the first search sought pre-clinical studies which explained the reproductive endocrine effects of whole herbal extracts in oligo/amenorrhoea, hyperandrogenism and pcos. this review examines the mechanisms of effect for a potential alternative treatment, herbal medicine, and reveals six herbal medicines with both pre-clinical and clinical data explaining the reproductive endocrinological effects in pcos and associated oligo/amenorrhoea and hyperandrogenism. the focus of this review was studies investigating whole herbal medicine extracts with direct effects on reproductive endocrinology for the treatment of women with irregular menstruation, hyperandrogenism and pcos. clinical studies were excluded based on the absence of evidence for a mechanism of effect for the whole herbal extract in reproductive endocrinology associated with pcos, oligo/amenorrhoea and hyperandrogenism. we excluded 15 studies for the following reasons; investigation of effects in male animals (n = 4) and investigations which commenced with constituents that were isolated from herbal medicines (n = 5). clinical equivalence for prolactin lowering effects of vitex agnus-castus (agnucaston® 40 mg per day) and the pharmaceutical bromocriptine (parlodel® 5 mg per day) was found in one study including 40 women with hyperprolactinaemia .
another clinical study evaluated the equivalence of tribulus terrestris (tribestan®) and pharmaceuticals for ovulation induction in women with oligo/anovular infertility (n = 148), . another single arm clinical trial investigated the effects of glycyrrhiza glabra in women with pcos, (n = 32). despite variability in the herbal extraction methods, both laboratory and clinical studies demonstrated anti-androgenic effects. this review synthesises the evidence for mechanisms of effect for herbal medicine in oligo/amenorrhoea, hyperandrogenism and pcos. clinical investigations found no adverse effects for the six herbal medicines included in this review (table 2). our inclusion criteria for clinical studies were specific and relied upon our identification of herbal medicines with preclinical (laboratory based) evidence explaining the mechanisms of reproductive endocrinological effects in oligo/amenorrhoea, hyperandrogenism and pcos. studies investigating chemical compounds derived from the herbal medicines, included in this review but investigating different outcomes were found for vitex agnus-castus  and cimicifuga racemosa .
this means that larger – and more robust – studies are needed before any conclusions can be made in regard to the treatments’ effectiveness in women with pcos. some parts of the body might be ‘resistant’ to insulin, and higher levels of this hormone are often produced to keep blood glucose in the normal range. a 2018 review of research found that ovulation rates and menstrual cycles appear to improve with inositol in women with pcos.
it is generally agreed that chromium improves the action of insulin in the body, but there are only a few small studies into the effects of chromium in women with pcos. a traditional chinese medicine of peony (paeonia lactiflora) and licorice (glycyrrhiza glabra), also known as the herbal formula tj-68 (shakuyaku kanzo-to), is often prescribed by herbalists for the management of infertility in women with pcos. there is conflicting evidence as to whether chromium supplementation improves acne or hirsutism in women with pcos. some limited research shows that the essential oil of tea tree can prevent growth of bacteria that is found in acne.
the root of the maca plant is a traditional herb used to boost fertility and libido. maca root may helptrusted source balance hormones and lower cortisol levels interventions included herbal extracts of vitex agnus-castus, cimicifuga racemosa, tribulus terrestris, glycyrrhiza spp., paeonia lactiflora and cinnamomum the natural remedies most often used include supplements, such as vitamins, minerals and fish oils, and herbal medicine in the forms of teas,, .
for women whose pcos-related hormone imbalances are making conception difficult, dr. stansbury recommends several herbs, including chaste tree berry, dong quai, herbal formula decoctions gui zhu yi kun formula (gzykf) (semen cuscutae, rhizoma atractylodis macrocephalae, angelica sinensis, adenophora these were cimicifuga racemosa, cinnamomum cassia, curcuma longa, glycyrrhiza spp., matricaria chamomilla, mentha piperita, paeonia lactiflora,, .
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