Acupuncture and Chinese Medicine for Polycystic Ovarian Syndrome (PCOS)
Women with PCOS, and especially those with irregular or infrequent periods, have their own particular problems when it comes to conceiving. Certain acupuncture protocols can reduce some of the factors that prevent polycystic ovaries working properly by reducing testosterone and LH (luteinising hormone) levels which allows for more frequent ovulation and better quality eggs.
If you have PCOS and are trying to conceive naturally or planning to do IVF, you can benefit from doing a course of acupuncture over 3 to 4 months to improve ovarian function and egg quality. For those PCOS patients who do IVF, certain acupuncture protocols during the stimulation phase and after embryo transfer will reduce the risk of hyperstimulation.
The Research
Clinical trials have shown that acupuncture can lower elevated levels of testosterone and luteinizing hormone (LH), which inhibit ripening of eggs and ovulation in PCOS patients. Acupuncture also decreases insulin resistance and reduces sympathetic nervous system activity both of which are often abnormally high in PCOS. By having these effects, acupuncture can improve ovarian function, increase the frequency of ovulation and thereby restore more regular cycles.
Furthermore, better quality eggs will be produced because the damaging effects of high testosterone and LH are ameliorated. Patients with PCOS who are undergoing IVF will usually have an abundance of eggs but of a lower quality. However, if testosterone and LH levels are reduced then a better ovarian and follicular environment is created which should lead to an increase in egg quality during the stimulation phase.
Another problem that PCOS patients face when doing IVF is a higher than normal risk of ovarian hyperstimulation. Researchers in China have found that acupuncture during the IVF stimulation phase reduces this risk.
This systematic review published in the British Medical Journal examined 4 trials that included 430 patients with PCOS and having IVF or ICSI. They found that acupuncture may increase the clinical and ongoing pregnancy rate and reduce the risk of ovarian hyperstimulation (OHSS) (click here for the full text article).
This comprehensive literature review of all studies of acupuncture and PCOS that meet the inclusion criteria concluded that: ‘Acupuncture is a safe and effective treatment to PCOS as the adverse effects of pharmacologic interventions are not expected by women with PCOS. Acupuncture therapy may have a role in PCOS by: increasing of blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia’ (click here for the full text article).
When overweight PCOS patients were given acupuncture treatment twice a week for 6 months they responded better than those patients given Metformin for the same period. Patients had an increased frequency of ovulation and weight loss (click here for the full text article).
This trial showed that repeated acupuncture treatments increased ovulation frequency in PCOS patients. High ovarian and adrenal hormone levels were also reduced (click here for the full text article).
A group of women with PCOS who were undergoing IVF were given 5 acupuncture treatments once they commenced the IVF drugs. Compared to a group who had no acupuncture they produced higher quality embryos but did not achieve a higher pregnancy rate. Generally, patients with PCOS can require several months of treatment to make a noticeable change in hormone levels and ovarian activity (click here for the full text article).
A reduction in LH levels and an increase in ovulation frequency was found in PCOS women having acupuncture using either real needling or sham needling (which pricks rather than penetrates the acupuncture points). It can be argued that sham needling is not a suitable control as even mild stimulation of an acupuncture point without penetration will exert some physiological response. True acupuncture but not sham acupuncture reduced levels of testosterone and insulin in the women who ovulated (click here for the full text article).
This trial found that 4 months of acupuncture effectively reduced testosterone and improved ovulation frequency in PCOS patients, and was superior to exercise in achieving these aims(click here for the full text article).
This trial found that activity of the sympathetic nervous system (which is abnormally pronounced in PCOS) can be reduced with acupuncture or with exercise. Acupuncture also significantly reduced the levels of testosterone in PCOS patients. Those women in the study who were not ovulating reported more regular menstrual cycles after acupuncture treatment (click here for the full text article).
A group of researchers in Shandong, China gave electroacupuncture to PCOS patients undergoing IVF. They found that there was a significant reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) if acupuncture was included. Since women with PCOS are at risk of OHSS then this finding is of great interest. Many other aspects of the IVF cycle improved but unfortunately the pregnancy rate was not significantly increased by the acupuncture.
IVF patients in the UK are generally advised not to take Chinese herbs during their IVF cycle so as to avoid any potential drug interaction but in China they are quite happy to combine therapies if it will benefit the patient. In this study, IVF patients with PCOS were given a herbal formula which supports ovarian function. The group in the study who received the herbs had significantly better uterine linings, used lower doses of FSH and had a higher success rate. Additionally, the incidence of ovarian hyperstimulation was reduced in the herb group (click here for the full text article).
This review describes the aetiology and pathogenesis of polycystic ovary syndrome (PCOS) and evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS (click here for the full text article).
A Chinese medicine herbal formula for tonifying the Kidneys was tested on PCOS patients after it had been shown to be effective in reducing testosterone and insulin, and promoting ovulation, in sterilised rats. PCOS patients took the formula for 6 months - it was effective in reducing obesity and acne as well as insulin and testosterone levels (click here for the full text article).
This trial showed that electroacupuncture can stimulate polycystic ovaries to ovulate more frequently (click here for the full text article).
This study compared the effects of a Chinese herbal medicine prescription with metformin in PCOS patients with high testosterone and high insulin levels. Both were found to be effective but the herbal medicine more so (click here for the full text article).
The References
Junyoung Jo and Yoon Jae Lee. Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis. Acup in Med, online 2017.
Lim DC et al. Current evidence of acupuncture on polycystic ovarian syndrome. Gynecol Endocrinol. 2010; Mar 16.
Zheng YH et al. Effectiveness of Abdominal Acupuncture for Patients with Obesity-Type Polycystic Ovary Syndrome: A Randomized Controlled Trial. Jnl of Alt and Comp Med. 2013;19(9):740-5.
Johansson J et al. Acupuncture for ovulation induction in polycystic ovary syndrome: A randomized controlled trial. Am J Physiol Endocrinol Metab. 2013;304(9):E934-43.
Rashidi BH et al. Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome. Acupunct Med. 2013;31(2):151-6.
Pastore L et al. True and Sham Acupuncture Produced Similar Frequency of Ovulation and Improved LH to FSH Ratios in Women with Polycystic Ovary Syndrome. Jnl Clin Endocrinol Metab; Aug, online jc.2011-1126.
Jedel E et al. Impact of EA and physical exercise on hyperandrogenism and oligo/amenorrhea in women with PCOS. Am J Physiol Endocrinol Metab. 2011;300:(1)E37-E45.
Stener Victorin E et al. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol. 2009 Aug;297(2):R387-95.
Chen Jun et al. Investigation on effect of electroacupuncture intervention on in vitro fertilization and embryo transfer of patients with polycystic ovarian syndrome. Maternal and Child Health Care of China 2009;30:28.
Fang Lian et al, Zhongguo Zhong Xi Yi Jie He Za Zhi. Combined therapy of Chinese medicine with in vitro fertilization and embryo transplantation for treatment of polycystic ovarian syndrome. Chinese Journal of Integrated Traditional and Western medicine 2008;28(11):977-80.
Stener-Victorin E et al. Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence. Journal of Neuroendocrinology 2008, 20 (3), 290–298.
Wu JH et al, Zhongguo Zhong Xi Yi Jie He Za Zhi. Clinical study on effect of Bushen Huayu Qutan Recipe in treating polycystic ovarian syndrome. Chin J Integ Trad Western Med. 2007;27(10):883-6.
Stener Victorin E et al. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000;79:180–188.
Hou et al, Zhongguo Zhong Xi Yi Jie He Za Zhi. Study on treatment of hyperandrogenism and hyperinsulinaemia in polycystic ovarian syndrome with Chinese herbal formula Tiangui Fang. Chin J Integ Trad Western Med. 2000;20(8):589-92.