Ayurvedic Management of Nashtartava with Suspected Resistant Ovary Syndrome

Resistant Ovary Syndrome (ROS) is a rare endocrinological disorder characterized by hypergonadotropic hypogonadism with preserved ovarian follicles but poor responsiveness to gonadotropins. Management remains challenging due to unclear pathogenesis and limited effectiveness of conventional therapies. In Ayurveda, such conditions can be correlated with Nashtartava, involving derangement of Apana Vata, Artavavaha srotas, and Beeja. A 43-year-old female presented with secondary amenorrhea of 5 months duration, along with weight gain, hirsutism, and acanthosis nigricans. Hormonal evaluation revealed elevated follicle-stimulating hormone (FSH) levels (46.60IU/ml), and ultrasonography showed thin endometrium with follicular atresia. The condition was diagnosed as Nashtartava with suspected Resistant Ovary Syndrome. The patient was managed with Shodhana and Shamana therapies, including Udwarthana with Vara churnam, Snehapana, Virechana, and Yogavasti, along with internal medications such as Gandharvahastadi kashaya, Sapthasaram kashaya, and Varasanadi kashaya etc. These interventions aimed at Kapha hara, Medohara, Vata anulomana, and Srotoshodhana. Following treatment, the patient showed significant clinical and radiological improvement, with restoration of menstrual cycles, improved follicular development, increased endometrial thickness, reduction in hyperpigmentation and hirsutism, and weight loss. This case highlights the potential role of Ayurvedic management in restoring ovarian function and menstrual regularity through a holistic approach.