Key terms for the first search included: title or abstract CONTAINS ‘herbal medicine’ OR ‘herbal extract*’ OR ‘phytotherapy’ OR ‘botanical’ AND title or abstract CONTAINS ‘androgen*’ OR ‘oestrogen*’OR ‘follicle stimulating hormone’ OR ‘luteinising hormone’ OR ‘prolactin’ OR ‘insulin’ OR ‘glucose’ OR ‘polycystic ‘ovar*’. Search terms for the second search included the following key words in the title or abstract, CONTAINS; ‘menstrual irregularity’ OR ‘oligomenorrhoea’ OR ‘amenorrhoea’ OR ‘hyperandrogenism’ OR ‘hirsutism’ OR ‘acne’, OR ‘polycystic ovary syndrome’ OR ‘PCOS’ OR ‘polycystic ovar*’ OR ‘oligo-ovulation’ OR ‘anovulation’ OR ‘fertility’ OR ‘infertility’ OR ‘pregnancy’ AND ten herbal medicines identified from the laboratory search; ‘Cimicifuga racemosa’ OR ‘Cinnamomum cassia’ OR ‘Curcuma longa’ OR ‘Glycyrrhiza ‘ OR Matricaria chamomilla OR ‘Mentha piperita’ OR ‘Paeonia lactiflora’ OR ‘Silybum marianum’ OR ‘Tribulus terrestris’ OR ‘Vitex agnus-castus’. Truncation was used to capture plural key words and synonyms, and acronyms were used for some hormones (FSH and LH).
As many as 70% of PCOS women are insulin resistant and 10% have DM[20-22]. In PCOS women with normal glucose metabolism initially, the rate of conversion to abnormal glucose metabolism can be 25% over just three years[23]. More alarming, insulin abnormalities are highly prevalent in adolescents with PCOS[24]. Almost 20% of young Thai women with PCOS actually have DM[25]. Overall, normal glucose levels on an OGTT do not predict IR and IR, despite normal glucose levels, is correlated with CRP, dyslipidemia and other CAD risk factors[26]. Therefore, glucose levels alone lack the sensitivity to predict metabolic risk in PCOS patients. Precursor states of insulin abnormalities likely predict long term CAD risk well before glucose abnormalities. IR can be just as severe in diabetics and non-diabetics[27], stressing the seriousness of this metabolic impairment as a precursor and not a separate disease. Animal models have shown that IR alone damages myocardial cells, providing direct evidence of end organ disease[28]. Human data link HOMA-IR to left ventricular dysfunction[29]. Abnormal glucose metabolism short of IGT and DM still deserves attention, identification and treatment[30].
High levels of androgens. Androgens are sometimes called "male hormones," although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.