In this condition of artava kshaya menstruation does not appear in its appropriate time or it is delayed (prolonged intermenstrual period). There is scanty menstruation and it does not last for 3 days. It is associated with pain in vagina.
Chakrapani opines that, pain is due to aggravation of vata caused by loss of artava which fills that region. Comparable modern disorder is oestrogen deficiency because pain in vagina is sometimes noted in this condition.
Vata kaphavrutha marganam tu apravartamanam // -Ashtanga Sangraha Shareera
The doshas (vata, kapha) obstruct the passage or orifices of channels carrying artava(menstrual blood)(artava vaha srotas), thus artava is destroyed. Artava is not finished completely and is not discharged monthly.
This condition can be compared with amenorrhoea caused by endometrial abnormalities.
Pathogenesis of PCOS
Kledaka kapha increases which affects jataragni (digestive fire) and aama forms. Kledaka kapha mixes with aama and both enters rasavaha srotas that affects the upadhatu (bi product) of rasa (lymph and plasma) which is raja (artava).
This kledaka kapha ,aama and rasa gets mixed with medo dhatu causing obesity which gradually affects free androgens resulting it to express cold(sheeta),heavy(guru) properties of oestrogen.
Menstrual fluid gets kaphaja quality and blocks apaana vayu. Apaana vayu is responsible for proper elimination of urine, faeces, menstrual blood and expulsion of foetus. Also rasa dhatu mixed with aama and kapha begin to coat insulin receptors of cell resulting in inability of insulin to engage with cellular receptors(as it suppresses pitta) begins to build up In blood stream, moves towards artava.
As vata gets blocked, it blocks pitta also which causes hormones that carry energy transformation unable to initiate their action and accumulated kapha is expressed as cyst in the ovary. Pitta aggravates at the level of bhrajaka and ranjaka (sub types of pitta) which manifests as acne, increased body hair and apaana vayu with other doshas causes menstrual problems.
One major cause of PCOS is the excess production of luteinizing hormone of pituitary gland that increases androgen production.
Symptoms of PCOS (due to high levels of androgen)
No menstrual periods or irregular bleeding
Inability to get pregnant(infertility)
Hirsuitism on chest, face etc.
Male pattern baldness, thinning of hair
Patches of thickened and dark brown or black skin on neck, arms, breasts, thighs.
Abnormal production of insulin leading to weight gain
Type 2 diabetes
Treatment Principle Followed
Normalize metabolism(correction of Agni)
Cleansing of the bowel
Regulate artava dhatu
Reducing circulating androgen
Optimising ovarian function
Supporting optimal endocrine function
Line of Management Recommended
In Amenorrhoea Phase
v Varanadi kashayam
v Rajapravartini vati
v Kulathadi kashayam
v Nashtapushpantaka rasam
v Lashuna erandadi kashayam
v Saptasaram kashayam
v Dashamoola preparations
v Sukumara rasayanam/ghritam
In Excessive Menstruation Phase
Gairika bhasmam/mouktika bhasmam
Important Tip: Soak fenugreek in water overnight and drink this next day early morning.
Panchakarma like vasti, uthara vasti.
High fibre diet(reduces fasting blood glucose without increasing insulin)
Regulate blood sugar and insulin levels
Consumption of vegetables like drumstick, bitter gourd is preferred.
Drink 8-10 glasses of water per day.
Avoid oily spicy food, sweets, honey, alcohol consumption and smoking.
Cut down on salt and salty food.
Reduce total intake of carbohydrates.
Limit the amount of caffeine.
Sesame, urad dal, garlic, curry leaves, jeera, pomegranate, hing, black pepper, long pepper, dry ginger are indicated.
ü Exercise and weight reduction is highly beneficial, exercise helps to combat the conditions like diabetes, heart disease which are associated with pcos apart from regulating menstrual cycles.
ü Practice yoga and meditation to ward off stress/depression.