Polycystic ovarian syndrome (PCOS) a herbal approach

PCOS 1 IN 5
70% 50-70% 30-75%
up to

is one of the women of child- of women with of women with

LEADING bearing age have PCOS have PCOS are also
CAUSES
PCOS 1 INSULIN
OBESE 2
of women with PCOS remain
of INFERTILITY UNDIAGNOSED 1
RESISTANCE 2

WHAT IS PCOS1-4 A HERBAL APPROACH TO PCOS1-10

Polycystic ovarian syndrome (PCOS) is a common GENETICS
GnRH: gonadotropin releasing hormone; LH: luteinising hormone; FSH: follicle stimulating
endocrine disorder among women of reproductive age. It hormone; E2: oestrogen
is characterised by hyperandrogenism and
hyperinsulinaemia.
PCOS has at least two of the following three criteria: GnRH
• Oligo/anovulation
• Hyperandrogenism:
- clinical (hirsutism or less commonly male LH FSH
pattern alopecia)
- biochemical (raised free androgen index LIQUORICE PEONY
or free testosterone)  LH Ž theca cells
• Polycystic ovaries on ultrasound Hirsutism Comorbid
Acne depression
PRESENTATION1-4 Alopecia

• Hirsutism and male pattern balding NORMAL ADRENAL

HEALTHY CORTEX
• Irregular or absent menstrual cycles OVARIES
• Subfertility or infertility LIQUORICE
• Anxiety, depression, eating disorders ANDROGEN
• Metabolic features – obesity, dyslipidaemia, diabetes EXCESS  extraglandular aromatisation
LIQUORICE PEONY DONG QUAI
COMPLICATIONS 1-4

Having PCOS may make the following conditions more

likely, especially if obesity also is a factor:
POLYCYSTIC OVARIES INSULIN RESISTANCE Acanthosis nigricans
• Cardiometabolic syndrome – diabetes, hypertension,
dyslipidaemia impaired follicle CINNAMON
development
• Nonalcoholic steatohepatitis
• Infertility
• Depression and anxiety ANOVULATION
HYPERINSULINAEMIA
• Abnormal uterine bleeding  free fatty acids
• Endometrial cancer (oestrogen influenced) no corpus luteum  inflammatory cytokines
• Gestational diabetes or pregnancy-induced high blood
pressure
 progesterone ANOVULATORY Irregular
SUBFERTILITY
RISK FACTORS 1-4 BLEED cycles

GENETICS: 20-40% of female first-degree relatives of  sex hormone  free fatty acids ADIPOSE
women with PCOS also have the condition, which binding globulin LIVER TISSUE
suggests a possible genetic component. PCOS is also impaired oocyte development, unopposed E2  insulin-like
more prevalent in South Asian women. breakthrough
high rate of miscarriage growth factor CINNAMON
OBESITY: Adipose dysfunction contributes to
development of insulin resistance and hyperinsulinaemia,
which in turn exacerbates hyperandrogenism. Obese endometrial hyperplasia
 risk endometrial cancer
women with PCOS are also at greater risk of anovulation
and subfertility. OBESITY