PCOD: the Ayurvedic medicines we prescribe

PCOD and PCOS are not one disease and no single herbal tablet settles them. What changes the cycles, the skin and the weight is a plan; the medicines sit on top of it.

Polycystic ovary syndrome is a pattern: the ovulation rhythm has slowed, the androgen side is running a little loud, and underneath most of these cases is the body handling insulin badly. The classical texts do not describe PCOS as such; they describe menstrual irregularity, difficulty conceiving, excess hair and weight, and they treated them as one family of problems rather than four separate complaints. That instinct was right, and it is the reason a woman with PCOS should be treated as a whole metabolic case and not as an ultrasound report.

The four things we are actually treating

• Cycles. Fewer than eight periods a year, or bleeding that comes heavy and unpredictable, is the first problem to fix — not for regularity's sake, but because an endometrium that is bathed in oestrogen without a monthly progesterone layer slowly builds up a real risk of thickening.
• The androgen side. Acne along the jaw, hair at the chin and abdomen, and thinning at the crown. These respond, but on a three-to-six-month clock, and anyone promising faster is promising the wrong thing.
• Insulin and weight. The engine underneath. A five to ten percent weight reduction restores ovulation in a meaningful share of women, which is a better result than most tablets and costs nothing.
• Conception, if that is the goal. It is a separate conversation with its own sequence, its own tests for both partners, and its own timelines. It is not the same prescription as cycle regulation.

What has to be excluded before the label is used

• Thyroid disease and high prolactin both stop ovulation and both have simple blood tests. Treating them looks exactly like treating PCOS and works far faster.
• Pregnancy, always, before anything is started.
• The rarer androgen causes: a rapid onset of masculine features, voice change, or a testosterone level far above the usual range points to the adrenal gland or an ovarian source and needs urgent investigation, not herbs.
• A polycystic-looking ultrasound alone is not the diagnosis. Many normal ovaries look like that, and some women with textbook PCOS have ordinary-looking scans. The diagnosis is symptoms plus bloods, which is why the report should be read with the history rather than instead of it.

The levers, in the order that works

• Food hours and portion, with protein at every meal and no third heavy meal at night. Not a crash diet; crash dieting costs muscle and rebounds the sugar.
• Activity that includes resistance work twice a week. Muscle is where glucose goes, and this is the cheapest insulin-sensitiser available.
• Sleep, because short sleep raises insulin resistance within days and because PCOS and snoring and daytime tiredness travel together.
• Weight, if it needs reducing, at half a kilo a week and no faster.
• Smoking and alcohol, both of which add to the metabolic and vascular load that already runs higher in PCOS.
• Then the medicines: metformin where the sugar side needs it, a combined pill where cycle control and acne are the complaint, an anti-androgen for hair growth where a doctor decides it fits, and ovulation-inducing tablets when the goal is pregnancy — the last of these prescribed and monitored, never bought over the counter.
• Inositol supplements are sold everywhere for PCOS. The evidence is real but modest and the doses in studies are much higher than most packets contain. Worth taking if you are already doing everything above; not worth taking instead of it.

What we prescribe from our side, and what it is for

• Guggulu-based formulations for the heaviness, the cystic tendency and the weight layer. They are not for anyone who is pregnant or trying in the same cycle, they can interact with thyroid tablets, and they are stopped when they have not helped in three months.
• Ashoka and lodhra where the bleeding is heavy and prolonged, along with the haemoglobin check that must accompany it.
• Kashmari where the androgen side and the ovarian picture are the complaint, as an add-on to the plan rather than a replacement for it.
• Shatavari and guduchi for the sleep, stress and sugar layer, with the caution that guduchi can pull sugar readings down and has produced liver problems in a small number of people.
• Triphala or isabgol for the constipation that comes with iron tablets and a low-fibre day, because nothing else on this list works in a woman who is uncomfortable.
• Ashwagandha for fatigue and sleep, with the honest note that it shifts thyroid readings, which matters in a woman whose thyroid was one of the things we tested.
• What we do not do: promise ovulation, promise conception, or hand out a six-powder mixture with no dates and no doses.

The hazards specific to this complaint

• Unlabelled 'PCOS cure' packets. They are adulterated with hormones, steroids and diuretics often enough to be a real danger, and they produce a dramatic result followed by a crash.
• Herbal slimming powders with a laxative or a diuretic in them, which make a woman feel treated while her potassium and cycle get worse.
• Stopping a prescribed pill abruptly to try for a baby without telling anyone, which loses months of planning and can bring a heavy, painful first cycle.
• Long stretches without a period because nothing hurts. This is the quiet risk in PCOS, and it is the reason we count cycles rather than symptoms.

When to be seen without waiting

• No period for three months with a negative test, or a positive test with one-sided pain or bleeding.
• Bleeding that soaks more than a pad an hour, or bleeding between periods after months of none.
• Rapidly increasing facial hair, voice deepening, or acne that appeared over weeks rather than years.
• Very high blood pressure, a fasting sugar in the diabetic range, or cholesterol that has jumped — all of which are part of this disease and are treated separately.
• Trying for a pregnancy for a year under thirty-five, six months over thirty-five, or any time if cycles are absent — with both partners tested, because male factors are as common here as anywhere.

At our two centres

• Model Town and Burari, first consultation free. We take the history, count the cycles, read the bloods you already have, decide what still needs doing, and put the herbal part where it belongs — on top of food, activity, sleep and the medicine your gynaecologist has already started. Nothing here is stopped to make room for something else, and nothing is promised about conceiving.

Counting the cycles, which is the actual monitoring

• Write down the first day of every bleed in a phone note. Three months of that tells us more than any single hormone report.
• Fewer than eight periods a year, or cycles longer than thirty-five days consistently, is the number that decides whether the endometrium needs protecting.
• Bleeding that is heavy for two days, or spotting for ten, is a different problem from no bleeding at all and gets a different answer.
• Ovulation kits are unreliable in PCOS, because the baseline LH is already high. A mid-luteal progesterone blood test, timed by the doctor, is the honest way to know whether you ovulated.
• Weight, blood pressure and a sugar reading belong in the same note. PCOS is not only a gynaecological condition, and the parts that shorten life are the metabolic and blood-vessel ones.

If a pregnancy is the goal

• Say so at the first visit, because the plan changes completely: no anti-androgen tablets, guggulu stopped, and the focus moves to ovulation, tubes, sperm and timing.
• Folic acid before conceiving, not after; sugar control built up over months rather than weeks; thyroid level corrected; vitamin D and iron fixed. All of this reduces miscarriage risk more than any packet.
• Weight and activity first, because in a woman with PCOS who is carrying extra weight, a five to ten percent reduction alone restores ovulation often enough that it is tried before tablets.
• Ovulation-inducing medicine is prescribed, dose-timed and monitored with scans. Bought privately and taken blindly, it produces cysts, multiples and a wasted cycle.
• Both partners are tested at the same time. A year of a woman's treatment while his semen report has never been seen is the most common avoidable delay we see.
• And the honest sentence: no herbal churn, capsule or syrup has ever been shown to make an egg release. Where they help is the layer around it — sleep, weight, sugar, inflammation and the day's routine.

Every individual is different. Before starting any new remedy or routine, please consult a qualified doctor, especially if you are pregnant or trying, on regular medication for BP, sugar or thyroid, take blood thinners, or have liver or kidney problems.