Polycystic Ovarian Syndrome (PCOs) in herbs' Points of View

  Kyle J. Norton (Draft article)

Epidemically, increased incidence and prevalence of overweight and obesity over 3 decades in the develop world now has spread to South East population, due to over 20 years of economic prosperity causes of lifestyle changes in populations with very different initial habits. Suggestions of reduced fat intake less than 30% of total calories with a low proportion of saturated fat with high in fiber from predominantly low-glycaemic-index-carbohydrate foods is recommended. Calorie intake should be distributed between several meals per day with restricted intake of snacks and drinks(1)(2).

Polycystic Ovarian Syndrome is defined as endocrinologic diseases caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries as resulting of enlarged ovaries, leading to hormone imbalance( excessive androgen), resulting in male pattern hair development, acne,irregular period or absence of period, weight gain and effecting fertility. It effects over 5% of women population or 1 in 20 women.

1. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belonging to the family Zingiberaceae, native to tropical South Asia. The herb has been used in traditional medicine as anti-oxidant, hypoglycemic, colorant, antiseptic, wound healing agent, and to treat flatulence, bloating, and appetite loss, ulcers, eczema, inflammations, etc.
 Berberine (BBR), a major chemical constituents found a abundantly in turmeric and plants such as goldenseal exerted its effect in improving some of the metabolic and hormonal derangement in a group of treated Chinese women with PCOS(3).

2. Korean red ginseng
Ginseng Asia is also known as Panax ginseng. Since it has been grown in the cold places in the Asian, Asian ginseng is considered as yang promoting, according to traditional Chinese medicine.
Korean red ginseng extract (KRGE) in the experiment in PCOs induced rat, using the long-acting compound estradiol valerate (EV), regulated sympathetic nerve activity by significantly lower expression of NGF protein (involved in the growth of peripheral nerve cells) and NGF mRNA(the form of RNA that carries information from DNA) involved in the abnormal process caused by steroid-induced PCO(4). Also, in the experiment of Ginseng total saponins (GTS) involved polycystic ovaries induced by a single intramuscular injection of 4 mg estradiol valerate (EV) in rats, GTS decreased the expression of NGF in ovary tissue(5).

3. Aloe vera
Aloe Vera is species of succulent plant in the genus Aloe, belonging to the Family Xanthorrhoeaceae, native to Sudan. It has become very popular for commercial cultivation due to its health benefits. Aloe vera has been used in herbal medicine in treating many kinds of disease, including wound, burn healing, minor skin infections, sebaceous cysts, diabetes, and elevated of cholesterol, etc. It is also one of many popular herb studied in scientific ways with some conflicted results.
Aloe vera gel (AVG) exhibited significant reduction in plasma triglyceride and LDL cholesterol levels, with an increase in HDL cholesterol and reversion of abnormal estrous cyclicity, glucose intolerance, and lipid metabolizing enzyme activities, to normal in PCOS induced in Charles Foster female rats(6). On Letrozole induced polycystic ovarian,  Aloe vera gel formulation exerted a protective effect in against the PCOS phenotype by restoring the ovarian steroid status, and altering key production of steroids activity(7).

4. Salvia miltiorrhiza (Dan Shen)
Dan Shen is also known as Red Sage Root. The bitter and slightly cold herb has been used in TCM as antithrombotic, antihypertonic (lowering blood pressure), antimicrobial, antipyretic, anti-inflammatory, sedative agent and to treat dysmenorrhea, amenorrhea, palpable tumors, angina,restlessness, insomnia, irritability, etc., by enhancing the functions of heart and liver. 
Cryptotanshinone, isolated from Salvia miltiorrhiza, in the experiment involved prenatally androgenized (PNA) rats as a model of polycystic ovary syndrome, improved estrous cycles, reduced 17-hydroxyprogesterone, androstenedione, testosterone, glucose, insulin levels, and  lowered AUC-Glu(Measurements were made of the area under the curve of glucose by intravenous glucose tolerance test) and HOMA-IR( a method used to quantify insulin resistance and beta-cell function)(8).

5. Chamomile
Chamomile is also known as camomile, common name of many species daisy-like plants in the family Asteraceae. The herb has been used in traditional medicine as antispasmodic and anti-inflammatory constituents and for treatments of menstrual cramps and sleep disorders, reduce cramping and spastic pain in the bowels, relieve excessive gas and bloating in the intestine, etc.
Intraperitoneal injections of Chamomile alcoholic-extract for ten days in the testing on the biochemical and clinical parameters in a rat model of PCOS not only induced recovery from a PCO induced state in rats, but also increased dominant follicles and better endometrial tissue arrangements(9).

6. Spearmint tea
Spearmint tea is a species of Mint belonging to the Lamiaceae, native to Europe and southwest Asia. The herb has been used in folk medicine for treatment of stomach ache.
Spearmint tea inhibited the production of the levels or activity of androgen hormones in the human body  may be considered as a natural agent for PCOs.(10). In Hirsutism polycystic ovarian syndrome (PCOS), drinking spearmint tea twice a day for a 1 month period, showed the significantly reduce total testosterone levels, due to the inhibition of  antiandrogen properties(11). In other study of polycystic ovary syndrome and idiopathic hirsutism, steep Spearmint tea for 5 days twice a day in the follicular phase of their menstrual cycles significant decreased in free testosterone and increased in luteinizing hormone, follicle-stimulating hormone and estradiol(12).

8.  Licorice
Gan Cao is also known as Licorice root. The sweet and neutral herb has been used in TCM as anti allergy, anti inflammation, anti ulcer, anti convulsion and to treat stomach weakness, tired and lack of strength, palpitation and short of breath, cough with abundance of phlegm, stomach and solar plexus pain, etc., as it tonifies the Spleen, benefits the Qi, moistens the Lungs, calms cough, deaf or acute pain, by enhancing all 12 channels. Combination of licorice and 100 mg spironolactone showed the activation of the renin-aldosterone system in lowering blood pressure and water (fluid) balance. These result showed licorice may be a potent agent for reducing the prevalence of side effects related to the diuretic activity of spironolactone(13). In model rats experiment, Ganshao Paste (CGP), showed the decrease of serum levels of LH, T, and FSH and increase of serum estradiol (E2), and progesterone (P)(14).

9. HemoHIM
HemoHIM is a herbal formula containing three edible herbs, Angelica Radix, Cnidium Rhizoma and Paeonia Radix approved by Korean FDA as  health functional supplement assisting functions of the immune system. In adult cycling rats, administered orally (100 mg/kg of body weight/day) for 35 consecutive days or injected intraperitoneally (50 mg/kg of body weight) every other day after EV injection, the formula lowered the high numbers of antral follicles and increased the number of corpora lutea, normalized Ovarian morphology and the expression of nerve growth factor (NGF) in PCOs(15)

Epidemiological studies, many herbs such as, Green tea, Milk thistle, Rosemary, Bupleurum, barberry and Schizandra linking to relieve symptoms of PCOs, prevent further disease and promote the body to heal itself have produced unfavorable results, excepting the above. Prevention and treatment of PCOs of  herbal medicine will be accomplished without accompanying healthy diet, life style and weight loss.
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References
(1) Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management by Farshchi H, Rane A, Love A, Kennedy RL(PubMed)
(2) The optimal diet for women with polycystic ovary syndrome? by Marsh K, Brand-Miller J.(PubMed)
(3) A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome by Wei W, Zhao H, Wang A, Sui M, Liang K, Deng H, Ma Y, Zhang Y, Zhang H, Guan Y.(PubMed).
(4) Effect of Korean red ginseng extract in a steroid-induced polycystic ovary murine model by Pak SC, Kim SE, Oh DM, Shim KM, Jeong MJ, Lim SC, Nah SY, Park SH, Kang SS, Moon CJ, Kim JC, Kim SH, Bae CS.(PubMed)
(5) [Effects of ginseng total saponins on nerve growth factor expression in rat with estradiol valerate-induced polycystic ovaries].[Article in Chinese] by Kuang HY, Shao H, Hou LH, Wu XK.(PubMed)
(6) Aloe barbadensis Mill. formulation restores lipid profile to normal in a letrozole-induced polycystic ovarian syndrome rat model by Desai BN, Maharjan RH, Nampoothiri LP.(PubMed)
(7) Effect of Aloe barbadensis Mill. formulation on Letrozole induced polycystic ovarian syndrome rat model by Maharjan R, Nagar PS, Nampoothiri L.(PubMed)
(8) Cryptotanshinone reverses reproductive and metabolic disturbances in prenatally androgenized rats via regulation of ovarian signaling mechanisms and androgen synthesis by Xinming Yang , Yuehui Zhang , Xiaoke Wu , Chun Sik Bae , Lihui Hou , Haixue Kuang , Yongyan Wang , Elisabet Stener-Victorin(American society physiology)
(9)Effects of chamomile extract on biochemical and clinical parameters in a rat model of polycystic ovary syndrome by Farideh ZZ, Bagher M, Ashraf A, Akram A, Kazem M.(PubMed)
(10) An update on plant derived anti-androgens. by Grant P, Ramasamy S.(PubMed)
(11) Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial by Grant P.(PubMed)
(12) Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. by Akdoğan M, Tamer MN, Cüre E, Cüre MC, Köroğlu BK, Delibaş N.(PubMed)
(13) Treatment of polycystic ovary syndrome with spironolactone plus licorice by Armanini D, Castello R, Scaroni C, Bonanni G, Faccini G, Pellati D, Bertoldo A, Fiore C, Moghetti P(PubMed)
(14) [Effects of compound ganshao paste on the levels of sex hormones and hepatic transaminases in polycystic ovarian syndrome rat model].[Article in Chinese] by Wang YH, Wang HL, Zhang YL.(PubMed)
(15) HemoHIM improves ovarian morphology and decreases expression of nerve growth factor in rats with steroid-induced polycystic ovaries by Kim SH, Lee HJ, Kim JS, Moon C, Kim JC, Bae CS, Park HR, Jung U, Jo SK.(PubMed)