Evidence-based natural medicines for polycystic ovarian syndrome (PCOS)

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  • Evidence-based natural medicines for polycystic ovarian syndrome (PCOS)

Between 12-21% of women of child-bearing age are affected by polycystic ovarian syndrome (PCOS).[1] This complex condition is multifactorial in nature, different for each affected person and thus requires individualised approaches for each woman.

PCOS symptoms may include:

  • male pattern baldness
  • excessive hair growth
  • infrequent menstrual cycles
  • acne
  • anovulation and infertility
  • weight gain
  • insulin resistance
  • polycystic ovaries – multiple cysts in one or both ovaries may develop where an egg has matured but not been released at ovulation each month (must be diagnosed by ultrasound).

Up to 70% of PCOS cases are undiagnosed.[1] And, although the exact sequence of events is unknown, excess androgens (e.g. testosterone) can contribute to PCOS. Development may be genetically linked but lifestyle is also an important contributing factor (since one in two affected women is overweight).

Over 60% of women with PCOS are insulin resistant.[2] Insulin resistance may indicate the early stages of type 2 diabetes and should thus be taken seriously. High circulating insulin levels are also associated with raised testosterone levels. The protein sex hormone-binding globulin (SHBG) generated by the liver plus brain, placenta and uterus, binds sex hormones in the blood effectively lowering circulating levels of free hormones. Low levels of SHBG means that free testosterone rises. Women with PCOS often present with these types of levels and both of these contribute to the symptoms of PCOS – hair growth, weight gain, irregular periods, fertility problems and more.

Conventional treatment may involve prescription of the biguanide, metformin, to treat insulin resistance. Metformin improves sensitivity of muscle, fat and liver cells to insulin. It also reduces glucose synthesis by hepatic cells and delays the glucose absorption from the intestines into the bloodstream thus reducing post-prandial blood glucose spiking. Metformin use in PCOS may help to restore ovulation, aid weight reduction, reduce circulating androgen levels, lower the risk of miscarriage and reduce the risk of gestational diabetes mellitus (GDM). Studies also suggest that metformin use may stimulate the ovaries in in vitro fertilisation (IVF), thus improving pregnancy outcome.[3]

The benefits of lifestyle changes cannot be overemphasised. One study in women with PCOS found that weight-loss (if overweight), a healthy diet and achievable exercise goals brought about positive results similar to metformin use.[4] There are also a number of herbs and nutrients which may help to manage PCOS and its symptoms.

A staple herb in traditional Chinese medicine (TCM), Glycyrrhiza glabra (licorice) is used for its adaptogenic properties. Its use may help to reduce acne and hirsutism associated with PCOS. It helps to lower testosterone and increases ovulation when combined with Paeonia lactiflora (peony).[5]

Peony is a popular herb in TCM for the treatment of dysmenorrhoea.[6] In vitro evidence shows that paeoniflorin, one of peony’s major active constituents, affects ovarian follicles through its action on the aromatase enzyme.[7] Laboratory evidence has demonstrated that peony elicits an antispasmodic effect on the ileum and uterus.[8] It is also used in TCM for menstrual irregularities; peony may reduce testosterone production by the ovaries.[9]

In laboratory studies, licorice and peony utilised in combination has been shown to modulate testosterone levels in PCOS. In fact, when used together, this herbal duo has been shown to lower the luteinising hormone (LH): follicle- stimulating hormone (FSH) ratio, which along with serum testosterone may improve ovulation in women with PCOS. Plus, a study showed that oestradiol: testosterone ratio increased significantly after four weeks of combined treatment.[10]

Used in western herbal medicine (WHM) to help relieve heavy menstruation, supplementation with Cinnamomum cassia (cinnamon) may improve menstrual cycle regularity, making it an effective treatment option for some women with PCOS. In one study, a total of 45 women with PCOS were randomised to receive cinnamon (1.5g daily) or placebo for six months. Menstrual cycles were more frequent in patients taking cinnamon compared with those taking placebo.[11]

Taraxacum officinale (dandelion) root is an effective liver tonic and choleretic. It is used to cleanse the liver and help metabolise hormone build-up. Its hepatoprotective properties are perhaps due in part to the polysaccharide content of the root.[12] Dandelion also aids the body’s natural channels of elimination such as urination as recognised by traditional WHM.[13]

Vitamin B6 is important for the formation of several neurotransmitters involved in the maintenance of healthy mood. Women with PCOS may not synthesise adequate serotonin; sufficient vitamin B6 may help facilitate serotonin production, and is important for the formation of several neurotransmitters involved in supporting a healthy mood. It can help to relieve breast tenderness, fluid retention, mood changes, irritability and fatigue associated with premenstrual syndrome (PMS).[14]

Myo-inositol, is one of the two main stereoisomers of inositol which is present in our body. It is the precursor to inositol triphosphate; a second messenger that regulates hormones such as thyroid-stimulating hormone (TSH), FSH and insulin, all important hormones implicated in PCOS pathophysiology.[15]

References

  1. Boyle J, Teede HJ. Polycystic ovary syndrome: an update. AFP 2012;41(10):752-756. [Abstract]
     
  2. DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril2005;83(5):1454-1460. [Abstract]
     
  3. Hany L. Role of metformin in the management of polycystic ovary syndrome. Ther Adv Endocrinol Metab 2010;1(3):117-128. [Abstract]
     
  4. Curi DG, Fonseca AM, Marcondes JAM. Metformin versus lifestyle changes in treating women with polycystic ovary syndrome. Gyn End 2012;3:182-185. [Abstract]
     
  5. Arentz S, Abbott JS, Smith CA, et al. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated olgo/amenorrhoea and hyperandrogenism;a review of the laboratory evidence for effects with corroborative clinical findings. BMC Complement Altern Med 2014;14:511. [Abstract]
     
  6. Bensky D, Clavey S, Stögen E. Chinese herbal medicine materia medica, 3rd ed. Seattle: Eastland Press, 2004. [Source]
     
  7. Ota H, Fukishima M. Stimulation by Kanpo prescriptions of aromatase activity in rat follicle cell cultures (pp.177-183). Recent advances in the pharmacology of Kanpo(Japanese herbal) medicines. eds E. Hosoya and Y. Yamamura. Amsterdam: Excerpta Medica, 1988. [Abstract]
     
  8. World Health Organisation (WHO). Radix paeoniae. Monographs on selected medicinal plants, vol. 1. Geneva: WHO, 1999. [Abstract]
     
  9. Romm A. Botanical medicine for women’s health. Missouri: Churchill Livingstone Elsevier, 2010. [Abstract]
     
  10. Takahashi K, Kitao M. Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease.Int J Fertil Menopausal Stud 1994;39(2):69-76. [Abstract]
     
  11. Kort DH, Lobo RA. Preliminary evidence that cinnamon improves menstrual cyclicity in women with polycystic ovary syndrome: a randomized controlled trial. Am J Obstet Gynecol 2014;211(5):487. [Abstract]
     
  12. Cai L, Wan D,Yi F, et al. Purification, preliminary characterisation and hepatoprotective effects of polysaccharides from dandelion root. Molecules 2017;22(9):1409. [Abstract]
     
  13. Braun L, Cohen M. Herbs and natural supplements: an evidence-based guide, 4thed. Sydney: Churchill Livingstone Elsevier, 2014. [Abstract]
     
  14. Pizzorno JE, Murray MT. Textbook of natural medicine. StLouis; Elsevier Churchill Livingstone, 2013. [Abstract]
     
  15. Bizzarri M, Carlomagno G. Inositol: history of an effective therapy for polycystic ovarian syndrome. Eur Rev Med Pharmacol Sci 2014;18(13):1896-1903. [Abstract]
     

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