Insights & Discussion
Acupuncture, when used in conjunction with medicine or alone, appears to improve certain PCOS outcomes such as ovulation rate and recovery of menstrual cycle.
This overview consolidates existing systematic reviews (SRs) on the efficacy and safety of acupuncture for treating Polycystic Ovary Syndrome (PCOS). Methodological quality, risk of bias, and confidence in evidence were assessed from these SRs to guide clinical practice and future research directions. However, due to the inconsistency and low quality of evidence, a definitive conclusion regarding the benefits of acupuncture for PCOS remains elusive. Notably, though all included SRs suggest potential benefits, their conclusions are undermined by defects in individual SRs and the limited reliability of evidence. Acupuncture, when used in conjunction with medicine or alone, appears to improve certain PCOS outcomes such as ovulation rate and recovery of menstrual cycle. Adverse events are mild, and while some evidence points to favorable effects on various outcomes, confidence remains too low to draw firm conclusions. The review highlights methodological shortcomings in SRs' assessments and calls for robust future studies. These studies should feature pre-registered protocols, comprehensive literature retrieval, detailed statistical methods, thorough reporting of trial characteristics and funding sources, and strategies to address bias and heterogeneity. In spite of potential benefits, the current evidence's poor quality and inconsistencies necessitate further high-quality research to establish acupuncture's effectiveness and safety for PCOS definitively.
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Pomegranate juice supplementation has been found to effectively decrease testosterone levels in overweight and obese women diagnosed with polycystic ovary syndrome.
2023 Phytotherapy Research The effect of concentrated pomegranate juice on biomarkers of inflammation, oxidative stress, and sex hormones in overweight and obese women with polycystic ovary syndrome: A randomized controlled trial Abedini M, Ramezani‐Jolfaie N, Ghasemi‐Tehrani H, Tarrahi MJ, Amani R
Randomised Controlled Trial PCOS Pomegranate Testosterone
In the methodology, the study employed a randomized controlled trial which involved 44 participants. The women, aged between 18 and 40 years, had all been diagnosed with polycystic ovary syndrome and had a body mass index exceeding 25 kg/m. They were randomly divided, with one group consuming 45 ml/day of concentrated pomegranate juice and the other group receiving no intervention. A variety of biomarkers for sex hormones, inflammation, and oxidative stress were measured before starting the trial and again after eight weeks.
Further discussion of the results revealed a significant decrease in testosterone levels among the overweight and obese women with polycystic ovary syndrome who took concentrated pomegranate juice over the eight week period, in contrast to those in the control group. Apart from testosterone, no significant changes were observed for luteinizing hormone, sex hormone-binding globulin levels or for markers of inflammation and oxidative stress between the two groups.
The compounds apocarotenoids and carotenoids found in saffron extract could potentially interact with multiple targets, helping to manage the symptoms of polycystic ovary syndrome.
2023 Medicine Network pharmacology-based strategic prediction and target identification of apocarotenoids and carotenoids from standardized Kashmir saffron (Crocus sativus L.) extract against polycystic ovary syndrome Tiwari A, Modi SJ, Girme A, Hingorani L
Network Pharmacology PCOS Saffron
The study utilized a network pharmacology-based approach to identify the possible therapeutic pathways for apocarotenoids and carotenoids in Crocus sativus on polycystic ovary syndrome. The Ultra-High-Performance Liquid Chromatography with Photodiode Array detector (UHPLC-PDA) standardized stigma-based Crocus sativus extract (CSE) was analyzed for these phytochemicals.
Information about polycystic ovary syndrome related genes was collected from a knowledge database and networks were established between these targets and Crocus sativus extract phytochemicals to understand its mechanism of action.
Through network analysis and screening conditions, the study found four significant targets, including serine/threonine kinase 1, signal transducer and activator of transcription, and two types of mitogen-activated protein kinases. Gene ontology and Kyoto Encyclopaedia of genes and genomes analysis showed that MAP kinase and serine-threonine pathways were crucial targets in polycystic ovary syndrome.
Further molecular docking studies were conducted, and carotenoids apocarotenoids were assessed for absorption, distribution, metabolism, excretion, and toxicity predictions. Elements like crocetin, picrocrocin, and safranal showed strong binding affinity for the identified targets. This analysis also revealed that these compounds had excellent bioavailability and could cross the blood-brain barrier without demonstrating toxicity.
In summary, the study demonstrated that these phytochemicals could act on the identified targets, thus pointing towards the potentiality of Crocus sativus extract in managing polycystic ovary syndrome.
PCOS patients suggests that combining acupuncture with metformin might enhance pregnancy and ovulation rates, as well as improve insulin resistance.
2022 Frontiers in Endocrinology Acupuncture combined with metformin versus metformin alone to improve pregnancy rate in polycystic ovary syndrome: A systematic review and meta-analysis Chen X, Lan Y, Yang L, Liu Y, Li H, Zhu X, et al.
Systematic Review PCOS Pregnancy
The study initially screened 330 relevant articles, eventually including nine randomized controlled trials (RCTs) that met the inclusion criteria. These trials encompassed 1,159 patients with PCOS who underwent acupuncture or acupuncture combined with metformin treatment. Using the GRADE method, a "Summary of Findings" table was employed to evaluate the quality of evidence for various outcome measures. The main results indicated that acupuncture combined with metformin exhibited superiority over metformin alone in terms of pregnancy rate, ovulation rate, and HOMA-IR (insulin resistance). Subgroup analysis highlighted that diagnostic criteria and random methods contributed to heterogeneity in results.
However, the evidence's quality was predominantly low or very low due to study limitations, inconsistencies, and imprecisions. The intervention measures, such as acupuncture methods and treatment parameters, varied substantially among studies. Challenges in contacting original authors and incomplete information posed further limitations. The study suggested potential improvements in pregnancy rate, ovulation rate, and HOMA-IR with acupuncture combined with metformin, but these findings were subject to uncertainties related to diagnostic criteria and overall evidence quality. Consequently, the conclusive efficacy of acupuncture combined with metformin for treating PCOS remains uncertain due to the dearth of high-quality research. The study called for well-designed and well-executed RCTs to address this question under standardized diagnostic criteria and treatment protocols for acupuncture and metformin.
Pomegranate juice extract may reduce the damage to the endometrium in Polycystic ovary syndrome through its antioxidant, anti-inflammatory, anti-fibrotic, and anti-proliferative effects.
2022 Morphologie Role of pomegranate extract in restoring endometrial androgen receptor expression, proliferation, and pinopodes in a rat model of polycystic ovary syndrome Ibrahim MAA, Sadek MT, Sharaf Eldin HEM
Experimental Study Endometrium PCOS Pomegranate
To test the possible benefits of pomegranate juice extract (PJE) on endometrial injury in Polycystic ovary syndrome (PCOS), forty adult albino rats were divided into four groups, control, PJE-treated, letrozole-treated (PCOS), and PJE & PCOS groups. The respective treatments were administered for a duration of three weeks. Serum and tissue samples were assayed for Follicle-stimulating hormone, Luteinizing hormone, testosterone, estradiol, and malondialdehyde. Uterine samples were also tested using a range of histological staining techniques and a scanning electron microscope.
In the rat model of PCOS, significant increases in certain biochemical indicators in serum samples were observed while uterine sections showed numerous alterations to the endometrium, signs of inflammation and an increase in the endometrial collagen fiber content. Additionally, there was increased expression of certain immunohistochemical staining markers and a decrease in the mean number of pinopodes observed through scanning electron microscopy. However, these various potentially harmful biochemical, histological and immunohistochemical alterations were efficiently reduced with the administration of PJE. This points towards the potential benefits of PJE in addressing and potentially reducing endometrial injury associated with PCOS.
In women with polycystic ovary syndrome, cinnamon reduced insulin resistance and testosterone levels similar to metformin, and ginger decreased follicle-stimulating and luteinizing hormones.
2022 Frontiers in Nutrition A comparison of the effects of cinnamon, ginger, and metformin consumption on metabolic health, anthropometric indices, and sexual hormone levels in women with poly cystic ovary syndrome: A randomized double-blinded placebo-controlled clinical trial Dastgheib M, Barati-Boldaji R, Bahrampour N, Taheri R, Borghei M, Amooee S, et al.
Randomised Controlled Trial Ceylon Cinnamon Cinnamon FSH
In the methodology of the study, 100 women diagnosed with polycystic ovary syndrome were divided into four groups. Each group received a different treatment: cinnamon, ginger, metformin, or placebo. The dosage for these treatments was 500 mg, three times a day, administered over a period of 8 weeks. The participants' sex hormones, weight revelations, along with glycemic and lipid markers were monitored before and after this period. Several participants were disqualified because of unspecified factors, resulting in a final sample size of 83.
In terms of results, all groups saw a decrease in weight and body mass index. The metformin and cinnamon groups specifically had notably decreases in their insulin resistance, meaning that these treatments were effective in improving metabolic health. Additionally, the ginger group experienced a reduction in follicle-stimulating hormone and luteinizing hormone levels unlike the other groups. Testosterone levels were lowered in the metformin and cinnamon groups, but no significant changes in dehydroepiandrosterone were observed in any of the groups. These results indicate the potential use of cinnamon and ginger as alternative treatments in managing polycystic ovary syndrome.
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