Vol. 2, Issue 2, Part A (2025)

Background: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine-metabolic disorder characterised by ovulatory dysfunction, hyperandrogenism and polycystic ovarian morphology, frequently accompanied by obesity, insulin resistance and dyslipidaemia. Ayurveda conceptualises this syndrome in terms of Vata-Kapha vitiation, Medo-dushti, Avarana of Artavavaha srotas and entities such as Nashtartava, Artava Kshaya and Sthaulya, recommending a sequenced approach of Shodhana followed by Shamana therapy.

Objective: To evaluate the effect of a combined Shodhana-Shamana Ayurvedic protocol on metabolic and reproductive parameters in women with PCOS diagnosed by contemporary criteria.

Methods: In this prospective single-centre cohort study, 60 women aged 18-40 years with Rotterdam-defined PCOS were enrolled; 54 completed 6-month follow-up. All participants underwent Deepana-Pachana, Snehapana, Abhyanga and Swedana as Purva Karma, followed by Virechana with or without Basti, and then 3-6 months of Medohara and Artava-janana Shamana therapy alongside Pathya-Ahara and Dinacharya advice. Outcomes included menstrual pattern, hirsutism and acne scores, anthropometry, fasting glucose, insulin, HOMA-IR, lipid profile, reproductive hormones and ultrasonographic ovarian morphology, assessed at baseline and 3 or 6 months. Data were analysed using paired tests for continuous variables and McNemar or chi-square tests for categorical variables.

Results: The proportion of women with regular cycles increased from 11.1% at baseline to 77.8% at 6 months, with mean cycle length normalising into the physiological range. Significant reductions were observed in hirsutism scores, BMI, waist-hip ratio, fasting insulin, HOMA-IR and atherogenic lipid fractions, with a modest rise in HDL cholesterol. Total testosterone and LH/FSH ratio declined, and the proportion of ovaries with classical polycystic morphology on ultrasound decreased from approximately four-fifths to under half. The protocol was well tolerated, with no serious adverse events.

Conclusion: A rationally sequenced Shodhana-Shamana Ayurvedic regimen may offer a clinically meaningful, non-hormonal option for improving both metabolic and reproductive outcomes in women with PCOS, supporting its further evaluation within integrative, evidence-based management frameworks.