The Family Medical Herbalist - PCOS Case
The Family Medical Herbalist - Holistic medical herbalism, mycotherapy and immunonutrition

Medical Herbalism: PCOS (Polycystic Ovarian Syndrome) Summary of Clinical Case History

Polycystic ovaries, case history, patientThe largest group of patients visiting Medical Herbalists are ladies presenting with menstrual and hormonal conditions, the most common presentation being Polycistic Ovarian Syndrome (PCOS). One of my patients visited me over a year. She was a 30-year old single woman living alone with no children. She held three jobs, including social work and writing; information on her third occupation was not released due to confidentiality. 

Her menarche had been at 15 years of age and always distressing premenstrually. PCOS had first been diagnosed at 17 and she had been hirsute since 16 years of age. She had been prescribed Dianette for 1 year. 10 years before, the patient had consulted with a private Practitioner, where she had been successfully treated of premenstrual irregularity. After two years free of premenstrual symptoms, the condition relapsed but went untreated until the patient visited me. Between 18 and 22 years of age, the patient had been sexually active and had experienced pain on intercourse, which however had not recurred afterwards. She had never tried to conceive.

During the worst menstrual day, the patient would be confined to bed with pain in the abdomen, knees, hips and arms. On the first day, the patient would experience incomplete emptying of her bowels accompanied by diarrhea. The pain would start 2 weeks before her menstrual cycle and disappear immediately after. She would also suffer from breast tenderness and swelling under the armpits. Premenstrually, she would feel hungrier than usual and crave carbohydrates, chocolate and other junk foods. Her cycle would typically last 4-5 weeks, although it had become more regular. Her bleeding would last 4 days. During the first day, there would be clots indicating heavy flow. She would also complain of acne, although this was never observed clinically. 

At the first visit, the patient's diet had been deficient and her appetite poor, she had been feeling fatigued, despite sleeping over 8 hours. the patient's premenstrual pain had worsened since October 2005 and had been severe premenstrually. 

The patient was monitored carefully. No gyneacological investigation had been carried out before her visiting a Herbalist. Then a smear and blood tests were requested and results were negative. On my advice, the patient had also asked her new GP for a a laparoscopy to rule out endometriosis. Blood tests continued to be normal but the GP did not deem it necessary to refer her for laparoscopy. 

The patient had also presented with mood depression and had been feeling angry. Premenstrually, her mood would lead to clumsiness, tearfulness, "breaking lots of things" and a feeling that life "simply gets our of hand". I suspected that her mood depression may have been stirred up by psychodynamic therapy, which she had been attending three times per month. By her third visit to me, she had been dramatically happier and by the end of the treatment, she had been considerably cheerful; she had been pleased that she finally was not experiencing any premenstrual symptoms at all. She vaguely mentioned some positive life events that involved her occupation as a writer and looked radiant. Since then, the patient continued to be "eating well" and there was no sign of depression. Her PMS had also stopped. Hirsutism was no longer a problem and visit to the beautician for facial hair removal were no longer required. Reassessment was carried out before discharge. 

Prognosis
The prognosis had been good from the start, although treatment required regular monthly visits for the first six months and continued to be monitored twice yearly since discharge. Had it been untreated, PCOS might have increased pain and then lead to infertility due to impairment of ovarian and tubal function and poor interaction with coital and sperm function with inappropriate immune responses between partners.

Management
Advice included eating more regularly and taking dietary supplements, in order to maintain the basal metabolic rate, as the patient's hands had been cold, particularly during episodes of panic attacks and tachycardia (sympathetic nervous system activation). 

Immunomodulating, immunostimulating herbs such as Echinacea, Siberian ginseng and Chaste berry were prescribed, as endometriosis had not been ruled out and the patient had been feeling fatigued and presented with lingering chest infections occasionally. Prolactin-lowering and hormone balancing herbs were blended. Uterine and bowel spasmolytic, relaxant and analgesic herbs were given in a pain mixture.