1
National Institute of Complementary Medicine, University of Western,
Locked Bag 1797, Penrith South, NSW 2751 Sydney, Australia
2 School of Women’s and Children’s Health, University of New South Wales, Sydney, Sydney, Australia
3 National Institute of Complementary Medicine (NICM), University of Western Sydney, Sydney, Australia
2 School of Women’s and Children’s Health, University of New South Wales, Sydney, Sydney, Australia
3 National Institute of Complementary Medicine (NICM), University of Western Sydney, Sydney, Australia
BMC Complementary and Alternative Medicine 2014, 14:511
doi:10.1186/1472-6882-14-511
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6882/14/511
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6882/14/511
| Received: | 17 July 2014 |
| Accepted: | 9 December 2014 |
| Published: | 18 December 2014 |
© 2014 Arentz et al.; licensee BioMed Central.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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) and 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.
