Research - Polycystic Ovarian Syndrome
A review on role of medicinal plants in polycystic ovarian syndrome: Pathophysiology, neuroendocrine signaling, therapeutic status and future prospects
Zahra Abasiana Ayoob Rostamzadehab Mohsen Mohammadic Masih Hosseinid Mahmoud Rafieian-kopaei
Polycystic ovary syndrome (PCOS) is one of the most important gynecological disorders among reproductive-age women. In patients with PCOS, the secretion rate and metabolism of androgens and estrogens are disrupted. With regards to the increasing prevalence of PCOS and associated physical and mental problems as well as the effects of changes in sex hormones in development of this disease, our aim is to investigate the effects of different herbal extracts on changes in the serum levels of sex hormones and ovarian tissue. To conduct this review, an extensive literature search was conducted using, relevant publications published between 1990 and 2017, and indexed in Google Scholar, PubMed, Elsevier, Scientific Information Database, and Science Direct were studied. The search terms used to retrieve the publications were as follows: Herbal medical extract، Names of medicinal plants ، polycystic ovary syndrome, PCOS, the mechanism of hormone. According to the evidence, herbal extracts containing phytoestrogens cause decrease in hyperandrogenism, insulin resistance, and ovary weight as well as increase in ovulation. Therefore, these plants can be partly effective in this syndrome via affecting the serum levels of different hormones and ovarian weight and morphology, representing an opportunity to investigate and discovery new bioactive products.
Source : Middle East Furtility Society Journal
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Licorice ethanol extract improves symptoms of polycytic ovary syndrome in Letrozole-induced female rats
Hyun Yang Hye, Jin Kim Bo-Jeong, Pyun Hye, Won Lee
Licorice (Glycyrrhizae radix et rhizome, GRR) has long been used as an ingredient in Korean traditional medicinal herbal formulas for various metabolic and reproductive diseases. Polycystic ovary syndrome (PCOS) is a common endocrine disorder in premenopausal women. In the present study, we examined the effects of GRR extract on PCOS-like symptoms in female rats.
Symptoms of PCOS were induced by Letrozole treatment for 4 weeks in 6-week-old female SD rats, after which the effects of GRR extract on recovery of normal hormonal levels and polycystic ovaries were assessed. Serum levels of luteinizing hormone (LH), follicular-stimulating hormone (FSH), LH/FSH ratio, and follicular cysts were evaluated, followed by the expression levels of known follicular phase markers such as Kitl, Cyp11a1, and Ptgs2.
The serum level of FSH was reduced only in the Lestrozole treatment group (PCOS), whereas significant recovery of FSH level was observed in the Letrozole and GRR co-treatment group (PCOS + GRR). Serum LH levels were not altered in any of the groups. Furthermore, the LH/FSH ratio (known biomarker for PCOS) was elevated only in the Letrozole treatment group (PCOS), whereas it was significantly reduced in the Letrozole and GRR co-treatment group (PCOS + GRR). For histological changes, follicular cysts, antral follicles, and increased thickness of the theca- and granulosa layers were observed in the PCOS group, whereas these alterations were remarkably reversed by GRR treatment.
These results suggest that GRR extract inhibits the symptoms of PCOS by regulating imbalanced hormonal levels and irregular ovarian follicles.
Source : Integrative Medicine Research
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The effects of acupuncture on polycystic ovary syndrome: A systematic review and meta-analysis
Fan Qua, 1, Yan Wua, 1, Xiao-Yang Hub, 1, John A. Barryc, Jue Zhoud, Fang-Fang Wanga, Ying-Hui Yea, Rong Zhange, Song-Ping Hane, Ji-Sheng Hane, Rong Lif, Malcolm B. Tawg, Paul J. Hardimanc, Nicola Robinsonb
A systematic review and meta-analysis was carried out to assess the clinical effectiveness of acupuncture in treating polycystic ovarian syndrome (PCOS).
RCTs that compared either acupuncture with no/sham (placebo) acupuncture or a certain therapy with acupuncture added in the treatment of PCOS were included in the review. Measures of treatment effectiveness were the pooled odds ratios (OR) for women with PCOS having acupuncture compared with women in the control group for the recovery of menstrual cycles, standardized mean difference (SMD) for body mass index (BMI), fasting insulin (FINS), fasting plasma glucose (FPG), luteinizing hormone (LH), follicle stimulating hormone (FSH), and the ratio of LH/FSH.
A total of nine RCTs (531 women) met criteria for inclusion into the systematic review. Using the random effects model, pooling of the effect estimates from all RCTs showed recovery of menstrual cycles (OR = 0.20, 95% CI: 0.09–0.41, P < 0.01), BMI (SMD = −0.63, 95% CI: −1.04 to −0.21, P = 0.04), and LH (SMD = −0.39, 95% CI: −0.65 to −0.12, P < 0.01) which favored the acupuncture group. No significant differences were observed for FINS, FPG, FSH and the ratio of LH/FSH between acupuncture and control groups (P > 0.05).
Acupuncture appears to significantly improve the recovery of the menstrual cycles and decrease the levels of BMI and LH in women with PCOS. However, the findings should be interpreted with caution due to the limited methodological quality of included RCTs.
Source : European Journal of Integrative Medicine
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Standardized Fenugreek Seed Extract May Improve Symptoms of Polycystic Ovary Syndrome (PCOS)
Swaroop A, Jaipuriar AS, Gupta SK, et al. Efficacy of a novel fenugreek seed extract (Trigonella foenum-graecum, Furocyst™) in polycystic ovary syndrome (PCOS). Int J Med Sci. October 3, 2015;12(10):825-831.
Polycystic ovary syndrome (PCOS) is characterized by the imbalance of normal female hormones, likely due to ovarian cysts, and may lead to diabetes, heart disease, and infertility. Hyperinsulinemia also is common to patients with PCOS, and therapeutics used to treat diabetes, such as metformin, are standards for PCOS treatment. Several botanicals have been reported to be efficacious in treating PCOS. Fenugreek (Trigonella foenum-graecum, Fabaceae) seed extract has shown bioactivity in diabetic animal models. This open-label, observational study investigated the effects of a fenugreek seed extract (Furocyst™; Cepham, Inc.; Piscataway, New Jersey) for the potential treatment of PCOS in premenopausal women.
The study took place at Garg Hospital in Gorakhpur and the Hormone and Maternity Clinic in Meerut, both in Uttar Pradesh, India. Patients with PCOS aged 18-45 years old, premenopausal, and with a body mass index of less than 42 kg/m2 were included. Patients were excluded if they were postmenopausal, pregnant, or lactating, or had a hysterectomy, adrenal hyperplasia, Cushing's syndrome, androgen-secreting tumors, thyroid dysfunction, or hypogonadism or hypogonadotropic. Furocyst is a water-ethanol extract of fenugreek seed standardized to contain 40% furostanolic saponins. From 67 potential patients, 50 were included in the study and were given 2 capsules of Furocyst (500 mg each) daily for 3 months.
Primary outcomes were any decrease of ovarian volume and cysts. Ovarian volume, cysts, and menstrual regularity were assessed at baseline and endpoint. Glucose, triglyceride, and high-density lipoprotein (HDL) cholesterol concentrations, as well as concentrations of liver and kidney function markers and hemoglobin and leukocyte, were measured at baseline and after 90 days. Blood parameters for efficacy, such as luteinizing hormone (LH, an ovulation signaler) and follicle-stimulating hormone (FSH, a hormone central to menstruation) concentrations, were measured at baseline and after 1, 2, and 3 months of the study. In addition to laboratory measurements, patients were asked to note any adverse side effects.
Significant increases were seen in LH concentrations (10.33 ± 7.25 IU/L vs. 13.93 ± 10.14 IU/L, P=0.045) from baseline to endpoint and in FSH concentrations from baseline to both 2 and 3 months (5.36 ± 1.73 IU/L vs. 6.38 ± 2.37 IU/L and 8.36 ± 3.34 IU/L, P=0.010 and P=0.000, respectively). [Note: Statistical tests were not specified in this study, and the reporting of P values as 0.000 is questionable.] At the end of the study, a significant reduction in right ovary volume was observed (14.00 ± 6.27 cm3 vs. 10.00 ± 4.19 cm3, P=0.000). The left ovary volume was nonsignificantly reduced. Regular menstrual cycles increased starting at 2 months into the study, with greater increases after 3 months. It is stated that 71% of patients had regular menstrual cycles at the end of the study. Statistical relevance is not stated. The authors also report that 46% of patients showed a reduction in cyst size and 36% showed no cysts at the end of the study. Data and statistical relevance are again not stated. Hemoglobin concentrations were increased from baseline to endpoint (12.37 ± 1.047 vs. 13.00 ± 0.926, P=0.000 [units not specified]). No significant differences were noted in leukocyte, triglyceride, or HDL concentrations. Indicative of safety, markers of liver and kidney function remained unchanged.
It is stated that 94% of patients saw improvement in PCOS in some form, whether reduction or elimination of cysts, regular menstrual cycles, or pregnancy (12% of patients became pregnant during the study), showing that daily consumption of Furocyst resulted in improvement of PCOS symptoms and characteristics. No adverse side effects were observed either by patients or with blood parameters. Furocyst appears to effectively alleviate PCOS independent of normalizing disrupted metabolism as supplementation had no effect on patients' diabetes-related symptoms such as blood glucose. In summary, this product may be an effective and safe treatment for those suffering from PCOS.
Three of the authors (A. Swaroop, M. Bagchi, and D. Bagchi) are employed by Cepham, Inc..
—Amy C. Keller, PhD
Source : American Botanical Council
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Phytotherapy for Polycystic Ovarian Syndrome: A review of the literature and evaluation of practitioners’ experiences
Polycystic Ovarian Syndrome (PCOS) is a common, complex, endocrine condition with potential long-term cardiovascular, endocrine and metabolic health implications. Currently, there exists no medical treatment that addresses all clinical presentations. Herbal practitioners often treat women with PCOS; yet, there is a lack of research investigating PCOS and herbal treatment. This study aimed to examine the current scientific literature on PCOS and phytotherapy, explore practitioners’ experiences treating women with the syndrome and evaluate whether there is a role for phytotherapy in the treatment of PCOS.
A literature search was conducted using the terms; ‘Polycystic Ovarian Syndrome’/‘PCOS’ and ‘phytotherapy’/‘herbal medicine’/‘herbs’. The published research identified by these terms was then reviewed. A brief questionnaire with a mix of eleven open and closed questions was sent to herbal practitioners on the National Institute of Medical Herbalists (NIMH) 2012 register.
The literature review found promising results for the use of Mentha spicata, Cinnamomum verum and berberine containing herbs. There was a weaker evidence base for the use of Glycyrrhiza glabra and Paeonia lactiflora. The questionnaire was completed by 72 practitioners, 71% had treated women with PCOS. The majority (38%, n = 50) felt herbal medicine was ‘quite successful’ in treating PCOS. The average time until herbal treatment started to be successful was 3.2 months. The most frequently used herbs were P. lactiflora, G. glabra and Vitex agnus castus. Dietary and lifestyle advice emerged as frequently identified therapeutic interventions.
This exploratory study suggests that there is a role for phytotherapy in the treatment of PCOS. Further investigation, consisting of well-designed clinical trials and monitoring the successful use of herbal medicine by practitioners, is clearly necessary. This future research would serve to substantiate positive empirical evidence, constructing a more robust evidence base for the effective use of phytotherapy as a therapeutic option for women with PCOS.
Source : Journal of Herbal Medicine
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[A meta-analysis on acupuncture treatment of polycystic ovary syndrome].
[Article in Chinese]
Ren LN, Guo LH, Ma WZ, Zhang R.
OBJECTIVE:To evaluate the effect and safety of acupuncture treatment of polycystic ovary syndrome (PCOS) by using systematic review in view of evidence-based medicine (EBM).
METHODS:Original articles about acupuncture treatment of PCOS published from the database-established year to November of 2013 were searched from the Chinese National Knowledge Infrastructure Database (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Library (CBM), Wanfang Data, PubMed, and the Cochrane Library and the associated references-indicated papers by using keywords of polycystic ovary syndrome, randomization, acupoint, acupuncture, acupuncture plus moxibustion, acupuncture plus acupoint-embedment of catgut, and acupuncture plus otopoint application. Those articles about treatment of PCOS with simple abdominal acupuncture, simple acupoint-embedment of catgut, simple otopoint-pellet-pressure, and simple moxibustion treatment, and simple abstracts were excluded. If the articles re-published in both Chinese and English and in academic conferences and journals, one of them with higher quality was included. Two independent reviewers extracted data from located articles in a pre-defined structured way, and the Meta-analysis was conducted using software RevMan 5.2, otherwise using the qualitative analysis.
RESULTS:A total of 31 articles (28 in Chinese, 3 in English) containing 2,321 cases of PCOS patients met the included criteria. Meta-analysis showed that the clinical efficacy of simple acupuncture was the same as that of western medicine, and the efficacy of acupuncture combined with Chinese herbal medicine interventions was obviously higher than that of western medicine (P < 0.05). In addition, simple acupuncture intervention and acupuncture combined with Chinese herbal medicines or with moxibustion treatment have advantages in reducing serum luteinizing hormone/follicle-stimulating hormone (LH/FSH), insulin resistance (IR), testosterone (T), and body mass index (BMI). However, the quality of the collected articles is generally lower due to unclear bias, no sample quantity estimation, incorrect randomization methods, no follow-up survey, etc.
CONCLUSION:Acupuncture therapy may be effective for PCOS, but needs to be confirmed further by larger sample randomized controlled trials.
Source : PubMed
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