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Chen H, Deng C, Meng Z, Meng S. Effects of TCM on polycystic ovary syndrome and its cellular endocrine mechanism. Front Endocrinol (Lausanne) 2023; 14:956772. [PMID: 37260441 PMCID: PMC10228207 DOI: 10.3389/fendo.2023.956772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 04/03/2023] [Indexed: 06/02/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a reproductive endocrine disease characterized by menstrual disorders, infertility, and obesity, often accompanied by insulin resistance and metabolic disorders. The pathogenesis of PCOS is relatively complex and has a certain relationship with endocrine disorders. The increase of androgen and luteinizing hormone (LH) is the main cause of a series of symptoms. Traditional Chinese medicine (TCM) has obvious advantages and significant curative effects in the treatment of this disease. It can effectively reduce the insulin level of PCOS patients, regulate lipid metabolism, and increase ovulation rate and pregnancy rate and has fewer side effects. This article reviews the efficacy and safety of Chinese herbs and other TCM (such as acupuncture) in the treatment of PCOS and its complications in recent years, as well as the effect and mechanism on cellular endocrine, in order to provide a new clinical idea for the treatment of PCOS.
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Affiliation(s)
- Huize Chen
- Department of Traditional Chinese Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chujun Deng
- Department of Traditional Chinese Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zeyu Meng
- The Second Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shengxi Meng
- Department of Traditional Chinese Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Xu G, Zhao X, Li Z, Hu J, Li X, Li J, Chen Y. Effects of electroacupuncture on the kisspeptin-gonadotropin-releasing hormone (GnRH) /luteinizing hormone (LH) neural circuit abnormalities and androgen receptor expression of kisspeptin/neurokinin B/dynorphin neurons in PCOS rats. J Ovarian Res 2023; 16:15. [PMID: 36650561 PMCID: PMC9844031 DOI: 10.1186/s13048-022-01078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, anovulation, and polycystic ovaries. Electroacupuncture (EA) can effectively improve hyperandrogenism and increase ovulation frequency in patients with PCOS. Pieces of suggest that androgen activity in the brain is associated with impaired steroid negative feedback in such patients. Studies have shown that EA regulated androgen receptor (AR) expression and local factor levels (such as anti-Müllerian hormone and inhibin B) in the ovary of PCOS rats. However, few studies have explored the effect of EA on androgen activity in the brain. OBJECTIVE This study investigated the effect of EA on the kisspeptin-gonadotropin-releasing hormone (GnRH)/luteinizing hormone (LH) neural circuit and sex hormone receptor expression in the hypothalamus of PCOS rats. METHODS PCOS signs were induced by letrozole administration, and the induced rats were treated with low-frequency EA at Guan Yuan acupoint (CV4). The effect of EA on PCOS-like signs was evaluated by observing changes in the body weight, ovarian quality, ovarian morphology, and serum sex hormone levels in rats. To explore the mechanism of the effect of EA on PCOS-like signs, the neuropeptide content of the kisspeptin-GnRH/LH neural circuit was assessed using enzyme-linked immunosorbent assay(ELISA); AR and estrogen receptor α (ERα) coexpression on kisspeptin/neurokinin B/dynorphin (KNDy) neurons was determined via triple-label immunofluorescence; and protein and mRNA expression of Kiss1, Ar, Esr1, and kisspeptin receptor (Kiss1r) was evaluated via western blotting and Reverse Transcription-Polymerase Chain Reaction (RT-PCR). RESULTS The results revealed that the estrous cycle of rats in the EA treatment group recovered, and their body and ovary weight reduced; ovarian morphology improved; serum testosterone and LH levels significantly decreased; and kisspeptin, GnRH, and dynorphin levels in hypothalamic arcuate nucleus significantly decreased. Compared with controls, the number of AR/Kiss1-positive cells increased, number of ERα/Kiss1-positive cells decreased, and protein and mRNA expression of Kiss1, Ar, and Kiss1r significantly increased in PCOS rats. However, EA treatment reversed these changes and reduced the expression of Kiss1, Ar, and Kiss1r significantly. CONCLUSION Improvement in the reproductive hallmarks of PCOS rats via EA may be achieved by regulating the kisspeptin-GnRH/LH circuit via androgen activity attenuation. Thus, the results provide an experimental basis for acupuncture as an adjuvant medical therapy on PCOS.
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Affiliation(s)
- Ge Xu
- grid.411480.80000 0004 1799 1816Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China ,grid.412540.60000 0001 2372 7462Shanghai University of Traditional Chinese Medicine, Shanghai, 201210 China
| | - Xuedan Zhao
- grid.411480.80000 0004 1799 1816Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China ,grid.412540.60000 0001 2372 7462Shanghai University of Traditional Chinese Medicine, Shanghai, 201210 China
| | - Zhihao Li
- grid.411480.80000 0004 1799 1816Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China
| | - Junwei Hu
- grid.411480.80000 0004 1799 1816Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China
| | - Xu Li
- grid.411480.80000 0004 1799 1816Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China
| | - Juanjuan Li
- grid.411480.80000 0004 1799 1816Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China
| | - Yuelai Chen
- grid.411480.80000 0004 1799 1816Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China
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The Application of Complementary and Alternative Medicine in Polycystic Ovary Syndrome Infertility. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5076306. [PMID: 36248406 PMCID: PMC9568292 DOI: 10.1155/2022/5076306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/07/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a lifelong reproductive endocrine disease, which is the most common cause of anovular infertility. Modern medicine mainly treats infertile patients with PCOS by improving living habits, ovulation induction therapy, and assisted reproductive technology (ART), but the effect is not satisfied. Complementary alternative medicine (CAM) has conspicuous advantages in the treatment of PCOS infertility due to its good clinical efficacy, wide mechanism of action, and no obvious adverse reactions, but its safety and effectiveness in the treatment of PCOS infertility have not been proved. Based on the existing clinical and experimental studies, this paper looks for the therapeutic effect and the mechanism behind it, and explores the safety and effectiveness of its treatment in PCOS infertility, in order to provide reference for future clinical treatment and experimental research.
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Ye Y, Zhou CC, Hu HQ, Fukuzawa I, Zhang HL. Underlying mechanisms of acupuncture therapy on polycystic ovary syndrome: Evidences from animal and clinical studies. Front Endocrinol (Lausanne) 2022; 13:1035929. [PMID: 36353235 PMCID: PMC9637827 DOI: 10.3389/fendo.2022.1035929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among women of reproductive age. Current standard treatment includes lifestyle change, oral pharmacological agents, and surgical modalities. However, the efficacy of current therapies is less than satisfactory. Clinical evidence has shown that acupuncture is effective for regulating hormone levels, promoting ovulation, and attenuating insulin resistance in patients with PCOS. Acupuncture may affect the production of β-endorphin, which may lead to gonadotropin-releasing hormone secretion and then affect ovulation, menstrual cycle, and fertility. The mechanism of acupuncture for patients with PCOS has not been comprehensively reviewed so far. Better understanding of the mechanisms of acupuncture would help popularize the use of acupuncture therapy for patients with PCOS. In this narrative review, we aimed to overview the potential mechanisms and evidence-based data of acupuncture on PCOS, and analyze the most frequently used acupoints based on animal and clinical studies. The results of this study will contribute to a better understanding of the current situation in this field.
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Affiliation(s)
- Yang Ye
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
| | - Cong-Cong Zhou
- School of Global Public Health, New York University, New York, NY, United States
| | - Hang-Qi Hu
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
| | - Ii Fukuzawa
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
| | - Hao-Lin Zhang
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
- *Correspondence: Hao-Lin Zhang,
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Effect of Electroacupuncture on Reproductive Disorders and Insulin Resistance in a Murine Polycystic Ovary Syndrome Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9968463. [PMID: 34987599 PMCID: PMC8720607 DOI: 10.1155/2021/9968463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/02/2021] [Accepted: 09/15/2021] [Indexed: 12/19/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is a common, complex, and heterogeneous endocrine and metabolic disorder. There is no standardized treatment, and it therefore requires individualized therapies according to the symptoms and pathogenesis of each patient. The present study aimed to determine the effect of electroacupuncture at the acupoints Zusanli (ST36), Sanyinjiao (SP6), and Neiguan (PC6) on reproductive disorders and insulin resistance in a murine model of PCOS induced by dehydroepiandrosterone (DHEA). Vaginal smear analysis was used to determine mice estrous cycle; intraperitoneal glucose and insulin tolerance tests were adopted to analyze metabolic characteristics; enzyme-linked immunosorbent assay was used to measure hormone levels; gene expression was quantified with real-time PCR; hematoxylin and eosin staining was used to observe ovarian morphology. We observed disordered estrous cycle, polycystic ovarian morphology, and higher levels of homeostasis model assessment-insulin resistance (HOMA-IR) and testosterone (T), indicating successful modeling of PCOS. DHEA increased levels of estrogen (E2), progesterone (P), testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH), and EA treatment restored them to levels seen in the control group. EA reduced the days in estrus caused by DHEA, improved the abnormal sex hormone receptor genes, and attenuated the DHEA-induced histomorphological changes in mouse ovaries. The average expressions of the androgen receptor (AR), estrogen receptor (ER), luteinizing hormone receptor (LHR), and follicle-stimulating hormone receptor (FSHR) genes in the ovary greatly increased after DHEA treatment and significantly decreased in the DHEA + EA group. After EA treatment, the cystic follicle (CF) number was reduced and corpora lutea (CL) increased in the DHEA + EA group compared to the DHEA group. EA improved glucose intolerance and insulin intolerance. Statistical analysis of intraperitoneal glucose tolerance test-area under curve (IPGTT-AUC) glucose levels revealed a significant decrease in DHEA group mice compared to the control and DHEA + EA groups. EA was found to restore fasting blood glucose, fasting serum insulin, and HOMA-IR. In summary, our study suggests that EA has a remarkable effect in the DHEA-induced murine PCOS model. Management of EA could improve estrous cycle, hormonal disorders, abnormal sex hormone receptors in ovaries, ovary morphology, and insulin resistance in PCOS mice.
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Budihastuti UR, Melinawati E, Anggraini NWP, Anggraeni A, Yuliantara EE, Sulistyowati S, Hadi C, Nurwati I, Yulyanti, Octavia DE, Wesliaprilius TA, Murti B. Electroacupuncture to Improve Endometrial Receptivity and Folliculogenesis in Polycystic Ovary Syndrome. Med Acupunct 2021; 33:428-434. [PMID: 34976276 DOI: 10.1089/acu.2020.1503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting folliculogenesis and endometrial receptivity. PCOS causes low fertility due to failures in folliculogenesis and ovulation. Electroacupuncture (EA) may help improve folliculogenesis and endometrial receptivity. EA can decrease tonic activity in the sympathetic vasoconstrictor pathway to the uterus. This study was conducted to determine the effect of the addition of EA therapy on folliculogenesis and endometrial receptivity in women with PCOS. Materials and Methods: This case-control study was conducted at the Dr. Moewardi General Hospital, in Jawa Tengah, Indonesia. The subjects were women with PCOS, ages 20-45, who were infertile. They were divided into a control group (17 women) and an experimental group (17 women). The control group received letrozole therapy, and the experimental group received EA + letrozole therapy. Folliculogenesis is determined by measuring the growth of follicle diameter on days 2, 6, 8, 10, and 12 of the menstrual cycle. Endometrial receptivity is determined by resistance index (RI) and pulsatility index (PI) examinations on days 19 and 21; endometrial thickness is measured on day 12. Results: There was a significant difference in folliculogenesis on days 2, 6, 8, 10, and 12. Folliculogenesis with letrozole versus EA + letrozole, respectively, were: day 2 = 5.59 ± 1.06 versus 7.01 ± 1.53, P = 0.004; day 6 = 6.71 ± 1.59 versus 9.11 ± 1.23, P < 0.001; day 8 = 9.51 ± 2.68 versus 12.44 ± 1.49, P < 0.001; day 10 = 11.30 ± 3.08 versus 15.53 ± 2.34, P < 0.001; and day 12 = 13.92 ± 3.61 versus 19.86 ± 0.75, P < 0.001. RI value with letrozole versus EA + letrozole were, respectively, day 19 = 0.91 ± 0.07 versus 0.88 ± 0.07, P = 0.150; day 21 = 0.88 ± 0.07 versus 0.79 ± 0.09, P < 0.001. PI value with letrozole versus EA + letrozole were respectively, day 19 = 3.00 ± 0.89 versus 2.30 ± 0.65, P = 0.009; and day 21 = 2.72 ± 0.88 versus 2.02 ± 0.55, P = 0.009. Endometrial thickness with letrozole versus EA + letrozole were, respectively, day 12 = 6.95 ± 1.82 versus 8.22 ± 1.76, P = 0.005. Conclusions: The addition of EA to letrozole therapy improved folliculogenesis, RI, PI, and endometrial thickness in patients with PCOS. Further studies are needed to gain a better understanding of the dosage and timing of this therapy and its potential synergy with other current treatments.
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Affiliation(s)
- Uki Retno Budihastuti
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia.,Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Public Health Science Study Program, Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Doctoral Program in Medical Science, Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Eriana Melinawati
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia.,Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Nutria Widya Purnama Anggraini
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia.,Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Asih Anggraeni
- Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Universitas Sebelas Maret Hospital, Jawa Tengah, Indonesia
| | - Eric Edwin Yuliantara
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia.,Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Sri Sulistyowati
- Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Doctoral Program in Medical Science, Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Universitas Sebelas Maret Hospital, Jawa Tengah, Indonesia
| | - Cahyono Hadi
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia
| | - Ida Nurwati
- Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Doctoral Program in Medical Science, Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Yulyanti
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia
| | - Dhamayanti Eka Octavia
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia
| | - Todung Antony Wesliaprilius
- Department of Obstetrics and Gynecology, Medical Faculty of Universitas Sebelas Maret/Dr. Moewardi General Hospital, Jawa Tengah, Indonesia
| | - Bhisma Murti
- Medical Faculty Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Public Health Science Study Program, Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia.,Doctoral Program in Medical Science, Postgraduate Program, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
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A Review of Acupuncture Treatment for Infertility. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2021.00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to analyze acupuncture treatment methods and acupoint used to treat infertility in the last decade. The data were retrieved from 2010.1 to 2021.8. using national and international electronic databases (PubMed, EMBASE, OASIS, NDSL, and KISS). “Infertility,” “sterility,” “acupuncture,” “electroacupuncture,” “bloodletting,” “pharmacopuncture,” were used as search terms. All studies were mainly concerned with acupuncture treatment of infertility, but the studies which were not related included; (1) infertility or acupuncture treatment; (2) animal studies; (3) review/meta/protocol or clinical study; comparative studies and case reports which were excluded from this review. Only clinical trials for acupuncture treatment of infertility were included in this review (n = 18). For infertility treatment studies using acupuncture, polycystic ovarian syndrome was the main cause of infertility, the most common acupoint used was CV4, CV3, CV6, SP6, BL23, and the treatment effect significantly improved in the group receiving acupuncture treatment compared with the control group, or the group taking Western medicine alone. In some studies, the group using acupuncture treatment did not show side effects. Acupuncture is an effective treatment for infertility.
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The Complementary and Alternative Medicine for Polycystic Ovary Syndrome: A Review of Clinical Application and Mechanism. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5555315. [PMID: 33727939 PMCID: PMC7935573 DOI: 10.1155/2021/5555315] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
As a reproductive endocrine disease, polycystic ovary syndrome (PCOS) has influenced billions of women during childbearing age worldwide. Owing to its complex etiology and ambiguous pathogenesis, there is still not a specific method to cure it. Clinical treatments, such as hormone therapy and surgical treatment, have side effects. Therefore, it is essential and urgent to seek alternative treatment to solve these problems. The satisfactory efficacy of complementary and alternative medicine (CAM), such as traditional Chinese medicine (TCM), immunotherapy, medicinal foods, vitamin therapy, diet therapy, psychotherapy, spa, and oxygen therapy, in treating PCOS, has aroused an increasing number of medical workers' concern and gradually become the mainstream. This paper reviews the application of CAM in the treatment of PCOS, especially from the perspective of TCM. Meanwhile, the limitations of the literature about CAM in the treatment of PCOS are mentioned and analyzed as well.
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