An exploration into the management and diagnosis of Polycystic Ovarian Syndrome by Complementary and Alternate Medical (CAM) practitioners in the eThekwini area

Abstract

Polycystic Ovarian Syndrome (PCOS) is a prevalent reproductive endocrinopathy which presents a significant clinical and public health problem (Morgante et al. 2015). PCOS can affect females throughout their lifespan leading to serious complications such as obesity, infertility, type two diabetes mellitus and cardiovascular disease (De Leo et al. 2016). The conventional approach to treating PCOS is guided by what symptoms affect the patient most such as infertility, hirsutism, acne and so forth. Many of the conventional treatments for PCOS such as metformin, anti-androgens and oral contraceptives can cause harmful adverse side-effects (Lamba et al 2018:65). Adverse side-effects, complications, dissatisfaction in various aspects of the patient- practitioner experience and failed therapies are among the main reasons that patients opt for Complementary and Alternative Medicine (CAM) therapy. CAM fulfils the expectations not met by conventional medicine, particularly the psychological impact of PCOS on patients, which are assessed by only a few conventional practitioners (Fauser et al. 2012). Aim of the study This study aimed to document existing therapeutic protocols in the management of PCOS from diagnosis to treatment used by practitioners within various disciplines of CAM in the context of their unique philosophical background. Furthermore, this information may be valuable in bridging any potential gap in information across the five CAM modalities investigated in this research with regards to PCOS. These modalities were: homoeopathy, Ayurveda (AV), Unani Tibb (UT), Traditional Chinese Medicine (TCM) and naturopathy. Methodology A qualitative approach was used to document the perceptions and protocols used in the diagnosis and management of PCOS by practitioners of the five selected CAM v modalities practicing within the boundaries of the eThekwini municipality. Stratified purposive sampling was implemented in order to select a sample frame of 12 participants. Data was collected by means of personalised, semi-structured interviews and the data collected was analysed using Tesch’s (Tesch 1990:329) and Creswell’s (Creswell 2014) methods. Results CAM philosophies are underpinned by the principles of innate healing, an individualised constitution and governing factors which manage homeostasis. TCM philosophy is guided by the yin and yang concept, homoeopathy by the vital force and miasms, AV by three doshas. UT by four humours and naturopathy by lifestyle factors. PCOS patients were generally classified as being sycotic and/or cancerinic (miasmatically) according to homoeopathy, having a melancholic, sanguineous temperament according to UT, presenting with excessive kapha and vata according to Ayurveda and a predominant yang deficiency with heat and moisture according to TCM. PCOS is a multi-faceted reproductive endocrinopathy which requires extensive management. The different roles of a family physician, endocrinologist, dermatologist, dietitian and gynaecologist in the diagnosis and holistic management of PCOS is performed collectively by a CAM practitioner. PCOS is considered an affliction of the woman and not merely as a disease of the ovaries and therefore much attention is drawn to the emotional drivers, particularly stress and abuse which affect these patients’ quality of life (QoL). Diagnostics reported by participants included: 1) A clinical diagnosis congruent with established diagnostic criteria such as the Rotterdam criteria which identified the pathognomonic features of PCOS and 2) A CAM-specific diagnosis which evaluated the entirety of the patient’s symptoms, emotions and characteristics in order to determine a constitutional weakness. vi

This study found that management of PCOS, according to CAM participants, was aimed at correcting hormonal, ovulatory and menstrual imbalances, improving fertility, reducing obesity, managing infertility and improving the patient’s QoL. Management strategies generally comprised: 1) CAM-specific therapy which included medicines and/or procedures, 2) Adjunctive therapy which included supplements and the use of other modalities and 3) Lifestyle intervention which included dietary counselling, physical activity recommendations and emotional counselling. Conclusion In conclusion, PCOS is a multi-faceted condition which requires emotional support concomitantly with therapeutic support due to the clinical spectrum of changes that can have an impact on females’ psychological health.