Principles Of Treatment For Hair Fall Associated PCOS

Article by Dr Raghuram Y.S. MD (Ay)
PCOS (Polycystic Ovarian Syndrome) or PCOD is a common endocrine system disorder among women of reproductive age. As the name indicates, the disease afflicts the ovaries (egg forming organs in the female, located in the pelvis, 2 in number, one on each side of the uterus or womb). It is the leading cause of infertility in women, though many cases may develop silently without intervening with fertility. It is caused by elevated androgens (male hormones in women). 

Other names – Hyperandrogenic Anovulation (HA) and Stein-Leventhal Syndrome
Diagnosis is based on the below mentioned findings –
– No ovulation
– High androgen levels
– Presence of Ovarian cysts (one to many, generally many, hence the name polycystic)

Note – Cysts are non-cancerous and have a sac-like structure that can be filled with fluid, pus, or other gaseous material. They are common and can occur anywhere on the body. Cysts are often caused by infection, clogging of sebaceous glands or around earrings.
It is a syndrome because it manifests in the form of group of symptoms which consistently occur together.

Symptoms

Menstrual disorders – Oligomenorrhoea (less than 9 menstrual periods in a year) or amenorrhoea (no menstrual periods for 1-3 consecutive months or more)
Infertility – result of anovulation or lack of ovulation
High levels of male hormones (hyperandrogenism) – Common signs include acne, hirsutism (male pattern hair, on chin, chest etc), hypermenorrhoea (heavy and prolonged periods), androgenic alopecia (increased hair thinning or diffuse hair loss) etc

Metabolic syndrome – tendency to get central obesity and other symptoms related with insulin resistance. Serum insulin, insulin resistance and homocysteine levels are higher in women with PCOS.

PCOS is the most common endocrine disorder among women. It manifests between the age groups of 18 and 44 years. It affects approximately 2-20% of this age group. It is one of the leading causes of poor fertility or infertility.
Read related: Polycystic ovarian syndrome: Ayurvedic Treatment, Remedies, Diet

PCOS and hair loss

Relation between PCOS and Hair loss, Ayurveda perspective
It is clear that PCOS presents with male pattern hair loss. PCOS can also cause male pattern hair growth on chin, chest etc in women.

In this article I will discuss PCOD related hair loss with an Ayurvedic perspective.
First of all, it is wise to see if the hair fall is due to PCOS or any other cause. Other causes of hair fall including local and systemic should be ruled out.
One needs to remember that all patients with PCOS might not have hair fall as a rule!!

But in conditions where in PCOS is directly related to hair fall, the below mentioned aspects need to be given a thought –
PCOS is many times a silent disease unless it seriously interferes with the a) regularity of menstrual cycles and b) fertility

Vata Dosha in PCOS

Vayu realted PCOS (Apana Vata vitiation, Prana-Vyana-Apana axis disturbance or hormonal disturbances, Ashayapakarsha and Avarana of Vata)
Menstrual cycles are regulated by Apana vayu or – Prana-Vyana-Apana axis (endocrine imbalances in relation to PCOS) if we are thinking in a modern perspective. Similarly the fertility also depends on the balance of lower vayu i.e. Apana Vayu.

PCOS due to Vata vitiation
Treat Vata Dosha: PCOS may be considered as a granthi rupa vikriti or cystic swelling (with accumulation). It may be though in the lines of Kapha blocking the functions of Apana Vata. This happens in 2 conditions,

– The normal kapha being pulled by apana vata into its place due to the suction action of vata (ashayapakarsha) or
– Kapha avrita vata i.e. kapha dripping into the vata places, especially the lower areas of the body and accumulating, blocking the smooth functioning of vata.

In these conditions, the kapha which is usually present in the upper part of the body drips down through the middle part of the body, which is a pitta place (agni sthana). While doing so, kapha drags down pitta too, as it moves into the vata sthana.

With this there is accumulation of fluids in the lower portion of the body and also inflammatory changes, which causes many diseases including PCOS. When this happens, the Prana-Vyana-Apana axis is disturbed because they are also subjected due to unnecessary and undesired displacements.
These changes will impact on hormonal imbalances, depletion of tissues, disturbed metabolism, loss of nutrition (including to hairs) and hair loss.
Read related: Polycystic ovarian syndrome, obesity and insulin resistance – natural management

Treatment principles

In these conditions concentrate on correcting Prana-Vyana-Apana axis, below mentioned treatments are effective in disease modulation and preventing hair loss –

• Sarvangadhara (stream pouring of medicated oils, milk, etc all over the body)
• Shiro dhara – stream pouring of medicated oils and milk over the head (any Murdni Taila procedures)
• Udwarthana (antagonistic to accumulation of fluids) – powder massages
• Abhyanga and Swedana – Herbal oil massage and sweat inducing treatments
• Vamana – Therapeutic emesis
• Virechana – Therapeutic purgation

Counselling and stress management, exercise and proper diet are a must.
Yoga will help!!

Nutrition related PCOS

Poshana (preenana) or Nutrition related PCOS
Look for Hair Nutrition – Ashayapakarsha and Avarana also cause vacant spaces in kapha and pitta sites because they have been gravitated to the vata place. This may lead to loss of strength and support (represented by kapha) in the upper portions of the body and pathological increase of vata. This may lead to anxiety, fear, palpitations, sleeplessness, felling of emptiness in the regions of head and chest, low oxygenation, hurried breathing, variations in blood pressure, functional abnormalities of heart and lungs etc. Here it may lead to deficit nutrition and oxygenation to the hairs. Deficit nutrition will also form deficit rasa, leading to deficit rakta and artava. Pathological increase of vata will lead to tissue depletion (dhatukshaya and anaemia) which in turn leads to hair fall. Dripping down of kapha and pitta will cause PCOS and further worsen hairfall.

Treatment – Here look for symptoms related to heart and lungs, Improve metabolism, treatments and medicines to enhance circulation of oxygen and nutrients. Improve heart and lung functioning, enhance nutrition and oxygenation to the body and hairs too!!

Metabolism related PCOS

Agni or Metabolism related PCOS

Look for metabolic errors and sluggish liver, anaemia – Ashayapakarsha and Avarana will also lead to metabolic disturbances due to displacement of pitta. This is supported by constant dripping and passage of kapha into the pitta place. This leads to indigestion and formation of metabolic toxins in stomach and cells. This also disturbs liver functions (by diluting ranjaka pitta). This in turn leads to many diseases including anaemia. Anaemia is one of the strongest cause of hair loss and anaemia is strongly associated with PCOS.

Lot of ama (immature essence of digestion) is formed. The Rasa or nutritive part of digestion is not formed properly. Artava or menstrual blood (includes ovum and ovulation process) is not formed properly as it is the bi-product and sub-tissue (upadhatu) of Rasa dhatu. Thus there are menstrual irregularities.

Gambhira Loma (deep rooted hairs) is one of the signs of a person having enriched rasa. Though loma denotes body hair, it can be taken as scalp hair in women. This shows that if Rasa is not properly formed, the menstrual irregularities, infertility and hair loss can occur. This points towards the symptoms of PCOS. In this case, look for digestive disturbances and liver dysfunctions as cause for hair fall associated with PCOS.
Treatment –
Correct liver functioning, anaemia;
improve appetite, digestion and nutrition

Medo roga related PCOS

PCOS related to Medo roga, i.e. obesity and errors of fat metabolism
The Fat connection – ‘Medasavruta Margatwat Pushyanti anye na dhatawaha’. The pathways blocked by excessive fat in the body will lead to depletion or mal-nutrition (insufficient nutrition) of all the tissues. This, in woman will lead to artava kshaya, and in retrograde way the depletion of rasa-rakta (blood and circulating nutrition, which is the manufacturer of artava), since fat takes away most of the nutrition. This leads to deficit production of artava and also its discharge (in monthly cycles). This leads to menstrual irregularities, collection of fat and fluids in the system and disturbance of Vyana functions or its axis with prana and vyana (hormonal imbalance). This leads to hair loss.

In the pathological manifestations of atisthoulya (obese and overweight individuals), Charaka has mentioned Krichchra Vyavaya (difficulty in sex or loss of interest in sex or sexual dysfunctions) due to sroto avarodha (block of channels of the body) by meda or fat leading to depletion of shukra dhatu. Good hairs are also the signs of a balanced and healthy fat in the body (meda sara or virtuous fat). Thus, if fat is imbalanced in the body, it can lead to hair loss. Obesity is most often related with PCOS.

Treatment – Concentrate on weight loss, light food, good exercise, Yoga and Panchakarma treatments especially Virechana, Swedana, Udwarthana and Vasti will be of extreme help.
Read related: Oral Ayurvedic Medicines For Hair Loss And Hair Growth

Asthi dushti related PCOS

Asthi dushti or Bone related PCOS
The bone connection and natural tendency to lose hair – Sushruta has also mentioned about Stree Shukra (female counterpart of shukra which lays unmanifested). He says when two women have coitus we get a ‘boneless foetus’. This means to tell that the shukra or semen is responsible for formation of bones. Kesha (hairs) are said to be Asthi mala or derivatives of bones.

Thus, women naturally have a tendency to have hair fall because of inadequate shukra representation. In women who doesn’t have hair fall, we can guess that the Shukra is represented in a good quantity or quality in her. We have seen hair fall in patients who have bone and joint pains or in cases of osteopenia and osteoporosis (asthi kshaya). Bone pains are also seen in PCOS. Hair fall is seen in women after menopause (shows, healthy hair is related to artava or stree shukra).

Treatment – In these conditions look for bone health, go with natural calcium supplements, nutritious food, supportive hair oils, shirodhara, Nasya, Virechana, Tikta Ksheera Vasti etc.
Read related: Ayurvedic Hair Care – Principles, Herbs, Oils And Medicines

Shukra dushti related PCOS

Shukra or semen Related PCOS
According to Sushruta, Pandutwa or anaemia is one of the symptoms of Shukra Kshaya or depletion of shukra. Anaemia can be one of the presentations of PCOS.

Thus PCOS reflects one or the other of Rasa Kshaya or Shukra Kshaya. This means that correction of Rasa Kshaya or Shukra Kshaya can be an effective remedy for PCOS and vice versa. We have seen the association of anaemia in PCOS.

According to Ayurveda, Pandu (anaemia or liver disorders) lead to shotha or swelling (inflammatory or non-inflammatory), which includes PCOS too.

Treatment – In PCOS associated with Vata vriddhi, tissue depletion is mandatory. To balance the Shukra part, Rasayana and Vajikarana herbs like Ashwagandha, Musali, Shilajit, Shatavari, Trivanga etc (or formulations having them) can be prescribed.

Alternatively the haematinics like Loha, Mandura etc can be given. They have proved to promote hair growth when PCOS is associated with Vata disturbance and Shukra Kshaya / Artava Kshaya.

Other treatment strategies

Other strategies of treating hair fall associated with PCOS
I have also noted that PCOS and related hair fall can be corrected by treating PCOS on the lines of Shotha, Granthi, Galaganda chikitsa (which almost resembles with Ayurvedic management of swelling or inflammation, cystic swellings, glandular swellings including thyroid diseases etc).

Example, getting Kanchanara Guggulu, Punarnava Mandura, Triphala Guggulu, Agastya Haritaki, Punarnava compounds, Ayaskriti, Aragwadha preparations, Haritaki, Shilajit, Trivanga and lot more.

Panchakarma and external treatments

Among treatments the below mentioned are highly effective in hair fall associated with PCOS –

• Virechana
• Udwarthana – ubtan – powder massage
• Nasya – nasal drop administration
• Lekhana Vasti
• Shiro lepa
• Shiro dhara etc

Last but not the least, a good nutritious diet, light enough to enable healthy weight loss, good physical exercise, Yoga, stress management and counselling and Rasayanas and Vajikara dravyas in the follow up period will have to be complemented with the main line of treatment.

Just before finish –
PCOS is a common condition encountered among women, while some remain clueless and harmless; the others meddle with fertility of the female. Not only that, it also causes an impact on overall health. PCOS is associated with multi-system disorders, including hormonal imbalances. Hair fall is a common complaint in PCOS. Ayurveda has unparalleled remedies for PCOS and associated hair fall. Get rid of your PCOS with natural, herbal Ayurveda remedies. If your hair fall is associated with PCOS, your hair fall will surely stop once you get rid of its cause!!
Click to Consult Dr Raghuram Y.S. MD (Ayu) by email / skype