Overview of systematic reviews of non-pharmacological interventions in women with polycystic ovary syndrome

Jyotsna Pundir et al, Hum Reprod Update, Volume 25, Issue 2, 2019, Pages 243–256

Human Reproduction Update

The authors reviewed 12 systematic reviews of randomized trials (high quality score AMSTAR) that have evaluated the effects of non-pharmacological interventions, such as lifestyle interventions, nutritional supplements or acupuncture and Chinese medicine in women with PCOS on fertility, endocrine, glycaemic and weight-related outcomes. Acupuncture and Chinese medicine, N-acetylcysteine and inositol were all seen to improve ovulation and show preliminary potential to improve fertility (odds ratios (OR) for clinical pregnancy rate range from 1.99 to 4.83)

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ACUPUNCTURE, HERBS AND PCOS: Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture

Foundation of American Experimental Biology Journal

This study explores the underlying mechanism for electroacupuncture and its use in PCOS. The results indicate that applying just one session of low frequency electroacupuncture can reduce blood sugar in overweight women with PCOS. This adds to the mounting evidence that electroacupuncture could be a valid treatment option for some PCOS patients.

Conclusions on clinical application will await an RCT.

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Herbal Medicines for Treating Metabolic Syndrome: A Systematic Review of Randomized Controlled Trials

Jang et al, Evid Based Complement Alternat Med. 2016:5936402

Evidence Based Complementary and Alternative Medicine

One of the concerns of many overweight or PCOS patients is elevated insulin levels and abdominal obesity, such as is seen in metabolic syndrome.  A reduction in these is correlated with better ovary function in these patients.

This systematic review examines the effect of Chinese herbs on such parameters and concluded that they could contribute to clinical management.

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Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis

Junyoung Jo and  Yoon Jae Lee, 2017 Acup in Med, Vol: 35 issue: 3, 162-170

British Medical Journal; Acupuncture in Medicine

This systematic review of randomised controlled trials examined the effect of acupuncture on 430 PCOS patients undergoing IVF, The findings indicate that acupuncture (both electro acupuncture and manual acupuncture) improves pregnancy rates and reduces the risk of OHSS. Acupuncture was delivered only during the IVF cycle and did not improve live birth outcomes in this review. Further studies are recommended to examine the efficacy and safety of acupuncture in PCOS patients doing IVF.

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Effectiveness of Abdominal Acupuncture for Patients with Obesity-Type Polycystic Ovary Syndrome: A Randomized Controlled Trial

Zheng YH et al, Jnl of Alt and Comp Med, 2013 Sep;19(9):740-5.
The Journal of Alternative and Complementary Medicine  

In this RCT 86 overweight PCOS patients were divided into acupuncture or Metformin groups and treated for 6 months before assessing a range of outcomes. While both groups improved, the acupuncture group responded significantly better than those given Metformin  in terms of increased frequency of ovulation and weight loss. Read More

Acupuncture for ovulation induction in polycystic ovary syndrome: A randomized controlled trial.

 Johansson J et al, Am J Physiol Endocrinol Metab. 2013 May 1;304(9):E934-43
American Journal of Physiology – Endocrinology and Metabolism 

This RCT showed that repeated acupuncture treatments increased ovulation frequency in PCOS patients and abnormally high ovarian and adrenal hormone levels were reduced, compared to controls subjects who had no acupuncture. Larger trials are needed to confirm this result.

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Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome.

Rashidi BH et al, Acupunct Med. 2013; 31(2):151-6
Acupuncture in Medicine (BMJ)

This randomised controlled trial divided 62 PCOS/IVF patients into a group who were given 5 acupuncture treatments once they commenced the IVF drugs and a group with usual care. There was no difference in the pregnancy rate between these 2 groups. Larger trials are needed to examine the effect of acupuncture on PCOS patients having IVF, and the effective acupuncture dose needs to be determined.

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Influence of acupuncture on leptin, ghrelin, insulin and cholecystokinin in obese women: a randomised, sham-controlled preliminary trial

Funda Gucel et al, Acup Med, 2012, Vol 30, Issue 3

BMJ journals, Acupuncture in Medicine

Not all PCOS patients have difficulties managing their weight. However where weight is a contributing factor, acupuncture may be considered as part of a successful weight loss programme.

This small RCT shows that acupuncture may help to reduce weight and indicates that it’s mechanisms may be beneficial effects on the relevant hormones. Larger RCTs will help to elucidate further.

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A systematic review on use of Chinese medicine and acupuncture for treatment of obesity

Sui Y et al, 2012, Obesity Rev, Vol 3, p 409–430
Obesity Reviews

This systematic review (which is not specific to obesity only in PCOS patients) collected data from RCTs that examined the effect of acupuncture and/or Chinese herbal medicine on nearly 5000 overweight patients, compared with a control group of nearly 4000 overweight subjects. The review reports that in terms of weight loss, acupuncture and Chinese herbal medicine are better than placebo and lifestyle interventions and have similar efficacy to anti-obesity drugs (including Metformin), but with fewer side effects. This review also noted that those who used acupuncture or Chinese herbal medicine to lose weight had a lower risk of relapse. More large RCTs are recommended before recommendations for therapeutic interventions can be made.

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True and Sham Acupuncture Produced Similar Frequency of Ovulation and Improved LH to FSH Ratios in Women with Polycystic Ovary Syndrome

Pastore L et al, 2011 Jnl Clin Endocrinol Metab Aug online jc.2011-1126 The Journal of Clinical Endocrinology & Metabolism

Pastore L et al, 2011 Jnl Clin Endocrinol Metab Aug online jc.2011-1126
Journal of Clinical Endocrinology & Metabolism

In a randomised controlled trial, a reduction in LH levels and an increase in ovulation frequency was found in PCOS patients having acupuncture using either real needling or sham needling (which pricks rather than penetrates the acupuncture points in a manner similar to Japanese acupuncture). True acupuncture but not sham acupuncture reduced levels of testosterone and insulin in the women who ovulated. Read More

Impact of EA and physical exercise on hyperandrogenism and oligo/amenorrhea in women with PCOS.

This trial found that 4 months of acupuncture effectively reduced testosterone and improved ovulation frequency in PCOS patients, and was superior to exercise in achieving these aims.

Jedel E et al, Am J Physiol Endocrinol Metab 2011 300:(1) E37-E45
American Journal of Physiology

This small RCT found that 4 months of electro-acupuncture effectively reduced testosterone and improved ovulation frequency in PCOS patients, and was superior to exercise in achieving these aims. Read More