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Herbal Management of PCOS

This is an article I wrote for the newsletter "In Touch" produced by Verity, the polycystic ovaries self help group.  I would recommend to any woman with PCOS that they join Verity, membership costs a mere £15 per year (£7 for concessions).  The website is at www.verity-pcos.org.uk or e-mail  veritymembs@aol.com

I have left in the editor's comments.

Introduction

PCOS is a poorly understood, complex, multifactorial syndrome involving both genetic and environmental influences (a bit like life, really). It is the most common endocrine abnormality in women of reproductive age. However, just because we don't understand a condition doesn't mean that we can't treat it. Throughout human history people have tried to explain disease with theories of differing credibility, while treatment (until the modern era) has stayed pretty much the same.

Symptoms

The symptoms of PCOS can roughly be lumped into four main groups for convenience, although they obviously all interact:

1. Hormonal – lack of periods, irregular periods, painful periods, premenstrual syndrome, infertility

2. Acne

3. Hirsutism

4. Metabolic – weight gain, insulin resistance, diabetes.

Women with PCOS can vary from having only one of these symptoms mildly to having all four severely, and this will affect the nature of the herbal treatment.

Herbal treatment

The aim of herbal treatment is to enable the body to readjust the excess levels of hormones to more 'normal' levels so that the menstrual cycle can occur in a 'normal' manner. In my experience, this often occurs very successfully, although the further the body is from 'normal', the longer it may take, and the less the likelihood of success eg women with irregular periods achieve a 28-day cycle much faster and more successfully than women who are completely without periods.

As the majority of my patients come to see me because they are trying to conceive or want to regulate their periods, I tend to concentrate on the first category of symptoms. I usually use a mixture of Chinese and traditional Western herbs:

Vitex agnus castus (chasteberry) – I give this separately, to be taken first thing in the morning, when it seems to be most effective. There is some debate as to whether vitex is appropriate for PCOS, but the majority of herbalists use it and find it effective. Reports from my patients indicate that it can maintain menstrual regularity on its own once this has been achieved with the other herbs, and it also reduces hair growth.

Angelica sinensis (Chinese angelica/dong gui) and Paeonia lactiflora (peony root/bai shao) – these two are often used together in traditional Chinese medicine for the treatment of menstrual irregularity and combine well with Glycyrrhiza glabra (liquorice root) – although this should not be used medicinally if there is high blood pressure.

Other herbs that might be used include:

Taraxacum officinalis radix (dandelion root) – Western herbal medicine places great emphasis on the liver and a PCOS formula would often contain ‘hepatics’ or liver herbs. Examples are milk thistle, barberry, schisandra berry and dandelion root. The latter is used to increase bile flow and biliary excretion of conjugated hormones, and also to increase production of sex hormone binding globulins (SHBGs), which basically ‘mop up’ free testosterone in the body, thus reducing its effects, including acne and hirsutism (see Jargon-buster box).

Cimicifuga racemosa (black cohosh root) – recent research has shown this herb contains three types of hormonally active compound, one of which suppress luteinising hormone secretion after prolonged administration.

Humulus lupulus (hops) – this has an action similar to black cohosh, but is used where stress and nervous tension accompany PCOS.

Trifolium pratense (red clover) – contains phyto-oestrogens and also acts as an alterative (blood purifier), so is useful where acne is a problem.

Hypericum perforatum (St John's wort) – used where depression, other than that of PMS, accompanies PCOS.

Treating acne and hirsutism

As these both occur as a result of excess androgens I will discuss them together. In PCOS there is an excess of testosterone produced in the follicles which is converted to dihydrotestosterone in the target tissues by the enzyme 5-alpha-reductase, and it is this action that causes the acne and male-pattern hair growth. The herb saw palmetto (Serenoa serrulata) has long been used for blocking this conversion in the male prostate, and logically should be of use in PCOS. However, actual experience is very variable, with some women reporting improvements but others experiencing a worsening of the symptoms.

Another indicated herb, or group of herbs, is Epilobii herba (E. angustifolium, E. parviflorum, E. hirsutum), which has been used in Europe for prostate problems. Recent research in Germany has shown that an infusion (ie a tea) can inhibit the enzyme 5-alpha-reductase, so again logically this would be a good herb to use, although so far it has not been used in PCOS long enough for there to be any results either way (Ed’s note: I have used it with some success for acne, and it actually tastes quite pleasant – a first for a herbal treatment?!).

So try either and see what happens. In my experience, if the menstrual cycle can be regulated or initiated, then the acne will improve although not, for some reason, the hair growth.

Metabolic symptoms

These are best controlled by a mixture of dietary change (eg the GI diet), lifestyle change (eg lots of exercise) and supplementation. I normally recommend a minimum of hemp seed oil (for the essential fatty acids it contains – see here) and a B-vitamin complex. More might be required eg chromium, depending on the person. Some herbalists also use herbs to regulate blood sugar and lipid levels; examples are Gymnema sylvestre, an Indian plant known as the ‘sugar destroyer’, Galega officinalis (goat's rue – NB guanidine, the active ingredient in goat's rue, was the inspiration for metformin) and Trigonella foenum-graecum (fenugreek).

To sum up, I hope I have shown that although PCOS is poorly understood, herbs can successfully be used, alongside supplements, lifestyle and dietary change, to treat the symptoms and successfully manage the syndrome.

Jargon-buster: conjugated hormones and SHBGs

Sex hormones are steroids ie fats and are therefore water insoluble – which is why they need the sex hormone binding globulins or SHBGs (which are water-soluble proteins) to move through the bloodstream. In order to get rid of used or excess hormones the liver conjugates, or joins, them with another molecule to make them water soluble. They are then excreted via the bile duct into the gut. If they hang about in the gut too long these conjugates are broken down by bacteria in the gut and the hormone component is reabsorbed into the hepatic portal vein. This is known as entero-hepatic recirculation. So by increasing bile flow you are helping to both improve the clearance of excess hormones via the liver and reduce the amount of entero-hepatic recirculation. Improved bowel function also helps to reduce insulin levels.

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Copyright © Graham White, B. Sc. Herb Med, 2014