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SYNOPSIS

Of

“To Understand Scope of Homoeopathy in Poly Cystic Ovarian

Syndrome”

A Dissertation to Be Submitted In Partial Fulfillment of the Requirement

For The Award of the Degree of

DOCTOR OF MEDICINE IN HOMOEOPATHY

(PRACTICE OF MEDICINE)

Of

DR. BHIM RAO AMBEDKAR UNIVERSITY, AGRA (U.P.)

At

BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,

GREATER NOIDA, (U. P)
By

ASTHA PUNHANI

Session: 2011-2014

Under the guidance & supervision of

DR. M. GHOSH

Principal, Prof. & HOD Practice of Medicine Bakson Homoeopathic

Medical College and Hospital
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SYNOPSIS PROFORMA OF THE PROPOSED DISSERTATION WORK FOR

ACCEPTANCE OF UNIVERSITY

1. NAME OF THE CANDIDATE:ASTHA PUNHANI

Permanent Address: 19/65 PUNJABI BAGH, NEW DELHI- 110026

2. NAME & ADDRESS OF THE INSTITUTION:

BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
36 B KNOWLEDGE PARK, PHASE I, GREATER NOIDA- 201306 (U.P)

3. COURSE OF STUDY AND SUBJECT:

DOCTOR OF MEDICINE IN HOMOEOPATHY, PRACTICE OF MEDICINE.

4. DATE OF ADMISSION TO THE COURSE & BATCH:

JULY 2011

5. TITLE OF THE TOPIC:

To Understand Scope of Homoeopathy in Poly Cystic Ovarian Syndrome.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1 Research Question:
Are homoeopathic medicines useful in the treatment of Poly Cystic
Ovarian Disease?
6.2 Research Hypothesis:
Homoeopathic medicines are useful in diagnosed cases of Poly
Cystic Ovarian Diseases.
6.3 Need for the Study:
Polycystic Ovarian Syndrome is an endocrine disorder portraying multiple
cysts (fluid filled sacs) in the ovaries, as an outcome of abnormal hormone
function that leads to excessive production of androgen (male hormone)
by the ovaries. This influences a woman’s hormonal levels, ovarian
functions, menstrual cycle, inability to have children and other body
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systems.
PCOS is a common female endocrine disorder with prevalence ranging
from 2.2% to 26%. Most reports have studied adult women with age
ranged from 18 to 45 years. Prevalence of PCOS in Indian adolescents is
9.13%.(1)
Use of different diagnostic criteria may partly account for it, as has
recently been shown (18%) in the first community based prevalence study
based on current Rotterdam diagnostic criteria.(2)
Although the exact pathophysiology is complex and remains largely
unclear, the underlying hormonal imbalance created by a combination of
increased androgens and/or serum insulin levels seems to be a central
focus. Genetic and environmental contributors along with the other
factors, including obesity, ovarian dysfunction and hypothalamic pituitary
abnormalities, complicate the pathological cycle. (3)
Homeopathic constitutional treatment helps balancing hyperactivity of
the glands, regulate hormonal levels, dissolve the cysts in the ovaries and
force them to resume normal functioning. Hence, Homeopathic medicines
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.
 A prospective study was conducted in PCOS patients using
homoeopathic medicine (pulsatilla), which shows that there is
significant difference between the scores representing the
symptoms of PCOS before & after treatment. The difference can
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be clearly attributed to homoeopathic medicines & can be said

that the treatment is effective. (4)
Therefore, this work is aimed at better understanding of poly cystic
ovarian syndrome and their treatment through the homoeopathic
medicines.

7. AIM
 To ascertain the usefulness of Homeopathic medicines in the
management of Poly Cystic Ovarian Syndrome.
OBJECTIVE
 To ascertain whether Homeopathic treatment can provide harmless
and long-lasting relief to females suffering from Poly Cystic Ovarian
Syndrome.
8. REVIEW OF LITERATURE:
PCOS affects between five and ten percent of reproductive age women.
The incidence of PCOS among adolescents is estimated to be between 11
and 26% (5) and about 50% are overweight.
PCOS is a hormonal condition, not a problem with the ovaries. Ultrasound
is NOT enough to diagnose PCOS. 25% of perfectly normal women display
polycystic ovaries at one time or other (6). A subsequent ultrasound will
show it to be normal again. True PCOS involves hormone irregularities that
must be picked up with blood test.
Many cases of PCOS are temporary. More specifically, many cases of so-
called PCOS that we see in our clinic can more accurately be described as
post-Pill syndrome. It is a medically recognized fact that it can take up to 2
years for normal ovulation to resume after stopping the Pill. (7)(8)(9)
It is important to understand a normal ovary produces fluid-filled follicles
that contain the eggs. Ovarian 'cysts' form and are reabsorbed every
month, in every woman. Follicles of different number and different size
will be visible in every ovary. When the follicles do not form properly cyst
is actually being formed. Follicles can be too large (a type of 'ovarian cyst'
that can cause pain or rupture), or too small (as seen is polycystic
ovaries). The 'cysts' seen in PCOS are actually small, underdeveloped
follicles. They look like that because ovulation is not occurring properly,
and this can be due to a number of causes, but in true PCOS, it is due to a
problem with insulin.
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The polycystic appearance may be normal. Or the ovaries may look that
way because something is preventing ovulation from progressing
normally. The "something" is either insulin (in classic, type 1 PCOS), or
something else (type 2 PCOS)
Type 1 PCOS: Insulin-resistant
The real underlying issue is insulin resistance and leptin
resistance. Improper signaling from these metabolic hormones inhibits
ovulation and causes the ovaries to produce testosterone. It is a problem
with the metabolic hormones that causes weight gain. The symptoms of
excessive testosterone, such as acne and facial hair will improve when
insulin and leptin sensitivity improve.
Type 2 PCOS: Non-insulin-resistant
The ultrasound may show multiple, undeveloped follicles. LH may be
elevated, and periods do not occur regularly. Testosterone may be high or
normal. If testosterone is normal, the acne and facial hair exist because
oestrogen is too low (compared to testosteorne). Body weight can be
normal.
In insulin-resistant Type 1 PCOS, the ovaries were prevented from
ovulating because of insulin. In type 2 PCOS; the ovaries are prevented
from ovulating because of something else.
The ovaries themselves do not cause the weight gain. It is the underlying
insulin resistance that causes weight gain, also causes the ovaries to look
that way. (Insulin prevents ovulation and causes a lack of periods.)
A recent German study has found that PCOS sufferers have an increased
risk for autoimmune thyroid disease. (10)
The researchers believe that the progesterone deficiency associated with
PCOS makes women more susceptible to the autoimmune condition. It
may also be that women with thyroid conditions are more like to develop
PCOS. Healthy thyroid function is necessary for healthy ovulation.
"As [PCOS patients] get older, their chance of getting pregnant may
actually be higher," according to Swedish researcher Miriam
Hudecova. Her research shows that by the age of 35, women with PCOS
have had as many successful pregnancies as women without PCOS, even
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without the assistance of fertility treatment. (11)

Symptoms
Women with polycystic ovary syndrome may display a wide range of
clinical symptoms but they usually present for three primary reasons:
menstrual irregularities, infertility and symptoms associated with
androgen excess (e.g., hirsutism and acne). In one study (12), 70 percent of
affected women reported menstrual dysfunction. A smaller percentage of
women with polycystic ovary syndrome actually have normal cycles. Most
women with the syndrome experience menarche at a normal age but have
irregular menstrual periods that gradually become more abnormal, often
leading to amenorrhea.

Clinical signs include those associated with a hyperandrogenic anovulatory

state. Hirsutism and acne are common. Approximately 70 percent of
affected women manifest growth of coarse hair in androgen-dependent
body regions (e.g. chin, upper lip, periareolar area, chest, lower abdominal
midline and thigh), as well as upper-body obesity with a waist-to-hip ratio
of greater than 0.85(13). Obesity is present in up to 70 percent of patients.
Ovarian enlargement may be unilateral or absent (14).

Diagnosis
To diagnose PCOS, a combination of clinical symptoms and lab tests. The
blood tests to consider are:

 Free testosterone - elevated in PCOS.

 DHEA -S- elevated in PCOS.

 Sex hormone binding globulin (SHBG) - usually low in PCOS.

 Fasting insulin - elevated in PCOS. Results greater than 9 or 10 can

indicate insulin resistance. Insulin resistance is usually the
underlying cause of PCOS. Also 2-hour post-prandial insulin test,
along with a 2-hour post-prandial glucose test.

 Fasting glucose or 2-hour post-prandial glucose - elevated in PCOS.

Using this information in combination with the insulin tests helps to
diagnose insulin resistance. Also, women with PCOS have a higher
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risk of diabetes so it is important to screen for this early and often.

 LH: FSH- ratio between these two hormones. In PCOS, we would

expect LH (Lutenizing Hormone) to be elevated in comparison to
FSH (Follicle Stimulating Hormone).

 Ultrasound to check for the presence of ovarian cysts. Even if the

ovaries do appear normal, the absence of ovarian cysts does not
mean that a woman doesn't have PCOS. Not every woman with
PCOS has ovarian cysts, and not every woman with ovarian cysts has
PCOS.

 Cholesterol levels and liver function tests, as these can also be

abnormal in PCOS.

Complications
Untreated polycystic ovary syndrome may be regarded as a disorder that
progresses until the time of menopause. Ongoing studies lend support to
the hypothesis that women with the syndrome are at increased risk for the
development of cardiovascular disease (15). Because the syndrome is also
associated with lipid abnormalities, affected women could benefit from
measures to prevent cardiovascular disease and the other squeal of
longstanding hypertension and diabetes mellitus that are associated with
the syndrome.

Other long-term effects of polycystic ovary syndrome are related to the

clinical consequences of persistent anovulation. These effects include
infertility, menstrual irregularities ranging from amenorrhea to
dysfunctional uterine bleeding, hirsutism and acne.

More important, the long-term effects of unopposed estrogen place

women with the syndrome at considerable risk for endometrial cancer,
endometrial hyperplasia and, perhaps, breast cancer (16, 17). The risk of
endometrial cancer is three times higher in women with polycystic ovary
syndrome than in normal women.

HOMOEOPATHIC APPROACH
Homeopathy is the dominant option to treat Polycystic Ovarian Syndrome. Homeopathic
approach towards management of PCOS is constitutional taking into account the patient’s
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physical symptoms along with their mental and genetic makeup that individualizes the person.
Early intervention with Homeopathy can assist in preventing further progress and hence
deterioration caused by PCOS. 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. Hence, Homeopathic medicines 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.(18)

Homoeopathy strongly believes in enhancing the body’s own defense

mechanisms to maintain good health.

Many stalwarts’ of Homeopathy and authors have suggested certain

medicines for providing permanent relive to the patients and also to
control the acute episodes. The different repertories also maintain the
homoeopathic medicines in different grades against rubrics. But since
PCOS is chronic disease as well, the mental symptoms, physical
generalities and characteristic particulars of each suffering from this
syndrome, will constitute the totality of symptoms which will be helpful
for selection of the similimum.

 Boericke William, in his boericke’s new manual of homoeopathic

materia medica with repertory, third revised and augmented edition
based on ninth edition has suggested following medicines in
repertory section for PCOS as stated below-

Female sexual system, TUMORS- fibroids, polypi, myo- fibromata (p-

870)- aur. i., aur. M., bell., calc., calc. i., calc. p., calen., chin., con.,
erod., ferr., frax., ham., hydr., hydroc., iod., ip., kali. i., lach., lyc.,
merc. c., merc. i. r., nit. Ac., phos., plat., pumb., puls., sabal., sabin.,
sang., sec., sep., sil., solid., staph., sulph., thals., thuj., thyr., tril. P.
(19)

 Kent J.T., in his repertory of Homoeopathic Materia medica, has

mentioned the following 1st grade medicines (in Bold letters) for
Tumors, ovaries (p-745)- apis, lach., lyc.(20)
 Boger C.M., in his boger boenninghausen’s characteristics &
repertory with corrected abbreviations & word index (36th
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impression:2010) state following medicines for PCOS such as-

GENITALIA- FEMALE ORGANS- Cysts (p- 659) - ap.,aur. (21)

9. MATERIALS AND METHODS:

9.1) Study setting & Study duration

The study will be conducted at the I.P.D, O.P.D and P.O.P.Ds of
Bakson Homoeopathic Medical College & Hospital, 36-B, Knowledge
Park-1, Greater Noida (U.P.)-201306. The study duration will be of
18 months.

9.2) Selection of samples

Sample selection will be done at the study setting on the basis of
inclusion and exclusion criteria as stated below.
9.3) Inclusion / Exclusion criteria

Inclusion Criteria -
1) Diagnosed cases of PCOS.
2) Females of age groups of 1 5 – 30 years.
3) Patients complying with regular follow up.

Exclusion Criteria –

1) Patients with complications of PCOS like endometrial cancer, heart

disease, diabetes and metabolic syndrome.
2) Patients with other systemic disorder.
3) Pregnant women.
4) Patients in need of emergency medical care.
5) Patients unable to comply regular follow up.

9.4) Study design

Prospective Observational Single Blind Clinical Study.

9.5) Intervention
Homoeopathic Medicines as per the totality of each case.

9.6) Selection of tools

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The following tools would be used during study:

 Case taking format,
 Questionnaires,
The PCOS consists of four domains, each relating to a common symptom of
PCOS; body hair, emotions, infertility and menstrual problems. Each question
was re‐coded from 0 to 6 in which 6 represents optimal function and 0 the
poorest. The extent of ill health to be measured (scale score = total of raw
scores for each item in the scale/maximum possible raw score×100).
 Investigations supporting the diagnosis,
 Screening procedures to fulfill the inclusion/exclusion criteria.

9.7) Outcome Assessment

Outcome assessment will be done with the help of measuring
Quality of Life Scale (QoL) in patients with PCOS by comparing the
result after treatment with previous status.
A positive outcome as to the improvement in Quality of life (QoL) of
the patient is dependent primarily on a reduction in number and
frequency of symptoms, days of work missed, doctor visits, through
avoidance of the aforementioned circumstances.

9.8) Statistical analysis

The data obtained from the observations after treatment will be
statistically analyzed by using appropriate techniques, especially
student’s‘t’ test, Chi-square test. Most care will be taken to remove
all kinds of bias and errors.

9.9) Does the study require any investigation or intervention to be

conducted on patients or other humans or animals? If so, please
describe briefly.
The trial will be conducted on patients. The required pathological
tests Hormonal investigations (FSH, LH and circulating male
hormones), Ultrasound scans, Blood tests (not hormones)
Testing for diabetes, blood fat and cholesterol levels will be done as
per need of cases.

9.10) Has Ethical Clearance been obtained from your Institution in

case of 9.11?
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The ethical clearance will be obtained prior to the initiation of the

study.

10. EXPECTED OUTCOME AND THEIR USEFULNESS:

 It is expected from the proposed study to obtain a group of most
useful medicines in the treatment of patients suffering from PCOS.
 The outcomes of the proposed study will enhance the knowledge of
homeopathic fraternity and for treatment of patients suffering from
PCOS.
 It will also help to carry out the further research on PCOS with
improved parameters.
11. REFERENCES:
1. 2011 North American Society for Pediatric and Adolescent
Gynecology. Published by Elsevier Inc.
2. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ.
The prevalence of poly cystic ovarian syndrome in a community
sample assessed under contrasting diagnostic criteria. Hum Reprod
2010;25:544-51
3. Doi SA, Al-Zaid M, Towers PA, Scott CJ, Al- Shoumer KA. Ovarian
steroids modulate neuroendocrine dysfunction in poly cystic ovarian
syndrome. J endocrional invest 2005;28:882-92
4. Sanchez-Resendiz J., Guzman-Gomez F., Polycystic Ovary Syndrome.
Boletin Mexicano de Homeopatica, 30, 1997, 11-15.
5. Driscoll DA. Polycystic ovary syndrome in adolescence. Annals of the
New York Academy of Sciences 2003 997 49–55.
6. Polson DW et al. Lancet. Polycystic ovaries--a common finding in
normal women.1988 Apr 16;1(8590):870-2.
7. Gnoth, C et al. Cycle characteristics after discontinuation of oral
contraceptives. Gynecol Endocrinol 2002:16(4): 307-17.
8. Vessey, M et al. Return of Fertility after discontinuation of oral
contraceptives: influence of age and parity. The British Journal of
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Family Planning. 1986: 11: 120-124.

9. Nader, S et al. The effect of desogestrel-containing oral
contraceptives on the glucose tolerance and leptin concentration in
hyperandrogenic women' J Clin Endocrinol Metab 1997 82: 3074-7
10.Janssen OE. High prevalence of autoimmune thyroiditis in patients
with polycystic ovary syndrome. Eur J Endocrin 150(3): 363-369
11. Hudecova, M et al. Long-term follow-up of patients with polycystic
ovary syndrome: reproductive outcome and ovarian reserve. Human
Reproduction, doi:10.1093/humrep/den482
12. Legro RS. Polycystic ovary syndrome: current and future treatment
paradigms. Am J Obstet Gynecol. 1998;179:S101–8.
13. Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A,
Licholai T. Evidence for distinctive and intrinsic defects in insulin
action in polycystic ovary syndrome. Diabetes. 1992;41:1257–66
14. Guzick D. Polycystic ovary syndrome: symptomatology,
pathophysiology, and epidemiology. Am J Obstet
Gynecol. 1998;179:S89–93.
15. Talbott E, Guzick D, Clerici A, Berga S, Detre K, Weimer K, et
al. Coronary heart disease risk factors in women with polycystic
ovary syndrome. Arterioscler Thromb Vasc Biol. 1995;15:821–6.
16.Coulam CB, Annegers JF, Kranz JS. Chronic anovulation syndrome
and associated neoplasia. Obstet Gynecol. 1983;61:403–7.
17.Ron E, Lunenfeld B, Menczer J, Blumstein T, Katz L, Oelsner G, et
al. Cancer incidence in a cohort of infertile women. Am J
Epidemiol. 1987;125:780–90.
18. http://www.amcofh.org/blog/homeopathic-treatment-polycystic-
ovarian-syndrome
19. Boericke, William, Boericke New Manual of Homoeopathic Materia
Medica with Repertory, Third revised and augmented edition based
on Ninth edition, USA, B. Jain Publishers (P) Ltd. India, 2007.
20. Kent, J.T., Repertory of the Homoeopathic Materia Medica,Enriched
Indian Edition, Reprinted from 6th American Edition,edited & revised
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by Clara Louise Kent, M.D., Modern Homoeopathic Publication,

Culcutta India, 1995.
21.Boger,C.M., Boger Boenninghausen’s Characteristics & Repertory
with corrected abbrevations & word index (36th impression), B. Jain
Publishers (P) Ltd. India, 2010.

12. SIGNATURE OF THE CANDIDATE: ASTHA PUNHANI

13. REMARKS OF GUIDE:

14. PARTICULARS OF GUIDE

14.1) Name &Designation: DR. M. GHOSH.

(in BLOCK letters)
14.2) Address: BAKSON HOMOEOPATHIC MEDICAL COLLEGE
14.3) Signature:

15. PARTICULARS OF CO-GUIDE(if any)

15.1) Name & Designation:

15.2) Address:

15.3) Signature:

16. 16.1 NAME OF THE DEPARTMENT: PRACTICE OF MEDICINE

16.2 Name of the H.O.D: DR. M. GHOSH

16.3 Signature:
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17. 17.1 REMARKS OF THE PRINCIPAL / HEAD OF THE INSTITUTION:

17.2 Signature:

17.3 Seal: