PCOS (Classification)

Dr Rupali Mahadik.
MD ( Streerog )
Amrutwel Women's Clinic Kharaghar.
Ex Prof and HOD streerog Dept.
D.Y.Patil Ayu College Nerul

PCOS (Classification )

Polycystic Ovary Syndrome (PCOS)  is an incompletely understood enigmatic disease.

It is usually, but not necessarily ; characterized by
- Oligomenorrhea
- obesity
- hyperandrogenaemia
- infertility

Although pathogenesis is unclear , chronic hyperandrogenaemia either due to

-Erratic high LH levels
  or
- insulin resistance with compensatory hyperinsulinaemia,
Is a predominant feature of this syndrome.

Both LH and Insulin act at the Thecal compartment of Ovary to stimulate hyperandrogenaemia.

Moreover the small and intermediate follicles predominate the PCOS scenaria and they gradually proceed to atresia rather than follicular dominance.

* Classification of PCOS -
Based on Endocrine and Sonographic  landmarks following classes of PCOS subjects are arbitrarily identified with gradation of hyperandrogenism , individual approach of treatment is needed.

1- PCO

Normoandrogenic, normoestrogenic and non obese subjects.

Do not exhibit usual manifestation of hyperandrogenaemia,
menstrual delay/ Oligomenorrhea ,

But anovulation is present.

These subjects have bilateral active ovaries with no evidence of follicular dominance or ovulation .

No significant alteration is expected in the hormonal profile.
Constitutes 80% of PCOS subjects and form the link between normal and significantly androgenised PCOS subjects.

2- PCOD

These are definitely hyperandrogenic and relatively obese.
Oligomenorrhea
anovulation are almost certain.
Evidence of high LH to FSH ratio
Higher testosterone levels
Ovaries large  with evidence of homogeneous polyfollicular enlargement with significant Thecal hyperplasia .
Necklace pattern in USG

20% of PCOS Pt gave the typical features of PCOD.

3. - Hyperinsulinaemia

Picture same like PCOD with Endocrine difference of hyperinsulinaemia instead of high LH levels.

4- Hyperthecosis

These subjects with Ovarian Hyperthecosis are much more androgenised, with testosterone levels bordering that of tumor range( > 1 ng/ml).

Sonographically they present with sparse Ovarian follicles and predominant thecal excess.

These patients could manifest insulin resistance and acanthosis Nigerians.
Hence condition is known as Hairan syndrome.

Less then 5 % among PCOS population .

5- Hyperprolactinaemia

Borderline Hyperprolactinaemia and hypodopaminergic state could co exist in nearly 5% PCOS subjects.

They may or may not be galactorrhoeic and may not evidence significantly high prolactin levels.
Represents like type 1 PCO case but with borderline/ Hyperprolactinaemia.

6 - High DHEAS

Few pts may present with Congenital adrenal hyperplasia, a genetic defect in 21- hydroxylase enzyme in adrenal cortex.
Only 3% have this defect and they present with high DHEAS levels ( between 250 and 800 ng/ml), .
They are usually thin , hirsute with ovulatory dysfunction, and an alternate presentation is that a thin adolescent subject with symptomatology of hirsutism.

7 - Tumour

Occasionally a Virilizing ovarian or adrenal tumours present with features of virilism , and  these subjects have serum testosterone (1.5 ng/ml or more) or DHEAS ( 9000 ng/ml or more) respectively.
Easily spotted at routine sonographic study of ovaries and adrenal in all PCOS subjects.

According to this the treatment protocol differs.

Obesity

Some Basics –

“Let thy FOOD be thy Medicine
Let thy medicine be thy food”
-Hippocrates

“Eat to live and not live to eat”

“Health is made or marred in the Kitchen ”

Now a days , menstrual abnormalities incidence have gone high,
we see only two types of young girls- one very lean with zero figure and others maximum in no a very Obese.

Obesity –
Obesity is a condition wherein the body weight is 20% or more above the ideal body weight.
Excessive accumulation of adipose tissue in relation to lean body mass.

Causes-
1. Overeating- and Fast food
This leads to excessive consumption of energy, which is stored in the body as fat. Consumption of high fat diet leads to increased triglycerides levels. Excess of Carbohydrate and Protein in food,which are not utilized,are stored as fat.

2. Physucal inactivity-
Lack of adequate exercise leads to a decreased energy requirements.Thus ,an imbalance between the energy intake and energy expenditure occurs.

3. Emotional disturbance-
During anxiety, frustration,tension or insecurity some people tend to overeat to allay their tension. Thus, they see food as a model of comfort resulting in overeating.

4. Heredity-
Studies indicate that if both parents are obese,there is an 80% chance of the child also becoming obese.

In postmenopausal women, estrogen levels are decreased, leading to the deposition of fat in abdominal region,thereby contributing to abdominal obesity.

MANAGEMENT OF OBESITY:

Behaviour modification together with diet and exercise help in prevention and treatment of obesity.
*Diet:
Do’s-
● High fibre foods like whole wheat flour, bajra,jowar, oatmeal etc
● Pulses,especially whole pulses and Sprouts.
●Use Skimmed milk
●More of Vegetables in raw or cooked form such as leafy vegetables, cabbage, gourds etc.
● Fruits like apple,Papaya,Orange,Sweetlime,guava,peach etc
● 8_10 glasses of water per day.
●Cut down on fruits like banana, chikoo,mango,custard apple and Vegetables like potatoes, sweet potatoes, yam etc.

Don’t-
● cut off sugar.
●Avoid refined products such as Maida,white bread,khari ,pasta etc.
● Reduce Consumption of Chocolates, Pastries,aereated drinks.
●Reduce /stop smoking,alcohol,tobacco chewing.

*Behaviour Modification
●Eat slowly -savour each bite.
● Regular meal pattern with frequent intervals
● Never skip meal
● Eat wisely and learn to say ‘No’ to temptation.

*Exercise-

Aim to increase your physical activity at least thirty minutes per day.

Exercise is excellent to burn calories out and improve both mental and physical health.

Dr.Rupali Mahadik

MD Streerog
Amrutwel Women’s Clinic
Kharghar

BREAST CANCER

BREAST CANCER
Breast cancer is a malignant proliferation of epithelial cells lining the ducts or lobules of the breast. Epithelial malignancies of the breast are the most common cause of cancer in women (excluding skin cancer), accounting for about one-third of all cancer in women.

Aetiology
Increased caloric intake contributes to breast cancer risk in multipleways: earlier menarche, later age at menopause, and increased postmenopausal estrogen concentrations reflecting enhanced aromatase activities in fatty tissues.
Moderate alcohol intake also increases the risk by an unknown mechanism. Folic acid supplementation appears to modify risk in women who use alcohol but is not additionally protective in abstainers.
Breast cancer is a hormone-dependent disease. Women without functioning ovaries who never receive estrogen-replacement therapy do not develop breast cancer.
Breast Examination
Women should be strongly encouraged to examine their breasts monthly.
Breast examination by the physician should be performed in good light so as to see retractions of nipple and other skin changes.
The nipple and areolae should be inspected, and an attempt should be made to elicit nipple discharge.
All regional lymph node groups should be examined, and any lesions should be measured.
Physical examination alone cannot exclude malignancy.
Lesions with certain features are more likely to be cancerous (hard, irregular, tethered or fixed, or painless lesions).
A negative mammogram in the presence of a persistent lump in the breast does not exclude malignancy.
Palpable lesions require additional diagnostic procedures including biopsy.
In premenopausal women, lesions that are either equivocal or nonsuspicious on physical examination should be reexamined in 2–4 weeks, during the follicular phase of the menstrual cycle. Days 5–7 of the cycle are the best time for breast examination.
A dominant mass in a postmenopausal woman or a dominant mass that persists through a
menstrual cycle in a premenopausal woman should be aspirated by fine needle biopsy or referred to a surgeon.
If nonbloody fluid is aspirated, the diagnosis (cyst) and therapy have been accomplished together.
Solid lesions that are persistent, recurrent, complex, or bloody cysts require
mammography and biopsy, although in selected patients the so-called triple diagnostic techniques (palpation, mammography, aspiration) can be used to avoid biopsy.
Ultrasound can be used in place of fine-needle aspiration to distinguish cysts from solid lesions.
Not all solid masses are detected by ultrasound; thus, a palpable mass that is not visualized on ultrasound must be presumed to be solid
Better mammographic technology, including digitized mammography, routine use of magnified views, and greater skill in mammographic interpretation, combined with newer
diagnostic techniques (MRI, magnetic resonance spectroscopy, positron emission tomography, etc.) may make it possible to identify breast cancers even more reliably and earlier. Screening by any technique other than mammography is not indicated; however, younger women who are BRCA-1 or BRCA-2 carriers may benefit from MRI screening where the higher sensitivity may outweigh the loss of specificity.

Not Recommended Test in Breast Cancer
Complete blood count
Serum chemistry studies
Chest radiographs
Bone scans
Ultrasound examination of the liver
Computed tomography of chest, abdomen, or pelvis
Tumor marker CA 15-3, CA 27-29
Tumor marker CEA

Ayurvedic Treatment that can be recommended in breast cancer is as follows:

Panchkarma: (Purificative Procedure) especially Vaman (Vomiting induced by medicine) will be very useful as a preventive as well as curative therapy.

Internal Medicines which havea role in Breast Cancer are as follows:
Vacha (Acorus calamus), Sweet Flag
Kutki (Picrorrhiza kurroa), Picrorrhiza
Shilajit (Bitumen),
Guduchi (Tinospora cordifolia), Tinospora
Bhallataka ghrit, (Semecarpus anacardium) Marking nut

External Application in the form of paste following drugs may be used:
Kombadnakhi ,
Shigru (Moringa pterygosperma), Drumstick tree.

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com   -

Infertility - Emotional impact

        Most people take their fertility for granted.
Infact a common complaint from individuals and couples when they have difficulty conceiving is " we were so careful to avoid pregnancy until we were ready."

         Couple go in short order from an assumption of assured fertility to one of absolute dismay at what is experienced as unfair and wholly unexpected Infertility.

          The intensively painful experience of finding oneself defined as infertile leads to feelings of isolation and guilt and the inevitable questions: " why me ?" .

           Guilt may b as a primary response common to many couples diagnosed with infertility : guilt about waiting too long to start a family, guilt about previous life events such as pregnancy termination.

In addition to the emotional impact of Infertility are the rigorous, expensive and often humiliating demands of medical treatment.

        Some patients jokingly say , " I have learned more about the reproductive system than I ever imagined I would need to," whereas for others the treatment regimens are confusing and difficult to understand.
All results in stress depression and anxiety , loss of self confidence , loss health etc.
Dr Rupali Mahadik

MD ( Streerog )
Amrutwel Women's Clinic
9322187726

Infertility Treatment Current Scenario

Infertility Treatment Current Scenario-

It involves an initial evaluation of the

First step

-History ,
-Physical examination,
-Semen Analysis
-Hormone evaluation in 35% of patients

Second step

- Female Factor

One third of patients are thought to have disorders of Ovulation -this problem is treated by correcting body weight, and / therapy with Clomiphene citrate, bromocriptine, or prednisolone for 6 cycles .

No pregnancy results , 30% of the patients undergo Diagnostic and Operative Hysteroscopy and Laparoscopy

Half are thought to have a good prognosis. They attempt pregnancy for 6 months ; if no pregnancy results approximately 40% undergo 3 cycles of IVF.

If poor prognosis ( Tubal diseases ) they undergo 3 cycles of IVF.

-Male factor

If male factor is present out of total diagnosed 80% are oligospermic and varicocele- medicines and operated for varicocele , if no pregnancy occurs following surgery , 3 cycles of IVF are attempted.

The Azoospermic Pt undergoes 6 cycles of therapeutic donor insemination. If no pregnancy results, 2 cycles of IVF are attempted.

 Dr Rupali Mahadik
MD Streerog
Amrutwel Women's Clinic
Kharghar
9322187726

Menstrual Cycle....

Good morning..
 Today topic ..
 Menstrual Cycle....
Topic for women's..
Are your Menses are reguler?? Menstrual cycle is monthly Natural Process It's NOT A PROBLEM...occurs in every women..
The first period usually begins between twelve and fifteen years of age, a point in time known as Menarche.They may occasionally start as early as eight, and this onset may still be normal.
The typical length of time between the first day of one period and the first day of the next is 21 to 35 days in women(an average of 28 days). Bleeding usually lasts around 3 to 5 days. At an average 4 to 5 days.
Menstruation stops occurring after menopause which usually occurs between 45 and 55 years of age.
Menstrual Cycle ...Is starts average from the age 12 to last up to age of 45 average.
 Menses are natural process..of cleansing of uterus..that keep women healthy where
 Endometruim shedding occurs..it's starts when Menses stops at the fifth day..And then development of ovarian follicles starts..
 Ovary are two main endocrine glands are responsible for the development of oocyte..And that development occurs from 8 th day to 14 th day..And there on 14 th day ovary rupture..And oocyte come out with life span of 24 to 42 hr..many Times ovary rupture..in between 14 to 16 day of cycle..in this period uterus developed with thick lining of endometrum for conceive of Zygote formation..it is just like bed formation for upcoming baby..but if sperms are not conceive in this period..then zygote is not formed and then slowly shedding of this bed of endometrum thickness over the wall of uterus..it starts...to prepare from 18 to 24 the day. And then on 28 th day...shedding of endometruim we called a Menses blood..starts for 3 to 4 days...!!!
Here hormones plays very important role.
 The ovarian cycle consists of
 the follicular phase where development of ovarian follicles occurs
ovulation - rupture of ovary..And oocytes comes out.
 Luteal phase whereas the uterine cycle is divided into menstruation, proliferative phase, and secretory phase.
Many hormones like estrogen,FSH,progesterone and lutinising hormone..are plays vital role in each menstrual cycle.
In ayurveda...
 Menstrual cycle and there secreation are diagnosed by form of Menses.. And Dosha,Dhatu status and Nadi parikshana..I e.pulse Examination.
Like it should be ..
सशाकरक्तवर्नम....!!!
लाक्षारसशशास्राभं धौतंयच्च विरज्यते..आर्तव!
Menses should be plain reddish like rabbit blood..which can be easily washed out if it placed on clothes..
 Flow should minimum pain or without pain
If menses..comes with blackish clot with painful menstruation it's because of VATAJ DOSHA DUSTHI
IF it's comes with yellowish and burning sensation in stomach it due PITTAJ DOSHA DUAHTI
IF it come with Whitish discharge with foul smell and irreuler flow it's due to KAPHAJ DOSHA DUSTHI..
AND SOME TIME SYMPTOMS COMES WITH Vat -Kaphaj
 Vat pittaj dosha...
That's all are abnormal...menses symptoms..
 If it's found then
 Consult with Doctor.
What should be do during period-
 Rest- as much as possible during menstruation. A woman's body goes through lots of changes and works hard to eliminate toxins. Even if you do have to go to work, you can make allowances for yourself -- not push quite so much, watch for opportunities to be more inward-oriented, and make a point of resting when you come home.
Rest. That's a Answer.
Diet-
 lighter diet will make everything go more smoothly.
 Rice washed water..or boil rice water with slightly rock salt during menses eases good flow..And less painful.
 Avoid junk ,oily And fermented food
Take vegetable soups.. While ayurveda gives us useful guidelines such as more rest and a lighter diet, it also tells us why. These guidelines are based quite firmly on a science of balance that identifies three basic elements in the physiology -- Vata, Pitta and Kapha -- and a number of sub-elements. Health entails keeping Vata, Pitta and Kapha in the right balance.
Symptoms of a Vata imbalance during the premenstrual period are anxiety, nervous tension, mood swings and feeling "spaced out." For Pitta, however, the mood is more anger and irritation. Kapha, as always is typified by lethargy.
As one might expect, women with a Vata imbalance get the best results from rest, meditation,pranayam.
 Those with a Pitta imbalance respond best to monthly internal cleansing, and those with a Kapha imbalance fine that herbal supplements and a diet that reduces impurities have the best result.
Menstrual cycle is Not Problem.
 It's An Natural Process for purity of health in women..
If any disturbance in menstrual
 ...painful menstrual
 Delay in menstrual
 Early menstrual..
 Heavy menstrual with bleeding..
 Reguler white discharges..
 Headache,backache,breast tenderness,weakness..
 That all leads to primary infertility..And soon consult the Doctor.
So take care..And consult with Register Gyanecologist...or
 For ayurvedic consultation..consult with Registered Ayurvedic Practitioner..
Sai ram.
Vaidya Sachin maruti bhor
 Sainath Ayurveda
 Thane/ Pune.
9821832578.

"PANCHAKARMA”.. A preparatory groundwork for conception...

"PANCHAKARMA”.........
A preparatory groundwork for conception.....

Panchakarma is a foremost set of treatment modalities in Ayurveda, which includes Vaman (induced emesis), Virechan (induced Purgation with oral medicines), Basti (Rectal administration of various formulations in the form of enema), Nasya (Administration of medicines through nasal route), Raktomokshan (Removing specific quantity of blood from the body).

These treatments are also termed as “Shuddhi-kriya” which means these treatments eliminate the toxic metabolites from the body. In short, Panchakarma helps to clean and detoxify the functional systems of the body.

This empowers immunity to such a level that pregnant woman will hardly become victim of any disease. It is indeed very essential as there are very limited medicinal preparations considered safe in pregnancy.

Secondly, sperm is like a guest in female body. As we beautify the house for any guest, decorate flowerpots, change the curtains and bed sheets, make the house neat and tidy, same thing should be followed in welcoming this guest. The meeting of sperm with oocyte (formation of zygote) becomes exceptionally pleasant when the guest is also well dressed, polite, joyful in nature and free from any disease.

In spite of experiencing regular bowel, urine etc., is it still necessary to clean the system before planning for conception?

The answer is 'YES'. We clean and mop the house daily. When a special cleaning campaign during festival or any special occasion is undertaken, we notice a huge amount of dirt accumulated behind the furniture, odd places and corners of the house. If this special cleaning is not done periodically, the entire atmosphere remains dull and the long-term ill effects are experienced thereafter. Thus, the importance of Panchakarma is unquestionable with respect to pregnancy.
Manoj Anant Joshi

AKSHAY PHARMA REMEDIES (INDIA) PVT. LTD.