Polycystic ovarian syndrome (PCOS) is the most common female endocrine disorder. Up to one-third of women in the UK have polycystic ovaries (i.e. 10 or more follicles per ovary detected on ultrasound), and around a third of these are thought to have the syndrome.(DTB 2001) PCOS is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity.(Stener-Victorin 2008) The syndrome also increases the risk for metabolic disturbances such as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life.(Stener-Victorin 2008)
Despite extensive research, little is known about the aetiology of PCOS, but the syndrome is associated with peripheral and central factors that influence sympathetic nerve activity.(Stener-Victorin 2008) Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS.
Many women with PCOS require prolonged treatment. Polycystic ovarian syndrome (PCOS) is characterised by the clinical signs of oligo-amenorrhoea (infrequent or very light menstruation), infertility (failure to conceive), acne, male patterned baldness and hirsutism (excessive hair growth). The current conventional medical treatments for women with PCOS are prescription medications, surgery, and lifestyle changes aimed at controlling symptoms.
Stener-Victorin E et al. Acupuncture in polycystic ovary syndrome: Current experimental and clinical evidence. Journal of Neuroendocrinology 2008; 20: 290-8.
Tackling polycystic ovary syndrome. DTB 2001; 39: 1-3
How acupuncture can help
This Factsheet focuses on the evidence for acupuncture in the treatment of PCOS. There are also Factsheets on Anxiety, Depression, Female Fertility, Infertility ART, Obesity, Stress and Type 2 Diabetes, which may have relevant information related to symptoms and conditions associated with PCOS.
Two systematic reviews by the same author (Lim 2010, 2011) of acupuncture for PCOS have drawn conflicting conclusions. One found no truly randomised controlled trials of acupuncture for PCOS and, while it found non-randomised studies that suggested acupuncture was associated with a low adverse events rate and no increased risk of multiple pregnancies, the reviewers concluded that properly designed RCTs are needed before a conclusive statement can be drawn to support the use of acupuncture in the management of PCOS.(Lim 2011) The other review concluded that acupuncture is a safe and effective treatment for PCOS, and may have a role: increasing blood flow to the ovaries, reducing ovarian volume and the number of ovarian cysts, controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia.(Lim 2010) Several randomised controlled trials have been published since the systematic reviews. One trial found that acupuncture can improve the clinical pregnancy rate in patients with PCOS undergoing IVF-ET.(Cui 2011)Another found that abdominal acupuncture treatment can improve the endocrine and metabolic function of patients with obesity-type PCOS.(Lai 2010) A third found low-frequency electroacupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS, and that it was superior to physical exercise.(Jedel 2011) Another recent study did not find a difference between ‘real’ and sham acupuncture protocols for women with PCOS.(Pastore 2011), but this may be due to sham acupuncture being an active treatment rather than a placebo (Lundeberg 2009).
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment may specifically help with symptoms of PCOS by:
- impacting on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion (Lim 2010; Stener-Victorin 2009;Feng 2009; Manneras 2009);
- a regulatory effect on follicle stimulation hormone (FSH), luteinising hormone ( LH) and androgens (Lim 2010; Feng 2009);
- modulating the activity of the sympathetic nervous system and improving blood flow to the ovaries (Stener-Victorin 2006, 2009);
- regulating steroid hormone/peptide receptors (Feng 2012);
- downregulating the expressions of serum levels of testosterone and oestradiol (Zang 2009);
- controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels (Lim 2010);
- acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
- increasing the release of adenosine, which has antinociceptive properties (Goldman 2010), and;
- reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).