PCOS is an endocrine and metabolic disorder affecting up to 10% of women of childbearing age. While pharmaceutical drugs and surgery are effective, they also carry with them obvious side effects and hence cannot be used over a long duration of time. For example, hormonal medication may reduce hirsutism and acne, but has an adverse effect of glucose tolerance, coagulability and fertility (Lanham et al). Acupuncture has been chosen by women with PCOS as an alternative treatment for the management of PCOS. Below are some of the research studies specific to the use of acupuncture in the treatment of PCOS. The results of some of these studies are also relevant to other gynecological conditions that relate to ovulatory dysfunction, e.g. oligomenorrhea (delayed ovulation), hypomenorrhea (scant menses), amenorrhea as well as ART techniques like IUI and IVF.
Studies on Animals:
The murine rat model is employed, using continuous release of DHT, continuous injections of DHEA or single injection of Estradiol Valerate (EV) to induce formation of polycystic ovaries as well as PCOS-like symptoms. Repetitive electro-acupuncture is then given and the effects are noted. From the research, it seems that acupuncture is successful at reversing most of these PCOS-like symptoms. Most agree it does so by down-regulating sympathetic output, which is associated with a reduction in abnormal levels of nerve growth factor (NGF), endothelin-1 (ET-1) and corticotrophin-releasing factor (CRF), as well as the enhancement of lowered levels of hypothalamic beta-endorphin concentration. It also seems from similar studies on murine models that repetitive use of acupuncture can lower increased leptin and cholesterol levels while modulating insulin resistance.
- Johannson et al, 2010 (http://onlinelibrary.wiley.com/doi/10.1113/expphysiol.2011.063131/pdf): Use of electro-acupuncture normalized insulin sensitivity, lowered cholesterol levels, and increased expression of GLUT4 in skeletal muscle when compared to control.
- Feng et al, 2009 (http://onlinelibrary.wiley.com/doi/10.1113/expphysiol.2011.063131/pdf): GnRH and androgen receptor expression levels were reduced with electro-acupuncture.
- Manneras et al, 2009 (http://www.ncbi.nlm.nih.gov/pubmed/19158405): Electro-acupuncture and exercises seemed to modulate sympathetic outflow to adipose tissue and ovaries, resulting in higher proportions of healthy antral follicles and a thinner theca interna.
- Manneras et al, 2008 (http://www.ncbi.nlm.nih.gov/pubmed/18388196): Electro-acupuncture and exercise improved insulin sensitivity. Electro-acupuncture restored leptin and coupling protein 2 levels, while exercise restored leptin and IL-6 levels.
- Manni et al, 2005 (http://www.ncbi.nlm.nih.gov/pubmed/15941472): EV-induced changes were normalized using electro-acupuncture. It is probable that acupuncture normalizes the sympathetic response that increases ovarian NGF.
- Bai et al, 2004 (http://www.ncbi.nlm.nih.gov/pubmed/14671415): Electro-acupuncture partially reversed NGF abundance in ovaries.
- Stener-Victorin et al, 2004 (http://www.ncbi.nlm.nih.gov/pubmed/14561641): EV-induced reduction in beta-endorphin concentrations in the hypothalamus were reversed with electro-acupuncture.
- Stener-Victorin at al, 2003 (http://www.ncbi.nlm.nih.gov/pubmed/14614964): Electro-acupuncture increases ovarian blood flow as a reflex response via the ovarian sympathetic nerves.
- Stener-Victorin et al, 2003 (http://www.ncbi.nlm.nih.gov/pubmed/12725645): Electro-acupuncture significantly reduces ovarian concentrations of endothelin-1, a potent vasoconstrictor involved in ovarian functions.
- Stener-Victorin et al, 2001 (http://www.ncbi.nlm.nih.gov/pubmed/12030806): Electro-acupuncture may improve PCOS symptoms by decreasing concentrations of corticotropin-releasing factor in the ovaries.
- Stener-Victorin et al, 2000 (http://www.ncbi.nlm.nih.gov/pubmed/11058557): Acupuncture significantly decreased NGF concentrations in the ovaries.
Studies involving Women with PCOS:
- Lai et al, 2010 (http://www.cnki.net/kcms/detail/detail.aspx?dbcode=cjfq&dbname=cjfqtotal&filename=XCYJ201004015&uid=&p=): Both the acupuncture-only group (daily acupuncture) and the control group (metformin usage) showed improvement in PCOS symptoms after 6 months of use. Daily acupuncture also significantly normalized menstrual frequency, free testosterone levels and BMI levels.
- Jedel et al, 2011 (http://www.ncbi.nlm.nih.gov/pubmed/20943753): Electro-acupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effective than no intervention.
- Stener-Victorin et al, 2009 (http://www.ncbi.nlm.nih.gov/pubmed/19494176): Electro-acupuncture and physical exercise lowers high sympathetic nerve activity in women with PCOS.
- Chen et al, 2007: Both the acupuncture group and clomid/hCG group showed blood hormone profile and ultrasound examination status after 3 cycles of treatment, but normal menstruation and ovulation was maintained in the acupuncture group.
- Stener-Victorin et al, 2000 (http://www.ncbi.nlm.nih.gov/pubmed/10716298): This “before-after” study showed that 38% of sample group experienced good effect and more ovulations after acupuncture as opposed to before treatment.
Reviews:
- Stener-Victorin et al, 2013 (http://www.ncbi.nlm.nih.gov/pubmed/23416841): For each aspect of PCOS, it is important to pursue new treatment strategies that have fewer negative side effects than drug treatments, as women with PCOS often require prolonged treatment. Increased sympathetic activity contributes to the development and maintenance of PCOS, and the effects of acupuncture are partly mediated by modulation of sympathetic outflow.
- Lansdown et al, 2012 (http://www.ncbi.nlm.nih.gov/pubmed/22882204): Patients with PCOS have evidence of increased muscle sympathetic nerve activity (MSNA), altered heart rate variability and attenuated heart rate recovery post-exercise, compared with age- and BMI-matched controls, suggesting a generalized increase in sympathetic nerve activity. Active weight loss can reduce MSNA and whole body noradrenaline spillover, whereas low-frequency electroacupuncture decreased MSNA in overweight women with PCOS.
- Raja-Khan et al, 2011 (http://www.ncbi.nlm.nih.gov/pubmed/21487075): Acupuncture reduces hyperandrogenism and improves menstrual frequency in PCOS. Acupuncture’s clinical effects are mediated via activation of somatic afferent nerves innervating the skin and muscle, which, via modulation of the activity in the somatic and autonomic nervous system, may modulate endocrine and metabolic functions in PCOS.
- Lim et al, 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20230329): 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.
- Stener-Victorin et al, 2008 (http://www.ncbi.nlm.nih.gov/pubmed/18047551): Acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exerts long-lasting beneficial effects on metabolic and endocrine systems and ovulation.
Especially in this new millennium, we are starting to see more research coming out on the beneficial effects of an ancient form of treatment. Acupuncture helps by “regulating the terrain” of the body. By doing so, it enhances general health but also can be used to treat medical condition e.g. to complement and enhance artificial reproductive technologies. Acupuncture as treatment for amenorrhea (originally termed “obstructed menses”) has been documented in the classic texts, but only today are we finding out that these small needles affect not just the endocrine system, but also the circulatory, nervous and metabolic systems in helping ladies regain proper ovulatory function.
