Author: Rositsa Tashkova, Master of Molecular Biology and Microbiology
Polycystic ovary syndrome (PCOS) is a complex endocrine disease that needs to be considered and treated taking into account all its aspects. Often the condition is related to something else - insulin resistance and this fact can be used as a starting point for treatment [ref.1]. If insulin resistance is controlled, this will have a significant positive effect on polycystic ovary syndrome.
Several characteristic manifestations of the syndrome are observed: the formation of cysts in the ovaries, lack of ovulation, irregular menstrual cycle, increased hair growth, acne, thinning of hair. Cysts in the ovaries are the most typical symptom and are detected during ultrasound examination by a gynecologist.
Polycystic ovary syndrome is one of the most common causes of infertility in women, due to the fact that ovulation does not occur or it is difficult to predict when this is most likely to happen if it does.
More and more women are looking for alternative ways to tackle the problem, i.e. regulating the cycle with changes in lifestyle, nutrition, with the help of herbs and andsupplements. In the article "What is the connection between polycystic ovaries, insulin resistance and infertility", we discussed the importance of sports and nutrition to deal with the problem, and in this article we will focus on herbs and supplements for which there is scientific evidence that can help those who suffer from polycystic ovaries.
As mentioned, polycystic ovary syndrome is a complex condition, Since reproductive health is loaded with additional emotional burden, this problem requires particular respect - it is extremely important to consult with your physician about each herb or supplement that you would like to take, so as not to inadvertently aggravate your condition. Each organism has its own specifics and each case is different - the doctor's job is to detect these differences and prescribe individual therapy to each patient.
In the following lines, we will look at scientific data on the benefits of certain herbs and supplements - information you can discuss with your physician. :)
Liquorice root lowers testosterone levels (Glycyrrhiza glabra and Glycyrrhiza uralensis)
Several preclinical and clinical trials of the effect of licorice have been conducted and it has been found that the herb can lower levels of testosterone and androgens in the blood, as well as improve the frequency of ovulation in women with polycystic ovaries [ref.2].
Maca improves fertility in both men and women (Lepidium meyenii)
Maca is also known as Peruvian ginseng. The root of the maca plant is often recommended as a means of improving fertility in both men and women, and for increasing libido. Unfortunately, there are no clinical trials that prove the benefit of maca in women with polycystic ovary syndrome, although the herb is used and prescribed very often. [ref.4]
This tree has many names - chaste tree (or chastetree), chasteberry, Abraham's balm, lilac chastetree, or monk's pepper. It is good to keep in mind that it can suppress sexual desire. There is evidence that it regulates the levels of sex hormones, cycles and can increase the chances of success in getting pregnant. [ref.5]
Black cohosh has multiple effects on female reproductive system (Cimicifuga racemosa)
The plant is also known as black bugbane, black snakeroot, or fairy candle. Several preclinical and at least 3 clinical studies have been conducted on the effects of black cohosh in women suffering from PCOS. Their results are encouraging and include lowering LH (luteinizing hormone), optimizing the ratio between hormones LH and FSH (favors ovulation) [ref.6], positive influence on the thickness of the endometrium (uterine mucosa) and others. [ref.2]
The cassia is a relative of the cinnamon and its bark is also used as a spice. There are at least two studies that show beneficial effect of the plant in polycystic ovary syndrome. One was conducted in rats and compared the effects of metformin with those of the herb [ref.7]. The other was conducted in overweight women and those with PCOS [ref.8].
In the 1980s, Bulgarian scientists conducted two clinical trials in women and found that the herb Tribulus terrestris increased FSH in healthy women [ref. 9] and induced ovulation in women who did not ovulate [ref.10].
According to a 2019 science review, fenugreek (Trigonella foenum-graecum) and cinnamon (Cinnamomum verum) are also worth attention, as they may exhibit additional positive effects on ovulation and menstrual disorders, obesity, insulin resistance, fat metabolism disorders and high levels of male sex hormones - androgens. [ref.12]
Other supplements and minerals
Inositol (vitamin B8) - ratio between its two forms is the key
It has been found that inositol restores ovulation and improves insulin sensitivity in women suffering from PCOS. It is found in two forms (stereoisomers) in supplements - myo-inositol and D-chiro-inositol. [ref.13]
In a 2020 article, scientists from the South Florida Institute of Reproductive Medicine wrote:
"... it is important to know that D-chiro-inositol treatment may be beneficial when administered in low doses, yet the progressive increase of its dosage results in the loss of its advantageous effects on the reproductive performance of women and a deterioration in the quality of blastocysts created via in vitro fertilization (IVF). In addition, we have to consider that the intestinal absorption of myo-inositol is reduced by the simultaneous administration of D-chiro-inositol since the two stereoisomers compete with each other for the same transporter that has similar affinity for each of them. A decrease in myo-inositol absorption is also found when it is coadministered with inhibitors of sugar intestinal absorption and/or types of sugars such as sorbitol, maltodextrin, and sucralose. The combination of these may require higher amounts of myo-inositol in order to reach a therapeutic dosage compared to inositol administration alone, a particularly important fact when physicians strive to obtain a specific plasma level of the stereoisomer. Finally, we must point out that D-chiro-inositol was found to be an aromatase inhibitor which increases androgens and may have harmful consequences for women. Therefore, the inositol supplements used in PCOS treatment must be carefully defined. Clinical evidence has demonstrated that the 40 : 1 ratio between myo-inositol and D-chiro-inositol is the optimal combination to restore ovulation in PCOS women. Therefore, it is quite surprising to find that inositol-based treatments for PCOS seem to be randomly chosen and are often combined with useless or even counterproductive molecules, all of which can weaken myo-inositol's efficacy." [ref.14]
Unfortunately, the same disproportion in the ratio between the two forms of inositol is also observed in widespread additives on the market.
Zinc is important for both men and women
Zinc is a trace element that is proven to be important for the proper functioning of the immune and reproductive system in both men and women. It can help regulate the menstrual cycle, affect insulin resistance and reduce the number of ovarian cysts [ref.15].
Vitamin D deficiency is a risk factor for PCOS
It has been found that a large percentage of women with polycystic ovary syndrome have vitamin D deficiency [ref.16]. There is evidence that restoring normal levels of this vitamin in the body can help deal with the problem.
According to one study in rats, the vitamin has contributed to normalization of the structure of the endometrium (lining of the uterus), which favors implantation of the embryo if fertilization occurs. In women with PCOS, implantation is difficult. [ref.17]
This article does not claim to be exhaustive, but we hope that it will give guidance to sufferers of polycystic ovary syndrome (PCOS) and will contribute to improving their chances of getting pregnant and dealing with the problem.