre-diabetes.
• Post-pill PCOS: It’s pretty common to experience a temporary surge in androgens when coming off a drospirenone or cyproterone pill
• Inflammatory PCOS: Chronic inflammation can stimulate the ovaries to make too much testosterone and is a contributing factor for every type of PCOS.
• Adrenal PCOS: Most women with PCOS have an elevation of all androgens including testosterone and androstenedione from the ovaries and DHEAS from the adrenal glands.

Causes:

• Excess insulin
• Low-grade inflammation
• Heredity
• Excess androgen

Symptoms:

• Irregular menses
• Excess androgen levels
• Sleep apnea
• High stress levels
• High blood pressure
• Skin tags
• Infertility
• Acne, oily skin, and dandruff
High cholesterol and triglycerides acanthosis nigricans, or dark patches of skin
• Fatigue
• Female pattern balding
• Insulin resistance, Type 2 diabetes
• Pelvic pain
• Depression and anxiety
• Weight management difficulties including weight gain or difficulty losing weight excessive facial and body hair growth, known as hirsutism
• Decreased libido

Complications:

• Infertility
• Gestational diabetes or pregnancy-induced high blood pressure
• Miscarriage or premature birth
• Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver
• Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
• Type 2 diabetes or prediabetes
• Disturbed sleeps
• Depression, anxiety and eating disorders
• Abnormal uterine bleeding
• Cancer of the uterine lining (endometrial cancer)

Conventional approach of PCOS

Allopathy employs a series of medicines and weight loss programs to manage symptoms of PCOS. To encourage regular menstruation, women may be asked to go on monthly oral contraceptive pills, or diabetes drugs, which can help fix the hormonal imbalance and improve symptoms. To treat infertility or to make a woman pregnant, she may be assigned a medicine to coax ovulation. Some women are also assigned periodic menses inducing medicines, which are taken around the menstrual cycle

Screening recommended: Investigations like blood sugar estimation, thyroid hormone tests, ultrasound of the abdomen and pelvis are done. Sometimes serum androgens, luteinising hormone The medical treatment of PCOD/PCOS focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity

• Lowering of blood glucose levels
• Restoration of fertility
• Treatment of hirsutism or acne
• Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer

Medications used to treat the abnormal hormones and menstrual cycles of PCOS include:

• Birth control pills or progesterone pills help to make menstrual cycles more regular
• Metformin, a medication that increases the body's sensitivity to insulin, can improve the symptoms of PCOS and sometimes will cause the menstrual cycles to normalize. For some women, it can also help with weight loss.
• LH-releasing hormone (LHRH) analogs
• Treatment with clomiphene citrate causes the egg to mature and be released. Sometimes women need this or other fertility drugs to get pregnant.

In addition to these patients may also be put on diets to help reduce weight. The doctor may also prescribe some high energy exercises to achieve the same.

According to Ayurveda, the pathology is an obstruction in the pelvic cavity causing disorders in the flow of Vata. This in turn leads to an accumulation of Kapha and Pitta. The treatment principle is to clear obstruction in the pelvis, normalize metabolism, repair endometrium and regulate the menstrual system so that overall fertility function is improved. Kapha reducing, insulin enhancing and hormone rebalancing drugs help to the relieve symptoms of Poly Cystic Ovarian Syndrome.

Early recognition and intervention such as the development of further complications, medical and surgical treatment advised according to the need and severity of the disease. Ayurveda advocate prevention of disease by use of diet and regimen, self care and also by avoiding unwholesome diet and regimen, eating excessive sweet and kapha aggravating food and lack of love etc. other etiological factors. Therefore kapha reducing, insulin rebalancing, obstruction clearing medicine, diet and regimen can helps t prevent/treat disease.

The Ayurvedic treatment protocol includes elimination treatment and palliative treatment and help in improving the ovulation, oocyte quality, endometrial receptivity and reducing weight.

Ayurvedic Management:

• Aama Chikitsa (treatment for undigested harmful metabolites): Select Ayurvedic medicines are recommened that helps in intensifying digestive fire and removing the toxins from body.
• Vatakapha Hara Drugs
• Elimination treatment – there are 5 fold classical therapies which help in elimination of toxins from the body and removing the obstruction. This helps the endometrial receptivity to increase and the menstrual system to improve.
• Palliative treatment:- after elimination treatment, to remove left over toxins and to increase the overall fertility rate, the oral drugs are given to strengthen the reproductive system

Many of the PCOS individuals who have undergone the program have conveyed benefit ssuch as reduced stress levels, reduced fatigue.

Naturopathic medicine focuses on persons living in accordance with nature. PCOS is a holistic disease having its effect on skin, hair, mood, sleep patterns, fat storage etc. the cross talk between lifestyle factors and mind is known to affect the abdomen and abdominal organs either positively or negatively depending upon the impulses. In naturopathy , abdominal disturbance or digestive imbalance is one of the important endocrine disruptor due to deranged circadian rhythms is regarded as the cause for all diseases.in this case , the impediment of the uterus with toxic substance is one of the prime causes. Improper lifestyle and unbalanced diet, which leads to abnormal inhibition of digestive fire, which manifests in irregular eating habits , which further leads to metabolic conditions are some of the causes for the accumulation of morbid matter resulting in encumbrance

In Yogic and Vedic scriptures health is defined as a balance at all levels and ill health as imbalance. According to the Yoga text, PCOS comes under stress-born-diseases (adhija vyadhi). Hence our main goal would be to reduce the patient's emotional entanglement and provide relaxation therapies in addition to replinishing with nutrient and hormonal balance. Primary aim of naturopathic management is to understand where the person is deviating from what the body requires and correct accordingly.

Specific Yoga therapy with asanas (postures) recommended in PCOS orchestrates fine tuning and modulates neuroendocrine axis which results in beneficial changes. It mainly improves reproductive functions by reducing stress and balancing the neurohormonal profile. It also reduces urinary excretion of catecholamines and aldosterone, decreases serum testosterone and levels, and increases cortisol excretion, indicating optimal changes in hormonal profiles.

Researchs have proven that alterations in brain waves (basically an increase in alpha waves) and decrease in serum cortisol level were observed during yoga therapy implicating reduction of stress level. Yoga as a form of holistic mind–body medicine is effective in reducing anxiety symptoms in PCOS patients. It mainly improves reproductive functions by reducing stress and balancing the neurohormonal profile. It also reduces urinary excretion of catecholamines and aldosterone, decreases serum testosterone and LH levels and increases cortisol excretion, indicating optimal changes in hormonal profiles. Alterations in brain waves (basically an increase in alpha waves) and decrease in serum cortisol level was observed during yoga therapy. Yoga helps in normalizing insulin resistance, improving androgen status, and aiding weight management thereby supporting the prevention of other related non-communicable diseases.

Yoga and change in lifestyle could be the first-line interventions for PCOS. Small changes in lifestyle improves symptoms and psychological well-being of PCOS patients.