Polycystic ovary syndrome (PCOS) is one of the most common disorders which cause infertility in women of reproductive age.
How is PCOS diagnosed?
PCOS is usually diagnosed by the presence of 2 of the following 3 criteria:
oligo- and/or anovulation,
clinical and/or biochemical hyperandrogenism, and
ultrasound showing polycystic ovaries, with the exclusion of other illnesses. [1]
What are the current treatment for PCOS and why alternative medicine is useful?
Women experience absence of menstrual cycles in PCOS and oral contraceptives are usually prescribed to PCOS patients. However, in women who wish to conceive, oral contraceptives are inappropriate.
Clomiphene is usually the first line of treatment to induce ovulation in PCOS patients. However, it is associated with a number of side effects including hot flashes, breast discomfort, abdominal distention, nausea, vomiting, nervousness, headache, hair loss, and disturbed vision.[2]
Metformin, another drug used to treat PCOS as well as diabetes, have also been linked to a series of side effects such as gastrointestinal tract discomfort and dizziness. [3]
Therefore, there has been a lot of clinical interest in this particular field, prompting clinical trials to evaluate the effectiveness of TCM in treating PCOS.
Below are some of the ways which PCOS can be treated by TCM.
1. Acupuncture
Acupuncture is an integral part of Traditional Chinese Medicine (TCM), which has more than 3,000 years of history. In recent years, the use of acupuncture to treat reproductive endocrinology and infertility has became more popular [4]. It works probably by modulating sympathetic activity arises and increases ovarian blood flow, an effect mediated as a reflex response via ovarian sympathetic nerves and via Central Nervous System [5].
A randomized controlled trial (RCT) found that 14 fourteen acupuncture treatments when combined with electrical and manual stimulation of the needles during 16 weeks, improved menstrual bleeding pattern and decreased high levels of sex steroid precursors, estrogens and androgens in women with PCOS when compared to 16 weeks of physical exercise with no treatment. [6]. In an another study, daily abdominal acupuncture during 6 months improved menstrual frequency and decreased circulating testosterone more effectively than metformin in the same period [7].
Therefore, there is promising evidence that acupuncture can help with PCOS and fertility, although more clinical research has to be done.
2. Moxibustion
Moxibustion is a noninvasive TCM therapy, has long been applied in various obstetrical and gynecological conditions, such as primary dysmenorrhea[8] and ovulation disorders.[9] Moxibustion has also been used along with chinese herbs in treating gynecological disorders including PCOS, especially in China.[10]
Moxibustion is a TCM method of heating certain acupuncture points on the skin, by putting moxa, a dried plant mugwort (Artemisia vulgaris) on skin points and burning it. According to TCM, this helps to regulate normal flow of Qi. TCM describes infertility as an imbalance of Qi and Yang in the lower abdomen of women, known as 'cold womb'. [11] Therefore, moxibustion is often used in TCM treatments to manage infertility.
A small randomized, controlled trial in Brazil showed that acupuncture with moxibustion in addition to in vitro fertilization(IVF) significantly improved clinical pregnancy rates in women who had embryo implantation failure.[12] Of course, more robust clinical trial will be needed in future to validate this.
3. Chinese Herbs
TCM formulas and herbs have been used to treat female gynecological disorders for hundreds of years. They are used to treat the imbalance of Qi, Blood, Yin and Yang in one's body. It is a process which first comprises of four diagnosis by a TCM physician, before a formula is prescribed. According to a study done, kidney deficiency with blood-stasis syndrome was the most frequent pattern noted in PCOS patients, followed by Spleen-deficiency with phlegm-dampness syndrome. [13]. However, in my clinical practice, patients present with different constitution and phenotypes that it is essential every patient is treated as an separate entity and varied individual. This is crucial for optimum treatment to be ensured for each patient.
Bottom Line
As with TCM formulas and single Chinese herbal therapy, acupuncture and moxibustion have also been used to treat female infertility disorders for many years. As PCOS is discovered only in the Western Medicine era, PCOS term is not found in TCM classics. However, its underlying pathogenesis in terms of TCM can still be traced to TCM classics, and by applying the TCM principles in treating PCOS patients, the success rate can still be improved.
[1] Rotterdam ESHRE/ASRM-Sponsored, PCOS, Consensus Workshop GroupRevised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19–25.
[2] Legro RS, Barnhart HX, Schlaff WD, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007;356:551–66.
[3] Costello M, Shrestha B, Eden J, et al. Insulin-sensitising drugs versus the combined oral contraceptive pill for hirsutism, acne and risk of diabetes, cardiovascular disease, and endometrial cancer in polycystic ovary syndrome. Cochrane Database Syst Rev 2007;(1):CD005552.
[4] C. Coulson and J. Jenkins, “Complementary and alternative medicine utilisation in NHS and private clinic settings: a United Kingdom survey of 400 infertility patients,” Journal of Experimental and Clinical Assisted Reproduction, vol. 2, article 5, 2005.
[5] L. Manni, T. Lundeberg, A. Holmang, L. Aloe, and E. Stener- ¨ Victorin, “Effect of electro-acupuncture on ovarian expression of 𝛼(1)- and 𝛽(2)-adrenoceptors, and p75 neurotrophin receptors in rats with steroid-induced polycystic ovaries,” Reproductive Biology and Endocrinology, vol. 3, article 21, 2005.
[6] E. Jedel, F. Labrie, A. Oden et al., “Impact of electro- ´ acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial,” American Journal of Physiology, vol. 300, no. 1, pp. E37–E45, 2011.
[7] M.-H. Lai, H.-X. Ma, H. Yao et al., “Effect of abdominal acupuncture therapy on the endocrine and metabolism in obesity-type polycystic ovarian syndrome patients,” Acupuncture Research, vol. 35, no. 4, pp. 298–302, 2010.
[8] Kim SO, Cho SH. The effect of hand acupuncture therapy and moxibustion heat therapy on dysmenorrhea. Korean Acad Womens Health Nurs 2001;7:610–21.
[9] Peng Y, Hou LH, Wu XK. Advances of modern studies of acupuncture and moxibustion for treatment of ovulation disorders. Zhongguo Zhen Jiu 2006;26:756–9.
[10] Zhang CR, Shen T. Thirty cases of PCOS treated by the according to stage moxibustion on medicinal cake and acupuncture. Zhongguo Zhen Jiu 2012;32:42
[11] Matsumoto K, Euler D. Kiiko Matsumoto's Clinical Strategies: In the Spirit of Master Nagano. Vol. 2. 2012: 287.
[12] N. Young. Acupuncture and Moxibustion May Increase Pregnancy Rates in IVF after Embryo Implantation Failure. Integrative Medicine Alert 17(1):8-11 · January 2014
[13] Li XB, Lan XY, Ou AH. Distribution of Chinese medicine syndrome patterns and its laws in patients with polycystic ovarian syndrome. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2011;31:323-326. PMID: 21485070