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

Published on Dec 18, 2014in BMC Complementary and Alternative Medicine2.479
· DOI :10.1186/1472-6882-14-511
Susan Arentz2
Estimated H-index: 2
(University of Western Sydney),
Susan Arentz2
Estimated H-index: 2
(University of Western Sydney)
+ 1 AuthorsAlan Bensoussan31
Estimated H-index: 31
(University of Western Sydney)
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.
Figures & Tables
  • References (107)
  • Citations (30)
📖 Papers frequently viewed together
4,521 Citations
1 Author (Bulent Yildiz)
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Ahmed Y. Shahin (Assiut University)H-Index: 13
#2Safwat A. Mohammed (Assiut University)H-Index: 1
AbstractBackground: Owing to their potential to act as estrogen receptor modulators and interfere with aromatase enzyme in animal studies, phytoestrogens (PE) may be useful as part of ovulation induction for polycystic ovary syndrome (PCOS).Patients and methods: Patients <35 years, presenting with infertility and PCOS, were included and randomly allocated to either group I (clomiphene citrate; CC) or group II (CC plus Cimicifugae racemosae; CR). Primary outcome was pregnancy rate. Secondary outc...
7 CitationsSource
4 CitationsSource
#1Farzad NajafipourH-Index: 5
Last. Akbar AliasgharzadehH-Index: 2
view all 6 authors...
Nowadays, the use of alternative medicine and complementary medicine more attention is to treat a variety of diseases and the use of herbal medicines for the treatment of various disorders of the body is considered by investigators and physicians in most clinical areas. The aim of this study was to evaluate the therapeutic effects of Urtica Dioica in women with Hyperandrogenism. In a randomized controlled clinical trial that performed in Endocrinology and Metabolism clinics of Emam Reza Hospital...
1 Citations
#1Helena J. Teede (Monash University, Clayton campus)H-Index: 53
#2Melanie Gibson-Helm (Monash University, Clayton campus)H-Index: 15
Last. Jacqueline Boyle (Monash University, Clayton campus)H-Index: 20
view all 4 authors...
Context: Polycystic ovary syndrome (PCOS) is an under-recognized, common, and complex endocrinopathy. The name PCOS is a misnomer, and there have been calls for a change to reflect the broader clinical syndrome. Objective: The aim of the study was to determine perceptions held by women and primary health care physicians around key clinical features of PCOS and attitudes toward current and alternative names for the syndrome. Design: We conducted a cross-sectional study utilizing a devised questio...
31 CitationsSource
#1Amie Steel (UTS: University of Technology, Sydney)H-Index: 18
#2Jon Wardle (UTS: University of Technology, Sydney)H-Index: 19
Last. Jon Adams (UTS: University of Technology, Sydney)H-Index: 39
view all 5 authors...
Abstract Objectives Despite high community use of complementary and alternative medicine (CAM) poor collaboration between conventional and CAM practitioners have been identified in many health sectors including maternity care. This is in part associated with a deficit in the formal training of CAM practitioners which overlooks collaborative practice skills and guidelines. This study evaluates the outcomes of an interprofessional education workshop which endeavours to improve the collaborative pr...
11 CitationsSource
#1Nasrin Jalilian (Kermanshah University of Medical Sciences)H-Index: 5
#2Masoud Modarresi (Kermanshah University of Medical Sciences)H-Index: 9
Last. Mohammadreza Bozorgmanesh (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 16
view all 5 authors...
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...
8 CitationsSource
#1Caroline A. Smith (University of Western Sydney)H-Index: 35
#2Deborah BatesonH-Index: 15
Last. Edith WeisbergH-Index: 25
view all 3 authors...
Background Complementary medicines (CMs) are widely used by women. Although, women in Australia are frequent users of CM, few studies have examined their utilisation by women attending a family planning service. The aim of this study was to examine (i) the extent of and type of CM, (ii) women’s views about safety and efficacy, and (iii) the factors influencing women’s decision-making.
17 CitationsSource
Abstract Objective To study the role of a phyto-oestrogen, Cimicifuga racimosa extract (Klimadynon ® , Bionorica, Neumarkt i.d.OBf., Germany), in ovulation induction in women with polycystic ovarian syndrome (PCOS). Study design Prospective randomized controlled trial in Minia University Hospital, Minia, Egypt. One hundred women with PCOS were allocated into one of two groups: one group ( n = 50) received clomiphene citrate 100 mg daily for 5 days, and the other group ( n = 50) received C. racim...
11 CitationsSource
#1Valiollah Hajhashemi (IUMS: Isfahan University of Medical Sciences)H-Index: 20
#2Vahid Klooshani (IUMS: Isfahan University of Medical Sciences)H-Index: 1
This study was aimed to examine the antinociceptive and anti-inflammatory effects of Urtica dioica leaf extract in animal models. Materials and Methods: Hydroalcoholic extract of the plant leaves was prepared by percolation method. Male Swiss mice (25-35 g) and male Wistar rats (180-200 g) were randomly distributed in control, standard drug, and three experimental groups (n=6 in each group). Acetic acid-induced writhing, formalin test, and carrageenan-induced paw edema were used to assess the an...
15 CitationsSource
#1Thomas TangH-Index: 8
#2Jonathan Lord (Royal Cornwall Hospital)H-Index: 11
Last. Adam H. BalenH-Index: 51
view all 5 authors...
Background Polycystic ovary syndrome (PCOS) is characterised by infrequent or absent ovulation, and high levels of androgens and insulin (hyperinsulinaemia). Hyperinsulinaemia occurs secondary to insulin resistance and is associated with increased risk of cardiovascular disease and diabetes mellitus. Insulin-sensitising agents such as metformin may be effective in treating PCOS-related anovulation. Objectives To evaluate the effectiveness and safety of insulin-sensitising drugs in improving repr...
417 CitationsSource
Cited By30
#1Eyad M. T. Ali (Taibah University)
#1Eyad M.T. AliH-Index: 3
Last. Sayed M. El-Sayed (Taibah University)
view all 3 authors...
: Diabetes mellitus (DM) affects the ovary by reducing the number and diameters of ovarian follicles and increasing atretic follicles. Follicular growth and diameters depend on VEGF production. Hyperglycemia causes ovarian stromal and follicular degeneration then fibrosis by activating TGF-β. Insulin and metformin promote development of ovarian follicles and reduce atretic follicles. Therefore, the present study investigates the ovarian VEGF and TGF-β immune-expression and its variations in diab...
#1Dongfang Xiang (Guangzhou University of Chinese Medicine)H-Index: 1
#2Jianping LuH-Index: 2
Last. Min WangH-Index: 1
view all 13 authors...
Many epidemiology studies have shown that maternal polycystic ovary syndrome (PCOS) results in a greater risk of autism spectrum disorders (ASD) development, although the detailed mechanism remains unclear. In this study, we aimed to investigate the potential mechanism and provide a possible treatment for PCOS-mediated ASD through three experiments: Experiment 1: Real time PCR and western blots were employed to measure gene expression in human neurons, and the luciferase reporter assay and chrom...
1 CitationsSource
view all 5 authors...
#2Richard AlexaH-Index: 4
Last. Abdel Halim Harrath (KSU: King Saud University)H-Index: 14
view all 3 authors...
Abstract The objective of our study was to examine the direct effects of the medicinal plant Tribulus terrestris L. (puncturevine) on the basic functions of ovarian cells, including their proliferation, apoptosis, and response to the physiological hormonal stimulator ghrelin. In the first series of experiments, porcine ovarian granulosa cells were cultured with or without puncturevine extracts at concentrations of 0, 1, 10, or 100 μg/ml. In the second series of experiments, these cells were cult...
#1Wan-Ting Liao (PRC: China Medical University (PRC))H-Index: 5
#1Wan-Ting Liao (PRC: China Medical University (PRC))
Last. Hung-Rong YenH-Index: 22
view all 7 authors...
Abstract Ethnopharmacological relevance Polycystic ovary syndrome (PCOS) is a common condition that affects 5%–10% of women of reproductive age worldwide. Patients with PCOS have a high degree of insulin resistance and are at an increased risk of developing type 2 diabetes mellitus (T2DM). The currently available therapeutic approaches for PCOS mainly focus on symptomatic treatment. Aim of the study This study aimed to determine whether Chinese herbal medicine (CMH)-based interventions could red...
1 CitationsSource
#1F. Ghavi (Shiraz University)H-Index: 1
#2M. TaghizadehH-Index: 1
Last. Somayeh Abdolahian (Shahid Beheshti University of Medical Sciences and Health Services)H-Index: 6
view all 4 authors...
Background: Polycystic ovarian syndrome (PCOS) is the most common cause of ovulatory infertility with an endocrine origin. An alternative therapy for PCOS is complementary medicine (CM), with herbal medicine becoming the most popular during the past ten years. The fennel plant (Foeniculum Vulgare Mill) belongs to the flowering plant of the fennel Apiaceae family. It is a medicinal plant that is commonly recommended by practitioners of Iranian traditional medicine for ovarian or unknown infertili...
1 CitationsSource
#1Jingyan Song (SDUTCM: Shandong University of Traditional Chinese Medicine)H-Index: 3
#2Shan Xiang (SDUTCM: Shandong University of Traditional Chinese Medicine)H-Index: 2
Last. Zhengao Sun (SDUTCM: Shandong University of Traditional Chinese Medicine)H-Index: 4
view all 4 authors...
Abstract Introduction Given the frequent use of traditional Chinese herbal medicine by women with polycystic ovary syndrome (PCOS) and the absence of robust evidence for taking Chinese herbs in accordance with different traditional Chinese medicine (TCM) syndromes (including ‘Kidney Yang Deficiency syndrome’ (KYDS), this study was designed to investigate the metabolomic characteristics of follicular fluid in PCOS patients with KYDS. Method(s) A retrospective cohort study was conducted to collect...
3 CitationsSource
#1Mohammed Azeemuddin (The Himalaya Drug Company)H-Index: 4
#2S. D. Anturlikar (The Himalaya Drug Company)H-Index: 9
Last. Paramesh Rangesh (The Himalaya Drug Company)H-Index: 2
view all 8 authors...
The objective of the present study was to evaluate “DXB-2030,” a polyherbal combination of Trigonella foenum-graecum, Aloe vera, Sphaeranthus indicus, Nardostachys jatamansi, and Symplocos racemosa extracts in an experimental model of testosterone propionate (TP), induced polycystic ovary syndrome (PCOS) in female rats. Thirty animals were divided into 3 groups of 10 each; group 1 served as normal control; group 2 was administered with TP and served as positive control; along with TP, group 3 wa...