Globally, PCOS affects between 5% and 10% of women of reproductive age, implicating not just reproductive health but also causing mood and metabolic disorders.
The multiple abnormalities associated with PCOS means no single drug or supplement has been found capable of effectively treating the condition's symptoms, though oral contraceptives are often prescribed for the menstrual irregularities that are common in PCOS patients.
However, this is not a suitable option for women intending to conceive. Moreover, while insulin-sensitising agents in such medications seem to lower insulin levels and hyperandrogenaemia — a major diagnostic feature in PCOS — in women with PCOS, they have also been linked to a high incidence of adverse gastrointestinal effects.
As it is common in Chinese culture for TCM to be applied to gynaecological problems and infertility — with recent studies reporting the beneficial effects of certain herbs and herbal formulas against PCOS — the researchers behind the current study sought to determine the effectiveness of popular TCM remedies used by Taiwanese women with PCOS.
They conducted the first large-scale survey via the Taiwan National Health Insurance (NHI) Programme database to analyse TCM utlisation patterns among women with PCOS in Taiwan between 1997 and 2010.
The results showed that 89.22% of newly diagnosed PCOS patients had received TCM therapy, with Jia-Wei-Xiao-Yao-San (bupleurum and peony formula) being the most commonly used herbal formula, and Xiang-Fu (Rhizoma Cyperi or nut grass) the most commonly used single herb.
Jia-Wei-Xiao-Yao-San has been used to treat anxiety, stress, irritability, premenstrual tension, and infertility. A previous study had reported that it increased plasma tumour necrosis factor-alpha (TNF-α) levels in depressed menopausal women, and an RCT had found it could alleviate depressive and obsessive-compulsive behaviour and anxiety in those with generalised anxiety disorder.
The second most commonly used herbal formula for PCOS was Gui-Zhi-Fu-Ling-Wan (cinnamon twig and poria pill), said to combat type 2 diabetes symptoms and lower total serum cholesterol and triglyceride levels, as well as total cholesterol levels in the liver. It is also said to improve glucose tolerance, and display protective effects against liver injury in patients with non-alcoholic fatty liver disease.
The third most commonly used herbal formula was Dang-Gui-Shao-Yao-San (angelicae sinesis and peony powder), which is said to suppress uterine contractions and alleviate abdominal pain.
The fourth most commonly used herbal formula, Wen-Jing-Tang (comprising 13 herbs, including peony and ginseng), has traditionally been used to treat amenorrhoea (the absence of menstruation), as well as infertility and excessive bleeding during menstruation.
The fifth most common herbal formula for Taiwanese PCOS patients was Ma-Zi-Ren-Wan (hemp seed pill). According to recent pharmaceutical research, it is safe and effective for alleviating functional constipation symptoms and increase complete spontaneous bowel movements.
Xiang-Fu, the most commonly prescribed herb, has been reported to exhibit antidepressant activity, while Da-Huang (rhubarb root and rhizome), the second most commonly prescribed herb, is said to have beneficial effects against type 2 diabetes and other metabolic disorders.
Yi-Mu-Cao (Chinese motherwort), the third most commonly prescribed single herb for PCOS treatment, has traditionally been thought to help promote blood flow to regulate menstruation, and to treat menstrual disorders. It is also said to have anti-inflammatory properties, as well as the ability to amerliorate diabetic symptoms.
The fourth most commonly used single herb, Yan-Hu-Suo (Corydalis Rhizome), is said to be able to treat dysmenorrheoa (painful menstruation often involving abdominal cramps), and has been reported to display analgesic effects in human clinical studies.
The fifth most commonly used single herb for PCOS was Dan-Shen (red sage), said to be useful in treating insulin resistance, obesity and type-2 diabetes. It is also known for its protective effects on the liver, and pancreatic beta cells.
The researchers wrote that "confirming the prescription patterns of TCM through the health insurance database helped avoid the possibility of memory bias associated with questionnaire-based investigation", and the study subjects had all undergone blood testing or gynaecologic ultrasonography before being diagnosed with PCOS, which lent the results a greater degree of credibility.
However, the database also lacked imaging and laboratory data, meaning that details to do with disease severity and treatment efficacy remained unknown.
At the same time, TCM decoctions or remedies purchased directly from TCM pharmacies are not covered by the NHI, which could have resulted in the researchers underestimating the actual frequency of TCM use for PCOS treatment.
Still, the NHI programme makes TCM remedies available at a relatively low cost, so the number of PCOS patients taking herbal medication outside of the system tends to be rather low.
They concluded: "Patients might be prescribed other Western medicines or self-purchase supplements for treating PCOS or other diseases during the follow-up period. The possibility of interaction of different types of medicines also requires longer following and analysis.
"This study is the first large-scale survey to analyse TCM utilisation patterns among women with PCOS in Taiwan. Jia-Wei-Xiao-Yao-San was the most commonly used TCM formula, while Xiang-Fu was the most commonly used single herb in our dataset.
"In addition, we found that the top five most commonly prescribed single herbs and herbal formulas have shown promise in treating symptoms associated with PCOS. Further pharmacological investigations and clinical trials could be developed on the basis of the present findings."
Source: Journal of Clinical Medicine
"Investigation on the Use of Traditional Chinese Medicine for Polycystic Ovary Syndrome in a Nationwide Prescription Database in Taiwan"
Authors: Wan-Ting Liao, et al.