A polycystic ovary is defined as an ovary containing 12 or more follicles (or 25 or more follicles using new ultrasound technology) measuring 2 to 9 mm in diameter or an ovary that has a volume of greater than 10 mL on ultrasonography. A single ovary meeting either or both of these definitions is sufficient for diagnosis of polycystic ovaries.23,25 However, ultrasonography of the ovaries is unnecessary unless imaging is needed to rule out a tumor or the patient has met only one of the other Rotterdam criteria for PCOS.19,26 Polycystic ovaries meeting the above parameters can be found in as many as 62% of patients with normal ovulation, with prevalence declining as patients increase in age.27
An animal study compared the effectiveness of Cinnamomum cassia and the pharmaceutical Metformin on hormone concentration in rats with PCOS [48] (Table 1). Both interventions demonstrated significant improvements compared to controls at 15 days for measures of testosterone ng/ml (control 0.747 ± 0.039; metformin 0.647 ± 0.027; Cinnamomum cassia 0.625 ± 0.029); LH ng/ml (control 7.641 ± 0.267; metformin 6.873 ± 0.214; Cinnamomum cassia 6.891 ± 0.221) and insulin resistance (HOMA-IR) (control 10.018 ± 0.217; metformin 7.067 ± 0.184 Cinnamomum cassia 8.772 ± 0.196) (p < 0.05) [48]. The metabolic effects for Cinnamomum cassia were further demonstrated in overweight women with oligo/amenorrhoea and PCOS in a placebo controlled RCT [66] (Table 2). However, although the RCT had low risks for bias, it was a pilot study primarily investigating feasibility. Outcomes were promising for metabolic profile in PCOS however the sample size was small and the authors recommended further studies.
Androgen lowering effects for Glycyrrhiza spp. have been demonstrated in one laboratory study examining hormone concentration in female rats (Glycyrrhiza uralensis), [53] and corroborated in two clinical trials, one including healthy women [55] and the other including women with PCOS (Glycyrrhiza glabra) [54] (Table 1). The animal study reported significantly reduced free and total testosterone and increased oestradiol in sterilised rats and no hormonal changes in oophrectomised rats. The authors conclude that the hormonal effects occurred primarily in the ovary via enhanced aromatisation of testosterone to 17-beta oestradiol. The investigators also observed significantly increased oestradiol. There were no changes to FSH or LH in androgen sterilised or oophrectomised rats [53].
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