Polycystic ovarian syndrome and homoeopathy

Dr Pallavi RN

Abstract
Polycystic ovarian syndrome (PCOS) is a widespread reproductive disorder associated with many health conditions. It is depicted by hyperandrogenism, polycystic ovaries and irregular menstruation. Adult women with age ranged from 18-45 years are prone to get polycystic ovarian syndrome4. Polycystic ovarian syndrome is the common cause of anovulatory infertility up to 30% of females seeking for treatment. Prevalence of PCOS is highly variable ranging from 2.2% to 26% globally. In few Asian countries prevalence figures are ranging from 2% to 7.5% in China and 6.3% in Srilanka. There are few studies conducted in India. Studies done in South India and Maharashtra, prevalence of PCOS were reported as 9.13% and 22.5% respectively1. As a conventional treatment in allopathy combined oral contraceptive pills are used as a first line of treatment. In homoeopathy treatment of PCOS is by individualising the subjects by considering individual’s mentals, physicals and genetic makeup. So that there will be significant increase in chances of conception with homoeopathic individualized remedies1.

Objectives

  • To define polycystic ovarian syndrome 
  • To identify homoeopathic management in pcos with the help of repertory

Keywords : Polycystic ovarian syndrome, Homoeopathy, Repertory, 

Polycystic ovarian syndrome
It is first reported by Stein and Leventhal in 19352. Rotterdam criteria is the main 3 key diagnostic feature of PCOS i.e, irregular menstruation, hyperandrogenism and polycystic ovaries .Patient must display 2 of the 3 phenotypes to be diagnosed as PCOS. Irregular menstruation is the most common phenotype among PCOS patients 95% of women experience this symptom displayed as oligomenorrhoea or amenorrhoea. Hyperandrogenism is another persistent diagnostic phenotype seen in about 60% of women this symptom displayed as hirsutism, acne and alopecia. Presence of polycystic ovaries is an important diagnostic criteria for PCOS about 17-33% prevalence is estimated.

Polycystic means many cysts and PCOS often causes cluster of small, pearl sized cysts in the ovaries. The cysts are fluid filled and contain immature eggs. Women with PCOS produce slightly higher amounts of male hormones known as androgens, which contribute to some of the symptoms of the condition.

In India it is more prevalent in adolescent age group. Compared to women with polycystic ovarian syndrome of Caucasian ethnicity, Indian women with polycystic ovarian syndrome have a higher degree of hirsutism, acne and infertility and experience low birth-rates following in vitro fertilization3.

It seems to be familial genetic syndrome caused by combination of genetic and environmental factors. Role of socio economic status and unhealthy behaviour including smoking, poor diet and lack of exercise play a role in pathogenesis of PCOS .Genetics also play a momentous role in PCOS that is hyperandrogenism and type 2 diabetes mellitus in first degree relatives of women with pcos. The developing countries such as India and China started following westernized diets and lifestyle, within two decades that may be a major cause for obesity .7Active and passive smoking found to be associated with ovarian dysfunction leading to menstrual irregularities and intake of high calorie diet can lead to insulin resistance and beta cell dysfunction.6Endocrine factors like onset of type 1 diabetes mellitus before menarche, obesity can lead to PCOS in future.8Antiepileptic drug such as Valproate can cause PCOS.8Bisphenyl A (BPA) is a commonly used industrial compound in plastic products, used for packaging can be a probable cause of PCOS. Stress can disrupt normal menstruation by causing hormonal change such as increased levels of cortisol and prolactin.9

Homoeopathy
In homoeopathy treatment of PCOS is by individualising the subjects by considering individual’s mentals, physicals and genetic makeup. By administering individualized homoeopathic remedy we can prevent further progress of the disease and also regulate hormonal imbalance by balancing the hyperactivity of glands and resume normal ovulation and menstruation so that it will avoid need for surgery and hormonal therapies. So that there will be significant increase in chances of conception with homoeopathic individualized remedy5. 

HOMOEOPATHIC THERAPEUTICS FOR PCOS10, 11, 12, 13

Calcarea carbonica: It is a great Hahnemannian antipsoric constitutional remedy. Its chief action is on glands leading to swelling of glands and scrofulous conditions. Indicated in suppressed menses. Sterility with copious menses, headache and colic before menses. Tenderness and swelling of breast before menses. In females with plethora menses will not appear.

Pulsatilla: it acts on female sexual organ causes hypertrophy and hyperesthesia of ovaries with scanty and delayed menses. Its full power is displayed on female organs in women with paleness irregular menses and who complains of headache. It is of great importance in amenorrhea and suppressed menses from wet feet, chill, nervous debility and chlorosis. Delayed menses, scanty thick, dark, clotted, and intermittent in character. It causes dysmenorrhea with scanty bleeding and diarrhea. Dysmenorrhea with violent pains, she tosses in every direction with tears. Warm room aggravates all the complaints. It causes contraction of abdomen with sensation as if menses would appear with nausea and vomiting. 

Cocculus indicus: it acts on ovaries, causing paroxysmal spasmodic pains in the hypogastric region of a twisting, colicky, bearing down sensation with complete prostration. It is indicated in profuse dark menses, too early, clotted with spasmodic colic. Dysmenorrhea followed by haemorroids or sero-purulent leucorrhea.  Before menses there is a sensation of sharp stones in the abdomen on motion. Gushing leucorrhea in between menses leading to complete prostration.

Nux vomica: It is indicated in irritable women with irregular menses and never at the same time. Menses too early and lasts too long, always irregular. Discharge black in color with fainting spells.  Pressure toward genital organs early in the morning. 

Sulphur: It is a great antipsoric remedy. Indicated in delayed menses or suppressed menses with great restlessness at night.  Menses too late, short, scanty and difficult. It is thick, black, acrid and making parts sore. Menses preceded by headache. Pain in abdomen during menses as if intestines were strung up in knots by threads, she has to sit up to get relieved by pain. It is helpful in restarting the suppressed menses due to cold or due to unknown cause. More frequently indicated remedy in amenorrhea than Pulsatilla. Excellent remedy for treating hot flushes in climacteric age group with burning pain on top of the head and soles of feet. 

Ignatia: Indicated in suppressed menses mainly due to grief. Menses too early and profuse or scanty. During menses great exhaustion with spasmodic pain in stomach and abdomen. Menses is black and of a putrid odour. Indicated in mild, gentle, introverted, yielding though whimsical women.

Sepia: Indicated in amenorrhea of feeble constitutions with delicate skin. Menses too late and scanty, irregular, early and profuse. Relaxed pelvic organs, sensation of bearing down as if everything would escape through vulva, must cross the limbs to prevent protrusion. Burning and shooting pain in the neck of the uterus with bearing down pain. Acrid leucorrhoea in young women before menses.  Menses appears too early with scanty discharge with violent colic in abdomen. Offensive sweat in axilla and soles between menses. 

Calcarea phosphoricum: menses too early, excessive and bright in girls. If late blood is dark, sometimes bright followed by dark. Menses once in every two weeks, excessive. Late menses with violent backache. Indicated in girls who attained puberty late, with painful menses which makes her cry, Labor like pain at the beginning of menses with weak sinking sensation in the pelvis. 

Phosphorus: Indicated in women who presents with vicarious menses with amenorrhea. Menses too early, scanty and not profuse but lasts too long. Menses too early and scanty from two to eight days. Menses pale with violent colic, nausea and diarrhea. Amenorrhea with blood spitting, epistaxis and bleeding from anus and urethra. 

Platina: Helpful in treatment of chronic ovarian diseases. It causes oophritis with sterility and produces premature and profuse menses. There is hypersensitivity of genitals. Amenorrhea with painful pressure, as if menses would appear with pain in small of the back. Pain in ovarian region as if burning and excessive sexual desire. Oophoritis during climaxis with menorrhagia and hot flushes.

Natrum muriaticum: Salt delays the menstrual function. Indicated in retarded menses preceded by anxiety and disposition to faint or nausea. Menses irregular usually profuse. Suppression of menses. Delayed menses with anemia and great chilliness. Sad and gloomy during menses with palpitations of heart. There is a sensation of pressing towards genitals every morning, she has to sit to prevent prolapses uteri. 

Bryonia alba: It is indicated in early and profuse menses aggravated on every movement, with tearing pain. Frequent bleeding from the nose when the menses should appear. Suppression of menses with splitting headache. Pain in right ovary as if torn, extending to thigh. Menstrual irregularities with gastric complaints. 

Lycopodium clavatum: Indicated in ovarian diseases like tumors, dropsy, especially acting on right side. Useful when menses suppressed due to fright with cutting pains from right to left ovary.  Menses too late, lasts too long, profuse with great sadness before menses. 

Baryta carb: especially suited to dwarfish women with scanty menstruation and troublesome weight about the pubes in any position. Menses scanty followed by pain in stomach and small of the back. 

Calcarea sulph: Indicated in girls who are with delayed puberty. Very much useful in ovarian cysts. Menses too late, long lasting with headache. Twitching pain with great weakness. Indicated in pimples, pustules in girls with exceedingly pale and sick appearance. 

Calcarea arsenicum: Indicated in amenorrhea and metrorrhagia. Dysmenorrhea when approaching menses. Burning pain in uterus and vagina. Clark says I is very much useful in obesity in women with irregular menses. 

Calcarea silicata: menses very irregular and painful. Sensation as if uterus is prolapsed and heavy. There is a flow between periods.  

REPERTORY
Rubrics related to pcos found in different repertories10, 14 , 15, 16 ,17

Kent repertory 

Genitalia female ,tumors ,ovaries ,cysts : Apis , Bov , Bufo , Canth , Carb-an , Coloc , iod ,Kalibr , Lach , Merc , Murx , Plat ,Prun ,Rhod ,Rhus-t , Thuj.

FEMALE GENITALIA – MENSES, – absent, amenorrhoea
Acon. aesc. agar. agn. alet. Am-c. am-m. Ant-c. Apis Apoc. arg-n. Ars. Ars-i. AUR. Bar-c. Bell. benz-ac. berb. Borx. Bry. Calc. calc-s. canth. CARBN-S. carb-v. card-m. Caul. Caust. Cham. chel. Chin. chinin-ar. cic. cimic. cina Cocc. colch. Coll. Coloc. CON. croc. crot-t. Cupr. Cycl. dig. Dros. DULC. euph. FERR. Ferr-ar. FERR-I. Ferr-p. gels. Goss. GRAPH. Guaj. Ham. Hell. helon. Hyos. Ign. Iod. Kali-ar. KALI-C. kali-i. Kali-n. Kali-p. kali-s. Lach. lil-t. lob. LYC. Mag-c. Mag-m. Merc. mill. nat-c. Nat-m. nat-p. Nux-m. Nux-v. ph-ac. Phos. Plat. podo. PULS. Rhus-t. Sabad. sabin. sang. sec. SENEC. SEP. SIL. Staph. stram. SULPH. TUB. Valer. verat. verat-v. xan. Zinc.

GENERALS – OBESITY
agar. ambr. Am-m. Ant-c. asaf. Aur. bar-c. borx. bry. CALC. Calc-ar. camph. canth. CAPS. chin. cocc. con. Cupr. euph. FERR. GRAPH. guaj. iod. ip. Kali-bi. Kali-c. Lac-d. lach. laur. Lyc. mag-c. merc. mur-ac. nat-c. nux-m. olnd. op. plat. plb. Puls. sabad. sars. seneg. sep. sil. spig. spong. Sulph. thuj. verat.

SKIN – DISCOLORATION, – blackish
acon. ant-c. Apis Arg-n. ARS. asaf. aur. Carb-v. chel. Crot-h. Lach. nit-ac. ph-ac. phyt. PLB. SEC. spig.

Synthesis repertory 

Female genitalia /sex –Tumors ,cysts –ovaries –am-c,am-I,am-m,apis,apoc,arg met,arg-n,arn, ars,aur,aur-i ,aur-m-n,bar-c,bar-i ,bell,bov,brom,bry,Bufo,calc,calc-f,calc-i ,calc-s,canth,carb-an,carc,chin,Coloc,con,ferr-I,foll,form,graph,iod,kali-bi,kali-br ,kali-c,lac-c,Lach,lil-tig,lyc,mag-i ,mag-m,med,merc,murx,naja,nat-m,nit-ac,ov,pall,phos,plat,podo,prun,puls,rhod,rhus-t,sabin,sec,sep,sil,staph,sulph,syc,syph,ter,thuj,zinc.

 Right side –Apis Bell,lyc,pall,podo

 Left side- kali-bich , lach , naja , pall ,phos,plat,thuj.

 Accompanied by sterility-leucorrhoea with-alet,borx,caul,kreos,lam,nat-c.

FEMALE GENITALIA/SEX – MENSES – absent
Acon. aesc. agar. agn. alet. all-c. aln. Am-c. am-m. ammc. Anac. Ant-c. Apis Apoc. arg-n. Arist-cl. Ars. Ars-i. asar. asar-c. AUR. aur-ar. aur-i. aur-s. aven. Bar-c. Bell. bell-p. benz-ac. berb. Borx. brass-n-o. brom. Bry. Calc. calc-i. calc-o-t. calc-p. calc-s. calc-sil. cann-s. canth. carb-v. CARBN-S. card-m. Caul. Caust. Cham. chel. Chin. chinin-ar. chlorpr. cic. cimic. cina Coca Cocc. Coch. colch. Coll. Coloc. CON. cortico. cortiso. croc. crot-t. Cupr. Cupr-act. Cycl. Cypr. dam. dig. dream-p. Dros. DULC. euphr. eupi. FERR. Ferr-ar. FERR-I. ferr-m. Ferr-p. ferr-r. gast. gels. Glon. goss. GRAPH. Guaj. Ham. hedeo. Hell. helo. helon. hoit. Hyos. hyper. ictod. Ign. indg. Iod. joan. Kali-ar. KALI-C. kali-i. Kali-n. Kali-p. Kali-perm. kali-s. kreos. lac-d. lac-f. Lach. lil-t. linu-c. lob. luf-op. LYC. m-arct. Mag-c. Mag-m. mag-s. mand. mang. med. Merc. Merl. mill. Mit. nat-c. Nat-m. nat-p. nat-sil. nep. Nux-m. Nux-v. ol-an. Ol-j. op. orot-ac. ovi-p. parth. ph-ac. Phos. Phyt. pin-l. pitu. Plat. plb. podo. polyg-pe. polyg-xyz. polytr-c. PULS. puls-n. rhod. Rhus-t. rub-t. Sabad. sabin. sang. sanic. sec. SENEC. SEP. sieg. SIL. Sin-n. spong. Staph. stram. sul-i. SULPH. syc. symph. tanac. tep. ther. thiop. Thuj. thyr. TUB. urt-u. ust. Valer. verat. verat-v. vib. wies. wye. x-ray xan. yohim. Zinc. zinc-p.

SKIN – HAIR – Unusual parts; on carc. lyc. med. thuj. thyr.

SKIN – DISCOLORATION – blackish =acon. ant-c. Apis Arg-n. arn. ARS. asaf. aur. Carb-v. chel. Crot-h. lac-e. Lach. nit-ac. ph-ac. phyt. PLB. SEC. sol-t-ae. spig

Boericke’s repertory

CYSTS, DROPSY  Apis,Apoc,Arn, Ars, Aur.iod, Aur.m.n, Bell, Bov, Bry, Cinch, Col, Con, Ferr.iod, Graph, Iod, Lach, Lil.tig, Lyc, Oophor, Rhod, Sab, Thereb, Zinc.

 Obesity
am-m. Ant-c. bell. bufo CALC. CAPS. Ferr. Graph. kali-bi. lac-d. lith-c. phyt. puls. rumx. seneg. sulph. thyr.

Hair – chin and upper lip in women; on ol-j

FEMALE SEXUAL SYSTEM – Menstruation – type – Amenorrhoea
Acon. alet. aln. Apis apoc. ars. aven. bell. bry. Calc. cann-s. Caul. caust. Cimic. con. Cycl. dulc. Euphr. Ferr. Ferr-ar. Ferr-r. gels. Glon. Graph. hedeo. Hell. Helon. joan. Kali-c. Kali-perm. lil-t. mang-act. Merl. Nat-m. nux-v. op. parth. ph-ac. pin-l. Plat. plb. Polyg-h. Puls. sec. Seneg. Sep. spong. Sulph. tanac. thyr. ust. Xan.

Boger Boenninghausen’s characteristics and repertory

GENERALITIES – Obesity – am-c. Ant-c. bell. bufo-s. CALC. Caps. ferr. graph. kali-bi. phyt. puls. sulph.

Murphy repertory :

Female – AMENORRHEA, menses, absent
Acon. aesc. agar. agn. alet. all-c. aln. Am-c. am-m. ammc. Anac. Ant-c. Apis Apoc. arg-n. Arist-cl. Ars. Ars-i. asar. AUR. aur-i. aven. Bar-c. Bell. bell-p. benz-ac. berb. Borx. brom. Bry. Calc. calc-i. calc-p. calc-s. calc-sil. cann-s. canth. carb-v. CARBN-S. card-m. Caul. Caust. Cham. chel. Chin. chinin-ar. chlorpr. cic. Cimic. cina Coca Cocc. Coch. colch. Coll. Coloc. CON. cortico. cortiso. croc. crot-t. Cupr. Cycl. Cypr. dam. dig. Dros. DULC. euph. eupi. FERR. Ferr-ar. FERR-I. Ferr-m. Ferr-p. gast. gels. Glon. Goss. GRAPH. Guaj. Ham. hedeo. Hell. Helon. Hyos. hyper. ictod. IGN. indgh. PULS. Rhus-t. Sabad. sabin. sang. sanic. sec. SENEC. SEP. sieg. SIL. Sin-n. spong. Staph. stram. sul-i. SULPH. symph. tanac. tep. thiop. Thuj. thyr. TUB. urt-u. ust. Valer. verat. verat-v. Vib. wies. Iod. Kali-ar. KALI-C. kali-i. Kali-n. Kali-p. Kali-perm. kali-s. kreos. lac-d. Lach. lil-t. linu-c. lob. LYC. Mag-c. Mag-m. mag-s. mand. mang. Merc. Merl. mill. Mit. nat-c. Nat-m. nat-p. nat-s. nat-sil. nep. Nux-m. Nux-v. ol-an. Ol-j. op. ovi-p. parth. ph-ac. Phos. Phyt. pin-l. pituin. Plat. plb. podo. Polyg-. wye. x-ray xan. Zinc. zinc-p.

Female – AMENORRHEA, menses, absent – girls, in young Ign. x-ray

Female – AMENORRHEA, menses, absent – women, in Ars. bar-c. Calc. cypr. Ign. petros. psor. Puls. SEP. sil. sulph.

Constitutions – YOUNG, constitutions Acon. Calc. Calc-p. ferr. gels. IGN. NAT-M. PHOS. SIL.

Generals – OBESITY, general – uterine, complaints, with calc. Graph. Kali-c. Sep.

Generals – OBESITY, general – young, people, in Ant-c. CALC. calc-act. lach.

Skin – HAIR, skin – unusual, parts, on carc. lyc. med. ol-j. thuj. thyr. tub.

Skin – HAIRY, skin – women, in carc. cortico. Sep.

Skin – BLACKISH, discoloration, skin
acon. aeth. anac. ant-c. Apis Arg-n. ARS. asaf. aur. both. Carb-v. chel. cic. Crot-h. ferr. Lach. Led. nit-ac. ph-ac. phos. phyt. PLB. rhus-t. sabin. sars. SEC. sol-ni. spig. vip.

Phatak repertory:

M – Menses – absent, suppressed, amenorrhoea
aur. bell. cimic. Con. cupr. cycl. Dulc. Graph. hell. helon. Kali-c. lac-d. lach. Lyc. nat-s. phos. PULS. Senec. sep. Sil. Sulph. tub. xan.

M – Menses – absent, suppressed, amenorrhoea – girls, young senec.

Cases

1. Case of Ms. XYZ of age 24 years complained of irregular cycles since 4 years, flow is very scanty, bright red in colour with severe pain during her menses, blackish discoloration around the neck since 4 years, abnormal hair growth all over the body since 2 years, and hair fall since 2 years 

Physical generals: hot, thirst less, sleeplessness 

Mentals: she is talkative, keeps secrets with herself, too much artistic, anger on triffles and weeping along with it, tells lie to maintain her secrets, she feels bettrt by sharing her problems, after death of her boyfriend she ended up getting delusions like seeing him when she is alone.

Rubrics:

  1. Mind- art ability for
  2. Mind- delusions –dead persons sees
  3. Mind- Manipulative
  4. Female genitalia- menses irregular 
  5. Sleep –sleeplessness, alone aggravation

Remedy given is Calcarea sulph 1M 1 dose on repertorizing by considering all the above rubrics

Follow up – got her menses, flow for 4 days, without any pain. Placebo was given 

On frequent follow-ups her cycles regularized, her hair fall reduced, sleep improved.

2.Case of Ms. ABC complained of irregular menses since 5 years, cycles once in 80 to 90 days with moderate flow, pain in back and leg during flow, pain is better by pressure, nausea before the menses, hair fall since  1 year, abnormal hair distribution all over the body since 5 years. 

Physical generals – she is chilly and thirsty, hunger cannot tolerated leading to headache, desire for sweets, head pain on sun exposure, dreams forgetful, intolerance for tight clothing around neck and waist

Mentals- angry tendency, very much fluctuating mood, artistic, wants to help others, do not like consolation from others, she is timid and very nervous to speak in public, she like be like men – in her dressing sense looking like a boy, she wanted to be a boy.

Rubrics-

  1. Mind- art ability for 
  2. Mind- Benevolence
  3. Mind- confusion of mind, identity, as to his
  4. Mind- consolation, agg
  5. Mind- mood, changeable
  6. Mind- timidity-public about to appear in
  7. Mind-unconscious blood sight of 
  8. Head- pain sun, exposure from

Based on above rubrics Phosphorus 1m 1 dose was given

Follow up – on 1st follow up she had a sensation as if menses would appear but no menses head pain on sun exposure is still present but intensity reduced –Phosphorus 1M 2 doses were given 

2nd follow up – got her menses, flow for 2 days Rx –Rubrum given

Other symptoms improved on frequent follow up with regular menses.

References

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  2. Zahid. Polycystic ovarian syndrome (PCOS): National health portal.2016feb26 https://www.nhp.gov.in/disease/endocrinal/ovaries/polycystic-ovary-syndrome-pcos. (cited on 16.2.18)    

 3.Malik S, Jain K, Talwar P, Prasad S, Dhorepatil B, Devi G, Khurana A, Bhatia V, Chandiok N, Kriplani A, Shah D. Management of polycystic ovary syndrome in India. Fertility Science and Research. 2014 Jan 1;1(1):23-43(cited on 18.2.18)Available online: http://www.fertilityscienceresearch.org                                                                   

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https://www.researchgate.net/profile/Muhas_Chelakkadan/publication/329326643_POLYCYSTIC_OVARY_SYNDROME_PCOS-AN_OVERVIEW/links/5c04db8aa6fdcc1b8d50a73c/POLYCYSTIC-OVARY-SYNDROME-PCOS-AN-OVERVIEW.pdf

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14. Phatak S.R. A Concise Repertory of Homoeopathic Medicines. 2nd edition. Bombay; the homoeopathic medical publishers. 

15. Frederick Shroyens. SYNTHESIS Repertorium Homoeopathicum Syntheticum. Edition 9.1. Noida. B Jain Publishers. 2016                                                                                                                                                                                                                                                                                    16. Kent.J.T, Repertory of the homoeopathic materia medica.IndIan editition reprint from 6th American edition, New Delhi. Indian books and periodical publishers. 2010

17. Boger C.M, Boger Boenninghausen’s Characteristics and repertory with corrected abbreviations, word index and thumb index.40th impression, New Delhi. B.Jain publishers.2015.

14. Murphy Robin, Homoeopathic Medical repertory. Third revised edition, Noida, B Jain publishers.2017

Dr. Pallavi R.N
PG scholar , Repertory department
GHMC &H, Bengaluru

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