PCOS Herbal Recommendations

From an article "Phytotherapy for polycystic ovarian syndrome" by Angela Hywood.
Link Here

The first step in restoring ovarian function and a normal menstrual cycle in a PCOS patient is to break the pattern of hyperinsulinemia with a combination of diet and lifestyle strategies. Implementing a low refined carbohydrate diet and exercise is essential for a truly successful protocol.

Primary Herbs

Paeonia lactiflora (White peony)
Paeonia lactiflora has been used for gynecological conditions by both Chinese and Western herbalists, and is used by Western herbalists for PCOS, hyperprolactinemia, endometriosis, ovarian failure and androgen excess. Paeonia has been shown to positively influence low progesterone, reduce elevated androgens (testosterone) and acts to modulate estrogen and prolactin. (7) In vitro, the active constituent paeoniflorin has been shown to affect the ovarian follicle by its action on the aromatase enzyme. (8) Aromatase is important for follicle maturation, ovulation and corpus luteum function, steroid hormone synthesis and the regulation of the conversion of androgens to estrogens. The biofeedback in the pituitary and hypothalamus rely on aromatase to regulate prolactin and GnRH. The daily dose for Paeonia is 4.5 to 9 mL of a 1:2 dried plant extract. (9)The traditional Chinese/Kanpo formula known as Shakuyaku-Kanzo-To or TJ-68, which is a decoction of Glycyrrhiza glabra and Paeonia lactiflora, has been the subject of a number of clinical trials, all of which demonstrate activity in the hormonal regulation of androgens. In one trial involving eight women with hyperandrogenism and oligomenorrhea, the formula was given for 2 to 8 weeks. This combination regulated the LH to FSH ratio. Over this period of time, serum testosterone levels decreased to less than 50 ng/dL and this resulted in seven of the eight women ovulating regularly. (10)Another trial involved 20 women diagnosed with PCOS. The formula was successful in lowering testosterone in 90% of the women, of which 25% went on to conceive. (11) It is suggested that it acts directly on the ovary, increasing the activity of aromatase, which promotes the synthesis of estradiol from testosterone, thus lowering serum testosterone levels. It also seems to regulate the LH to FSH ratio. (12)

Gymnema sylvestre (Gymnema)
Gymnema is a traditional Ayurvedic herb used as an antidiabetic, hypoglycemic, lipid lowering agent and to support weight reduction. Gymnema possibly has a trophorestorative action of the beta cells of the pancreas. (13) The plant part used as medicine is the leaf. Gymnema is well indicated for PCOS, due to its insulin modulating activity and the added benefits of reducing the elevated triglycerides associated with PCOS. Key constituents of Gymnema include saponins, especially the gymnemic acids. Gymnemic acid suppresses the sweet taste on the taste buds, so if taken before food masks the sweet sensation. Gymnema has demonstrated hypoglycemic activity in experimental models of diabetes and regulated blood sugar in hyperglycemia. The mechanism of action also includes the inhibition of glucose absorption in the intestine. The daily dose of Gymnema is 3.5 to 11 mL of 1:1 liquid extract. (9,14) Since conventional medical models are focussing on pharmaceutical agents such as metformin to control PCOS, Gymnema may prove to be one of the most significant herbs in the treatment of the underlying factor of insulin resistance.

Tribulus terrestris (Tribulus)
Tribulus is an endemic weed to many regions of the world, such as the Mediterranean, India, China, South Africa and Australia and is commonly known as puncture vine. The aerial parts, particularly the leaf, are used for medicinal purposes in the Western tradition. As a result of Bulgarian research, Tribulus has become a popular herb for the treatment of female and male endocrine disorders. (15) It acts as a general tonic, aphrodisiac, estrogen modulator and androgen modulator and is used to restore vitality, libido and reduce the physiological effects of stress. (9,11) The Bulgarian research has identified a unique steroidal saponin class known as furostanol saponins, and extracts are standardized to contain at least 45% of these saponins, calculated as protodioscin. The leaf is noted to be higher in these unique saponins rather than the fruit or root. Other active constituents include phytosterols and spirostanol glycosides. The tonic activities of Tribulus have been shown to act by intensifying protein synthesis and enhancing the activity of enzymes associated with energy metabolism. It increased iron absorption from the small intestines and inhibited lipid peroxidation during stress. This leads to more muscle strength and improved endurance and stamina. (9)To ensure the desired clinical results, it is recommended to use only the Bulgarian grown Tribulus standardized to 40% furostanol saponins. It is not interchangeable with the Chinese or Indian Tribulus. The daily dose of Tribulus corresponds to extracts containing furostanol saponins as protodioscin at 300 mg to 400 mg per day. In PCOS it is best used on days 5 to 14 of the menstrual cycle to restore menstrual regularity. For more information on Tribulus, see the forthcoming review which will be published in next months Townsend Letter.

Vitex agnus-castus (Chaste tree)
Vitex beneficial for ovulatory factors associated with PCOS, in particular it has been shown to downregulate the production of excess prolactin, a condition known as hyperprolactinemia. (16) Vitex is also postulated as having antiandrogenic properties. (16) Hyperprolactinemia is related to adrenal stress and hyperinsulinemia in PCOS. It is well documented that the active constituents in Vitex demonstrate a dopaminergic activity and dopamine inhibits the production of prolactin. The dopaminergic compounds in Vitex have been identified as the diterpene, including rotundifuran and 6[beta], 7[beta]-diacetoxy-13-hydroxy-labda-8, 14-diene. However, recent research is pointing to other phytochemicals which may have this activity. (17) Other constituents of Vitex include essential oils, flavonoids (such as casticin) and iridoid glycosides (including aucubin and agnuside). (9,14)Hyperprolactinemia, or the more subtle condition of latent hyperprolactinemia, are amongst the most frequent causes for cyclical disorders, including corpus luteal insufficiency. This can lead to premenstrual syndrome (PMS) and progesterone deficiency, secondary amenorrhea and premenstrual mastalgia. (18) In an uncontrolled study, Vitex reduced elevated prolactin levels in 80% of 34 women with hyperprolactinemia at a dosage of 30 to 40 mg per day for 1 month and improved symptoms of a variety of menstrual disorders, including secondary amenorrhoea, cystic hyperplasia of the endometrium, deficient corpus luteum function, metrorrhagia, polymenorrhea and oligomenorrhea. (9)Vitex reduced the thyroxin releasing hormone (TRH)-induced prolactin release (essentially a pituitary-thyroid axis problem), normalized shortened luteal phases, corrected luteal phase progesterone deficiencies and reduced PMS symptoms in women with luteal phase defects due to latent hyperprolactinemia. (9)Vitex should be considered first line botanical therapy for hyperprolactinemia and given for the duration of at least 3 to 6 months. In herbal writings Vitex is often attributed to increasing LH, which is not desirable in PCOS. However, clinical experience has shown that it is valuable in PCOS, especially when combined with other herbs, probably because of its action in reducing prolactin. The daily dose of Vitex to is 1 to 4 mL of a 1:2 dried plant tincture or 500 to 1000 mg of dried berries daily. (9) It is best taken as a single dose in the morning. (9) In PCOS it is best combined with Tribulus and Paeonia.

Caulophyllum thalictroides (Blue cohosh)
Caulophyllum thalictroides is known by the common name of blue cohosh and is native to North America. Within traditional use among the Native North Americans it was used by women as a remedy for amenorrhea and profuse menstruation, both of which are common features of PCOS. It is particularly useful to being on the menses in PCOS. It has action as a uterine and ovarian tonic and pelvic anti-inflammatory. The known constituents of Caulophyllum root include glycosides, caulosaponin and caulophyllosaponin, which are known to stimulate the uterus. Other identified constituents include N-methylcystine, taspine and thalictroidine. (9) The daily dose is 1.5 to 3 mL of 1:2 dried plant extract. (9)

Sample PCOS Formula
Vitex agnus-castus 1:2 12.5 mL
Glycyrrhiza glabra 1:1 12.5 mL
Paeonia lactiflora 1:2 25 mL
Gymnema sylvestre 1:1 25 mL
Schisandra chinensis 1:2 25 mL Dose: 15 mL per day or 5 mL three times daily 100 mL

In a case of a PCOS patient with amenorrhea, include Caulophyllum thalictroides at a dose of 2 mL per day to help induce the menses. When a cycle has been initiated, change to Tribulus concentrated extract, equivalent to furostanol saponins (as protodioscin) 300 to 400 mg per day on days 5 to 14 of the cycle to ensure cyclic regularity.