Polycystic Ovary Syndrome (PCOS)

2022 Evidence-Based Complementary and Alternative Medicine

Among patients with PCOS, the combined use of acupuncture and moxibustion as a complementary therapy has additional efficacy regarding increased pregnancy and ovulation rates and reduced miscarriage rate.

The systematic review included 25 RCTs assessing the efficacy and safety of acupuncture combined with moxibustion in treating PCOS, and all of them contributed data to the meta-analysis. Evidence of an association between acupuncture and moxibustion therapy and greater increases in the pregnancy rate and ovulation rate and greater reductions in the miscarriage rate and ovarian volume was found. Additionally, patients receiving acupuncture and moxibustion also exhibited greater improvements in some sex hormones (LH level, LH/FSH ratio and total testosterone level) and indicators related to metabolic disorders (fasting insulin level and BMI). Nevertheless, acupoint stimulation therapy had no significant effect on the levels of FSH, DHEAS, or oestradiol.

In this systematic review, the pregnancy rate among patients who received acupuncture combined with moxibustion reached 50.9%. This value represents a substantial increase compared to that of patients who did not receive acupuncture (27.5%), with an RR of 1.81 and a 4.9% additional increase compared with patients receiving acupuncture + active drugs in the PCOSAct trial (46.0%).

Effects of Acupuncture Combined with Moxibustion on Reproductive and Metabolic Outcomes in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis Li P, Peng J, Ding Z, Zhou X, Liang R

2021 Evidence-Based Complementary and Alternative Medicine

Acupuncture could improve body mass index, waist-to-hip ratio as well as insulin resistance (HOMA-IR) in patients with PCOS.

Overall, we found that acupuncture was closely associated with decreased BMI, WHR, FPG, and HOMA-IR and that acupuncture could significantly improve HOMA-IR and the level of fasting glucose in patients with PCOS, which confirms previous reports. It is also reported that acupuncture can decrease BMI and WHR. FINS, 2hFPG, and 2hFINS were reduced in the acupuncture groups, but these differences were not significantly different.

The results of the lipid profile were reported in a few studies, and we found that acupuncture significantly improved triglycerides levels, while the differences in total cholesterol, LDL-C, and HDL-C were not significant.

Acupuncture seems to be associated with a few adverse events, and the reported adverse events, such as bleeding, were mild and transient, demonstrating that acupuncture is safe and reliable. Thus, we conclude that acupuncture, compared with standard therapy, is more effective and safer in improving glucose metabolism and insulin sensitivity in patients with PCOS.

The Effect of Acupuncture on Glucose Metabolism and Lipid Profiles in Patients with PCOS: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Ruqun Zheng, Peng Qing, Mei Han, Jinlong Song, Min Hu, Hongxia Ma, Juan Li

2021 Reproductive Biology and Endocrinology

Green tea extract could be considered a potential agent to attenuate PCOS complications mainly due to its effect on weight loss and glycemic levels.

Current evidence indicates that green tea extract (GTE) supplementation has potential beneficial effects on PCOS. Of 314 articles found in the search, four human studies and four animal studies were included. All studies in humans showed the effects of GTE on weight loss. GTE's effect on decreasing testosterone levels in humans and LH levels in animals were also reported. In addition, increases in FSH and progesterone levels in animal models were observed. Although GTE improved fasting blood sugar and insulin levels, the effect of GTE on inflammatory parameters, such as TNF-alpha and IL-6 and antioxidant status, was limited to animal studies.

A comprehensive insight into effects of green tea extract in polycystic ovary syndrome: a systematic review Maleki V, Taheri E, Varshosaz P, Tabrizi FPF, Moludi J, Jafari-Vayghan H, Shadnoush M, Jabbari SHY, Seifoleslami M, Alizadeh M

2021 Evidence-Based Complementary and Alternative Medicine

Acupuncture alone or traditional Chinese medicines (taken orally) in combination with western medicine significantly increased the pregnancy rate of PCOS patients and CAM was more effective than western medicine alone for improving hormone levels.

This review identified 13 RCTs involving 1,297 PCOS patients with abnormal endometrial status. This systematic review suggests that CAM has potential for improving endometrial thickness, endometrial type, serum hormone level, and pregnancy rate in PCOS patients. However, due to the limited quantity and the general low quality of the methodology of the included trials, more in-depth research is required before CAM can be applied more widely in clinical practice. Thus more rigorous double-blind, placebo-controlled trials should be conducted to confirm the efficacy of CAM in improving endometrial condition in PCOS patients.

Complementary and Alternative Medicine for the Treatment of Abnormal Endometrial Conditions in Women with PCOS: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Jiayu Hu, Wenhua Shi, Jiayue Xu, Shaoxuan Liu, Siya Hu, Wenjing Fu, Jing Wang and Fengjuan Han

2020 Medicine

Acupuncture could promote the recovery of menstrual cycles as well as downregulate the levels of LH and testosterone in patients with PCOS.

Twenty two studies with 2315 participants were included in this systematic review and meta-analysis. A pooled analysis showed a recovery of the menstrual period in the acupuncture group. Furthermore, there were significant decreases in the luteinizing hormone (LH) and testosterone in the acupuncture group. No significant differences were observed in the rates of live birth, pregnancy, and ovulation, and no significant differences were observed in the LH/follicle-stimulating hormone (FSH) ratio.

There was insufficient evidence to support that acupuncture could promote live birth, pregnancy, and ovulation. However, acupuncture could promote the recovery of menstrual cycles as well as downregulate the levels of LH and testosterone in patients with PCOS.

Effectiveness of acupuncture in polycystic ovary syndrome Wu J, Chen D, Liu N

2020 Journal of Food Biochemistry

Cinnamon supplementation contributes to the improvement of insulin resistance in patients with PCOS.

As the first systematic review and meta-analysis evaluating the effect of cinnamon in women with PCOS, this study indicates that supplementation with cinnamon reduced HOMA-IR and FSI.

The effect of cinnamon supplementation on glycemic control in women with polycystic ovary syndrome: A systematic review and meta-analysis Javad Heshmati, Mahdi Sepidarkish, Mojgan Morvaridzadeh, Farnaz Farsi, Nishant Tripathi, Maryam Razavi, Mahroo Rezaeinejad

2020 Frontiers in Pharmacology

Herbal medicines were shown to normalize female hormones, diminish male hormones, recover the estrous cycle, ameliorate insulin resistance, and improve lipid metabolism in PCOS.

In this review, a total of 27 studies involving 22 herbal medicines exhibited beneficial effects on PCOS. Herbal interventions in the 27 studies comprised four compounds isolated from herbs (6 studies), nine individual herbal extracts (11 studies), and nine herbal formula decoctions (10 studies).

Herbal medicines were shown to normalize female hormones, diminish male hormones, recover the estrous cycle, ameliorate insulin resistance, and improve lipid metabolism in PCOS.

The mechanisms underlying the beneficial effects of herbal medicines on PCOS are associated with anti-inflammation, anti-oxidative stress, inhibition of autophagy and/or apoptosis, and ovarian NGF reduction.

Chinese herbal medicines can be considered as promising resources in the development of effective therapeutic agents for PCOS.

Therapeutic Effects and Mechanisms of Herbal Medicines for Treating Polycystic Ovary Syndrome: A Review Kwon Chan-Young, Cho Ik-Hyun, Park Kyoung Sun

2018 Nutrients

Welsh onion root extract administration influenced aromatase production, enhanced the estrogen steroid synthesis, and consequently restored the estrogenic feedback mechanism on the pituitary-ovary system.

Using letrozole-induced PCOS rats, we focused on herbal therapy using extract of Allium fistulosum (AF; A. fistulosum) roots to improve ovarian functions. As a nonsteroidal aromatase inhibitor, letrozole blocks conversion of testosterone to estrogen and subsequently induces PCOS phenomenon. We divided six-week-old female rats into four groups, including control, letrozole, letrozole + AF extract, and temporary letrozole groups. In our study, treatment with AF extract shows a low plasma LH/FSH ratio, and reveals high estrogen levels, ovarian morphology, folliculogenesis-related genes, and aromatase expression under PCOS mimic conditions.

Welsh Onion Root (Allium fistulosum) Restores Ovarian Functions from Letrozole Induced-Polycystic Ovary Syndrome Lee YH, Yang H, Lee SR, Kwon SW, Hong EJ, Lee HW.

2018 Medicine

Chinese herbal medicine combined with moxibustion might be beneficial for treating PCOS, and the treatment might improve the therapeutic effects of conventional western medications including clomiphene citrate, oral contraceptives, and/or metformin.

According to current evidence, oriental herbal medicine combined with moxibustion might be beneficial for treating PCOS. Moreover, the treatment might improve the therapeutic effects of conventional WMs including clomiphene citrate, OCPs, and/or metformin. However, the findings should be interpreted with great caution, owing to poor methodological quality of the included studies, especially the high risks of selection bias, performance bias, and detection bias. Further larger, high-quality, rigorous RCTs should be conducted in this regard.

Oriental herbal medicine and moxibustion for polycystic ovary syndrome Kwon, Chan-Young, Lee, Boram, Park, Kyoung Sun

2017 Medicine

Acupuncture adjuvant to other active medications could affect hormonal levels such as LH, LH/FSH ratio, testosterone, and fasting insulin in women with polycystic ovarian syndrome.

Although limited by heterogeneity across studies, we found that acupuncture adjuvant to other active medications could affect hormonal levels such as LH, LH/FSH ratio, testosterone, and fasting insulin. Neuroendocrinological mechanisms of acupuncture have been extensively studied not only in pain research but also in reproductive medicine. Acupuncture is also known to modulate hypothalamic-pituitary-ovarian axis, which can affect menstruation cycles. Given that acupuncture stimulates pituitary beta-endorphin production, which has a tonic inhibitory effect on gonadotropin-releasing hormone pulse generator and pituitary LH secretion, it is possible that acupuncture may reduce ovulatory dysfunction and thus decrease the secretion of ovarian androgens in women with PCOS. Considering detected heterogeneity from our analysis, known variability in hormonal levels, the poor standardization of assays, and the specific PCOS phenotypic features, however, the currently available data from RCTs has yet to allow us to draw any firm conclusion whether acupuncture affects hormonal levels, thus recovering ovulatory function and menstruation cycle in women with PCOS.

Acupuncture for polycystic ovarian syndrome: A systematic review and meta-analysis Jo, J., Lee, Y. J., & Lee, H.

2017 Acupuncture in Medicine

Acupuncture may increase the clinical pregnancy rate and ongoing pregnancy rate and decrease the risk of ovarian hyperstimulation syndrome in women with PCOS undergoing IVF or ICSI.

Acupuncture may increase the CPR and OPR and decrease the risk of OHSS in women with PCOS undergoing IVF or ICSI. Further studies are needed to confirm the efficacy and safety of acupuncture as an adjunct to assisted reproductive technology in this particular population.

Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis. Jo, J., & Lee, Y. J.