The definition of PCOS in Western medicine has been much debated. However, it is generally defined as a disorder of ovulation, which the key features include menstrual cycle disturbance, hyperandrogenism and obesity. There are many extra-ovarian aspects to the pathophysiology of PCOS. It is recognised that affected 20-33% of the UK female population and 5-10% of women across the world, and is the most common cause of anovulatory infertility.
It is believed that in 25% of women with PCOS is an inherited disorder, endocrine malfunction and environmental factors may also playing a part in the development of PCOS. Due to the impaired metabolic and endocrine functions in PCOS, 90% of women with PCOS suffering from irregular menstrual cycles or absent periods, and 50-70% of women have insulin resistance, which may further raises the risk of developing diabetes, endometrial cancer, high blood pressure, high cholesterol, and cardiovascular disease. Getting symptoms controlled as soon as possible can decrease a woman’s chance of developing any of these other conditions.
PCOS is considered a syndrome because it has a number of unrelated symptoms, it often occurs with one or more of the following factor:
- Irregular menstrual cycle,
- Anovulatory infertility
- Hirsutism and/or acne:
- Ultrasound-scan showing enlarged ovaries with multiple cysts (immature follicles).
- Blood tests: increased LH and testosterone levels, LH / FSH ratio>3, elevated prolactin level.
Western Medical treatment depends on the presenting symptoms and the health concerns of each patient, which including oral contraceptive pills, Clomiphene citrate (Clomid), and Metformin. Laparoscopic ovarian drilling by laser or diathermy may be considered if all of these treatments have failed, however, this carries a risk of scar tissue forming on the ovaries. In-Vitro Fertilization (IVF) is a another treatment option for infertility caused by PCOS, however, women with PCOS often do not respond well to hormonal stimulation drugs used in the IVF treatment, either produce very few eggs with poor quality, or suffering from ovarian hyper-stimulation syndrome (OHSS), which can be life threatening.
In terms of TCM, PCOS is classified as amenorrhoea or scanty periods, abdominal masses and/or infertility. Clinically PCOS is seen as more of a combination of both an excess and deficient condition. The most involved organ systems include Spleen, Kidney and Liver with a subsequent disharmony of Chong and Ren channels. PCOS generally derives from a deficiency of Kidney Yang and Spleen Qi, in its inability to transform, transport and evaporate fluids in the lower burner. The accumulation of water in the pelvic cavity enlarges the ovaries, leading to phlegm-damp and/or blood stagnation, which manifests as abdominal masses.
From a TCM perspective, it is always important to look at the individual presentation of each patient and not automatically put a disease or disorder into one generic pattern or diagnosis. All the signs, symptoms, tongue, and pulse need to be evaluated in making a diagnosis. Diagnosis and treatment will be specific to the individual presentation and modified accordingly as treatment progresses in this complex syndrome.
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