Polycystic ovarian disease by Dr.Shuchita Chattree

1. Polycystic Ovarian Disease
And Its Homoeopathic Approach
By: Dr. Shuchita Chattree
M.D. (PGR)
Department of Materia Medica
Homoeopathy University, Jaipur
Email: shuchita.chattree@gmail.com
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3. NNoorrmmaall OOvvaarriieess
Normal size: 5 x 3 x 3cm
:Variation in dimensions can result from
Endogenous hormonal production varies with age and –
(menstrual cycle
Exogenous substances, including GnRH agonists, or –
.ovulation-inducing medication, may affect size
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5. OOvvaarriiaann AAttttaacchhmmeennttss
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• Several ligaments hold each ovary in position.
• The largest is called the broad ligament and is attached to the
uterine tubes and uterus.
• The suspensory ligament holds the ovary at the upper end.
• The ovarian ligament is a rounded, cord-like thickening of the
broad ligament.
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8. HHiissttoollooggyy
• Ovary has 3 layer of tissues:
• Ovarian surface epithelium or Germinal epithelium: Tunica
albuginea.
• Ovarian Cortex: cellular connective tissue ovarian follicles corpora
lutea and albicans.
• Medulla: vascular connective tissue
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10. SSttaaggeess ooff DDeevveellooppmmeenntt
• Ovarian follicles – in cortex and consist of oocytes in various stages
of development. Surrounding cells nourish developing oocyte and
secrete estrogens as follicle grows.
• Mature (graafian) follicle – large, fluid-filled follicle ready to expel
secondary oocyte during ovulation.
• Corpus luteum – remnants of mature follicle after ovulation
Produces progesterone, estrogens, relaxin and inhibin untill it
degenerates into corpus albicans.
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13. MMeennssttrruuaall CCyyccllee
• Normal Female Reproductive cycle is divided into
two phases:
• Ovarian phase
• Uterine phase (Menstural cycle)
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16. OOvvaarriiaann CCyyccllee
Follicular Phase
•Menstural phase (1st-5th day)
•Pre-ovulatory phase. (5th-13th days)
Ovulation Phase
•Ovulatory phase. (13th-18th day)
Luteal Phase
•Post-ovulatory phase. (18th – 28th days)
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19. Histological appearance dduurriinngg RReepprroodduuccttiivvee
CCyyccllee
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20. MMaaggnniiffiieedd VViieeww
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21. Graffian Follicle
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22. CCoorrppuuss LLuutteeuumm
After ovulation, the remaining wall
of the graafian follicle transforms
.into the corpus luteum
The wall of the corpus luteum is
folded and contains granulosa
lutein cells derived from granulosa
.cells which secrete progesterone
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23. CCoorrppuuss AAllbbeeccaannss
In the absence of
fertilization the corpus
luteum degenerates,
decreases in size and form
the corpus albicans which
consists of dense connective
tissue
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24. FFoorrmmaattiioonn OOff CCYYSSTT
In female reproductive cycle during follicular phase water starts
accumulating around the egg cell, size increases as more water
.accumulate
Because of accumulation of water Follicle comes to the periphery and
.Release of ovum ovulation occurs. If not fertilized, Menstruation occurs
In case of ovarian cyst this collection of fluid remain, surrounded by a
. very thin wall, within an ovary
Any ovarian follicle that is larger than about two centimeters is termed
.an ovarian cyst
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25. OOooccyyttee
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26. CCYYSSTTIICC OOOOCCYYTTEE
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27. NNoonn NNeeooppllaassttiicc OOvvaarriiaann EEnnllaarrggeemmeenntt
Follicular Cyst
Corpus Luteum Cyst
Theca Lutein And Granulosa Lutien Cyst
Polycystic Ovarian Syndrome
Endometrial Cyst
Except the last all are functional cysts of the Ovary
and are loosely called CYSTIC OVARY
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28. PPoollyyccyyssttiicc OOvvaarriieess
:Rotterdam criteria defines
PCO solely on total follicle no. Presence of ≥ 12 follicles
measuring 2-9 mm in diameter Epidemiology
and/or increased ovarian
.volume >10 mL in at least one ovary
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29. EEppiiddeemmiioollooggyy
Very prevalent disease affecting
between 6.5 and 8% of women
overall
It is prevalent in Young Reproductive
Age group (20-30%)
Prevalence much higher in obese
women (28% versus 5.5%).
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30. HHiissttoorryy
 Originally described by Stein and Leventhal in 1935, first
known as the “Stein-Leventhal syndrome”.
 They saw in 7 women with amenorrhoea, hirsutism, and
obesity found to have a polycystic appearance to the
ovaries.
 Insulin resistance described later by Burghen (1980)
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31. EETTIIOOLLOOGGIIEESS
No one is quite sure what causes PCOS, and it is likely to
:be the result of
( Genetic (inherited(1
. Environmental factors(2
(Metabolic disorder (IR(3
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32. Pathophysiology
Hypothalamic – pituitary abnormalities( 1
that result in gonadotropin – releasing hormone and
.leutinizing hormone dysfunction
A primary enzymatic defect in ovarian or combined ( 2
.ovarian and adrenal steroidogenesis
A metabolic disorder characterized by resistance in ( 3
conjunction with compensatory hyperinsulinaemia that
exert adverse effects on the hypothalamus, pituitary,
.o3v2 aries, and possibly the adrenal glands 11/09/14

33. PPAATTHHOOGGEENNEESSIISS
The ovaries are stimulated to produce excessive amounts of
androgens, particularly testosterone, by either one or a
combination of the following (almost certainly combined with
(.genetic susceptibility
.The release of excessive LH by the anterior pituitary gland
Through hyperinsulinaemia in women whose ovaries are sensitive
.to this stimulus
Alternatively or as well, reduced levels of sex-hormone binding
.globulin(SHBG) can result in increased free androgens 33 11/09/14

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35. ABNORMALITIES OF PCOS OVARY
• Increase activity in chromosome CYP17 region leads to
increased p450c17 enzyme and hence increased
androgen synthesis.
• Decrease in chromosomal region CYP19 activity
decreases aromatase enzyme activity and conversion
of androgens to E2 (Estradiol) is reduced.
• This loss of aromatase and E2 biosynthesis has been
proposed to involve dysregulation of signaling within
the follicle leading to follicular arrest. 11/09/14 35

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40. CClliinniiccaall FFeeaattuurreess
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43. Diagnostic Criteria
ASRM/ESHRE, 2003 Criteria
2 out of 3 required
•1. Menstrual Irregularity
•2. Hyperandrogenism (Clinical or Biochemical)
•3. USG – Polycystic ovary
•Exclusion of other etiologies
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44. Androgen Excess & PCOS society Criteria 2006
•Menstrual irregularity +/- USG - Polycystic ovary.
•Hyperandrogenism.
•Exclusion of other etiologies
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45. IInnvveessttiiggaattiioonnss::
• History-taking, specifically for menstrual pattern, obesity, hirsutism,
and the absence of breast development.
• BBT (basal body temperature)
• Ultrasonography.
• Serum (blood) levels of androgens (male hormones), including
androstenedione and testosterone may be elevated.
• Serum values of Luteinizing Hormone (LH)
• levels or the ratio between LH : FSH is > 3 : 1
• Laproscopic view
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46. USG of Normal Ovary
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47. USG of Polycystic Ovary
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48. LLAAPPRROOSSCCOOPPIICC VVIIEEWW
B/L Polycystic ovaries are characteristic of PCOS.
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49. DIFFERENTIAL DIAGNOSIS
• Late onset congenital adrenal hyperplasia
• DHEAS (Dehydroepiandrosterone) >18mmol/l
• 17 OH Prog (17 hydroxyprogestrone) > 6 mmol/l
• Ovarian + adrenal androgen secreting tumours
• Very high testosterone > 6mmol/l
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50. • Cushings Syndrome:
• - Dexamethsone suppression test
• - 24 hours urinary cortisol
• - DHEAS (Dehydroepiandrosterone) > 13 mmol/l
• Iatrogenic and illegal androgen ingestion.
• Hypothyroidisms (Thyroid profile test).
• Hyperprolactinemia. (Serum Prolactine estimation)
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51. MMiiaassmmaattiicc SSyymmppttoommss
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53. RRuubbrriiccss
KKEENNTT’’SS RREEPPEERRTTOORRYY
:FEMALE GENITALIA - TUMORS - Ovaries – cysts
. Apis Bov. Bufo canth. carb-an. Coloc. Iod. Kali-br
.Lach. merc. murx. Plat. prun. rhod. Rhus-t. thuj
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54.  GENITALIA - Female organs - swollen – ovaries:
GRAPH. LACH.
 GENITALIA - Female organs - swollen - ovaries
[double]: Apis bufo nux-m.
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55. MMUURRPPHHYY RREEPPEERRTTOORRYY
 Female - CYSTS, genitalia - cysts, ovarian:
APIS apoc. arn. ars. Aur-i. aur-m-n. aur. bell. Bov. bry. Bufo
canth. carb-an. chin. Colch. Coloc. con. ferr-i. form. graph.
Iod. Kali-br. kali-fcy. Lach. lil-t. Lyc. med. merc. murx. Ov.
Plat. prun. rhod. Rhus-t. sabin. sep. syc. syph. ter. THUJ.
zinc.
 Female - TUMORS, genitalia - tumors,
ovaries:
APIS apoc. ars-i. Ars. aur-m-n. Bar-m. bov. Calc. Coloc. con.
ferr-i. fl-ac. graph. hep. Iod. Kali-br. lach. lyc. med. ov. Pall. Plat.
Podo. Sec. staph. stram. syph. Thuj. zinc. 11/09/14 55

56.  Pulse - FAST, pulse, elevated, exalted -
ovarian cyst, in: Iod.
 Pulse - IRRITABLE, pulse - ovarian
cyst,in: Iod.
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57. SSYYSSTTHHEESSIISS RREEPPEERRTTOORRYY
 FEMALE GENITALIA/SEX - TUMORS -
Ovaries – cysts: Apis arg-met. Aur-m-n. bell. Bov.
brom. Bufo canth. carb-an. carc. Coloc. foll. Iod. kali-bi. Kali-br.
Lach. lyc. merc. murx. naja ov. Pall. Phos. Plat. podo. prun.
rhod. Rhus-t. syc. syph. thuj.
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58. TThheerraappeeuuttiiccaall MMeeddiicciinneess
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59. Hedera helix (common lvy)
• Cystic ovaritis, especially on the
left side.
• Amenorrhea in young girls.
Infrequent menses.
• Menses late, shorter and less
copious. Pre-menstrual
leucorrhea.
• (Murphy)
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60. Cobaltum nitricum (nitrate of cobalt)
• Lack of libido.
Metrorrhagia. Secondary
amenorrhea.
• Cystic inflammation of
the ovary. Sterility
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61. Hirudo medicinalis (leech)
 Left-sided ovarian pain like
being stabbed.
 Brownish leucorrhea two days
before menses.
 Menses: too early or late,
heavy or light, painful or less
painful than usual.
 Feeling in the pelvis as if
menses would come on two
weeks before due.
 Ovarian cysts
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62. Rhododendron chrysanthum
• Pain in ovaries; agg. in
change of weather.
• Caused rupture of cyst in
right ovary.
• (CLARKE J. H., Dictionary of
Practical Materia Medica)
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63. AArrggeennttuumm mmeettaalllliiccuumm
 Hard, indurated, cystic ovaries,
especially the left.
 (FARRINGTON E. A.,
Comparative Materia Medica)
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64. MMuurreexx ppuurrppuurreeaa
• Large cyst, supposed to be connected with left ovary,
occupied space between rectum, uterus and vagina, so as
to obliterate posterior cul de sac and almost occlude
vagina; abdomen somewhat distended; confined to her
room and bed for more than a year.
• (HERING C., Guiding Symptoms of our Materia Medica)
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65. The Important Common Homoeopathic drugs indicated for
:Ovarian cysts are
Bovista
Apis mellifica
Platina
Lycopodium
Thuja
Lachesis
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66. BBOOVVIISSTTAA
Mind -Enlarged sensation. [Arg.n.]
Awkward; everything falls from
. hands.Sensitive
. Diarrhoea before and during menses
Menses too early and profuse; worse at
night. Voluptuous sensation.
Leucorrhoea acrid, thick, tough,
greenish, follows menses. Soreness of
pubes during menses. Metrorrhagia;
6.6 Parovarian cysts 11/09/14

67. APIS MELLIFICA
Mind -Apathy and indifference. Awkward;
Listless; cannot think clearly. Jealous, fidgety,
. hard to please
Tearfulness. Jealously, fright, rage, vexation,
grief. Cannot concentrate mind when
. attempting to read or study
Ovaritis; worse in right ovary. Menses
suppressed, with cerebral and head
symptoms, especially in young girls.
. Dysmenorrhoea, with severe ovarian pains
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68. Colocynthis
.Boring pain in ovary
Must draw up double, with great
.restlessness
Round, small, cystic tumous in ovaries
.or broad ligaments
Bearing-down cramps, causing her to
.bend double
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69. LACHESIS MUTUS (lach.)
Menses too short, too feeble; pains all relieved
by the flow. [Eupion.]
Left ovary very painful and swollen, indurated.
Acts especially well at beginning and close of
menstruation.
Ill effects of suppressed discharges.
Mind.-Great loquacity. Jealous. [Hyos.] Mental
labor best performed at night.
Suspicious; nightly delusion of fire.
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70. Platina
.Parts hypersensitive
Ovaries sensitive and burn; vaginismus, nymphomania, pruritus
.vulva, ovaritis with sterility
Menses too early, too profuse, dark clotted with spasms and
.painful bearing down and sensitiveness of the parts
Mental troubles associated with suppressed menses
Self exaltation
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71. THUJA
. Left-sided and chilly
Mind.-Fixed ideas, Emotional sensitiveness; music causes weeping and
.trembling
.[Female.-Vagina very sensitive. [Berb.; Kreos.; Lyssin
Warty excrescences on vulva and perineum. Profuse leucorrhoea; thick,
.greenish
Severe pain in left ovary and left inguinal region. Menses scanty,
; retarded. Polypi
.Ovaritis; worse left side, at every menstrual period
. Profuse perspiration before menses 71 11/09/14

72. BBUUFFOO
Burning heat and pain in the ovaries which extends down the thigh.
Dysmenorrhoea with cysts and hydatids about ovaries.
IIOODDUUMM
Congestion and dropsy of right ovary with dwindling of the mammae.
Dull pressing pain extending to the uterus.
Wedge like pain in the right ovarian region.
LLIILLIIUUMM TTIIGG
Ovarian neuralgia.
Burning pains from ovary up into abdomen and down into thighs.
Shooting pain from left ovary across the pubes or upto the mammary
gland.
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73. CCOONNIIUUMM MMAACCUULLAATTUUMM
Ovary enlarged, indurated, lancinating pain.
Breast enlarge and become painful before and during menses.
Menses delayed and scanty.
Dysmenorrhoea, with drawing down thigh.
Mammae lax and shrunken, hard painful to touch.
Ill effects of repressed sexual desire or suppressed menses.
KKAALLII BBRROOMMAATTUUMM
Ovarian neuralgia with great nervous uneasiness.
Cystic tumours of ovaries.
Exaggerated sexual desire.
Vomiting with intense thirst after each meal
Fidgety of hands, jerking and twitching o muscles.
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74. TTHHAANNKK YYOOUU
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