Preclinical and clinical studies provide evidence that six herbal medicines may have beneficial effects for women with oligo/amenorrhea, hyperandrogenism and PCOS. However the quantity of pre-clinical data was limited, and the quality of clinical evidence was variable. Further pre-clinical studies are needed to explain the effects of herbal medicines not included in this review with current clinical evidence but an absence of pre-clinical data.
In a patient not seeking pregnancy, the Endocrine Society recommends hormonal contraception (i.e., oral contraceptive, dermal patch, or vaginal ring) as the initial medication for treatment of irregular menses and hyperandrogenism manifesting as acne or hirsutism.19,30 Small studies have shown that metformin can restore regular menses in up to 50% to 70% of women with PCOS,39,40 but oral contraceptives have been shown to be superior to metformin for regulating menses and lowering androgen levels.30 There are no studies demonstrating superiority of one oral contraceptive over another in treating PCOS. Prevention of endometrial hyperplasia from chronic anovulation may be accomplished either by progesterone derivatives, progestin-containing oral contraceptives, or the levonorgestrel-releasing intrauterine system (Mirena).31,41 Patient comfort and preference should also be taken into account when treating irregular menses.
Myo-Inositol es un compuesto que debe transformarse en el cuerpo en D-Chiro-Inositol. Sin embargo en las mujeres con el Síndrome de Ovario Poliquístico esta transformación no es completa y por eso surge el déficit en D-Chiro-Inositol. El aporte que hace PCOS® de D-Chiro-Inositol compensa ese déficit de los cuerpos que sufren Síndrome de Ovario Poliquístico.
During a transvaginal ultrasound, your doctor or a medical technician inserts a wandlike device (transducer) into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs, including your ovaries. On an ultrasound image (inset), a polycystic ovary shows many follicles. Each dark circle on the ultrasound image represents a fluid-filled follicle in the ovary. Your doctor may suspect PCOS if you have 20 or more follicles in each ovary.
A case control study examining 100 infertile women with PCOS found that those who supplemented a daily 1500 mg dose of metformin, a medication commonly used to treat PCOS symptoms, with calcium and vitamin D saw improvements in BMI, menstrual abnormalities, and other symptoms. The women in the study added 1,000 mg of calcium a day and 100,000 IU of vitamin D a month to their daily metformin dose for six months.
One laboratory study and two clinical investigations provided evidence for the two herb combination, Glycyrrhiza uralensis and Paeonia lactiflora[53, 58, 59] (Table 1). An animal study found significant reductions in free and total testosterone following exposure to the combination  (Table 1). These findings were supported in two open label clinical trials including women with PCOS (n = 34)  and women with hyperandrogenism (n = 8) . Both trials examined the effects on androgens for the aqueous extract TJ-68 (equal parts Glycyrrhiza uralensis and Paeonia lactiflora), 75 grams per day for 24 weeks and 5–10 grams per day for 2–8 weeks respectively. In the trial including women with PCOS, mean serum testosterone was significantly reduced from 137.1 ng/dL (±27.6) to 85.3 ng/dL (±38), p < 0.001 at four weeks of treatment . Similar effects were observed in the women with oligomenorrhoea and hyperandrogenism which showed serum testosterone reduced from 50-160 ng/dL prior to treatment to less than 50 ng/dL . However statistical significance was not reached due to the small sample size despite positive outcomes in seven out of eight participants (Table 1).
“There are very good fertility options for PCOS women that have been well studied with randomized clinical trials,” says Dunaif. If a woman wants to become pregnant, her doctor may prescribe oral medication that work very well to induce ovulation, like clomid or letrozole (traditionally a breast cancer treatment but is now also used off-label to stimulate ovulation). Injectable gonadotrophins may also be used, as well as in vitro fertilization (IVF).
Increasing evidence in animal models and in humans shows that sympathetic nerve activity controls ovarian androgen biosynthesis and follicular development. Thus, sympathetic nerve activity participates in the follicular development and the hyperandrogenism characteristics of polycystic ovary syndrome, which is the most prevalent ovarian pathology in women during their reproductive years. In this study, we mimic sympathetic nerve activity in the rat via "in vivo" stimulation with isoproterenol (ISO), a β-adrenergic receptor agonist, and test for the development of the polycystic ovary condition. We also determine whether this effect can be reversed by the administration of propranolol (PROP), a β-adrenergic receptor antagonist. Rats were treated for 10 days with 125 μg/kg ISO or with ISO plus 5 mg/kg PROP. The ovaries were examined 1 day or 30 days following drug treatment. While ISO was present, the ovaries had an increased capacity to secrete androgens; ISO + PROP reversed this effect on androgen secretory activity. 30 days after treatment, androstenedione secretion reverted to normal levels, but an increase in the intra-ovarian nerve growth factor (NGF) concentration and luteinizing hormone (LH) plasma levels was detected. ISO treatment resulted in follicular development characterized by an increased number of pre-cystic and cystic ovarian follicles; this was reversed in the ISO + PROP group. The lack of change in the plasma levels of progesterone, androstenedione, testosterone, or estradiol and the increased LH plasma levels strongly suggests a local intra-ovarian effect of ISO indicating that β-adrenergic stimulation is a definitive component in the rat polycystic ovary condition.
Disclosure: Eli Lilly & Co Grant/research funds Investigator; MacroGenics, Inc Grant/research funds Investigator; Ipsen, SA (formerly Tercica, Inc) Grant/research funds Investigator; NovoNordisk SA Grant/research funds Investigator; Diamyd Grant/research funds Investigator; Bristol-Myers-Squibb Grant/research funds Other; Amylin Other; Pfizer Grant/research funds Other; Takeda Grant/research funds Other
Goodman, N. F., Cobin, R. H., Futterweit, W., Glueck, J. S., Legro, R. S., & Carmina, E. (2015). American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 1. Endocrine Practice, 11, 1291–300.