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Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings
Abstract
Background: Polycystic ovary syndrome (PCOS) is a prevalent, complex endocrine disorder characterised by polycystic ovaries, chronic anovulation and hyperandrogenism leading to symptoms of irregular menstrual cycles, hirsutism, acne and infertility. Evidence based medical management emphasises a multidisciplinary approach for PCOS, as conventional pharmaceutical treatment addresses single symptoms, may be contra-indicated, is often associated with side effects and not effective in some cases. In addition women with PCOS have expressed a strong desire for alternative treatments. This review examines the reproductive endocrine effects in PCOS for an alternative treatment, herbal medicine. The aim of this review was to identify consistent evidence from both pre-clinical and clinical research, to add to the evidence base for herbal medicine in PCOS (and associated oligo/amenorrhoea and hyperandrogenism) and to inform herbal selection in the provision clinical care for these common conditions. Methods: We undertook two searches of the scientific literature. The first search sought pre-clinical studies which explained the reproductive endocrine effects of whole herbal extracts in oligo/amenorrhoea, hyperandrogenism and PCOS. Herbal medicines from the first search informed key words for the second search. The second search sought clinical studies, which corroborated laboratory findings. Subjects included women with PCOS, menstrual irregularities and hyperandrogenism. Results: A total of 33 studies were included in this review. Eighteen pre-clinical studies reported mechanisms of effect and fifteen clinical studies corroborated pre-clinical findings, including eight randomised controlled trials, and 762 women with menstrual irregularities, hyperandrogenism and/or PCOS. Interventions included herbal extracts of Vitex agnus-castus, Cimicifuga racemosa,Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia. Endocrine outcomes included reduced luteinising hormone (LH), prolactin, fasting insulin and testosterone. There was evidence for the regulation of ovulation, improved metabolic hormone profile and improved fertility outcomes in PCOS. There was evidence for an equivalent effect of two herbal medicines and the pharmaceutical agents bromocriptine (and Vitex agnus-castus )a nd clomiphene citrate (and Cimicifuga racemosa). There was less robust evidence for the complementary combination of spirinolactone and Glycyrrhiza spp. for hyperandrogenism. Conclusions: Preclinical and clinical studies provide evidence that six herbal medicines may have beneficial effects for women with oligo/amenorrhea, hyperandrogenism and PCOS. However the quantity of pre-clinical data was limited, and the quality of clinical evidence was variable. Further pre-clinical studies are needed to explain the effects of herbal medicines not included in this review with current clinical evidence but an absence of pre-clinical data.
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  • References (109)
  • Cited By (17)
  • References (109)
  • Cited By (17)
Milewicz A1
Estimated H-index: 1
,
Gejdel E1
Estimated H-index: 1
+ 4 AuthorsSchmitz H1
Estimated H-index: 1
The efficacy of a Vitex agnus castus preparation (Strotan® capsules) was investigated in a randomized double blind study vs. placebo. This clinical study involved 52 women with luteal phase defects due to latent hyperprolactinaemia. The daily dose was one capsule (20 mg) Vitex agnus castus preparation and placebo, respectively
55 Citations Source
1984 in Fertility and SterilityIF: 4.80
Anthony A. Luciano1
Estimated H-index: 1
(Tufts Medical Center),
Frederick K. Chapler1
Estimated H-index: 1
(Tufts Medical Center),
Barry M. Sherman1
Estimated H-index: 1
(Tufts Medical Center)
With the use of multiple blood sampling, the prevalence of hyperprolactinemia in 150 consecutive patients with polycystic ovary syndrome (PCO) was found to be 17%. To further compare these two groups of PCO patients, the pituitary responses to gonadotropin-releasing hormone and thyrotropin-releasing hormone and the adrenal responses to dexamethasone suppression and adrenocorticotropic hormone stimulation were evaluated in 40 normoprolactinemic and 10 hyperprolactinemic PCO patients. Adrenal and ...
79 Citations Source Cite
Ézer A. Melo1
Estimated H-index: 1
,
Eduardo B. Bertero3
Estimated H-index: 3
+ 1 AuthorsDemerval Mattos5
Estimated H-index: 5
Objectives: In spite of its historical use, published data about phytotherapic products is characterized by the absence of well conducted studies, leading to conflictive and indefinite results about efficiency and safety of theses drugs. In that sense, we have analyzed the results of a combination of Pygeum africanum and stinging nettle (Urtica dioica) extracts in patients with benign prostatic hyperplasia (BPH), based in a double-blind, randomized, placebo-controlled protocol. Materials and Met...
18 Citations Download PDF
2013 in Phytotherapy ResearchIF: 3.35
Nasrin Jalilian4
Estimated H-index: 4
(Kermanshah University of Medical Sciences),
Masoud Modarresi1
Estimated H-index: 1
(Kermanshah University of Medical Sciences)
+ 2 AuthorsMohammadreza Bozorgmanesh9
Estimated H-index: 9
(Shahid Beheshti University of Medical Sciences and Health Services)
Pharmacological treatments of polycystic ovary syndrome (PCOS) have side effects. We compared the efficacy and safety of the aerial parts of wood botany (AWB) with those of Medroxyprogesterone acetate (MPA) in the management of abnormal uterine bleeding (AUB) due to PCOS. We conducted a randomized clinical trial of 66 women aged 15–45 years, with AUB. Participants were randomly assigned to either cyclical 10-mg BD MPA for three cycles or 5 g ABW TDS for three months. Clinical symptoms and paracl...
5 Citations Source Cite
2003 in Planta MedicaIF: 2.49
Hubertus Jarry45
Estimated H-index: 45
,
Barbara Spengler10
Estimated H-index: 10
+ 3 AuthorsVolker Christoffel13
Estimated H-index: 13
Recent cell culture experiments indicated that extracts of Vitex agnus-castus (VAC) may contain yet unidentified phytoestrogens. Estrogenic actions are mediated via estrogen receptors (ER). To investigate whether VAC compounds bind to the currently known isoforms ERa or ERss, ligand binding assays (LBA) were performed. Subtype specific ER-LBA revealed a binding of VAC to ERss only. To isolate the ERss-selective compounds, the extract was fractionated by bio-guidance. The flavonoid apigenin was i...
45 Citations Source Cite
A Dehghan1
Estimated H-index: 1
(Islamic Azad University),
A Esfandiari1
Estimated H-index: 1
(Islamic Azad University),
S Momeni Bigdeli1
Estimated H-index: 1
(Islamic Azad University)
Contents Tribulus terrestris has long been used in traditional medicine to treat impotency and improve sexual functions in man. The aim of this study was to evaluate the efficiency of T. terrestris extract in the treatment of polycystic ovary (PCO) in Wistar rat. Estradiol valerate was injected to 15 mature Wistar rats to induce PCO. Rats were randomly divided into three groups (control, low-dose and high-dose groups) of five each and received 0, 5 and 10 mg of T. terrestris extract, respectivel...
5 Citations Source Cite
2007
Ricardo Azziz63
Estimated H-index: 63
(Georgia Regents University),
Enrico Carmina40
Estimated H-index: 40
(University of Palermo)
+ 7 AuthorsBulent O. Yildiz24
Estimated H-index: 24
(Hacettepe University)
Polycystic ovary syndrome (PCOS) is a common disorder affecting (depending on the population studied and the definition of the syndrome) between 5 and 20% of reproductive age women.1 If the middle of this range is considered as a realistic prevalence, then PCOS may be the most prevalent endocrine disorder in women. In spite of the widespread presence of PCOS, its precise definition still eludes both investigators and practitioners. Most consensus definitions describe PCOS as a disorder character...
857 Citations Source Cite
2003 in MaturitasIF: 3.31
Hubertus Jarry45
Estimated H-index: 45
(University of Göttingen),
Maria Metten5
Estimated H-index: 5
(University of Göttingen)
+ 2 AuthorsWolfgang Wuttke45
Estimated H-index: 45
(University of Göttingen)
Abstract Objectives: Extracts of Black cohosh ( Cimicifuga racemosa or CR) have been used for the treatment of climacteric complaints since decades. Efficacy, particularly concerning neurovegetative and psychic symptoms, has been proven in clinical trials. As active principle yet unknown substances with selective estrogen receptor modulator (SERM) activity are assumed. Recently, evidence arose that CR may also contain dopaminergic compounds, which may contribute to the therapeutic activity of th...
84 Citations Source Cite
  • References (109)
  • Cited By (17)
Kunyan Zhou1
Estimated H-index: 1
(Sichuan University),
Jing Zhang6
Estimated H-index: 6
(Sichuan University)
+ 2 AuthorsChi Eung Danforn Lim11
Estimated H-index: 11
(University of Technology, Sydney)
Background Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinology abnormalities, and affects 5% to 10% of women of reproductive age. Western medicines, such as oral contraceptives, insulin sensitizers and laparoscopic ovarian drilling (LOD), have been used to treat PCOS. Recently, many studies have been published that consider Chinese herbal medicine (CHM) as an alternative treatment for women with PCOS. Objectives To assess the efficacy and safety of CHM for sub...
18 Citations Download PDF Cite
Milena Masullo15
Estimated H-index: 15
,
Paola Montoro22
Estimated H-index: 22
+ 2 AuthorsSonia Piacente32
Estimated H-index: 32
Abstract During last decades an increasing number of herbal products specifically targeting women's disorders has appeared in the worldwide marketplace. This growth highlights the need for a critical evaluation of quality, safety and efficacy of these products. Analytical techniques applied to the quality control of the main medicinal plants used for women health (relief of menopause and menstrual related symptoms) have been reviewed. Thanks to the innovation in analytical technology, identifica...
5 Citations Source Cite
Jufeng Xia7
Estimated H-index: 7
(University of Tokyo),
Yoshinori Inagaki21
Estimated H-index: 21
(University of Tokyo)
+ 2 AuthorsPeipei Song14
Estimated H-index: 14
(University of Tokyo)
Chinese medicine (CM) has been used in clinical treatment for thousands of years in China, Japan, Korea, and other countries. CM is at present attracting many attentions around the world for reproductive health care and disease prevention, including treatment of female infertility. This review focuses on the CM treatment for female infertility patients, and supplies a summary on the efficacy, safety, and mechanism of some Chinese herbal medicines, herbal medicine-derived active compounds, and ac...
5 Citations Source Cite
Ayda Hosseinkhani3
Estimated H-index: 3
(Shiraz University of Medical Sciences),
Nasrin Asadi8
Estimated H-index: 8
(Shiraz University of Medical Sciences)
+ 1 AuthorsMohammad M. Zarshenas12
Estimated H-index: 12
(Shiraz University of Medical Sciences)
Abstract Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Its cause is unknown and it remains the most enigmatic of reproductive disorders. The extant written documents of Traditional Persian Medicine (TPM) – with holistic approaches towards human health – contain remedies used for centuries. Before further experimental research on any of these treatments, it is appropriate to study current related scientific evidence on their possible pharmacological...
3 Citations Source Cite
2017 in Primary CareIF: 1.83
Melinda R Ring2
Estimated H-index: 2
(Northwestern University)
2 Citations Source Cite
2017 in Phytotherapy ResearchIF: 3.35
Susan Arentz3
Estimated H-index: 3
(University of Sydney),
Caroline Smith31
Estimated H-index: 31
(University of Sydney)
+ 3 AuthorsAlan Bensoussan27
Estimated H-index: 27
(University of Sydney)
Polycystic ovary syndrome (PCOS) is a common, complex reproductive endocrinopathy characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries. Lifestyle modification is a first-line intervention; however, there are barriers to success for this form of self-care, and women often seek adjunct therapies including herbal medicines. This pragmatic, randomized controlled trial, delivered in communities of Australia in overweight women with PCOS, compared the effectiveness and sa...
7 Citations Source Cite
Susan Arentz3
Estimated H-index: 3
(University of Sydney),
Caroline Smith31
Estimated H-index: 31
(University of Sydney)
+ 1 AuthorsAlan Bensoussan27
Estimated H-index: 27
(University of Sydney)
Polycystic ovary syndrome (PCOS) is a common, reproductive endocrinopathy associated with serious short and long term health risks. Many women with PCOS use ingestible complementary medicines. This systematic review examined the effect on menstrual regulation and adverse effects from randomised controlled trials. Randomised controlled trials (RCTs) that compared herbal or nutritional supplements to placebo or active controls in women with PCOS were eligible for inclusion. Electronic databases we...
3 Citations Source Cite
2018 in Phytotherapy ResearchIF: 3.35
Mahdie Hajimonfarednejad2
Estimated H-index: 2
(Shiraz University of Medical Sciences),
Majid Nimrouzi6
Estimated H-index: 6
(Shiraz University of Medical Sciences)
+ 3 AuthorsBahia Namavar Jahromi5
Estimated H-index: 5
(Shiraz University of Medical Sciences)
Our aim is to assess the effect of cinnamon powder capsules on insulin resistance, anthropometric measurements, glucose and lipid profiles, and androgens of women with polycystic ovarian syndrome (PCOS). Out of 80 women that were diagnosed as PCOS by Rotterdam Criteria, 66 were enrolled in this randomized double-blind placebo-controlled clinical trial. All of the PCOS women were taking medroxy progesterone acetate 10 mg/day for the last 10 days of their menstrual cycles. The cases were randomly ...
4 Citations Source Cite
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