Polycystic ovarian syndrome PCOS now known as Polyendocrine metabolic ovarian syndrome is a condition that affects women of all reproductive ages. It is a hormone related disorder which affects about 170 million women around the globe. It is one of the most common causes of infertility among women affecting 1 in every 10 women.
What is PCOS/PMOS?
Polyendocrine metabolic ovarian syndrome is a disorder caused by hormonal imbalance. This hormonal imbalance is the result of the ovaries producing excess androgen hormone, which is a male hormone. Androgen imbalances other female hormones and causes irregular menstruation and ovulation. In some of the cases of PMOS, there are follicles of immature eggs on the ovary. They are not painful or harmful, but can increase the androgen hormone and cause missed periods and other symptoms.
In Ayurveda, Polycystic ovarian syndrome, now known as PMOS, is not seen as a single disease; it is rather correlated with conditions like Pushpagni jataharini, which is characterized by obesity and hairy cheeks, and Artava kshaya, which is a deficiency of menstrual fluids. These conditions are caused by the imbalance of the three doshas (Vata, Pitta, and Kapha), which affect the Artavavaha srotas (reproductive channels). Treatment is focused on balancing the doshas and detoxifying the body.
How is PCOS/PMOS connected to fertility?
PCOS affects fertility by disrupting ovulation. Ovulation is a process in which an egg is released from the follicles which grow and burst each month releasing an egg in one of the fallopian tubes. This is what happens in a normal menstrual cycle with ovulation.
In people with PCOS, the follicles do not grow or do not release an egg every month. Instead of bursting they accumulate on the ovaries and start to look like cysts in a scan, this is why PCOS had its name but there are not cysts so it was renamed PMOS.
The reason behind disruption of ovulation is the unbalanced hormones that do not let the eggs mature and release. There are a number of complications caused due to PCOS which directly or indirectly affect fertility-
- Anovulation- In PCOS due to high androgen and an imbalance of other hormones the eggs do not mature or release as they should, this cause unpredictable, infrequent or absent periods.
- Insulin resistance- In women with PCOS the insulin released by the body is not absorbed effectively which causes ovaries to release excess male hormones (androgens). High insulin levels and excess weight further disrupt ovulation and hormonal balance.
- Egg quality- The hormonal imbalance inside the ovaries can disrupt egg maturation decreasing the quality of the eggs. The ovaries wall can harden up and make it difficult for the egg to be released. Due to infrequent periods the uterine wall may not completely shed and can cause difficulty in the implantation of the fertilized eggs.
- Increased risk of miscarriage- Because of imbalanced hormones, poor egg quality and insulin resistance women who conceive have a higher risk of early miscarriage compared to women without the condition.
Diagnosis of PCOS/PMOS
To diagnose PCOS, doctors will ask some questions about your symptoms, medical history, family medical history, and medications. After the question, doctors may perform a physical examination and a pelvic examination for further knowledge about your condition. A pelvic ultrasound is done to check for cyst growth on the ovaries, the thickness of the uterine lining, and other causes of heavy bleeding. Blood tests are done to check the hormone levels in the body, which are the most common cause of PMOS.
In Ayurveda, the diagnosis of PMOS is done by Ashtavidha pareeksha (eight-fold examination), which includes Nadi pareekshan (pulse exam), Jihva pareekshan (tongue examination for toxins), and Mal/Mutra pareekshan (urine and stool analysis), clinical history, dosha imbalance diagnosis, and Samprapti (Agni, srotarodha, and dhatus dushti).
