Polycystic Ovary Syndrome is a heterogeneous condition affecting women of reproductive age. Globally, more than 7 % of the women are suffering from the disease, of which five million are in the United States (Palomba, 2). According to the National Institute of Health, more than $ 4 billion is spent annually in the treatment and management of patients suffering from PCOS (Palomba, 2). The condition manifests in the form of menstrual irregularities, elevated androgen levels, and unilateral or bilateral presence of a cyst in the ovaries (Arora& Arora, 2).
Question One
The morphological changes in the ovaries reveal numerous small ovarian cysts that are pearl-sized and fluid-filled (Kumar, 728). As a result, there is an abnormal regulation of estrogen and androgen hormone production, causing oligo-ovulation and hyperandrogenism (Kumar, 728). Histologically, the affected ovaries have between one and 12 fluid-filled follicles. The ovaries have thickened fibrotic outer tunica, absent corpora Lutea, and innumerable cyst lining granulosa cells (Kumar, 728). Therefore, the diagnosis criteria for the condition rely on the presence of excess androgen, anovulation, and oligo ovulation in the absence of other endocrine disorders, for instance, hyperprolactinemia and Cushing’s syndrome (Arora& Arora, 2).
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Patient with PCOS presents with complaints of infertility, obesity, hirsutism, and menstrual disorder (Dennett, 116). For adolescents, the menstrual disease usually occurs around menarche and can present as oligomenorrhea, abnormal uterine bleeding, or amenorrhea. The elevated level of androgen hormone causes male pattern hair distribution in the lower abdomen, chin, and upper lips (Arora& Arora, 2). Furthermore, the women suffer from other coronary heart diseases, diabetes mellitus and glucose intolerance due to increased levels of lipoprotein secondary to metabolic syndrome (Dennett, 116).
Question Two
The condition is caused by a cluster of genetic and environmental that determines its biochemical and genetic phenotype. Several studies have revealed the familial link with an autosomal dominant pattern in its etiology (Dennett, 116). However, the pathophysiology of the condition involves a malfunction in insulin secretion, insulin action, ovarian function, and impairment of the hypothalamic-pituitary axis (Dennett, 117). Notably, insulin resistance may occur together with hyperinsulinemia and obesity and increases the production of androgen by the ovaries (Dennett, 116). The resistance is caused by the downgrading of the insulin signal pathway that interferes with post-binding, resulting in hyperinsulinemia and anovulation (Dennett, 117). Moreover, insulin resistance reduces adiponectin hormone secreted by adipocytes, hence impairing glucose regulation and lipid metabolism, resulting in obesity and other metabolic disorders (Palomba, 13).
Furthermore, the clinical manifestation of the condition is caused by reduced follicular stimulating hormones, and elevated levels of gonadotropin-releasing hormone and luteinizing hormone (Dennett, 116). The reduced level of the follicular stimulating hormone is caused by an ovarian abnormality that impairs follicular maturation. Additionally, the elevated levels of the gonadotropin-releasing hormone cause increased secretion of androgen secondary by overstimulating the ovarian cells (Dennett, 118).
Therefore, therapeutic management of the condition tailored towards managing elevated insulin levels increased the production of androgen and restoring the sex-hormone globulins (Palomba, 55). Pharmacological therapy involves the use of antidiabetic drugs such as metformin together with clomiphene to decrease insulin resistance and increase fertility level by lowering circulating androgen (Palomba, 55). Secondly, clomiphene citrate is used in the treatment of anovulation since it triggers ovulation. However, in case the drug fails, the physician can use follicular stimulating hormone (FSH), though both FSH and clomiphene increases the chance of pregnancy (Palomba, 55). Moreover, the combined oral contraceptive is prescribed to prevent pregnancy, regulates menstrual periods, and treats acne and hirsutism (Palomba, 55). Other treatment strategies include weight reduction, physical exercise, and ovarian resection (Arora& Arora, 3).
Question Three
Alternative medicine holds that environmental factors, for instance, lifestyle and diet, plays a significant role in the etiology of the disease. Stressful situations have also been cited as a possible cause of PCOS since it induces the production of cortisol’s and androgen in the blood (Briden, np). Additionally, nutritional transition among the Indian and Asian women may be a possible cause of increased incidence of PCOS in Asia, since it delayed ovulation and increased the production of androgen hormone (Rath, 95). Several traditional remedies are used in the management of PCOS.
First, acupuncture is widely used alternative medicine treatment for PCOS among American women. The method uses needles to stimulate somatic afferent nerves in the muscles and skin, either through manual or electronic means (Johansson, 3). Chinese medicine supports the use of acupuncture in restoring the balance between Yin and Yang, commonly referred to as the parasympathetic and sympathetic nervous system (Johansson, 3).
Secondly, Chinese Herbal Medicine is used together with conventional medicine among. The Chinese people believe that the drug restores imbalance in the body system (Raja-Khan, 5). They hold that PCOS is caused primarily by the impairment in kidney function, resulting in abnormalities in reproductive systems such as anovulation (Raja-Khan, 5). Many of the herbal products come from plants and animal byproducts. However, concerns about the safety and efficiency of the medicines, especially concerning potency and toxicity, are raised (Raja-Khan, 6). Additionally, Spearmint and green tea are used for reducing weight, increasing lipid metabolism, and insulin secretion.
Thirdly, dietary supplements address nutritional deficiencies that cause the condition (Raja-Khan, 6). Vitamin D deficiency is one of the causes of metabolic syndrome common among women with PCOS (Raja-Khan, 6). Therefore vitamin D supplements help in improving metabolism and induce anovulation among women with PCOS. Moreover, Vitamin B12 and Folates supplements manage obesity and reducing high levels of homocysteine that is common among patients with the condition (Raja-Khan, 6).
Additionally, physical exercise plays a critical role in the management of the metabolic disorder and cardiovascular disease among patients with PCOS (Raja-Khan, 6). A typical physical activity is the Tai Chi and Qi Gong exercise that reduces reproductive and metabolic disturbances. However, no study has been conducted to investigate the effectiveness of such physical activity in the management of PCOS (Raja-Khan, 6). Lastly, mindful meditation, for instance, Zen meditation and Vipassana Meditation, is used to enhance psychological health and wellbeing among PCOS women. Finally, meditation and wellness are also used to improve the functioning of the autonomic nervous system and the hypothalamic-pituitary axis (Raja-Khan, 6).
Question Four
Women suffering from PCOS have both short term and long term complications that impact significantly on their quality of life. Consequently, they present with poor quality of life and psychological disturbance characterized by low self-esteem, negative body image, depression, and psychosocial dysfunction (Rath, 95). Thus, the homeopathic system of therapy is an affordable therapy that heals holistically. The treatment method is individualized and tailored to the specific needs of the patient (Arora& Arora, 9).
The main goal of the therapy is to relieve symptoms of the disease, stop its progress, and offer a cure. To achieve that, it stimulates the hypothalamic-pituitary axis, thus boosting the production of hormones and restores the immune system. The commonly used drugs are Apis mellifica, platinum, and natrum muriatic (Arora& Arora, 10). Additionally, the therapy is a multistage treatment strategy that involves an initial stage, developed stage, and management PCOS together with other morbidities (Arora& Arora, 3).
During the initial management phase, the treatment tailored towards addressing specific signs and symptoms of the disease, while the developed stage regulates the body hormones and control symptoms (Arora& Arora, 9). Lastly, the third stage aims at improving the quality of life by repeatedly administering the medications. The drugs are used as adjunct treatment together with modern medicine and have demonstrated success in curing PCOS (Arora& Arora, 9).
There are numerous benefits associated with homeopathic therapy in the management of PCOS. Importantly, the treatment adopts a holistic approach in the management of the patient, has no side effects, and takes into account all aspects of the patient during prescription (Rath, 98). Secondly, the treatment is more cost effective compared to the use of pharmacological therapy and surgical resection of the ovary (Rath, 98). Lastly, among patient treated using the method, symptoms of the condition did not recur for more than three years. Consequently, the results suggest that the therapy can successfully treat and cures the disease among women of reproductive age (Rath, 98). However, there is still a need for a randomized study to investigate its efficiency in the management PCOS.
In Conclusion, PCOS is a complex condition that requires early diagnosis and treatment. There is a need to increase awareness of the disease among women of reproductive age to facilitate early diagnosis and treatment. Moreover, there is a need for more research study to investigate the effectiveness of traditional treatment remedies and whether homeopathic therapy is a possible cure for the condition.
References
Briden, Lara. “Deep Diagnosis: A Naturopathic Approach To PCOS”. Helloclue.Com, 2018, https://helloclue.com/articles/cycle-a-z/deep-diagnosis-a-naturopathic-approach-to-pcos.
Dennett, Carrie C, and Judy Simon. “The role of polycystic ovary syndrome in reproductive and metabolic health: overview and approaches for treatment.” Diabetes spectrum : a publication of the American Diabetes Association vol. 28,2 (2015): 116-20. doi:10.2337/diaspect.28.2.116
Johansson, Julia, and Elisabet Stener-Victorin. “Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction.” Evidence-Based Complementary and Alternative Medicine 2013 (2013).
Kumar, Vinay, Abul K. Abbas, and Jon C. Aster. Robbins basic pathology e-book. Elsevier Health Sciences, 2017.
Palomba, Stefano, et al. “Complications and challenges associated with polycystic ovary syndrome: current perspectives.” International journal of women’s health 7 (2015): 745.
Raja-Khan, Nazia, et al. “The physiological basis of complementary and alternative medicines for polycystic ovary syndrome.” American Journal of Physiology-Endocrinology and Metabolism 301.1 (2011): E1-E10.
Rath, Padmalaya. “Management of PCOS through Homoeopathy-A case report.” Indian Journal of Research in Homoeopathy 12.2 (2018): 95.
Saurav Arora, and Bharti Arora. “Polycystic Ovarian Syndrome & Role of Homeopathy in PCOS.” Public Health and Homeopathy Awareness (PHHA) Series, 2017, www.researchgate.net/publication/323357436_Polycystic_Ovarian_Syndrome_and_Role_of_Homeopathy_in_PCOS.