Arentz Susan, Abbott Jason Anthony, Smith Caroline Anne, Bensoussan Alan
National Institute of Complementary Medicine, University of Western, Locked Bag 1797, Penrith South, NSW, 2751, Sydney, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, Sydney, Australia.
BMC Complement Altern Med. 2014 Dec 18;14:511. doi: 10.1186/1472-6882-14-511.
Polycystic ovary syndrome (PCOS) is a prevalent, complex endocrine disorder characterised by polycystic ovaries, chronic anovulation and hyperandrogenism leading to symptoms of irregular menstrual cycles, hirsutism, acne and infertility. Evidence based medical management emphasises a multidisciplinary approach for PCOS, as conventional pharmaceutical treatment addresses single symptoms, may be contra-indicated, is often associated with side effects and not effective in some cases. In addition women with PCOS have expressed a strong desire for alternative treatments. This review examines the reproductive endocrine effects in PCOS for an alternative treatment, herbal medicine. The aim of this review was to identify consistent evidence from both pre-clinical and clinical research, to add to the evidence base for herbal medicine in PCOS (and associated oligo/amenorrhoea and hyperandrogenism) and to inform herbal selection in the provision clinical care for these common conditions.
We undertook two searches of the scientific literature. The first search sought pre-clinical studies which explained the reproductive endocrine effects of whole herbal extracts in oligo/amenorrhoea, hyperandrogenism and PCOS. Herbal medicines from the first search informed key words for the second search. The second search sought clinical studies, which corroborated laboratory findings. Subjects included women with PCOS, menstrual irregularities and hyperandrogenism.
A total of 33 studies were included in this review. Eighteen pre-clinical studies reported mechanisms of effect and fifteen clinical studies corroborated pre-clinical findings, including eight randomised controlled trials, and 762 women with menstrual irregularities, hyperandrogenism and/or PCOS. Interventions included herbal extracts of Vitex agnus-castus, Cimicifuga racemosa, Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia. Endocrine outcomes included reduced luteinising hormone (LH), prolactin, fasting insulin and testosterone. There was evidence for the regulation of ovulation, improved metabolic hormone profile and improved fertility outcomes in PCOS. There was evidence for an equivalent effect of two herbal medicines and the pharmaceutical agents bromocriptine (and Vitex agnus-castus) and clomiphene citrate (and Cimicifuga racemosa). There was less robust evidence for the complementary combination of spirinolactone and Glycyrrhiza spp. for hyperandrogenism.
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.
多囊卵巢综合征（PCOS）是一种常见的复杂内分泌疾病，其特征为多囊卵巢、慢性无排卵和高雄激素血症，可导致月经周期不规律、多毛、痤疮和不孕等症状。循证医学管理强调对PCOS采取多学科方法，因为传统药物治疗只能解决单一症状，可能存在禁忌证，常伴有副作用，且在某些情况下无效。此外，PCOS患者对替代治疗有强烈需求。本综述探讨了替代治疗草药对PCOS的生殖内分泌影响。本综述的目的是从临床前和临床研究中找出一致的证据，以增加草药治疗PCOS（以及相关的月经过少/闭经和高雄激素血症）的证据基础，并为这些常见病症的临床护理中的草药选择提供参考。
我们对科学文献进行了两次检索。第一次检索寻找解释全草药提取物对月经过少/闭经、高雄激素血症和PCOS生殖内分泌影响的临床前研究。第一次检索中的草药为第二次检索提供了关键词。第二次检索寻找证实实验室研究结果的临床研究。研究对象包括PCOS、月经不规律和高雄激素血症患者。
本综述共纳入33项研究。18项临床前研究报告了作用机制，15项临床研究证实了临床前研究结果，包括8项随机对照试验，涉及762例月经不规律、高雄激素血症和/或PCOS患者。干预措施包括贞节树、黑升麻、刺蒺藜、甘草属植物白芍和肉桂的草药提取物。内分泌指标包括促黄体生成素（LH）、催乳素、空腹胰岛素和睾酮降低。有证据表明PCOS患者的排卵得到调节、代谢激素谱得到改善、生育结局得到改善。有证据表明两种草药与药物溴隐亭（和贞节树）及枸橼酸氯米芬（和黑升麻）具有同等效果。对于螺内酯和甘草属植物联合治疗高雄激素血症，证据不足。
临床前和临床研究提供了证据，表明六种草药可能对月经过少/闭经、高雄激素血症和PCOS患者有益。然而临床前数据的数量有限，临床证据的质量参差不齐。需要进一步的临床前研究来解释本综述未涵盖的草药的作用，目前临床证据存在但缺乏临床前数据。
