SHRI GUJARATI SAMAJ, INDORE

S. K. R. P. GUJARATI
HOMOEOPATHIC MEDICAL COLLEGE,
HOSPITAL & RESEARCH CENTRE
Polycystic ovarian syndrome

2013-
2014

Guided by: Submitted By:

Dr. S. P Singh sir Batul Salpura wala.
Dr. Anjali Nigam Mam Internee
 Index
Aim
Objectives
Introduction
Review of literature
Homoeopathic Approach
Miasmatic approach
Therapeutic Approach
Repertorial Approach
Case presentation
Analysis & comment
Bibliography and References
 Aim
Polycystic Ovarian Syndrome can be
an awfully exasperating condition. My
aim is to provide an immense
understanding of PCOS and how to
reverse its underlying condition. It will
motivate every woman to have an
enhanced sense of optimism and
assurance to improving their health. A
woman's reproductive health is closely
associated with her overall health.
 Objectives
The objective of this review is to
briefly address the current
knowledge of diagnosis, cause,
complications, and infertility
treatment
 Introduction
. Polycystic Ovarian Syndrome was
first recognized by Stein and
Leventhal who observed the
relationship between obesity and
reproductive disorder, what is now
known as the syndrome O (over-
nourishment, overproduction of
insulin, ovarian confusion, and
ovulation disruption).
 Since then, this condition is considered to
be the most common endocrine disorder
of pre-menopausal women, affecting an
estimated 5% of the population. Current
literature has suggested a higher
frequency range (5-10%) through
investigations into ethnicity including
Hispanic/Latino females who are at an
increased risk of diabetes.
triad of amenorrhea, obesity and
hirsutism (1935)
Review of literature
PCO syndrome definition
(2 out of 3)
Irregular periods
Evidence of raised male hormone
levels
PCO & exclusion of other causes
POLYCYSTIC
POLYCYSTIC OVARIAN
OVARIAN SYNDROME
SYNDROME

Normal ovaries Polycystic ovaries

volume < 8 cm3 mildly enlarged
scattered follicles generally > 8 cm3
peripheral distribution
of follicles
increased stroma
 Causes
Intra-uterine Geneti
Nutritional c
Hormonal

Fat
Insulin
Skin sensitivity

Disordered ovulatio
Hirsutism, acne
 Symptoms of PCOS
Missed or irregular menses.
Development of male sex
characteristics.
Excessive hair growth all over the body.
Male pattern baldness or thinning of
hair.
Deepening of the voice.
Oily skin.
Acne.
Fatigue.
Lack of mental alertness.
Decreased sexual drive.
 Skin pigmentation.
Pelvic pain.
Pain during sexual intercourse.
Weight gain.
Infertility.
Type 2 diabetes.
High cholesterol.
High blood pressure.
Chances of getting endometrial cancer.
Tests and Diagnosis

PCOS is a diagnosis of exclusion,

and
biochemical (Blood) and/or
radiologic and imaging studies
must be done to ascertain the
diagnosis.
Pelvic examination If one has an ovarian
cyst, the doctor may find that the ovaries
feel larger than normal, and there is more
discomfort during the bimanual exam
than normally do. In this case, the doctor
may recommend additional laboratory
tests to help make a diagnosis.
Imaging
Studies
Ultrasound
Ovarian ultrasonography:-
preferably by transvaginal
scan, can be performed to
assess ovarian
morphology.
Ultrasound is one of the
most frequently used
methods of diagnosing
ovarian cysts.
 Blood Test
Testosterone
DHEA sulfate Additional
Luteinizing hormone (LH) blood testing
Follicle-stimulating
may include:
hormone (FSH) Fasting
glucose
17-hydroxy progesterone
Cholesterol
Prolactin
Triglyceride
Thyroid-stimulating
levels
hormone (TSH)
 Differential Diagnosis

Cushing syndrome
Adrenal hyperplasia
Hypothyroidism
Hyperprolactinaemia
Acromegaly-insulin resistance
Diagnosis Of Polycystic
Ovary Syndrome
Symptoms of androgen excess
Irregular menses
Acne, hirsutism
Biochemical androgen excess
Total / free testosterone,
androstenedione, LH
Level of sex hormone binding globulin
are in patient with PCOS
DHEA- sulphate is normal or slightly
above in PCOS.
Pelvic ultrasound
Management of
PCOS
 General
Management
Self care measures for PCOS:
Exercise regularly.
Eat a healthy diet with lots of vegetables, nuts,
beans and whole grains.
Cut down on your sugar, carbohydrate, salt
intake.
Limit your saturated fats.
Avoid fruits high in sugar.
Avoid artificial additives in your foods.
If you are overweight, work on reducing your
weight.
Women with PCOS should have their Blood
Pressure, Glucose levels and Cholesterol levels
checked regularly.
 Medicinal Management
Consider OCP, Metformin, Progestins,
Antiandrogens, Ovulation induction,
Lipid lowering agents,
Antihypertensives as necessary
 Surgical Management
Surgical management is aimed
mainly at restoring ovulation.
Ovarian wedge resection.
Laparoscopic surgery Various
laparoscopic
methods,including:
Electrocautery, Laser drilling, and
multiple biopsy, have been
used with the goal of creating
focal areas of damage in the
ovarian cortex and stroma.
HOMOEOPATHIC
APPROACH

Miasmatic Approach
Therapeutic Approach
 Homoeopathic
Approach
Homeopathy is the dominant option to treat
Polycystic Ovarian Syndrome. Homeopathic
approach towards management of PCOS is
constitutional taking into account the
patients physical symptoms along with their
mental and genetic make up that
individualizes the person. Early intervention
with Homeopathy can assist in preventing
further progress and hence deterioration
caused by PCOS.
Miasmatic Approach
Psora
PCOD basically comes
under sycotic miasm and
many homeopathic
remedies with sycotic
dominance come into
picture
 Psora
As we all know the PCOD is deficiency of
oestrogen hormone & deficiency is a peculiar
manifestation of Psoric miasm.
The symptoms of PCOD which are covered under
psora are:- Amenorrohea, dysmennorrhoea
with sharp pain & associated with anxiety and
mental restlesness.
Sterility with out any organic defect is also a
good symptom of psora.
 Sycosis
Sycosis is a prominent miasm in PCOD
It covers all the symptoms of PCOD &
endometriosis, sterility & infertility from
hormonal disbalance.
Pruritis vulvae due to acidic pH of vaginal fluid.
Mental weakness is experienced during
luecorrohea.
Sycosis, incordination result in incapability to
concieve due to various factors including
hormonal imbalance.
 Syphilis

Syphilis failure to discharge

the ovum at ovulation
resulting in infertility
 Therapeutic
Approach
Homeopathic constitutional treatment will
help balance hyperactivity of the glands,
regulate hormonal balance, dissolve the
cysts in the ovaries and force them to
resume normal functioning.
so can restore hormonal balance, normal
ovulation, menstrual cycles, and also
eliminate the need for hormone therapies
and surgery.
This can significantly increase the chances
of conception. The different expressions of
this disease can be managed effectively,
safely and gently with Homeopathic
remedies.
 Repertoial Approach
For Pcos
Mind, mood alternating 67
Mind, irritability, waking on 60
Mind, Irritability, menses before 59
Stomach, desire ,sweet 486
Genitalia, female, painful, dysmennorrhoea 727
Genitalia, female, menses, dark - 726
Genitalia, female, tumor ovaries, cyst 745
Genitalia, female, leucorrhoea, acrid
Skin, eruption, pimples, painful - 1315
 Medicine
Agnus Castus Sepia
Apis Mellifica Platinum
Cimicifuga Metallicum
Lachesis Oophorinum
Lycopodium Conium
Maculatum
folliculinum
Ova Tosta
Some constitutional medicine like
Natrum Mur
Pulsatilla
Lachesis
Sepia
Platina
Sulphur
Thuja
Constitutional medicine have their
effect on every system of the body as
body hormones which are secreted in
minimum amount and regulate all the
system so in case of PCOS,
contitutional medicine effects a lot.
 Agnus Cactus
Generally we consider Agnus as a male
remedy.
This remedy is especially good for
neutralizing excess testosterone, which
occurs in PCOS. Menses is irregular and
very scanty. The patient is unable to get
pregnant with loathing of sexual
intercourse.
 Apis Mellifica
This remedy is exceptionally used for arresting
ovarian cysts when there is inflammation of
the ovaries, with soreness, burning and
stinging in the inguinal region. Numbness
down the thigh is an indicating feature of this
remedy.
Right sided dropsy of ovary.
Apis is also used in general retension of fluid
with scanty urine so have capacity to cure
PCOD.
Oophorinum (ovarian
extract)
Ovarian cysts, climatric
disturbance generally,
suffering following
ovariotomy.
It is used in 6x potency
for continues 3 month
twice daily.
 Conium Maculatum
Conium contain active principle
methylconiine/ coniine which is used in
treatment for hirsuitism.
A good medicine for old maids/
bachelors

Stress, depression can be the reason for

PCOD to develop with scanty menses
and infertility.
 Lachesi
s
This remedy is suggested when there is
suppuration and chronic enlargement of
left ovary with pain relieved by menses,
left ovarian dropsy, with intensive pain
sensation as if something is rolling at that
side, cannot tolerate anything heavy on
her pelvic area. The patient is extremely
talkative, restless, uneasy, does not want
to attend to work. Menses is too short and
all pains are relieved by the flow.
 Sepia
The main tissue affinity of sepia is with the
endocrine gland resulting in hormonal
imbalance of adrenocortico-gonadal-pitutary
system, relative adrenal insufficiency is
associated with prepondrence of androgens
to excessive pigmentation like acanthosis
nigricans, hirsuitism, alopecia and acne.
The SEPIA female show both the hormone in
equal or balance quantity. So she have both
pole and because of this there is lack of
attraction towards opposite sex
Platinum Metallicum
This is a paramount womans remedy for
ovarian problems causing sterility. The
ovaries feel sensitive and burn. Menses is
dark clotted with spasms and bearing down
pains. These patientss have an increased
sexual appetite and are very arrogant, proud
with contempt for others.
According to the research the female having
multiple ovarian cyst have desire to have
multiple sexual partners as we saw this in
platina lady.
Platina is a second grade remedy for PCOD
as per KENTS REPERTORY.
 folliculinum
Folliculinum is an alternative to
estrogen hormone. Made up from
estron, an estrogen secreted by
ovaries, it was created to assist
women with a variety of
menstrual, polycystic ovarian
syndrome, endometriosis,
ovarian cyst and physical issues.
It can be used in 3x, 6x, 30, 200.
 Some Researches
If there lots of fluid or scarring around the
ovaries the remedy Thiosinaminum 6x
can help down the scar tissue.
Pulsatilla 6x BD x 15 days is
recommended by CCH research for PCOD.
Trifolium Pratense, Lilium Tig, Senecio,
Agnus Castus is usually recommented
twice daily during the follicular phase of
menstrual Cycle.
 Case - 1
A patient named Farah aged about 27years,
unmarried Female. Address south Toda. OPD-
maharani road
Date:- 10/8/13
Presenting complaints:-
Had been suffering from irregular and painful
menstruation and diagnosed as a case of
bilateral polycystic ovarian disease.
Character of blood is dark, clotted, and profuse.
Menses in every 2-3 month, since 3 yr
LMP:- 27/6/13
 Physical generals
Physical constitution a normal
heighted n smart looking lady with fair
comlexion.
Patient :- hot
Appetite good.
Desire for sweet.
Intolerance of cold food
Moderate thirst for large quantity.
Stool hard as if burnt, constipated,
once in a day.
Sleep sound.
Dreams: Happy, of daily life
 Mental generals
Dont like to talk to anyone but only to
her family members,
Anger ++, expressive and feel very
uncomfortable afterward, feels uneasy.
She said my mood is also changes
frequently, if I am enjoying a movie
than after sometimes I dont like to
see that.
 Laboratory
Investigation
Ultrasound Scan Report: (27/05/13)
Ovaries Multiple follicles are seen in
the periphery with central echognic
stroma.
Blood report :-
Hb 11.6 mg%, WBC 7900/cumm
Neutrophil 65%, Lymphocyte 29%
Monocyte 01%, Eosinophil 05%,
Basophil 0% ESR 48mm (1 st hour)
 Rubrics For
Repertorization
Mind, mood alternating 67
Mind, haughty 51
Mind Ailments, after anger 63
Stomach, desire ,sweet 486
Stomach, aversion, food, cold 481
Sleep, dream, pleasant 1242
Stool, hard, burnt as if -638
Genitalia, female, menses, late 727
Genitalia, female, painful, dysmennorrhoea
727
Genitalia, female, menses, dark - 726
Genitalia, female, tumor ovaries, cyst - 745
 Repertorial Result
1. China - 812
2. Ignitia - 613
3. Lycopodium - 81
4. Merc.sol. - 810
5. Nat. mur. - 711
6. Platina - 922
7. Sulphur - 616
 Prescription
Rx 10/8/13
PLATINA 200] 6 doses
BD x 3 days
Plc 30 ] 1 drm
BD x 7 days
Patient was advised to come after 10
days.
 Follow up
Date :- 21/o8/13

C/o:- Menses arrived 5 days after she

visited, but same as before
dysmenorrhoea very much with scanty
menses this time.
Date:- 20/8/13
Rx
Placebo 200 ] 1 drm
BD x 7 days
 Follow up
Date :- 29/o8/13

C/o:- Better, in mood swing.

Rx
Platina 200 ] 4
dose
BD x 2 days
Placebo 30] drm
BD x 7 days
 Case - 2
Name :- A young lady 22 yrs name Reeta
Thakur working as a nursing tutor in
Hospital, visited me on -19/7/13 with
Presenting complaints:
Leucorrhoea, acrid and scanty.
Spotting between periods (Mc) since 1 yr
Pimples on the face, chest, and
shoulders, pimples are painful since 1 yr
 Family History
Mother :- HTN
Father : HTN
G. Mother (M) : HTN, DM, Uterine prolapsed

Menstrual History
Menarche at the age of 13 yrs.
Regular periods in 28 days, normal flow.
Painful on first day.
LMP:- 25/6/13
Leucorrhoea:- discharge, acrid, scanty
 Physical General
Physical Appearance :- Moderate built,
Fair complexion
Appetite:- good eat 5 chapaties at a time.
Food desire:- pickles
Sleep :- Disturbed
Thirst:- Normal
Perspiration:- Reduced
Bowel movements Normal
Urine:- Normal
 Mental General
Affectionate, very easily get close to others,
Company aversion,
very talkative
Irritability, on waking at morning.
Religious, cant remain a day without praying

Investigation
ultrasound Scan Report:
(03/04/013)
Both ovaries show 12-15 follicles of 3-8
mm diameter In Developing follicle of 12
mm diameter is seen in the left side.
 Rubrics for
Repertorization
Mind, company, aversion to 12
Mind, affectionate 1
Mind loquacity 63
Mind, irritability, waking on 60
Mind , religious, affection 71
Stomach, desire ,pickles 485
Genitalia, female, menses, black 724
Genitalia, female, tumor ovaries, cyst -
745
Perspiration, scanty - 1300
 Genitalia, female, leucorrhoea, acrid
Skin, eruption, pimples, painful -
1315
Perspiration, scanty 1300
Sleep; disturbed
 Repertorial Result
1. Belladona - 714
2. Lachesis - 1022
3. Natrum mur - 711
4. Nux vomica - 714
5. Pulsatilla - 816
6. Sepia - 712
7. Sulphur - 919
 Prescription
19/07/13
Rx
lachesis 200 ] 5 doses
BD x 2 days
phytum 200 ] drm
BD x 5 days
 Follow up
Date:- 28/7/13
Menses arrived. LMP 23/07/13.
This time dysmenorrhea reduced in intensity.
sleep - sound
Rx
lachesis 200] 2 dose
OD x 2 days
phytum 200 ] drm
BD x 5 days
 Follow up
Date :- 2/0913

C/o:- menses arrived at time LMP-

21/08/13
No pain during menses
Pimples is also reduced
Rx
Placebo 200 ] 1 drm
BD x 7 days
 Case 3
Name:- Saida bee
Age :- 26
Sex :- female
Add:- Sirpur
Date:- 18 may 2013
 Present complaint
Irregular menses, early in every 15-
20 days since 2 yr
Burning in whole GIT, since 4 yr <
spicy things
< By cold milk , soft drink
Burning in sole sometimes
H/o typhoid and malaria 6 yr back
 Menstrual history
Irregular menses
Menses, early, profuse, dark colored,
remain for 3-4 days
Pain in abdomen when flow is there.
LMP :- 16/4/13
Leucorrhoea :- watery 2-3 days before
menses.
Taken allopathic treatment OC pills to
regulate menses but when stop the
medication menses again become irregular.
 Physical general
H/C relation:- chilly
Appetite :- good
Thirst:- decreased, 3-4 glass
Desire:- salty
Perspiration :- less, only around neck
Sleep :- sound, but palpitation when
sleep in noon
 Mental general
Highly irritable
If very angry then dont say anything
but weeps.
Consolation aggravates
Fear of river water, fear of stage
Adjustable
 Investigation
Date 22/3/13
Pelvic Sonography
uterus is anteverted, measuring 5.5 x 2.5 x 4.5
cm
right ovary measuring 3.7 x 2.5 x 2.2 cm(vol 11
cc)
Left ovary measuring 3.3 x 2.5 x 2.2 cm(vol 10 cc)
B/L ovaries are bulky and show evidence of
multiple small follicle.
Impression:- PCOD
 Rubric For
Repertorization
Mind, weeping consolation, aggravates 93
Mind, Irritability, menses before 59
Mind, fear, water of 48
Mind , fear, people 46
Stomach, desire, salty things 486
Stomach, heartburn, eating after - 500
Genitalia female, tumor, ovaries, cyst 745
Genitalia female, menses, dark 725
Generalities, food, milk, ameliorates - 1363
 Repertorial Result
1. Calc carb - 712
2. Calc phos - 512
3. Lycopodium - 69
4. Natrum mur - 819
5. Nux vom - 612
6. Platina - 511
7. Sepia - 611
 Prescription
Rx date:
18/5/13
Natrum mur 30 ] 4 dose
BD x 2 days
Phytum 30] 1 drm
TDS x 10 days
 Follow up
C/o :- Date: 28/5/13
she get some relief in burning in epigastrium.
Rx
Natrum mur 200] 4 dose
BD x 2 days
Phytum 30] 1 drm
TDS x 10 days
 Follow up
Date :- 13/o9/13

C/o:- Her last sonography was on

11/9/13 and that shows normal study
with no evidence of PCOD
Rx
Placebo 200 ]
drm
BD x 5 days
 Selection Of Potency
PCOD primarily involves prescribing
a contitutional Homoeopathic
remedy capable of working on the
ovaries.
The constitutional remedy is
prescribed in higher triturition but in
PCOS there is organic changes so we
can also go for 3x, 6x potency.
 Bibliography
Text book of Gynaecology - Dr. D.C Dutta
Miasm and their pathology - Dr. Subruto
Benerjee
Principle & Practice of medicine Davidson
A pocket manual of materia medica and
repertory william boerick
Repertory Of Homoeopathic Materia Medica
Dr. J.T Kent
www.Similima.com
www.google.com