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International Journal of Pharmaceutical and Phytopharmacological Research

ISSN (Online) 2249 – 6084

ISSN (Print) 2250 – 1029
Int.J.Pharm.Phytopharmacol.Res. 2012, 1(6): 396-402
(Review Article)

Natural Remedies for Polycystic Ovarian Syndrome (PCOS) : A Review

*
Priyanka Kantivan Goswami, Dr. Anubha Khale, Sunita Ogale

H K College of Pharmacy, Jogeshwari (West), Mumbai- 400102

Received on: 02/05/2012 Accepted on: 26/06/2012

ABSTRACT
Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine disorder that affects about one in 15 women worldwide. It is a
major disorder characterized by elevated levels of male hormones (androgens), acne and hirsutism. It can even cause insulin
resistance, anovulation and infertility on prolong incidence of cysts. Since PCOS is a curable disorder, it can be cured by use of
natural remedies or allopathic medication. The natural remedies include treatment with phytoestrogenic and non-estrogenic
herbs such as Liquorice, Ginseng, Black cohosh, Dong qui, Hops and Kelp which are effective and safe. In this review, an attempt
has been made to study the use of natural remedy for treatment of PCOS.

Key Words: PCOS, Hormone, Liquorice, Ginseng, Exercise

INTRODUCTION CAUSES OF PCOS

Herbs can be defined generally in commerce as a plant, Following are few important causes8 of PCOS:
plant part or extract there of used for flavour, fragrance or 1) Genetic predisposition
medicinal purposes. Traditional herbal medicines are 2) Strong stimulation in adrenals in childhood
naturally occurring substances with minimal or no industrial 3) Raised insulin levels
processing that have been used to treat various illnesses. 4) Contraceptive pills
Traditional herbal medicines are getting significant attention 5) Hormonal imbalance
in global health debates. Traditional medicine has 6) Stress
established promotive, preventive, curative and
rehabilitative role1-3.
Herbal therapy has reached a turning point. It is fighting to
be recognised as a science-a particular field with its own
identity. It has become necessary to show that herbal
therapy can match other fields of medicine in the
thoroughness of its scientific work and its practical use.
Benefit of herbal therapy compared to conventional therapy
is that herbal therapy is safe with lesser side effects and
presence of multiple active compounds in medicinal herbs
altogether provides a potentiating effect4-5.
The polycystic ovary syndrome is originally called as the Fig.1: Polycystic Ovary
Stein–Leventhal syndrome. Polycystic Ovarian Syndrome
(PCOS) is a serious disorder in women in which the ovaries
become enlarged with many ‘cysts’ which are in fact small
undeveloped follicles. Over time there is thickening and
fibrosis of the ovarian casing which prevents any follicles
which do ripen from being released. PCOS is associated
with anovulation and menstrual irregularities, infertility and
insulin resistance. There may be acne, hirsutism and weight
gain. As the condition progresses it may become associated
with dysfunctional uterine bleeding, obesity, Type 2
diabetes, endometrial cancer, high cholesterol and
cardiovascular disease6-7. Fig.2: Role of Hypothalamus in PCOS

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SIGN and SYMPTOMS OF PCOS Spearmint Tea
The principal signs and symptoms9 of PCOS are : (Botanical Name: Mentha spicata, Family: Labiatae)
1) Irregular or absence of periods
2) Acne
3) Excess body hair (hirsutism)
4) Weight gain or difficulty losing weight
5) Pain in Pelvic region
6) Elevated Luteinizing Hormone (LH) and decreased
Follicle stimulating hormone (FSH)
7) Infertility (difficulty becoming pregnant)

HISTOLOGICAL FEATURES OF PCOS

Histological features10 of PCOS includes:
1) Whole ovarian hypertrophy
2) Thickened capsule (>100 µ) The study was carried out in Turkey in a two centre as 30
3) Increased number of sub capsular follicle cysts day randomized controlled trial. Forty two volunteers were
4) Scarcity of corporea lutea or albicantia randomized to take spearmint tea twice a day for a 1 month
5) Hyperplasia and fibrosis of the ovarian stroma period and compared with a placebo herbal tea. At 0, 15 and
6) Premature luteinization of theca cells 30 days of the study serum androgen hormone levels and
gonadotropin were checked; the degree of hirsutism was
ALLOPATHIC THERAPY FOR PCOS clinically rated. 41 out of 42 patients completed the study.
1) Nafarelin-a specific gonadotropin-releasing- Free and total testosterone levels and degree of hirsutism
hormone agonist11 were reduced over the 30 day period in the spearmint tea
2) Triglitazone12 group. LH and FSH were increased. It was demonstrated
3) Clomiphene13 and confirmed that spearmint has antiandrogen properties18.
4) Metformin14
5) Spironolactone15 Ginseng saponin
6) Laproscopy16 (Botanical Name: Panax ginseng, Family: Araliaceae)

ALTERNATIVE REMEDIES AVAILABLE FOR

PCOS

1. Medicinal Herbs

Liquorice
(Botanical Name: Glycyrrhiza glabra, Family:Leguminosae)

Female Sprague-Dawley rats (190-210 g) were induced

polycystic ovary with intramuscular injection of Estradiol
Valerate (EV) and separated into three groups: EV control
(n=10), EV plus Ginseng Total Saponins (n=10), and oil
control (n=10). Ovarian morphology and Nerve Growth
Factor (NGF) protein expression were observed. Increased
expression of Nerve Growth Factor was noted in the ovaries
and the brain of rats with Poly Cystic Ovary. Ginseng Total
Saponis administration attenuated NGF expression in the
ovaries19.
The effect of liquorice was investigated on androgen
metabolism in nine healthy women 22–26 years old, in the Flaxseed
luteal phase of the cycle. They were given 3.5 g of a (Botanical Name: Linum usitatissimum, Family: Linaceae)
commercial preparation of licorice (containing 7.6% W/W
of glycyrrhizic acid) daily for two cycles. They were not on
any other treatment. Plasma renin activity, serum adrenal
and gonadal androgens, aldosterone, and cortisol were
measured by radioimmunoassay. Total serum testosterone
decreased gradually within two months. It returned to pre-
treatment levels after discontinuation. Licorice can reduce
serum testosterone probably due to the block of 17-
hydroxysteroid dehydrogenase and 17–20 lyase. Licorice
could be considered an adjuvant therapy of hirsutism and
In this study the impact of flaxseed supplementation (30
polycystic ovary syndrome17.
g/day) on hormonal levels in a 31-year old woman with
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PCOS was observed. During a four month period, the sensitivity indices using fasting and 2-hour oral glucose
patient consumed 83% of the flaxseed dose. Height, weight tolerance tests showed significant reductions in insulin
measurement and fasting blood samples taken at baseline resistance in the cinnamon group but not in the placebo
and 4-month follow-up indicated significant decrease in group22.
Body Mass Index (BMI), insulin, total serum testosterone
and free serum testosterone levels. The patient also reported Chaste berry
a decrease in hirsutism at the completion of the study period. (Botanical Name: Vitex agnus-castus, Family: Lamiaceae)
The clinically-significant decrease in androgen levels with a
concomitant reduction in hirsutism reported in this case
study20.

Aloe-vera
(Botanical Name: Aloe barbadensis, Family: Liliaceae)

In this study, 93 women who had tried to conceive for 6-36

months were given a supplement containing chaste tree, L-
arginine, vitamins and minerals. Their progesterone level,
menstrual cycle length, pregnancy rate and side effects were
documented. After 3 months, the supplementation group
demonstrated increased mid-luteal progesterone and
normalized menstrual cycles compared to no significant
changes in the placebo group. 14 out of the 53 women who
received the supplement became pregnant as compared to 4
In the present study, the efficacy of Aloe vera gel of the 40 women who received placebo. 3 other women in
formulation in a PCOS rat model was checked. Five month the supplement group conceived after 6 months. The
old Charles Foster female rats were orally fed with letrozole, recommended dose is 1-4 ml of 1:2 dried plant tincture of
a non-steroidal aromatase inhibitor, to induce PCOS. The 500-1000 mg of dried berries daily23.
rats were then treated orally with the Aloe vera gel
formulation (1 ml dose daily for 45 days). This restored their White peony
estrus cyclicity, glucose sensitivity, and steroidogenic (Botanical Name: Paeonia lactiflora, Family: Paeoniaceae)
activity. Co-treatment of the inductive agent (letrozole) with
the Aloe vera gel prevented the development of the PCO
phenotype. Aloe vera gel formulation exerts a protective
effect in against the PCOS phenotype by restoring the
ovarian steroid status, and altering key steroidogenic
activity. This can be attributed to phyto-components present
in the extract21.

Cinnamon
(Botanical Name: Cinnamomum zeylanicum, Family:
Lauraceae)
In the present study, we investigated the in vivo effects of
unkei-to (Japanese herbal medicine) and its compounds on
the steroidogenesis and cytokine secretion in human
granulosa cells. Unkei-to stimulate the secretions of 17-beta-
estradiol and progesterone from highly luteinized granulosa
cells obtained from in vitro fertilization patients. Effect
observed due to its key ingredients like Paeoniae radix,
Paeonia lactiflora, Cinnamomi cortex and Cinnamomum
cassia. The various beneficial actions of unkei-to on the
ovary may result from a combination of different ingredient
herbs with different stimulatory effects on both
steroidogenesis and the ovulatory process within the ovary,
Cinnamon extract has been shown to reduce insulin as well as stimulatory effect on the hypothalamus-pituitary
resistance in in vitro and in vivo studies by increasing axis24-25.
phosphatidylinositol 3-kinase activity in the insulin
signaling pathway and thus potentiating insulin action.
Fifteen women with polycystic ovary syndrome (PCOS)
were randomized to daily oral cinnamon and placebo for 8
weeks. Comparisons of post-treatment to baseline insulin
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Milk thistle
(Botanical Name: Silybum marianum, Family: Asteraceae )

PCOS herb treated rats received a daily oral dose of

(50mg/kg body weight), dissolved in 1 ml of deionised
water, for 4-5 weeks. PCOS controls received 1 ml of
In this study, the effect of silymarin which is known to have deionised water on the same schedule. Result showed
insulin sensitivity effects on the levels of glucose, insulin, reducing body weight gain in ovariectomized rats. Herb
testosterone, leutinizing hormone (LH) and progesterone treatment increases uterine weight, indicating estrogenic
was tested. Ovulation rate and Homeostasis Model effects and improves insulin sensitivity and lipid profile in
Assessment of insulin Resistance (HOMA) ratio were PCOS rats without affecting body composition30.
determined. A 3-months of treatment were conducted in 60
PCOS patients in three well-matched groups. The first one Chamomile
(n=20), received silymarin (750mg/day). The second group (Botanical Name: Matricaria Chamomilla, Family:
received metformin (1500mg/day) while the third group Asteraceae)
treated by combination of metformin (1500mg/day) and
silymarin (750mg/day). All these groups had taken the drugs
in divided doses. The results showed significant increment
in progesterone levels after completion of treatment. In
conclusion the addition of silymarin to metformin in
treatment of PCOS patients has improving effect on
disturbed hormones and ovulation rate26.

N-acetyl cysteine (NAC)

(Source: amino acid derivative of cysteine)
One hundred fifty women diagnosed with Clomiphene Thirty virgin adult cycling Wistar rats, weighting 200 - 220
citrate (CC) resistant PCOS; aged 18-39 years, undergoing g were divided into two groups and housed every six mice
therapy for infertility were selected. The patients were into cage under standard conditions (21 ± 2°C, 12-hour
assigned randomly to receive either NAC 1.2 gm/day (group light/ 12-hour dark cycles) for at least one week before and
I) or placebo (group II) with CC 100 mg/day for 5 days throughout the study. Estrous cyclicity of 30 virgin adult
starting at day 3 of the cycle. Ovulation rate and pregnancy cycling rats was monitored by vaginal smears obtained
rate were observed. Combination of CC and NAC between 0800 and 1200 hours. After about 4 days, each rat
significantly increased both ovulation and pregnancy rate received an i.m. injection of Estradiol Valerate), 2 mg in 0.2
and PR in women with CC-resistant PCOS27. ml of corn oil, to induce PCO. Corn oil was injected to the
rats in the control group. All the rats in the experimental
D-chiro-inositol group were evaluated for follicular cysts 60 days after the
(Source: breakdown of phytic acids found in vegetables, injection. Rats with PCOS were treated by multiple doses
fruits, legumes, nuts and whole grains28) (25, 50, 75 mg/kg) of intraperitoneal injections of
In this study 44 obese women with PCOS were selected for Chamomile alcoholic-extract for ten days. The histological
clinical trial. Serum steroids and glucose tolerance tests and hormonal results showed that Chamomile can decrease
were carried out before and after the oral administration of the signs of PCOS in the ovarian tissue and help LH
1200 mg of D-chiro-inositol or placebo once daily for six to secretion in rats31.
eight weeks. The serum progesterone concentration was
measured weekly to monitor for ovulation. The level of Astragalus polysaccharide
serum free testosterone, plasma triglyceride and blood (Botanical Name: Astragalus spp, Family: Fabaceae)
pressure was found to be decreased and 19 out of the 22
women who received D-chiro-inositol ovulated29.

Kasip Fatimah
(Botanical Name: Labisia pumila var. alata, Family:
Myrsinaceae)
In this study, effect of a Malaysian herb Kasip Fatimah had
been checked on 9 week old PCOS rats. PCOS was induced
in female rats before puberty by treating continuously with
dihydrotestosterone. The PCOS rats were randomly
subdivided into two groups; PCOS herb treated and PCOS In this study, 32 women with PCOS were administered with
control. combined application of astragalus polysaccharides and
diane-35 for 3 months. Sex hormones, insulin sensitivity and
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blood lipid were evaluated before and after the therapy. control (oil); (ii) exercise group (oil + exercise); (iii) a PCO
After the treatment, fasting serum insulin levels, LH/FSH group (EV); and (iv) a PCO exercise group (EV + exercise).
ratio was found be reduced and insulin sensitivity index The exercise and PCO exercise groups ran voluntarily for 5
increased significantly. Astragalus polysaccharides plus weeks in computer-monitored wheels placed in the cages
diane-35 can be effective in improving insulin resistance, where they were housed. The results obtained indicated that
high androgen hormone status and lipid metabolism in ovarian morphology was almost normalised in the PCO
patients with PCOS and it may be alternative for PCOS32. exercise group; NGF mRNA and protein concentrations
were normalised in the PCO exercise group; high numbers
2.Acupuncture of NGF receptor expressing cells in PCO ovaries were
Poly cystic ovary syndrome (PCOS) is associated with lowered by exercise; and the number of immunopositive
peripheral and central factors that influence sympathetic cells of the different AR subtypes were all reduced after
nerve activity. Thus, the sympathetic nervous system may exercise in the PCO group, except for the α1b- and β2-AR
be an important factor in the development and maintenance whereas the mRNA levels were unaffected, indicating
of PCOS. Acupuncture can affect PCOS via modulation of transcriptional regulation. In conclusion, our data indicate a
endogenous regulatory systems, including the sympathetic beneficial effect of regular exercise, as a modulator of
nervous system, the endocrine and the neuroendocrine ovarian sympathetic innervation, in the prevention and
system33. treatment of human PCOS34.
b. Dietary intake
3.Life Style Modification Low glycemic index diet may helps to manage insulin
a. Exercise resistance, cardiovascular risk and irregular menstrual
The study was carried out to check whether 5 weeks of patterns in women with PCOS. One should avoid saturated
voluntary exercise influence ovarian morphology and the fat intake. Lifestyle modification, including effective
expression of sympathetic markers in the Estradiol Valerate exercise regimens and dietary advice, should be the first line
(EV)-induced PCO rat model. The effect of exercise on (i) of treatment in women with polycystic ovary syndrome35-37.
ovarian morphology; (ii) mRNA and protein expression of
nerve growth factor (NGF); and (iii) mRNA and number of FUTURE COMPLICATION OF PCOS
ovarian-expressing cells for the NGF receptor (p75 1) Cardio vascular disorders38
neurotrophin receptor) and the α1a-, α1b-, α1d- and β2- 2) Diabetes mellitus39
adrenergic receptors (ARs) in rats with EV-induced PCO 3) Obesity40
was evaluated. PCO was induced by a single intramuscular 4) Metabolic syndrome41
injection of EV, and controls were injected with oil alone in 5) Endometrial carcinoma42
adult cycling rats. The rats were divided into four groups: (i)

Table 1: Medicinal Herbs used in Poly Cystic Ovarian Syndrome43-53

No. Name Botanical Name Family Part Used Constituent Present Other Uses
1 Bitter melon Momordica charantia Curcurbitaceae Fruit Glycoside Anti diabetic
Resin, Amenorrhea,
2 Indian madder Rubia cordifolia Rubiaceae Root
Phenolic compounds DysmenorrheaManopause, Manorrhagia,
Coumarin,
3 Angelica Angelica glauca Umbelliferae Root Liver and Heart disorder
Sesquiterpene
4 Myrrh Commiphora molmol Burseraceae Oil Volatile oil Laxative, Anti-inflammatory
5 Sesame Sesame indicum Pedaliaceae Seeds Protein Culinary
6 Rose Rosa spp Rosaceae Flower Carotenoids Perfumary
7 Black seed Nigella sativa Ranunculaceae Seeds Fatty acid Anti oxidant
8 Garlic Allium sativum Liliaceae Flower buds Sulphides Anti atherosclerotic
1. Emblica Officinalis Euphorbiaceae
9 Triphala 2. Terminalia beletica Fruit Tannin Astringent
Combretaceae
3. Terminalia chebula
10 Cummin Cuminum cyminum Umbeliferae Fruit Volatile oil Digestant
11 Betel nut Areca Catechu Palmae Seed Alkaloid Anti parasitic
12 Colic root Dioscorea villosa Dioscoreaceae Root Steroidal saponin Rheumatism
13 Kelp Nereocystis leutkeana Laminariaceae Seaweed Algin Hormone balance
14 Dandelion root Taraxacum officinale Asteraceae Whole plant Germacronalide Bitter
Bladder Iodine
15 Fucus vesiculosus Fucaceae Aerial part Cosmetics
wrack Bromine
16 Sqauw vine Mitchella repens Rubiaceae Aerial part Resin Hypotension
17 Oat straw Avena sativa Poaceae Seed Carbohydrate Food
Leaves
18 Mugwort Artemisia vulgaris Asteraceae Essential oil Antidote
Seed oil
Root,
19 Blue cohosh Caulophyllum thalictroides Berberidaceae Saponin Female problems
Rhizome
20 Dong quai Angelica sinesis Apiaceae Root Coumarine Female, Anti coagulant
21 Hops Humulus lupulus Cannabinaceae Female cons Essential oil Flavouring agent
22 Alfalfa Medicago sativa Fabaceae Seed Protein Anti oxidant
23 Sarsaparilla Smilax officinalis Smilacaceae Rhizome Resin Antibiotic
Flower
24 Saraca Saraca indica Fabaceae Tannin Uterine tonic
Leaves
25 Black Cohosh Actaea racemosa Ranunculaceae root Glycoside Women problems
26 Red Clover Trifolium pretense Fabaceae flower Glycoside Skin problem

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CONCLUSION Polycystic Ovarian Syndrome: A Case Study. Curr Top

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