Journal of Ayurveda and Integrated Medical Sciences

2016 | 9,058,717 words

The Journal of Ayurveda and Integrated Medical Sciences (JAIMS) is an international double-blind peer-reviewed monthly journal published by Maharshi Charaka Ayurveda Organization. It focuses on research in AYUSH fields (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy) and related sciences. JAIMS aims to disseminate scientific findings, promo...

A review of management of Polycystic Ovarian Syndrome through Ayurveda

Author(s):

Smita Mallikarjun Patil
Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Government Ayurvedic College Osmanabad, Maharashtra, India.
Veena Ajay Patil
Guide, Professor and HOD, Department of Prasuti Tantra and Stree Roga, Government Ayurvedic College Osmanabad, Maharashtra, India.


Year: 2021 | Doi: 10.21760/jaims.v6i5.1492

Copyright (license): Creative Commons Attribution 4.0 International (CC BY 4.0) license.


Download the PDF file of the original publication


[[[ p. 1 ]]]

[[[ p. 2 ]]]

[Summary: This page is the first page of a review article about the management of Polycystic Ovarian Syndrome (PCOS) through Ayurveda. It introduces PCOS as an endocrinological disorder with clinical, endocrinal, and metabolic manifestations, affecting a significant percentage of women globally and in India. It also highlights limitations of modern treatments.]

[Find the meaning and references behind the names: Patil, Long, Ajay, Smita, Heart, Ama, Veena]

REVIEW ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 161 A review of management of Polycystic Ovarian Syndrome through Ayurveda Smita Mallikarjun Patil 1 , Veena Ajay Patil 2 1 Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Government Ayurvedic College Osmanabad, Maharashtra, India. 2 Guide, Professor and HOD, Department of Prasuti Tantra and Stree Roga, Government Ayurvedic College Osmanabad, Maharashtra, India. I NTRODUCTION In today’s era polycystic ovarian syndrome (PCOS) is an emerging endocrinological Complex disorder characterised by - clinical, endocrinal and metabolic manifestations. It is also known a Stein - Leventhal Syndrome (1935) [1] Manifested By - Amenorrhea, Address for correspondence: Dr. Smita Mallikarjun Patil Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Government Ayurvedic College Osmanabad, Maharashtra, India. E-mail: smitapatil 062@gmail.com Submission Date: 13/09/2021 Accepted Date: 18/10/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA Hirsutism, Obesity, Enlarged Polycystic Ovaries. It also has associated comorbidities which includes irregular menses, insulin resistance leads to Type 2 Diabetes, infertility, and obesity, hirsutism, alopecia, acne, anxiety, depression and sleep apnoea and coronary heart disease [2] Due to wide range of sign and symptoms and different clinical presentation it is underdiagnosed or not diagnosed properly. It is more annoying for female because with time distressing aspect of disease changes like from hirsutism, acanthosis, acne as a teenager to infertility as an adult. In modern medicine approach is symptomatic which includes oral contraceptives, periodic progesterone withdrawal, and metformin, antiandrogen and clomiphene citrate. But they have their own complications and long-term use associated with fatal and nonfatal lactic acidosis, weight gain, cardiovascular and thromboembolic events, hepatic toxicity which could be fatal. So, its need of time for safe and cost-effective treatment. PCOS is not directly A B S T R A C T Polycystic ovarian syndrome (PCOS) is one of the fastest growing endocrinological disorder in females of reproductive age. In PCOS, follicular growth is influenced by hormonal imbalance due to which affected follicles remain in the ovary. The prevalence of PCOS is estimated 6-10% globally and 3.7% - 22.5% in Indian female population, which is relatively high. It is characterised by hyperandrogenism, anovulation and polycystic ovaries seen on USG which clinically manifests in the complex form of amenorrhea or oligomenorrhea, hirsutism, acne, infertility etc. incidence of this disease increasing exponentially due to faulty dietary habits, lack of exercise, sedentary lifestyle, only focusing on career ignoring health etc. PCOS is not directly explained in Ayurveda we can corelate it with some of the conditions like Vandhya Yonivyapada, Arajaska Yonivyapada, Artava Kshaya, Nastartava, Pushpaghni Jataharini , etc. Its Hetu can be understood by different Yoniyapada Hetu, Artavavaha Srotodusthi Hetu etc. and treatment can be planned by assessing the Dosha , Dushya, Agni, Ama and Prakruti of patient. We can plan ayurvedic treatment with the help of various Ayurvedic herbal and mineral preparations, Panchakarma, along with diet and lifestyle modifications Which can be judiciously implemented to alleviate PCOS and all associated problems Key words: PCOS, Artavakshaya, Vandhya, Ayurveda, Yonivyapada.

[[[ p. 3 ]]]

[Summary: This page discusses Ayurvedic correlation of PCOS with conditions like Vandhya Yonivyapada and outlines treatment approaches involving herbal and mineral preparations, Panchakarma, diet, and lifestyle modifications. It also covers the etiology, clinical manifestations, and diagnosis of PCOS based on Rotterdam's criteria, and limitations of modern treatments.]

[Find the meaning and references behind the names: Low, Main, Nil]

Smita Mallikarjun Patil et al. Management of Polycystic Ovarian Syndrome through Ayurveda ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 162 explained in Ayurveda we can corelate it with some of the conditions like Vandhya Yonivyapada, Arajaska Yonivyapada, Artava Kshaya, Nastartava, Pushpaghni Jataharini , etc. Its Hetu can be understood by different Yoniyapada Hetu, Artavavaha Rasavaha, Medovaha, Srotodusthi Hetu etc. and treatment can be planned by assessing the Dosha , Dushya, Agni, Ama and Prakruti of patient. We can plan ayurvedic treatment with the help of various ayurvedic herbal and mineral preparations, Panchakarma along with diet and lifestyle modifications Which can be judiciously implemented to alleviate PCOS and all associated problems. M ATERIALS AND M ETHODS All available References have been collected from literatures, Ayurvedic Samhitas, Ayurvedic textbooks and modern text books, different websites, published articles and critically analysed. DISCUSSION Polycystic ovarian syndrome (PCOS) It is a heterogenous, multisystem endocrinopathy in reproductive age women with ovarian expression of various metabolic disturbance and wide spectrum of clinical features such as obesity, menstrual abnormality and hyperandrogenism [3] Etiology Exact cause is unknown. Some factors influencing PCOS are Sedentary lifestyle, Stress, Improper diet, Insulin resistance, Enhanced androgen secretion, Genetic cause, family history, etc. Main pathology lies in Abnormalities in HPO axis, Ovaries, Adrenals and Periphery. Clinical Manifestations [4] ▪ Menstrual abnormalities like oligomenorrhoea, hypomenorrhea, amenorrhoea. ▪ Infertility due to chronic absence or low rate of ovulation. ▪ Hyperandrogenism - in fully developed form we can see Hirsutism, acne, alopecia, acanthosis nigricans are seen ▪ Metabolic Syndrome - here we can see the Insulin resistance, Obesity, Dyslipidemia, Type 2 Diabetes, Increased risk of Cardiovascular disorders. Diagnosis Rotterdam’s Criteria – Presence of any two factors among oligomenorrhoea/ Anovulation, Hyperandrogenism and Polycystic ovaries on USG (>12 small peripheral cysts or ovary >10 cc in volume) [5] Treatment The objective of Treatment includes Reduce ovarian volume, Regularization of menses (use of O C Pills.), treating infertility (ovulation induction by clomiphene citrate), reducing androgens (anti androgen - cyproterone acetate), managing insulin resistance (Metformin). Surgical methods like drilling or puncture of cysts [6] But, all these measure in their own complications and long-term use associated with fatal and nonfatal lactic acidosis, weight gain, cardiovascular and thromboembolic events, hepatic toxicity which could be fatal. So, there is need to find out a safe effective with minimal or nil Side effects. Ayurvedic approach PCOS is not directly explained in Ayurveda we can corelate it with some of the conditions like Vandhya Yonivyapada, Arajaska Yonivyapada, Artava Kshaya, Nastartava, Pushpaghni Jataharini etc. Hetu Artavavaha, Rasavaha, Medovaha, Srotodusthi Hetu and Yonivyapada Hetu etc ▪ Yonivyapada Hetu - Mithyachara - It includes Mithyaahara (faulty dietary habits) and Mithyavihara (faulty lifestyle) both. reproductive age women which are undergoing rapid nutritional transitions due to westernized diets and lifestyles has more prevalence rate of PCOS [7] Pradushtartava - Any hormonal imbalance or ovarian disorders, also Dysregulation of CYP 17, the androgen forming enzyme in both adrenals and ovaries.

[[[ p. 4 ]]]

[Summary: This page details Samprampti and Roopa and discusses treatment options, including Nidana Parivarjana (avoiding causative factors), Ahara (diet), and Vihara (lifestyle). It mentions Agneya Dravya Prayoga and emphasizes Dincharya, Ritucharya, and Rajaswala Paricharya. Yoga, including Suryanamaskara and Pranayama are also mentioned.]

[Find the meaning and references behind the names: Daiva, Kala, Sura]

Smita Mallikarjun Patil et al. Management of Polycystic Ovarian Syndrome through Ayurveda ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 163 ▪ Bijadosha - Chromosomal and genetic abnormality comes under Bijadosha . During intrauterine life excessive exposure to androgens have a permanent effect on gene expression resulting in PCOS, prevalence of PCOS features among first degree relatives is suggestive of genetic influences. ▪ Daiva - Unknown or idiopathic causes comes under Daiva . Samprampti Mainly Sanga and Vimargagamana can be taken. Kaphamedakara Ahara Vihara Agnimandhya Amotpattii Srotorodha Dhatvagnimandhya Apachita Rasadhatu Uttorottara Dhatu Apachana leading to Medodusthi and Alpartava like Lakshanas are seen . Roopa: we can co relate some of the Lakshanas explained under following disorders ▪ Rajakshianata - Yathochita Kala Adarshana (irregular menses), Alapata (Scanty menses) ▪ Nastharatava - Artava Nasha due to Avrutamarga , here Acharya Dalhana commenting on Acharya Sushruta verse, explains that Nastha means Na Tu Sarvatha Kshaya (not completely lost) it is just reduced in quantity so its Apravartamana (unable to express out). In Samhita Artava word extensively used in context of menstrual blood, ovum and ovarian hormones so, it can be taken in terms of oligo/anovulation, oligomenorrhoea, reduced duration of flow [80] Vandhya - Vandhya is considered as Nasthartava , it can be taken as the patient facing the issues of infertility due to anovulatory cycles and hormonal imbalance. ▪ Pushpghani Jatharini - Keeping this in view, we can consider it as female whose menstrual flow is regular, but cycle is without ovulation. It results in corpulent and hairy cheeks which are associated comorbidities with PCOS. This condition is seen in PCOS as 30% of women with PCOS have normal menses. ▪ Lohita Kshaya, Alapartava etc. can also be considered by seeing towards symptoms of PCOS. Chikitsa: Treatment can be divided into Nidana Parivarjana, Ahara-Vihara and Aoushadhi. Nidana Parivarjana - avoid the disease-causing factors for the disease like junk foods, cold drinks, sedentary life style etc. Ahara - One should take a healthy diet, follow Aharavidhi Vidhanas (rules of dietics). Acharya Sushruta has mentioned the Agneya Dravya Prayoga [9] in case of Arthava Kshaya like Masha, Tila, Kulatha, Matsya, Udvisha, Dadhi, Sura which will help to increase the Agneyatwa of Artava . Vihara - One should attain Dhatusamya (homeostasis) in body by observing Dincharya (daily regimen), Ritucharya (seasonal regimen), Rajaswala Paricharya (regimen to be followed during menstruation) Swasthavritta (code of conduct), Achara Rasayana etc. Yoga - Asana regular practice of Suryanamaskara, Sarvangasana, Paschimottanasana, Ardhamatsayendrasana, Matsyasana will help improving lipid, glucose including insulin resistance values. Pranayama - Nadishodhana Pranayama, Kapalbhati and Bhramari are known to be beneficial in brain-pancreas endocrine pathway and also helps in managing insulin resistance and dyslipidaemia. Panchakarma Vamana - Virechana Karma - Acharya Sushruta explained that in Artava Kshaya Samshodhana should be done followed by use of Aagneya Dravya . Acharya Dalhana commented on that for purification only Vamana Karma should be used, not the Virechana Karma. Because Virechana Karma reduces Pitta which results in reduction in Agneyatwa of A rtava which again leads to Artava Kshaya [10] . Vamana Karma expels Saumaya (Kapha) substance results in relative increase of Aagneya constituent of body, consequently, increases Artava . Acharya Chakrapani states that use of both Vamana Karma (emesis) and Virechana Karma (purgation) clears the upward and downward channels respectively. So, both procedures

[[[ p. 5 ]]]

[Summary: This page discusses Panchakarma treatments like Vamana, Virechana, Basti (including Uttara Basti), and Nasya for PCOS. It also lists various Ayurvedic formulations and single drugs such as Kanchanara Guggulu, Shatavari, Methika, Kumari, Jatamansi, and Lodhra, highlighting their benefits based on Ayurvedic principles and modern research.]

[Find the meaning and references behind the names: Vera, Rasa, Kumari]

Smita Mallikarjun Patil et al. Management of Polycystic Ovarian Syndrome through Ayurveda ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 164 can be done accordingly. Vamana helps to increase metabolism of body therefore reduce weight Which can therefore improve the circulation of androgen, glucose level and help ovulation and thus enhances pregnancy rate in obese women with PCOS [11] . Basti - As there is not any Yonivyapada without Vatadosha , Basti is main treatment for Vatadosha (Ardhachikitsa) helps to maintain function of Apana Vata which is required for the normal functioning of Artava . As per Kashyapa, Anuvasana Basti is the choice of treatment in Artavakshaya (oligomenorrhoea, amenorrhoea). Basti may stimulate the parasympathetic nerve supply which in turns helps for development of follicles and release of ovum from ovary. Uttara Basti - It is highly beneficial in gynaecological disorders as it clears the Artavavahasrotasa and pacifies vitiated Apana Vayu and promotes follicular maturity. Nasya - It may stimulate olfactory nerves and limbic system, which in turn stimulates hypothalamus leading to stimulation of Gonadotropin Releasing Hormone (GnRH) neurons, regularizing GnRH pulsatile secretion and maintaining the HPO axis, helps in regular and normal menstrual cycle. Drugs used - depending upon the Prakruti, Vikruti, Dosha, Dushya, Agni, Ama etc of the patient we can chose some of the ayurvedic formulations like Kanchanara Guggulu, Kuberaksha Vati, Latakaranaja Ghana Vati, Pushpadhanva Rasa, Nasthapushpantak Rasa, Rajapravartani Vati, Lashunadi Vati, Chandraprabha Vati, Rasapachak Kashaya, Medopachaka Kashaya, Dashamoolaristha, Ashokaristha, Daryaristha, Saraswataristha, Phalaghrita, Shatavari Ghrita, Dadimadi Ghrita, Rasona Ghrita etc. We can also use single drugs like: Meshshringi - ( Gymnena sylvestre , Family-Asclepiadaceae) Studies reported that it reduces the absorption of glucose in intestines, stimulates beta cell pancreatic growth and insulin release from beta cells. Shatavari - ( Asparagus racemosus , Family- Liliaceae) Many research prove that it is beneficial in infertility as it stimulates folliculogenesis, ovulation, prepares the uterus for conception and prevents miscarriages. Its alcohol extract significantly enhances insulin release [12] Methika - ( Trigonella foenum graceum , Family- Fabaceace) Studies on seed extract shown significant reduction in ovarian volume and size of cyst. It also showed increase in LH and FSH level. Kumari - ( Aloe vera , Family- Liliaceae) - Experimental studies shown that Aloe Vera decrease the levels of testosterone and insulin through improving the levels of progesterone and estradiol, decreasing the transcription levels of steroidal receptors; increasing aromatase expression which converts testosterone into estradiol and androstenedione into estrogen Also helps in regulating hyperglycaemia and modulating steroidogenesis. Jatamamshi – ( Nardostachys jatamansi , Family- Valerianaceae)- It is reported to be beneficial in management in PCOS by its antiandrogenic effect [13] . Lodhra ( Symplocos racemose , Family-Symplocaceae) - Its bark is prescribed in menorrhagia and other female reproductive dysfunctions it significantly decreases the elevated levels of testosterone and restored the levels of estrogen, progesterone and cholesterol levels, maintain the normal weight and histology of ovarian tissue and these effects were found to be comparable with clomiphene citrate CONCLUSION Polycystic ovarian syndrome (PCOS) is an emerging Complex endocrinological disorder whose main culprit are changing sedentary lifestyle, faulty food habits, not following the regimens explained according to Desha, Kala and Rutu . Not properly following menstrual regimen ( Rajaswala Paricharya ), lack of exercise etc. While adopting the modern medicine like hormonal pills, clomiphene citrate, antiandrogens, etc having its own limitations and patient have to face side effects like weight gain, drug reaction, headache, risk of thromboembolism [14] etc. PCOS is not directly mentioned in Ayurveda , but it can be corelated with some of the diseases like Vandhya, Nasthartava, Aratava Kshaya, Pushpaghni Jataharini , etc. and also my considering the particular Sroto Dushti, Avarodha, Agni, Ama , etc. we can choose proper Shodhana and

[[[ p. 6 ]]]

[Summary: This page concludes that PCOS is related to lifestyle and diet and that Ayurveda offers a holistic approach. It emphasizes Nidana Parivarjana, Vyayama, Pranayama, and improved diet. It claims that Ayurveda can help patients with PCOS and related metabolic abnormalities with minimal side effects. It includes references.]

[Find the meaning and references behind the names: Krishnan, Kumar, Ayu, Krishna, Ray, Med]

Smita Mallikarjun Patil et al. Management of Polycystic Ovarian Syndrome through Ayurveda ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 165 Shamana drugs for patient. Along with that following Nidana Parivarjana, doing proper Vyayama - Pranayama , improving dietic habits. With all these holistic approaches of Ayurveda will help the patient to come out of PCOS and its related metabolic abnormalities in the body successfully with no or minimal side effects. Hence, Ayurveda is a ray of hope for the patients suffering from Polycystic Ovarian Syndrome. REFERENCES 1 Dutta.D.C. Textbook of Gynaecology, 6 th edition, New Delhi, Jaypee brothers’ medical publishers, November 2013, Page.no. 459. 2 Dutta. D.C. Textbook of Gynaecology, 6 th edition, New Delhi, Jaypee brothers’ medical publishers, November 2013, Page.no. 460. 3 Howkins and Bourne, Shaw’s Textbook of Gynaecology, edited by Sunesh kumar, et al, 17 th edition, Elsevier RELX India Limited, Page.no. 314. 4 Howkins and B ourne, Shaw’s Textbook of Gynaecology, edited by Sunesh kumar, et al, 17 th edition, Elsevier RELX India Limited, Page.no. 315. 5 Rotterdam ESHRE/ASRM- Sponsored PCOS Consensus Workshop Revised 2003. 6 Howkins and Bourne, Shaw’s Textbook of Gynaecology, edited by Sunesh kumar, et al, 17 th edition, Elsevier RELX India Limited, Page.no. 317. 7 Prof. Tewari Premvati, Ayurvediya prasootitantra evam streeroga part 2, 2 nd edition, reprint 2018, chaukumbha orientalia, Page.no.10. 8 Sushruta, Kaviraj Ambikadattashastri, sushruta samhita with ayurveda tattva sandipana hindi commentary, part 1, sharirasthana 2/21, Varanasi, chaukumba publications, reprint edition 2014, Page.no.16. 9 Sushruta, Kaviraj Ambikadattashastri, sushruta samhita with ayurveda tattva sandipana hindi commentary, part 1, sutrasthana 15/16, Varanasi, chaukumba publications, reprint edition 2014, Page.no. 77. 10 Sushruta, Kaviraj Ambikadattashastri, sushruta samhita with ayurved tattva sandipana hindi commentary, part 1, sutrasthana 15/16, Varanasi, chaukumba publications, reprint edition 2014, Page.no. 78. 11 Bhingardive KB, Sarvade DD, Bhatted S. Clinical efficacy of Vamana Karma with Ikshwaaku Beeja Yoga followed by Shatapushpadi Ghanavati in the management of Artava Kshaya w. s. r to polycystic ovarian syndrome. Ayu. 2017 Page.no 127 – 132. 12 Impact of stress on female reproductive health disorders: Possible beneficial effects of Shatavari (Asparagus racemosus) . Biomedicine & Pharmacotherapy Volume 103, July 2018, Page.no 46- 49. 13 Palarhil S, Mavilavalappil, Toine B, Krishnan S. Antiandrogenic activity of Nardostachys jatamansi DC and Tribulus terestris Linn and their beneficial effects on Polycystic Ovary syndromeinduced rat model. Metabolic syndrome and related disorders 2015, Page. no 248-254. 14 Dutta. D.C. Textbook of Gynaecology, 6 th edition, New Delhi, Jaypee brothers’ medical publishers, November 2013, Page.no. 470 ******************************* How to cite this article: Smita Mallikarjun Patil, Veena Ajay Patil. A review of management of Polycystic Ovarian Syndrome through Ayurveda. J Ayurveda Integr Med Sci 2021;5:161-165. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘A review of management of Polycystic Ovarian Syndrome through Ayurveda’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Dosha, Yoga, Pranayama, Agni, Ayurveda, Vamana, Ama, Kumari, Hetu, Vyayama, Agnimandya, Nasya, Shatavari, Lodhra, Apanavata, Dushya, Basti, Daiva, Vandhya, Panchakarma, Methika, Ritucharya, Mithyachara, Lohitakshaya, Phalaghrita, Anuvasanabasti, Achararasayana, Dincharya, Aloe vera, Asparagus racemosus, Nardostachys jatamansi, Depression, Anxiety, Prakruti, Amenorrhea, Obesity, Herbal preparation, Lifestyle modification, Alopecia, Shatavarighrita, Infertility, Virechana Karma, Menstrual abnormalities, Dadimadighrita, Insulin resistance, Weight gain, Lashunadi vati, Polycystic Ovarian Syndrome, Metabolic syndrome, Swasthavritta, Nidana Parivarjana, Oligomenorrhea, Dyslipidemia, Ovulation induction, Anovulation, Type 2 diabetes, Rajaswala Paricharya, Srotorodha, Hirsutism, PCOS, Ahara Vihara, Dhatvagnimandhya, Kanchanara guggulu, Hyperandrogenism, Artava Kshaya, Hypomenorrhea, Chandraprabha vati, Coronary heart disease, Metformin, Uttara Basti, Clomiphene citrate, Acne, Ashokaristha, HPO Axis, Yonivyapada, Irregular menses, Menstrual abnormality, Polycystic Ovaries, Metabolic disturbance, Pushpadhanva rasa, Pushpaghni Jataharini, Dietic habits, Mithyaahara, Vandhya Yonivyapada, Kuberaksha Vati, Lactic Acidosis, Hepatic toxicity, Increased risk, Oral contraceptive, USG, Surgical method, Enlarged polycystic ovaries, Sleep Apnoea, Bijadosha, Cardiovascular Event, Thromboembolic event, Anti androgen.

Let's grow together!

I humbly request your help to keep doing what I do best: provide the world with unbiased sources, definitions and images. Your donation direclty influences the quality and quantity of knowledge, wisdom and spiritual insight the world is exposed to.

Let's make the world a better place together!

Like what you read? Help to become even better: