Polycystic ovarian disease by Dr.Shuchita Chattree

1. Polycystic Ovarian Disease
And Its Homoeopathy approach
By: Dr. Shuchita chattree
M.D. (PGR)
Department of Materia Medica
Homoeopathy University, Jaipur
Email: shuchita.chattree@gmail.com
11/09/14 1

2. o 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.

3. OOvvaarryy

4. 4
Ovarian Attachments
• 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.

5. 5

9. Ovary have 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

12. ◦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.

17. o Normal Female Reproductive cycle is divided into
two phases:
o Ovarian phase
o Uterine phase (Menstural cycle)

21. Ovarian Cycle is divided into:
Menstural phase (1st-5th day)
Pre-ovulatory phase. (5th-13th days)
Ovulatory phase. (13th-18th day)
Post-ovulatory phase. (18th – 28th days)
Follicular phase
Ovalution
Luteal phase

30. OOooccyyttee cceellll

31. Graafian follicle cell

32. SSeeccoonnddaarryy ffoolllliiccllee cceellll

33. 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.

34.  Corpus Albicans
In the absence of
fertilization the corpus
luteum degenerates,
decreases in size and
form the corpus
albicans which consists
of dense connective
tissue

36. ● In female reproductive
cycle During follicular
phase water starts
accumulating around the
egg cell.
● Continuously size
increases as more water
accumulates.

37. Because of
accumulation of water
Follicle comes to the
periphery.
Release of ovum
ovulation occurs

38. Remnants of the
follicle called
‘‘CCOORRPPUUSS LLUUTTEEUUMM’’..
If not fertilized,
Menstruation occurs.

39. ● 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.

40. Cystic Oocyte

41. Rotterdam criteria defines PCO solely on total follicle no.:
Presence of ≥≥ 1122 ffoolllliicclleess measuring 22--99 mmmm in diameter
and/or increased ovarian volume >>1100 mmLL in at least one
ovary.

42.  In The 2003 Rotterdam consensus workshop
concluded that:
“PCOS is a syndrome of
ovarian dysfunction along
with the cardinal feature of
hyperandrogenism and
polycystic ovary
morphology.”

43.  Very prevalent disease affecting between 6.5 and 8%
of women overall.
 Prevalence much higher in obese women (28%
versus 5.5%).

45. • Originally described by Stein and Leventhal in 1935, first known as the
“Stein-Leventhal syndrome”
• They saw in 7 women with amenorrhea, hirsutism, and obesity, found to
have a polycystic appearance to their ovaries.
• Insulin resistance described later by Burghen (1980)

46. ETIOLOGIES
• No one is quite sure what causes PCOS, and it is likely to be the
result of:
1)Genetic (inherited)
2)Environmental factors.
3)Metabolic disorder (IR)

48. Different HHyyppootthheessiiss::
1) Hypothalamic – pituitary abnormalities that result in
gonadotropin – releasing hormone and leutinizing hormone
dysfunction.
2) A primary enzymatic defect in ovarian or combined ovarian and
adrenal steroidogenesis.

49. 3) A metabolic disorder characterized by
resistance in conjunction with
compensatory hyperinsulinaemia that
exert adverse effects on the
hypothalamus, pituitary, ovaries, and
possibly the adrenal glands.

50.  PPAATTHHOOGGEENNEESSIISS
 Polycystic ovaries develop when 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).

51. This occur because of:
 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
can result in increased free androgens.

52. • Chronic endocrine disorder resulting in:
 Insulin resistance
Hyperandrogenism
 Altered gonadotropin functioning

56. OVARIAN STEROID
BIOSYNTHETIC
Wickenheisser, McAllister, 2007
PATHWAY

58. ABNORMALITIES OF PCOS
Wickenheisser, McAllister, 2007
OVARY

59. • Increase activity in chromosome CYP17 region leads to
increased p450c17 enzyme and hence increased
androgen synthesis.

60. Wickenheisser, McAllister, 2007

61. Decrease in chromosomal region CYP19 activity
decreases aromatase enzyme activity and conversion of
androgens to E2 (Estradiol) is reduced.

63. • This loss of aromatase and E2 biosynthesis has been
proposed to involve dysregulation of signaling within
the follicle leading to follicular arrest.

64. Wickenheisser, McAllister, 2007

69.  Abnormal Pituitary Function—Altered Negative Feedback Loop
hypothalamus
pituitary
oovvaarryy
Negative feed back effect blocked.
GnRH
LH
androgens
Androgens block
inhibitory effect of
progesterone X

71. Polycystic ovaries

75. • Ovulatory dysfunction:
• Amenorrhea
• Oligomenorrhea
• Irregular uterine bleeding
• Infertility

76. • Androgen excess:
• Hirsutism
• Seborrhea

77. HIRSUTISM

78. Male Type Hair Growth on Abdomen-PCOS

80. • Androgen excess:
•Acne
•Alopecia
•Virilization.

81. ALOPECIA

83. ACNE

85. • Insulin resistance:
• Acanthosis nigricans.
• Skin tags.
• Obesity.

86. Obesity

87. AAccaanntthhoossiiss
NNiiggrriiccaannss

90. SSkkiinn TTaaggss

91. DIAGNOSTIC CRITERIA
NNIIHH RRootttteerrddaamm

92. 92
PCOS – Diagnostic criteria
• NIH (1990)
• Menstrual Irregularity
• Hyperandrogenism
• Exclusion of other
etiologies
• Rotterdam (2003)
• 2 out of 3 required
1.Menstrual Irregularity
2.Hyperandrogenism
3.USG – Polycystic ovary
• Exclusion of other etiologies

93.  Androgen Excess & PCOS society Criteria 2006
• Menstrual irregularity +/- USG - Polycystic ovary.
• Hyperandrogenism.
• Exclusion of other etiologies

95.  Diagnosis
 History-taking, specifically for menstrual pattern,
obesity, hirsutism, and the absence of breast
development.
 BBT (basal body temperature)

96. • 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

97. PCOS – Evaluation
• Biochemical evidence of hyperandrogenism
• S. Total testosterone
• USG evidence of Polycystic ovary
• 12 or more follicles in each ovary measuring 2-9 mm in
diameter +/- inc. ovarian volume (>10 mL) [Rotterdam
criteria]
November 9, 2014 97

98. USG view of Normal Uterus & Ovaries.

99. USG view of Normal Ovary

100. USG view of PCOD Ovary

101. USG view of PCOD Ovary

102. PPEEAARRLLYY WWHHIITTEE SMOOTH ENLARGED AND THICK WALLED OVARY
ON LAPROSCOPY ( PCOS)

103. LLaappaarroossccooppyy –– BB//LL ppoollyyccyyssttiicc oovvaarriieess aarree
cchhaarraacctteerriissttiicc ooff PPCCOOSS..
www.similima.com 103

105.  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

106. • 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)

109. PPCCOODD
PPssoorraa iinniittiiaallllyy
bbrriinnggss aabboouutt
ffuunnccttiioonnaall
cchhaannggeess iinn tthhee
ffoorrmm ooff nneeuurroo
hhoorrmmoonnaall
ppaatthhwwaayy lleeaaddiinngg
ttoo hhoorrmmoonnaall
cchhaannggeess..
SSyyccoottiicc mmiiaassmm
bbrriinnggss aabboouutt
ppaatthhoollooggiiccaall
cchhaannggeess iinn
OOVVAARRIIEESS
lleeaaddiinngg ttoo
ffoorrmmaattiioonn ooff
CCYYSSTTSS..
MMaalliiggnnaannccyy
TTuubbeerrccuullaarr
mmiiaassmm aaddddss
bblleeeeddiinngg ttoo
tthhee CCYYSSTT..
psora
sycosis
tubercular
syphilis

111.  FEMALE GENITALIA - TUMORS - Ovaries
– cysts:
Apis Bov. Bufo canth. carb-an. Coloc. Iod. Kali-br.
Lach. merc. murx. Plat. prun. rhod. Rhus-t. thuj.
KKeenntt
RReeppeerrttoorryy

112.  GENITALIA - Female organs – ovaries:
Acon. agar. agn. Ambr. Ant-c. arn. Ars. ASAF. AUR. BELL.
calc. CANTH. CARB-AN. Carb-v. caust. Chel. CHIN. clem.
CON. dros. DULC. Graph. hyos. Ign. KALI-C. kali-n.
LACH.
laur. LIL-T. LYC. MERC. Mez. nat-c. Nit-ac. Nux-v. pall.
PLAT.
plb. puls. RAN-B. Ran-s. ruta SABIN. sars. SEC. SEP.
STAPH. Sulph. THUJ. ZINC. BBBBCCRR
RReeppeerrttoorryy

113.  GENITALIA - Female organs - swollen –
ovaries: GRAPH. LACH.
 GENITALIA - Female organs - swollen -
ovaries [double]: Apis bufo nux-m.
BBBBCCRR
RReeppeerrttoorryy

114.  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.
MMuurrpphhyy
RReeppeerrttoorryy

115.  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.
MMuurrpphhyy
RReeppeerrttoorryy

116.  Pulse - FAST, pulse, elevated, exalted
- ovarian cyst, in: Iod.
 Pulse - IRRITABLE, pulse - ovarian
cyst,
in: Iod.
MMuurrpphhyy
RReeppeerrttoorryy

117.  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.
SSyynntthheessiiss
RReeppeerrttoorryy

119.  Hedera helix (common lvy)
 Female
 Cystic ovaritis, especially on the left
side.
 Amenorrhea in young girls. Infrequent menses.
 Menses late, shorter and less copious. Pre-menstrual leucorrhea.
-MURPHY R., Homeopathic Remedy Guide

120.  Cobaltum nitricum (nitrate of cobalt):
 Female:
 Lack of libido. Metrorrhagia. Secondary
amenorrhea.
 Cystic inflammation of the ovary. Sterility
-MURPHY R., Homeopathic Remedy Guide

121.  Chlorpromazinum (largactil)
 Female:
 Considerable leucorrhea like egg-white.
 Amenorrhea.
 Stretch-marks.
 Sexual precocity.
 Painful menses.
 Cystic inflammation of the ovary.
-MURPHY R., Homeopathic Remedy Guide

122.  Hirudo medicinalis (leech):
 Female:
 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.

123.  Nepenthes distillatoria:
 Female:
 Stinging, needle-like, flashing pains around the right
ovary in the morning.
 Left ovarian pain, spreading to the left kidney. Menses
early by 5 days and copious.
 Menses repeat after a period of amenorrhea lasting 6
months.
 Feeling of swelling of whole body 10 days before
menses.
 Cystic ovaritis.

124. Ovininum: Ovary gland: (Oophorinum)
 Ovary has been suggested
as a remedy in ovarian
cysts.

125.  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

126.  Robinia pseud-acacia, L
 Swelling as if there were an ovarian
cyst, especially in the left side of the
abdomen.
ALLEN T. F., Encyclopedia of Pure Materia Medica

127.  Argentum metallicum:
 Hard, indurated, cystic ovaries,
especially the left.
FARRINGTON E. A., Comparative Materia Medica
(with therapeutic hints)

128.  Murex purpurea
 ¤ 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

129.  The Important Common Homoeopathic drugs
indicated for Ovarian cysts are:
● Bovista
● Apis mellifica
● Platina
● Lycopodium
● Thuja
● Lachesis

130.  BOVISTA
 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; Parovarian cysts.

131.  APIS MELLIFICA
 Mind -Apathy and indifference. Awkward;
drops things readily. Listless; cannot think
clearly. Jealous, fidgety, hard to please.
Sudden shrill, piercing screams. Whining.
 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.

132.  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

133.  Lycopodium
 Vagina dry, painful coition.
 Varicose veins of pudenda.
 Leucorrhoea acrid with burning in
vagina.
 Discharge of blood from vagina during
stool.
 Melancholy; afraid to be alone.

134.  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.

135.  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.

136.  Bufo
 Burning heat and pain in the ovaries
which extends down the thigh.
 Dysmenorrhoea wwiitthh ccyyssttss aanndd
hhyyddaattiiddss aabboouutt oovvaarriieess..

137.  Iodum:
 CCoonnggeessttiioonn aanndd ddrrooppssyy ooff rriigghhtt oovvaarryy
wwiitthh ddwwiinnddlliinngg ooff tthhee mmaammmmaaee..
 Dull pressing pain extending to the
uterus.
 Wedge like pain in the right ovarian
region.

138.  Lilium Tig.
 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.

139.  Conium Mac.
 Ovary enlarged, iinndduurraatteedd,, llaanncciinnaattiinngg
ppaaiinn..
 Ovaritis
 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.

140.  Colocynthis
 Boring pain in ovary.
 Must draw up double, with great
restlessness.
 RRoouunndd,, ssmmaallll,, ccyyssttiicc ttuummoouuss iinn
oovvaarriieess oorr bbrrooaadd lliiggaammeennttss..
 Bearing-down cramps, causing her to
bend double.

141.  Kali Bromatum
 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.

142. Other Rare drugs indicated for Ovarian cyst
 Oophorinum
 Aur. Iod.
 Xantoxylum