INTRODUCTION

Polycystic Ovarian Syndrome is one of the most common female

endocrine (or hormonal) disorders, characterized by multiple abnormal
ovarian cysts. PCOS is accompanied by such conditions as anovulation,
hipertestosteronism, lower cell sensitivity to insulin, type II diabetes,
hyperlipidemia and obesity. Each of the above-mentioned conditions is
an approved risk factor proved to predispose towards cancer. Women
diagnosed with PCOS develop higher level of testosterone, insulin,
growth factors such as IGF-1 (Insulin Growth Factor1), which were
experimentally proved to have potential for direct stimulation of cancer
cells proliferation. Now a day various anti-cancer drug available in the
market with highly toxicity, that’s why we should keep our attention
towards natural remedies. The root of various species of Pulsatilla plant
(pulsatilla koreana, pulsatilla chinensis) contain saponin which shows
anti-cancer properties anddifferent species of pulsatilla also helps to
reduce PCOS.

The genus Pulsatilla contains about

33 species of herbaceous perennials native
to meadows and prairies of North America, Europe, and Asia.
Common names include pasque flower (or pasqueflower), wind
flower, prairie crocus, Easter flower, and meadow anemone.
Several species are valued ornamentals because of their finely-
dissected leaves, solitary bell-shaped flowers, and
plumed seed heads. The showy part of the flower consists
of sepals, not petals.
The genus Pulsatilla is sometimes considered a subgenus under
the genus Anemone or as an informally named "group" within
Anemone subgenus Anemone section Pulsatilloides.[1]
The flower blooms early in spring, which leads to the common
name Pasque flower, since Pasque refers to Easter (Passover).
In South Dakota in the center of North America, the flower sprouts
from late March through early June.[2]
Pulsatilla patens is the provincial flower of Manitoba,
Canada[3] and (as the synonym P. hirsutissima) is the state flower
of the US state of South Dakota.[4] Pulsatilla vulgaris is the County
flower for
both Hertfordshire and Cambridgeshire in England.[5] Pulsatilla
vernalis is the county flower of Oppland, Norwa.

Pulsatilla is highly toxic, and produces cardiogenic toxins and

oxytoxins which slow the heart in humans. Excess use can lead
to diarrhea, vomiting and
convulsions,[6]hypotension and coma.[7] It has been used as a
medicine by Native Americans for centuries. Blackfoot Indians
used it to induce abortions and childbirth.[6] Pulsatilla should not
be taken during pregnancy nor during lactation.[8]
Extracts of Pulsatilla have been used to treat reproductive
problems such as premenstrual
syndrome and epididymitis.[8] Additional applications of plant
extracts include uses as a sedative and for treating coughs.[8] It is
also used as an initial ingredient in homeopathic remedies.

Polycystic Ovarian Syndrome is one of the most common

female endocrine. Many papers reported the correlation
between infertility that most eminently predisposes
towards cancer in PCOS women from many years. From
both clinical and experimental research one can conclude
that correlation between PCOS and endometrial cancer is
the strongest. Most studies on correlation between PCOS
and ovarian cancer as well as breast cancer failed to
show a link though Pulsatilla have a strong effect on it.
Various synthetic drugs which mainly used in the
treatment of PCOS and endometrial cancer but here the
problem is those drugs has lots of side effect/Adverse
effect so we should go with the natural product Pulsatilla
Sp. Which is used on PCOSand various cancer. Pulsatilla
is a well establish drug for PCOS with unknown
mechanism of action. Deoxypodophyllotoxin, which was
isolated from the roots of P. koreana, was found to inhibit
the tube-like formation of HUVECs (human umbilical
venous endothelial cells) and have a potent antitumor
effect. The chemical constituent saponin D present in
Pulsatilla root is responsible for the anti tumor activity.
The results, which are expressed as Pulsatilla saponin D
has such a potent antitumor effect (IR, 82 %) on a solid
tumor, which is higher than Adriamycin (IR, 64%). 23-
Hydroxybetulinic acid synthesized from Pulsatilla
chinensis also shows anti tumoral activity. Though the
potency of pulsatilla sp. Are less than synthetic marketed
drugs but by structural modification we may get potent
anti canceral agent .

PHARMACOGNOSY OF PULSATILLA
PLANT

SYNONYMS :

1.Magnoliid dicot
2. Crow foot
3.Pasque flower
4.Butter cup

SPECIES USED:

There are about 33 species, including:

 Pulsatilla alpina
 Pulsatilla bungeana
 Pulsatilla cernua
 Pulsatilla chinensis
 Pulsatilla grandis
 Pulsatilla halleri
 Pulsatilla koreana
 Pulsatílla kostyczewii
 Pulsatilla montana
 Pulsatilla nigricans
 Pulsatilla occidentalis
 Pulsatilla patens
 Pulsatilla pratensis
 Pulsatilla subslavica
 Pulsatilla vernalis
 Pulsatilla vulgaris

PULSATILLA ALPINIA

Pulsatilla alpina (alpine pasqueflower or alpine anemone) is

a species of flowering plant in the family Ranunculaceae, native to
the mountain ranges of central and southern Europe, from central
Spain to Croatia. It is an herbaceous perennial growing to 15–
30 cm (6–12 in) tall by 20 cm (8 in) wide, and can be found at
altitudes of 1,200–2,700 m (3,900–8,900 ft).
Characteristics
Pulsatilla alpina has deeply divided, hairy leaves. It has more
upright flowers than other species of Pulsatilla, which generally
have drooping flowers. They are white or, in the case of
subsp. apiifolia, yellow. The flowers are produced very early, often
opening while still under snow cover. They have prominent
yellow stamens. As with all pasqueflowers, the flowers have a
silky, hairy texture, and are followed by prominent seedheads
which persist on the plant for many weeks.[1]
Subspecies
A number of subspecies are recognised, based largely on the
form and hairiness of the leaves. P.
alpina subsp. schneebergensis is endemic to the easternmost
Alps of Austria, and is named after the Schneeberg mountain. It is
replaced further west by the widespread taxon P.
alpina subsp. alpina. P. alpina subsp. austroalpina is found in the
Southern Alps from Switzerland eastwards, most commonly
over dolomite. P. alpinasubsp. apiifolia and P.
alpina subsp. alba grow over siliceous rock, but are easily
distinguished by the flower colour. Further subspecies have been
named for local variants in the Cantabrian
Mountains (subsp. cantabrica) and Corsica (subsp. cyrnea).
Cultivation
P. alpina is suitable for cultivation in an alpine garden, or in any
sharply drained soil in full sun. It is extremely hardy but dislikes
winter wet. The subspecies P. alpina subsp. apiifolia has gained
the Royal Horticultural Society's Award of Garden Merit.[
PULSATILLA CHINENSIS
Kingdom: Plantae

(unranked): Angiosperms

(unranked): Eudicots

Order: Ranunculales

Family: Ranunculaceae

Genus: Anemone

Species: A. chinensis

Binomial name

Anemone chinensis

Bunge[1]

Synonyms

 Pulsatilla chinensis (Bunge) Regel[1]

Anemone chinensis is a basionym of the currently

known Pulsatilla chinensis and is one of the 50 fundamental
herbs used in traditional Chinese medicine. There it has the name
bái tóu wēng.
PULSATILLA GRANDIS

Pulsatilla grandis, or the greater pasque flower, is

a species of flowering plant in the genus Pulsatilla of the
family Ranunculaceae. It is a perennial plant that grows
on calcium-rich soil in dry grasslands, in rocky outcrops, and in
pine and oak forests. It flowers from February to April, in the time
of the Easter (which gives it its name), with intensively blue to
violet flowers. Its silk stalk is protected from the cold by
velvety trichomes (hairs). Pulsatilla grandis is native to the
countries of Central, Eastern and Southeastern Europe, and is
particularly frequent in Hungary. In some of them, it is classed
as threatened.
Slovenia
In Slovenia, Pulsatilla grandis (named velikonočnica, the Easter
flower) is a rare and protected plant. It has four growing places in
the country: the southern slope of Boč, near the village
of Boletina, near the village of Ljubično, and near the village
of Zlateče. All of them are situated in the sub-
Pannonian phytogeographical area in the northeastern part of
Slovenia. The plant is the symbol of the Boč–Donatus Mountain
Landscape Park. On a small rise near the Boč growing place, a
stone sculpture of the flower, created by the sculptor Franc
Tobias from Razvanje, has been put on display in the
2000s. Pulsatilla grandis is also depicted on the coat of arms of
the Diocese of Celje.
PULSATILLA HALLERI

Anemone halleri, Haller's anemone, is a species

of anemone that can be found in sub-alpine and alpine regions of
southern France, southern Switzerland, northern Italy and Poland,
extending eastward to Greece, Bulgaria and Ukraine. It is found in
mountain meadows, dry hills, dry grassy locations and openings
in mountainous forests. It is collected and cultivated for botanical
and private gardens.
PULSATILLA KOREANA

Pulsatilla koreana, the Korean pasque flower (Korean Hal-mi-

kkot, 할미꽃), is one species of the genus Pulsatilla. P. koreana is
a hairy, tufted, perennial herb. It is a native perennial
plant growing in Korea and used as a traditional Korean herbal
medicine.

Pulsatilla koreana has six petal-like segments that have a silky

exterior; stamens in a central boss are surrounded by a ring
of staminoids. Leaves are 3–4 cm (1.2–1.6 in) long and are two-
to three-lobed. The leaves are pinnate in a basal rosette and
there are five leaflets which are white-woolly pubescent (covered
with erect hairs) beneath. The plant has bell-shaped flowers
with scapose and pendent,[clarification needed] blooming in spring. The
flowers are hermaphrodite (have both male and female organs)
and are pollinated by insects. They are solitary terminal on
a peduncle of 30–40 cm (12–16 in) length. The flower is about
35 cm (14 in) long, 12 mm (0.47 in) across, and its color is usually
red to purple. Fruit is borne in heads with long feather styles.
Distribution and cultivation

Korea
Pulsatilla koreana is a native perennial plant growing in Korea.
According to its native range, it is likely to succeed outdoors in
most areas of the country. The following notes are based on the
general needs of the genus Pulsatilla. The plant requires a well
drained humus rich gritty soil and a sunny position. It also
tolerates acid, neutral and basic (alkaline) soils and can grow in
very alkaline soil. The plant prefers light (sandy) and medium
(loamy) soils. It cannot grow in the shade and requires moist soil.
Traditional medicine
Pulsatilla koreana is a traditional Korean herbal medicine.[1]
Fairy tale
Pulsatilla koreana is called the "grandmother flower" in Korea. A
long time ago, according to a fairy tale, there was a widow who
had two daughters. The older daughter married a rich man but the
younger daughter married a man who wasn’t as luxurious. Time
passed and the widow was now very old and she decided to visit
her two daughters. However the older one refused to let her stay
and she was forced out of the house. So the widow turned to her
younger daughter. But she lived very far away over many
mountains. The widow fainted while going over the mountain from
exhaustion. Some hours later, the younger daughter found her
mother but it was already too late and she ended up dying. The
younger daughter was extremely sad and buried her near the
house. The next spring, a flower bloomed over her grave. The
flower was bent like her mother’s back. So the daughter believed
her mother had come back as the "grandmother flower".
PULSATILLA OCCIDETALIS

Anemone occidentalis, the white pasqueflower[1] or western

pasqueflower, is a herbaceous plant species in the
genus Anemone and family Ranunculaceae. Other authorities
place it in the genus Pulsatilla.[citation needed] Individuals are 10–
60 cm (3.9–23.6 in) tall, from caudices, with three to six leaves at
the base of the plant that are 3-foliolate, each leaflet pinnatifid to
dissected in shape. Leaf petioles are 6–10 cm (2.4–3.9 in) long.
Leaves have villous hairs and their margins are pinnatifid or
dissected. Plants flower briefly mid-spring to mid-summer, usually
soon after the ground is exposed by melting snow. The flowers
are composed of five to seven sepals (sometimes called tepals),
normally white or soft purple, also mixed white and blueish purple,
one flower per stem. The sepals are 15–30 mm (0.59–1.18 in)
long and 10–17 mm (0.39–0.67 in) wide. Flowers have 150–200
stamens. The fruit occurs in heads rounded to subcylindric in
shape, with pedicels 15–20 cm (5.9–7.9 in) long. The achenes are
ellipsoid in shape, not winged, covered with villous hairs, with
beaks curved that reflex as they age and 20–40 mm (0.79–
1.57 in) long, feather-like. Generally, the fruit persists into fall.
Native to far western North America including British Columbia to
California and Montana, it is found growing in gravelly soils on
slopes and in moist meadows
PULSATILLA PATENS

Pulsatilla patens is a species of flowering plant in the

family Ranunculaceae, native
to Europe, Russia, Mongolia, China, Canada and the United
States. Common names include Eastern pasqueflower, prairie
crocus, and cutleaf anemone.
Taxonomy
Pulsatilla patens is often placed in the genus Anemone,
as Anemone patens L..[3]
Cultural associations
Pulsatilla patens is the provincial flower
of Manitoba, Canada[4] and (as P. hirsutissima) is the state flower
of South Dakota, United States.[5]
Declining population noted
Advocates report that the population of Pulsatilla patens is
declining, due to the synergy between the prairie crocus and
shortgrass prairie ecosystems. Plowing up the prairie causes the
crocus to disappear.[6]
Subdivisions

Young leaves
Two subspecies have been distinguished:[1][2]

 Pulsatilla patens subsp. patens

 Pulsatilla patens subsp. multifida (Pritz.) Zämelis—cutleaf
anemone

Diseases and pests

Anemone species are sometimes targeted by cutworms,
the larvae of noctuid moths such as Angle Shades and Heart and
Dart.[citation needed]

Cultivation
Many of the species are favorite garden plants, providing colour
throughout the season from early Spring into Autumn. Numerous
cultivars have been selected. In horticultural terms there are three
main groups:

1. spring-flowering species found in woodland and alpine

meadows, often tuberous or rhizomatous; e.g. A.
nemorosa, A. blanda
2. spring- and summer-flowering species from hot dry areas,
with tuberous roots, e.g. A. coronaria
3. summer- and autumn-flowering species with fibrous roots,
which thrive in moist dappled shade; e.g. A. hupehensis[12]
Of the late spring bulbs, A. blanda is one of the most common,
and is often sold as a mixture of colours, although purple
predominates. The genus contains many other spring-flowering
plants, of which A. hortensis and A. fulgens have less divided
leaves and splendid rosy-purple or scarlet flowers. They require
similar treatment.[13]
Among the best known summer anemones is A. coronaria, often
called the poppy anemone, a tuberous-rooted plant, with
parsleylike divided leaves, and large showy poppylike blossoms
on stalks of from 15–20 cm high; the flowers are of various
colours, but the principal are scarlet, crimson, blue, purple, and
white. There are also double-flowered varieties, in which the
stamens in the centre are replaced by a tuft of narrow petals. It is
an old garden favourite, and of the double forms there are named
varieties.[13]
Anemone hupehensis, and its white cultivar 'Honorine Joubert',
the latter especially, are amongst the finest of autumn-flowering
hardy perennials; they grow well in light soil, and reach 60–
100 cm in height, blooming continually for several weeks. A group
of dwarf species, represented by the native British A.
nemorosa and A. apennina, are amongst the most beautiful of
spring flowers for planting in woods and shady places.[13]
Anemones grow best in a loamy soil, enriched with well-rotted
manure, which should be dug in below the tubers. These may be
planted in October, and for succession in January, the autumn-
planted ones being protected by a covering of leaves or short
stable litter. They will flower in May and June, and when the
leaves have ripened should be taken up into a dry room till
planting time. They are easily raised from the seed, and a bed of
the single varieties is a valuable addition to a flower-garden, as it
affords, in a warm situation, an abundance of handsome and
often brilliant spring flowers, almost as early as
the snowdrop or crocus.[13] Anemone thrives in partial shade, or in
full sun provided they are shielded from the hottest sun in
southern areas. A well-drained slightly acid soil, enriched with
compost, is ideal.[citation needed]
It is best to harvest cut flowers early in the morning while it is still
cold outside while the bloom is still closed. To open your flowers
place in room temperature water out of direct sun. Anemones are
a great cut flower and will give you around nine days of vase
life when properly cared for. Anemone blooms can be purchased
from a florist between November and June depending upon
availability.
Anemone in culture
The anemone has several different meanings depending on the
culture and context in which the flower is being used.
Several of the Western meanings of anemone flowers pertain to
the Greek Mythology of the origin of the anemone flower
featuring Adonis and Aphrodite. The goddess Aphrodite kept the
mortal man Adonis as a lover; when Adonis was gored by a wild
boar, Aphrodite's tears at his death mixed with his blood and gave
rise to the Anemone flower.[14] In other versions, the boar was
sent by other jealous Greek gods to murder Adonis.[15] These
origin stories reflect the Classical dual meanings of the arrival of
spring breezes and the death of a loved one.
In the Victorian language of flowers, the anemone represented a
forsaken love of any kind, while European peasants carried them
to ward off pests and disease as well as bad luck.
In other cultures, the meanings can be very different.
In Chinese and Egyptian cultures, the flower was considered a
symbol of illness due to its coloring. It can be a symbol of bad luck
in Eastern cultures, and because of its origins the Japanese
Anemone tends to be associated with ill tidings.

MORPHOLOGY

Anemone are perennials that have basal leaves with long leaf-
stems that can be upright or prostrate. Leaves are simple or
compound with lobed, parted, or undivided leaf blades. The leaf
margins are toothed or entire.
Flowers with 4–27 sepals are produced singly, in cymes of 2–9
flowers, or in umbels, above a cluster of leaf- or sepal-like bracts.
Sepals may be any color. The pistils have one ovule. The flowers
have nectaries, but petals are missing in the majority of species.
The fruits are ovoid to obovoid shaped achenes that are collected
together in a tight cluster, ending variously lengthened stalks;
though many species have sessile clusters terminating the stems.
The achenes are beaked and some species have feathery hairs
attached to them.[3]
Anemone are called "wind flowers." Anemone is derived from the
Greek word anemoi, which in english means "winds" .

MICROSCOPY OF PULSATILLA
Transmission electron microscope (TEM) image of Pulsatilla 15 th
centesimal dilution (without agitation) showing nanoparticles with
conglomerate or a nanochunk.
Uses & Effectiveness
Insufficient Evidence for

 Conditions of the male or female reproductive

system.
 Tension headaches.
 Migraine headaches.
 Hyperactive states.
 Trouble sleeping (insomnia).
 Boils.
 Skin diseases.
 Asthma and other lung diseases.
 Earache.
 Nerve problems.
 General restlessness.
 Digestive tract problems.
 Urinary tract problems.
 Other conditions.

Side Effects & Safety

Fresh pulsatilla plant is UNSAFE when taken by mouth or

applied to the skin. It is a severe irritant anywhere it
comes in contact with the body, such as the mouth, throat,
digestive tract, urinary tract, and skin. It can also cause
allergic reactions. Contact with the skin can cause rash,
inflammation, and itching. Inhaling the volatile oil can
irritate the nose and eyes.
There isn't enough information about the dried plant to
know if it is safe or what the side effects might be.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Pulsatilla

is UNSAFE when taken by mouth during pregnancy. Both
the fresh plant and the dried plant might cause
a miscarriage or birth defects. Applying fresh pulsatilla
directly to the skin is also considered UNSAFE. Don’t do it.
Not enough is known about the safety of applying dried
pulsatilla directly to the skin during pregnancy. Stay on the
safe side and avoid use.

It’s UNSAFE to take fresh pulsatilla by mouth or apply it

to the skin during breast-feeding. Not enough is known
about the safety of the dried plant when taken by mouth
or applied to the skin. Don’t use it.

Interactions
We currently have no information for PULSATILLA
Interactions.

Dosing
The appropriate dose of pulsatilla depends on several
factors such as the user's age, health, and several other
conditions. At this time there is not enough scientific
information to determine an appropriate range of doses for
pulsatilla. Keep in mind that natural products are not
always necessarily safe and dosages can be important. Be
sure to follow relevant directions on product labels and
consult your pharmacist or physician or
other healthcare professional before using.

EFFECT OF PULSATILLA ON
POLYCYSTIC OVARIAN SYNDROME
AND ITS ASSOCIATED CANCER

Poly cystic ovary syndrome:

Polycystic ovary syndrome (PCOS), also called

hyperandrogenic anovulation (HA), or Stein–Leventhal
syndrome, is a set of symptoms due to a hormone
imbalance in women. Symptoms include: irregular or no
menstrual periods, heavy periods, excess body and facial
hair, acne, pelvic pain, trouble getting pregnant, and
patches of thick, darker, velvety skin. Associated
conditions include: type 2 diabetes, obesity, obstructive
sleep apnea, heart disease, mood disorders, and
endometrial cancer.
PCOS is due to a combination of genetic and
environmental factors.Risk factors include obesity, not
enough physical exercise, and a family history of
someone with the condition. Diagnosis is based on two of
the following three findings: no ovulation, high androgen
levels, and ovarian cysts. Cysts may be detectable by
ultrasound.
Common Age of Onset
Common age of onset is adolescence.
# Common time of diagnosis:
#2 nd to 4th decade of life.
#Some symptoms may appear starting at menarche or post menopause.

What is PCOS
The first consensus definition of PCOS arose from the proceedings of an
expert meeting in April 1990 in USA (1990 NIH criteria). It defines
PCOS as the combined presence of: 1) Hyperandrogenism, 2)
Oligoovulation and 3) Exclusion of related disorders such as Cushing’s
syndrome, hyperprolactinemia, and congenital adrenal hyperplasia.
However, in today’s scenario, an increasing awareness about PCOS
suggests that the clinical expression of PCOS are broader than that
specified by the 1990 NIH criteria.
Important terms
Hyperandrogenism = Androgen excess = excessive levels of androgens
(male sex hormones such as testosterone). Oligoovulation: Infrequent or
irregular ovulation (usually defined as cycles of ≥36 days )
How it happens
The exact cause of PCOS is still unknown. It is believed that the
hormonal imbalances and genetics play important role in its
pathogenesis.
Females with PCOS often struggle with higher-than-normal production
of androgens.
This affect the development and release of eggs during ovulation.
In many cases excess serum insulin may cause high androgen levels.
Clinical Presentation
The type and severity of symptoms varies from individual.
Hyperandrogenism is a primary hallmark of PCOS. PCOS may cause
women to develop certain characteristics, such as:
Abnormal growth of hair on the face, chest, stomach, thumbs, or toes
(hirsutism),
 Acne
 Weight gain
 Other symptoms/signs include:
# Deeper voice
 Decrease in breast size
 Thin hair
 Pelvic pain
 Anxiety or depression
 Infertility
 Along with PCOS a female may have other concurrent health
problems, such as diabetes, hypertension, and high cholesterol. These
are linked to the weight gain typical in PCOS patients.

Types of PCOS PCOS

may express in following subtypes:
1. HYPERANDROGENISM, normal cycle, PCO IN ULTRASOUND.
2. Normal androgens, OLIGO-ANOVULATION, normal ultrasound.
3. HYPERANDROGENISM, OLIGO-ANOVULATION, normal
ultrasound
4. HYPERANDROGENISM, OLIGO-ANOVULATION, PCO IN
ULTRASOUND

Prevalence:
PCOS is the most common endocrine disorder among
women between the ages of 18 and 44. It affects
approximately 5% to 10% of this age group. It is one of
the leading causes of poor fertility. The earliest known
description of what is now recognized as PCOS dates
from 1721 in Italy.

Few studies have attempted to define its prevalence in

women with these symptoms. In a study of 175
anovulatory women presenting consecutively to a
reproductive endocrine clinic, 30 percent of those with
amenorrhea and 75 percent of those with oligomenorrhea
had ultrasonographic evidence of polycystic ovaries. More
than 60 percent of these women were hirsute, and 90
percent had elevated serum concentrations of luteinizing
hormone or androgens (or both). [1] These findings are
supported by a study in which clinical and biochemical,
rather than ultrasonographic, criteria were used to make
the diagnosis of polycystic ovary syndrome. In a series of
women being treated at a regional infertility center in
southwest England, 37 percent of those with amenorrhea
and 90 percent of those with oligomenorrhea (overall, 73
percent of the cases of anovulatory infertility) were found
to have the polycystic ovary syndrome. Subsequently,
clinical and biochemical markers of the syndrome were
correlated with ultrasonographic results, and a high
degree of concordance was observed between the
findings. Surprisingly, polycystic ovaries were detected
by ultrasonography in 40 of 46 women (87 percent)
presenting with hirsutism but with regular menses
(i.e.,“idiopathic hirsutism”).

Diagnosis PCOS
It is diagnosed clinically, but certain investigations are advised to
diagnose it completely, such as:
 Androgen level: free testosterone, DHEAS and androstenedione
 Sex hormone binding globulin (SHBG): usually low in PCOS.
 Fasting insulin: elevated in PCOS.
 Fasting glucose or 2-hour post-prandial glucose: elevated in PCOS
 LH/FSH Ratio: PCOS is associated with high LH with normal
FSH. Normally, the ratio of LH: FSH is 1:1, but in PCOS, this ratio
can get altered to 2:1 or even more.
Cholesterol levels: Impaired lipid metabolism may occur together with
impaired blood sugar metabolism leading to an increase in both HDL
and LDL.
 Ultrasound to check for the presence of ovarian cysts in a typical
pattern.

Differential Diagnosis
 Pregnancy
 Premature ovarian failure
 Hyperthyroidism
  Hypothyroidism
 Pituitary adenoma
 Late-onset congenital adrenal hyperplasia
 Congenital adrenal hyperplasia
 Androgen-producing tumor of the ovary or adrenal gland
 Discontinuation of oral contraceptives
 Rapid weight loss

Complications
Untreated PCOS may be associated with

 Increased risk for cardiovascular disease.

 Dyslipidaemia

 Infertility

 Menstrual irregularities like amenorrhea, dysfunctional uterine

bleeding

 Permanent hirsutism
Persistent acne

 In some cases increased risk for endometrial cancer, endometrial

hyperplasia and, breast cancer.

Some Important facts

 This disorder was first identified in 1935 by Stein and
Leventhal who noticed a condition
in women characterized by irregular menstruation, obesity, and
hirsutism, in addition to cysts on the women's ovaries.
 Genetic and environmental factors when combined with ovarian
dysfunction
 hypothalamic pituitary abnormalities, and obesity can accentuate
PCOS.
 Hormones imbalance involves estrogen, progesterone and
androgens, such as testosterone.
 The syndrome has major metabolic as well as reproductive
morbidities. Reproductive problems may include infertility and
various pregnancy complications and clinical signs of androgen
excess. Since it is reflected as hormone imbalance, there are
instances where metabolic problems are also seen such as insulin
resistance, metabolic syndrome, impaired glucose tolerance etc.
 It is a psychological stress to a female and may result in lack of
confidence, poor quality of life, poor self-esteem, depression,
anxiety, and possibly eating disorders.
Management
The management of PCOS has four thumb rules:
 Education: The PCOS and its causes must be taught to the patient.
Many times it may be due to an underlying risk factor such
obesity or stress.
 Understanding: PCOS and its pathophysiological understanding is
a must. Its present form, how much it is going to trouble a
patient, what would be the probable outcome in future etc. must
be understood.
 Treat the Cause As a thumb rule we need to identify the
underlying cause of the PCOS, thus the treatment must aim at
considering the root cause and not superficial symptoms only.
 Eat Healthy Live Healthy: It is now an established fact that PCOS is
related to poor life-style, stress and genetics. We can’t modify
genetics but we can modify body’s expression and health status.
Involment in health activities and treatment is the key rule. The
patient is advised to take active interest and participation in
timely medication, exercise, and dietary restrictions. Activities
 may include controlling cholesterol levels, reducing obesity,
maintaining blood pressure etc

Clinical..representation:

Typical clinical features of the polycystic ovary syndrome

are summarized in Table
DIAGNOSTIC CRITERIA

HISTOLOGIC
Feature (GOLDZIEHER
ULTRASONOGRAPHIC ULTRASONOGRAPHIC
AND GREEN)
(FRANKS) (CONWAYETAL)

Hirsutism 64 61 69

Acne 27 24 __

Obesity 35 35 41

Infertility 42 29 74

Amenorrhea 28 26 51

Regular
menstrual 20 25 15
cycle

*Data were compiled from two recent studies in which

ultrasonography was used as the primary method of
diagnosis (Franks and Conway ) and from the classic
review by Goldzieher and Green in which the diagnosis
was based on proved histologic features of ovaries after
wedge resection. Note the similarity in the distribution of
symptoms in the three studies.

PCOS_and_its_link_with_cancer:

Many papers reported the correlation between infertility

that most eminently predisposes towards cancer in PCOS
women from many years. In a study of 1983 it’s reported
that 3-times higher risk of endometrial cancer in patients
suffering from chronic anovulation. Women who were
infertility-patient displayed 7.6-fold risk of endometrial
cancer. From the above mentioned statement, one can
conclude that infertility increases risk of endometrium
cancer, especially if accompanied by chronic anovulation.
Many papers aimed at linking breast cancer to hormonal
factors which is also the case in PCOS. Brinton et
al.[2] did not show correlation between infertility and
breast cancer. These conclusions were confirmed in other
research. . However, one research showed 1.8-fold risk in
infertile patients with chronic anovulation, and yet
another one showed 5.4-fold incidence of breast cancer
in pre-menopause women who were previously
diagnosed with anovulation. Two other papers seem very
interesting with respect to PCOS patients. One of them
showed that in breast cancer patients suffering from
ovulation problems the risk of breast cancer was 3.5-
times higher. If the same patients had signs of
hyperandrogenism (persistent acne, excess of body hair),
the risk was 6.8 higher.. The second paper showed that
in patients with obesity, hypertension and diabetes
(conditions that frequently coincide with PCOS) the risk
of breast cancer is 3-times higher. In a research risk of
ovarian cancer in nullipara was 2.45-times higher
compared to multipara and 1.27-times higher compared
to unipara. The analysis of 12 case control studies
showed 2.1- fold risk in nullipara with infertility history.
Obesity, which coincides with PCOS is a risk factor in all
the above mentioned types of cancer. Meta-analysis of
studies into coincidence of ovarian cancer and obesity
showed that in 10 per 28 population-based studies
correlation was statistically significant, and pooled effect
estimate for adult obesity was 1.3 [3]. Recent
epidemiologic studies have shown a positive relationship
between BMI and breast cancer with a significant relative
risk ranging from 1.26 to 2.52. Theoretical premises for
correlation of PCOS and cancer are based on very specific
observations. Unopposed stimulation of the endometrium
in the setting of chronic anovulation in women with PCOS
is an acknowledged factor leading to endometrial cancer
development.

Endometrial_cancer:

From both clinical and experimental research one can

conclude that correlation between PCOS and endometrial
cancer is the strongest. Endometrium of PCOS patients is
known to be more sensitive to steroid hormones. Women
with PCOS exhibit elevated endometrial androgen
receptor expression compared to normal, fertile controls
and endometrium of PCOS patients shows higher
concentration of estrogen receptors. It was also proved
that PCOS patients exhibit higher Cyr61 protein
expression [4], protein which is integrin-binding,
angiogenic factor, that also promotes cell migration and
adhesion. This protein is also an apoptosis regulator and
is associated with tumor genesis. Higher Cyr61
expression was also present in uterine myoma and in
endometriosis. In the case of breast cancer its elevated
expression was found both in tumor biopsy and in
metastasis. In the course of PCOS endometrial
homeostasis is disturbed. Apart from a change in Cyr61
production, a number of other modifications are
identified; a change in Ki-67 expression, lower p53
production, higher cyclin D1 expression and higher bcl-
2/bax ratio [5]. Disturbed homeostasis may result from
intensified proliferation which may in turn lead to
abnormal cell division possibly followed by tumorgenesis.
However, clinical studies do not provide straightforward
answer to the question about correlation between PCOS
and endometrial cancer. This correlation was observed as
early as 1949, 14 years after the first description of the
syndrome. However, both this and some other studies on
this problem [6] did not include study controls, which
disqualifies explicit conclusions.
There was also an attempt to conclude that PCOS may
provide better prognosis once endometrial cancer has
been diagnosed [7], as histopathological research of
preparations from PCOS patients showed well
differentiated tumors or moderately well differentiated.

Ovarian_cancer:
The most quoted paper showing correlation between
ovarian cancer and PCOS is by Schildkraut et al. [8]. It
showed 2.5-fold risk of ovarian cancer in PCOS. In the
group of patients diagnosed with ovarian cancer there
were only 7 PCOS women who accounted for 1.5% of the
group, while in the study control there were 24 cases of
PSOC, i.e. 0.06% of the control. Conclusions on
correlation between ovarian cancer and PCOS seem
inaccurate based on such a small group of PCOS patients
in research groups. Most studies on correlation between
PCOS and ovarian cancer failed to show a link.

Breast_cancer:

In the case of correlation between breast cancer and

PCOS proofs are also not convincing, and research results
even show reverse correlation [9]. The basic problem
underlying these studies was the fact that in the second
study PCOS women accounted just for 0.94% of the
study control and for 0.49% of breast cancer group,
while in the first study for 1.35% of the overall study
group. Based on available literature one may draw a
conclusion that correlation between adenocarcinoma of
endometrium and PCOS is likely to exist. This results
both from clinical trials and papers on changes of
endometrium in PCOS patients. However, despite single
papers that report on the link, correlation between
ovarian or breast cancer and PCOS is doubtful.
So we should pay attention how to get recovery from
PCOS as well as endometrial cancer, PCOS is not
responsible for ovarian cancer and breast cancer, so our
aim will be the procurement of PCOS and endometrial
cancer.

Role of Homeopathy in PCOS

Homeopathy heals holistically!
 Treat the Cause: Homeopathic system of medicine is a therapeutic
system of symptoms similarity which is safe, effective, affordable
and within reach. It takes into account the holistic approach i.e.
person as a whole. This means that we treat every patient on the
basis of individualization. During this process prescription is based
upon the many factors such as symptoms, sign, causation, history,
family history, mental status and inherent nature of the person,
likings, disliking etc. This is synonymous with term Constitutional
Medicine.
 The PCOS has been termed as a syndrome as it affects many
systems of the body. Therefore, it may be considered as a
constitutional problem rather than a local disease.
 Homoeopathic intervention aims at halting the progress,
providing symptomatic relief and curing the patient.
 Homeopathic medicines stimulate the hypothalamic-pituitary-
ovarian axis thereby strengthens the immune system and trigger
the natural release of hormones.
 The homeopathic treatment of PCOS is divided into three major
parts:
 Initial stages (detected early): Constitutional treatment
and/or specifics to control the symptoms.
 Developed stages: Specific medicines to control symptoms
and to regularise the body’s hormonal imbalance. O
 PCOS with other morbidities: Specific medicines are
repeated too often and given for longer duration. The aim is
 to control the situation and improve quality of life of
patients.
 Homeopathic medicines can be taken safely along with
other/conventional medications (ADD-ON Therapy).
 The patient is asked to maintain a gap of approx. 30
mins between different medications.
 The key point of treating PCOS is holistic healing and
not hormonal or ultrasonography normalcy only.
 Following medicines are commonly used frequently in
homeopathy as constitutional or specific or both: o
 Apis mellifica
 Natrum muriaticum
 Platina
 Phosphorus
 Sepia
 Pulsatilla (both in potency and mother tincture)
 Thuja occidentalis
 Senecio aureus
 Oophorinum
 Jonesia Asoca Etc.
 As a common myth, mother tinctures are not always superior to
potencies. The right potency may be mother tincture, trituration
or a dilution depending on severity and presentation of the case

Synthetic Drugs used in PCOS and their major

side effects (ADR)
Side effect/adverse drug reaction
Medication Description
(ADR)

· Ovarian enlargement presenting as

Clomiphene Ovulation induction
abdominal or pelvic pain, tenderness,
(Clomid) agent
pressure, or swelling;
 · Breast tenderness or discomfort;
· Blurred vision or other visual
disturbances;
· Abnormal uterine bleeding.

· Acne, "hair bumps" (folliculitis)

Eflornithine · Serious allergic reaction, including: rash,
Inhibits hair growth
(Vaniqa) itching/swelling.
· Severe dizziness.

· Muscle pain or weakness; trouble

breathing;
· Cold feeling in your arms and legs;
Metformin Insulin-sensitizing · Feeling dizzy, light-headed, tired, or
(Glucophage) agent very weak;
· Stomach pain, nausea with vomiting;
or.
· Slow or uneven heart rate.

· Flu-like symptoms
Pioglitazone Insulin-sensitizing
· Muscle pain, back pain, tooth problems,
(Actos) agent
and mouth pain.

· Feeling short of breath, even with

mild exertion;
· Swelling or rapid weight gain;
· Chest pain or heavy feeling, pain
spreading to the arm or shoulder,
Rosiglitazone Insulin-sensitizing sweating, general ill feeling;
(Avandia) agent · Nausea, stomach pain, low fever,
loss of appetite, dark urine, clay-
colored stools, jaundice ,blurred
vision;
· Pale skin, easy bruising or bleeding,
weakness.

· Muscle pain or weakness

· Numbness or tingling
· Paralysis in the arms or legs
Arrhythmia
Antiandrogenic · Confusion, extreme tiredness, and
Spironolactone antimineralocorticoid fainting
(Aldactone) · Life-threatening skin reactions
· Flu-like symptoms, pain in the upper
right abdomen, loss of appetite, vomiting
blood, or bloody stools
· Difficulty breathing or swallowing
Decreased urination
 · Severe stomach pain, severe
constipation;
· Diarrhea that is watery or bloody;
Acarbose Insulin-sensitizing
· Easy bruising, unusual bleeding.
(Precose) agent
· Nausea, upper stomach pain,
itching, loss of appetite, dark urine,
clay-colored stools, jaundice

ACTION OF PULSATILLA ON PCOS

Pulsatilla is a natural medicine for treating PCOS. It is especially

beneficial for treating PCOS cases in females who suffer from
suppressed periods for a long duration. In women requiring Pulsatilla,
the periods when they appear remain very scanty and extremely painful.
Pulsatilla removes the obstacles that cause the periods to be suppressed
and the periods start to flow normally. Pulsatilla increases the body’s
power and directs its path towards removing the obstacle, thus re-
establishing the menstrual flow. Pulsatilla is of great help for young girls
at puberty who suffer from PCOS with irregular periods. Though the
mechanism of action is not known clearly but the effect is well known
proven. Pulsatilla and its antitumor activity: The Pulsatilla genus,
Pulsatilla koreana Nakai (Ranuculaceae) in Korea is an important herb
in traditional medicine that has been used to treat amoebic dysentery and
malaria. It had been reported that plants from the Pulsatilla genus
contain ranunculin, anemonin, protoanemonin, triterpenes, and saponins
(9 %), mainly the oleanane and lupane-type saponins. A paper also
reported that ranunculin has cytotoxicity against KB cells by inhibiting
DNA polymerase. [10] Recently, deoxypodophyllotoxin, which was
isolated from the roots of P. koreana, was found to inhibit the tubelike
formation of HUVECs (human umbilical venous endothelial cells) and
have a potent antitumor effect. Previously, it was reported that the
anticancer preparation called SB31®, [11] which was produced from the
roots of Pulsatilla koreana. Therefore, its major ingredients, the roots of
P. koreana, might be an important component that is responsible for its
potent antitumor activity. In vitro cytotoxic assay: In a study the level of
cytotoxicity was measured using the sulforhodamine B (SRB)
method.[12] Viable cells kept in the growth medium (180 μL) into 96
well microtiter plates (3-4×104 cells per each well) and allowed to attach
overnight. The test sample (Pulsatilla saponin D) was dissolved in
DMSO and adjusted to a final sample concentration ranging from 0.3
ng/mL to 10 μg/mL by a dilution with the growth medium. Each sample
was prepared in triplicate. The final DMSO concentration was then
adjusted to absorbance relative to the vehicle-treated controls by 50%. In
vivo anti-tumor activity assay: In study the antitumor activity was
measured according to Teruhiros method. [13] 2×2×2 mm3 tumors were
transplanted into the auxiliary region of the BDF1 mice. Twenty-four
hours after tumor transplantation, the mice were divided into several
groups consisting of 5 mice each. The samples, WT, SPX fractions, and
Pulsatilla saponin D were then dissolved in saline, and injected
intraperitoneally on the 1st to 7th and 9th to 14th day at a dose of 280
mg/kg, 70 mg/kg, and 6.4 mg/kg of Pulsatilla saponin D, respectively.
The experimental mice were weighed twice a week in order to evaluate
the toxicity of Pulsatilla saponin D. The tumor volume (TV) was
measured on the 15th and 16th day, and calculated according to the
following formula: TV = L (mm) × W2 (mm2 ) / 2 where L and W
represent the length and the width of the tumor mass, respectively. The
inhibition ratio (IR) was calculated according to the following formula:
IR (%) = *(Mean TV of control group − Mean TV of treated group) /
Mean TV of control group] × 100

RESULT AND DISCUSSION

The 50% aqueous EtOH fraction (WT fraction) of the roots of P.

koreana was evaluated in a BDF1 animal model. The WT fraction was
injected at the maximum tolerated dose of 280 mg/kg/day and
Adriamycin, which was used as the positive control, was administered at
0.5 mg/kg/day to the right groin of the BDF1 mice. The results, which
are expressed as the inhibition ratio (IR, %), are the WT fraction
exhibited significant antitumor activity with an IR of 56 % (day 14) and
55 % (day 15), although it was less than that of Adriamycin (60% and
64%). The Pulsatilla saponin D was further evaluated for their antitumor
activity in the same animal tumor model, and for their cytotoxic activity
against three cancer cell lines (human lung cancer, human melanoma,
and human breast cancer). The Pulsatilla saponin D showed moderate
cytotoxic activity (ED50, 6.3 μg/mL to >10 μg/mL) against the cancer
cell lines. Considering its low cytotoxic activity, it is remarkable that the
Pulsatilla saponin D has such a potent antitumor effect (IR, 82 %) on a
solid tumor, which is higher than Adriamycin (IR, 64%). From another
study it can be reported that 23- Hydroxybetulinic acid synthesized from
Pulsatilla chinensis also shows anti tumoral activity. 23-
Hydroxybetulinic acid has been found to have cytotoxicity against a
variety of tumor cell lines, [14] but the exact mechanism of action is still
unclear. In addition, it is not as potent as the classical antitumor agents
but it’s also has advantages that it has not any major side effect.

CONCLUSION

So here we can conclude that various species of pulsatilla has potent

anti tumoral effect and it’s also used in poly cystic syndrome. So the
Pulsatilla sp. May used in PCOS as well as various types of cancer
which may or may not stimulated by PCOS. Pulsatilla sp. Show low
potency in various cancer but by structural modification of the saponin
present in Pulsatilla, we may prepare a potent anti tumoral agent and
there are various anti tumoral drugs are present in the market , they are
mostly potent but also they have maximum side effects so if we can
prepare a ponent anti tumoral agent with least side effect then that will
open a new gate of chemotherapy.