Polycystic ovary syndrome (PCOS) is a leading cause of poor fertility and endocrine dysfunction in women. It affects up to 7 per cent of women with a combination of intermittent or absent ovulation, excessive male hormones (hirsutism, acne) and very often insulin resistance. This last connection is significant, as 60 per cent of sufferers are overweight, and half of even normal weight PCOS sufferers also have insulin resistance. There is also an increased risk of type 2 diabetes and associated cardiovascular problems among PCOS sufferers later in life. Insulin-sensitising drugs like metformin are now common treatments to stabilise cycles.
Some of the key endocrine imbalances in PCOS are:2 increased serum androgens (testosterone, androstenedione, DHEAS); decreased sex hormone binding globulin (SHBG) levels; increased luteinising hormone (LH) levels; increased prolactin levels in some cases; increased oestrone levels. Oestradiol can be increased, but is typically low or normal; and increased fasting insulin or fasting glucose.
Ancient Chinese herbal combo conquers symptoms
Research from the 1980s showed that the traditional Chinese combination of white peony (Paeonia lactiflora) and liquorice roots (Glycyrrhiza species) in equal parts effectively relieves many of the imbalances associated with PCOS. The potent combo significantly decreased serum testosterone in women with PCOS, especially in those described as infertile, or with a disturbed cycle. The dosage of extract was 5 to 7.5g/day (equivalent to 4 to 6g of dried white peony root and 4 to 6g of dried liquorice root), given for periods ranging from two to eight weeks, up to 24 weeks.
In two trials testosterone levels were shown to drop by more than 30 per cent with the herbal treatment. In some cases regular ovulation was established and some women even became pregnant. Several of the trials documented that no side effects occurred. The combination also significantly decreased serum free testosterone compared to baseline values in women with acne, significantly reducing the number of comedones (zits).
The white peony and liquorice combination may also be of benefit in lowering raised prolactin levels. After its administration (7.5g/day), a rapid decrease in prolactin levels was observed in 10 non-ovulating women with elevated serum prolactin. The decrease reached significance two weeks after the start of treatment.7 In case observation studies the combination (7.0g/day) also successfully treated drug-induced hyper-prolactinaemia (elevated prolactin) in men and a woman.
Fight off PCOS fertility issues with black cohosh
In one study published in 2014 the effects of the herb black cohosh on women being treated for PCOS-related infertility was tested. Women under 35 with infertility and PCOS were randomly divided into either group I (the fertility drug clomiphene) or group II (clomiphene plus black cohosh).10 Significant differences were found for endometrial thickness (8.5 versus 12.5mm) and serum levels of mid-luteal and mid cycle oestradiol, LH and mid-luteal progesterone.
Group II had significantly more pregnancies per cycle 71/204 (34.8 per cent), p < 0.01, than group I at 33/192 (17.2 per cent). The authors concluded that adding black cohosh to clomiphene-induction cycles with timed intercourse improves reproductive cycle health and the ability to get pregnant in PCOS sufferers.
A trial around the same time from a second research facility compared black cohosh on its own against clomiphene for ovulation induction in PCOS.11 One hundred women with PCOS were allocated into one of two groups: one group (50 women) received clomiphene 100mg daily for five days, and the other group (50 women) received black cohosh extract 20mg daily for 10 days. Both groups received the treatments starting from the second day of the cycle for three consecutive cycles. They were similar in terms of age, clinical presentation and hormonal levels before treatment. Following treatment, significant favourable changes in LH were seen in the herbal group. In this group, the progesterone level was higher from the first treatment cycle, indicating better ovulation, and endometrial thickness was greater. The pregnancy rate was also higher in the black cohosh group (seven versus four pregnancies) but the difference between the groups did not quite reach statistical significance (p = 0.1).
The reduction in LH level induced by black cohosh in both trials is consistent with other clinical findings.12 This suggests a role for the herb as part of the treatment of all those conditions that might benefit from a lowering of LH levels such as unexplained infertility, miscarriage, cyst formation, ovarian tumours and of course PCOS.
These trials support aspects of the traditional perspective on black cohosh. For example, it was a favourite of the Eclectic physicians, who used it for myalgia, neuralgia (not of spinal origin), chorea, female reproductive tract disorders (amenorrhoea, dysmenorrhoea, ovarian pain, and menorrhagia) and rheumatic conditions (arthralgia, muscular rheumatism). Black cohosh is also used to treat premenstrual syndrome and secondary amenorrhoea in Germany.12
Herbs effectively target insulin resistance
PCOS has been linked to insulin resistance and metabolic dysfunction. So it’s not surprising that an extract of cinnamon (in this case C. burmannii, a close relative of cassia cinnamon) was assessed in women with this disorder.13 In a prospective, placebo-controlled, double-blinded trial, 45 women with PCOS were randomised to receive cinnamon extract (1.5g/day) or a placebo for six months. Twenty six of the volunteers completed three months of the study and 17 completed the entire six months of the study. During the six-month intervention, menstrual cycles were more frequent in women taking cinnamon compared with those taking the placebo. However, measures of insulin resistance and serum androgen levels did not change for either group. These results should be regarded as preliminary, especially because of the high dropout rate for the trial (the cinnamon dose was rather high and might be one reason for this, the recommended 1,800 calorie dietary restriction could be another).
Fenugreek (Trigonella foenum-graecum) is a traditional treatment for type 2 diabetes with proven clinical value. In a double-blind, placebo-controlled trial, 58 women with PCOS and irregular periods were given an extract of fenugreek seeds (1g/day) with metformin, or metformin plus a placebo.14 While there was no additional benefit from the fenugreek on insulin resistance, ultrasound scans of the women’s ovaries revealed improvement only in the group taking fenugreek.
Wishing you the best of health,
Dr. Jonathan V. Wright
Nutrition & Healing
Vol. 9, Issue 4 • April 2015
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.