Researches on Acupuncture for PCOS​

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​Acupuncture and herbal medicine has indicated beneficial effects for menstrual irregularities and ovulation induction in women with PCOS.

​​Pathology and treatment of PCOS

What is PCOS?

• PCOS has been recognized for more than 70 years, but there is no cohesive definition and diagnostic criteria still remain on debates.
• Despite high incidence, the etiology of PCOS remains unclear, but it is considered a hormonal disorder. Genetics and environmental factors are believed to be involved in the development of PCOS.
• Prevalence is between 6~15% but sometimes even up to 20% of women in reproductive age depending on used criteria.
• The most common endocrine disorder in women of reproductive age.
• The most common cause of anovulatory infertility of women of reproductive age.
• PCOS is associated with type 2 diabetes, obesity, hypertension and elevated risks of cardiovascular diseases.

What is ovarian cyst?

The definition of a cyst is a fluid-filled sac. Cysts can occur anywhere in the body. With PCOS, women can develop "cysts" due to eggs not being released over time. The follicles keep growing and form multiple "cysts." These may be described as appearing like a "string of pearls" in an ultrasound image.
Despite the name, women with PCOS don't need to have ovarian cysts. Women without PCOS may develop cysts related to other reasons. The most common type of ovarian cyst is called a functional cyst.
These cysts are described as "functional" because they often develop during the menstrual cycle.

There are 2 types:

• Follicular cysts: These usually go away on their own in 1 to 3 months. These form when an egg doesn't get released as expected, so the follicle keeps growing to become a cyst.

• Corpus luteum cysts: These also usually go away on their own. These form after the follicle ruptures and releases the egg (ovulation). The follicle reseals and fluid starts to buildup within it. They can enlarge and cause pain, bleed, or twist the ovary. Fertility medicines used to promote ovulation (such as clomiphene) can increase the chances of developing this type of cysts.

Ovarian cysts can also be related to endometriosis, or formed from the outer surface of the ovary (cystadenomas), or formed with non-ovarian tissue (dermoid cysts).
<Sources: Office of Women's Health, Department of Health and Human Services. American College of Obstetrics and Gynecology.>

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Symptoms of PCOS

Symptoms of PCOS may begin shortly after puberty, but can also develop during the later teen years and early adulthood. Because symptoms may be attributed to other causes or go unnoticed, PCOS may go undiagnosed for some time.
Common symptoms are

• Irregular period, missed period, or no period. Scanty menstrual flow.
• Infertility (anovulation)
• Hirsutism, acne, and sometimes scalp hair loss(alopecia)
• Being likely to be overweight (Central obesity), diabetes and/or hypertensive.

Other symptoms include

• Fatigue: Many women with PCOS report increased fatigue and low energy. Related issues such as poor sleep may contribute to the feeling of fatigue.
• Mood change: Having PCOS can increase the likelihood of mood swings, depression, and anxiety.
• Pelvic pain: Pelvic pain may occur with periods, along with heavy bleeding. It may also occur when a woman isn’t bleeding.
• Headaches: Hormonal changes prompt headaches.
• Sleep problems: Women with PCOS often report problems such as insomnia or poor sleep. There are many factors that can affect sleep, but PCOS has been linked to a sleep disorder called sleep apnea.  With sleep apnea, a person will stop breathing for short periods of time during sleep.

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Diagnostic criteria

There is no single special test that can diagnose PCOS. Your doctor will ask many questions about history of symptoms such as irregular period or skipped period, hair growth, acne and weight gain, personal medical history and family’s medical history. A number of lab tests may be carried out including blood test for blood sugar and hormone levels. A sonogram may also be done to evaluate the ovaries.

• Hyperandrogenism: Clinical and biochemical signs. Hyperandrogenism can result in the clinical signs of hirsutism, acne and to some extent alopecia. In PCOS, high circulating levels of androgens, estrogens, sex steroid precursors, and glucuronidated androgen metabolites have been demonstrated.
• Ovulatory dysfunction: Oligoovulation, anovulation, oligomenorrhoea or amenorrhoea. BBT is uniphasic. Diagnostic curettage shows endometrial hyperplasia and no secretary endometrium.
• PCO morphology: Ultrasonography and/or laparoscopy examination. Accumulation of ≥12 small antral follicles of size 2mm~9mm and/or enlarged ovarian volume of ≥10㎖ in one or both ovaries. Despite the name, many women do not have cysts on their ovaries. In 2013, an independent panel of experts recommended to the National Institutes of Health that the name be changed because the name is confusing and hinders patient care and research efforts.
  
• Hormonal changes in women with PCOS: LH level is higher and FSH level is lower than normal.  Serum LH/FSH≥3,  E1/E2≥1, and Prolactin (PRL) is also elevated. AMH is higher than normal.

Pathopysiology and etiology of PCOS

Both of androgen and insulin have been presented as a key underlying cause of PCOS. Both increase during puberty where PCOS symptoms actually begin to manifest.
One of most common features of PCOS is insulin resistance and compensatory hyperinsulinemia, represented in 85% of PCOS women. The other common feature of PCOS is Elevated androgen levels affect around 60~80% of PCOS women.

1. Hyperandrogenism
2. Hyperinsulinemia
3. Increased LH secretion and decreased FSH
4. Abnormal follicle development
5. Increased AMH levels
6. Increased sympathetic activities

 1. Hyperandrogenism

• All females make androgens (also referred to as “male hormones”), but there are often higher levels of androgens in women with PCOS. The excess androgens are produced mostly by the ovaries, but the adrenal glands can also be involved. Excess androgens are responsible for many PCOS symptoms including acne, unwanted hair, thinning hair on the head, and irregular periods.
• Androgen plays a central role in the pathology of PCOS. High level of circulating androgen alone can affect many of the systems that are impaired in the syndrome and are sufficient to cause PCOS like states. It can directly manifest clinical signs of hirsutism, acne and, to some extent, alopecia.
• In PCOS, high circulating levels of androgen, estrogen, sex steroid precursors, and glucuronidated androgen metabolites have been demonstrated.
• Hyperandrogenemia in PCOS originates mainly from the ovaries. High levels of circulating androgen can themselves further increase hyperandrogenemia (positive feedback?) via a few ways written below. Consequently, a vicious circle is created where individual pieces may augment each other, although it is not clear where it started.

1. By increasing gonadotropin secretion via affecting sex-steroid negative feed-back systems.
2. Enhancing the effects of gonadotropin on ovarian gonadotropin stimulated sex steroid production (increased sensitivity of theca cells to LH in androgen production).
3. Androgens also directly impair follicle development and maturation and thereby contribute both to the PCO morphology and to the ovarian pool of androgen producing cells.

• Ovarian steroid production is based on a close collaboration between theca and granulosa cells in the growing follicles and requires gonadotropin input. Women with PCOS appear to have theca interna hyperplasia, a thicker layer of the theca cells, which seem to be responsible for their increased androgen steroidogenesis. Moreover, each theca cell has increased expression of LH receptors, with increased susceptibility to LH stimulation.

• Additionally, though the mechanism is not completely clear, increased adrenal androgen production can also contribute to the hyperandrogenism to some part.
• Since it is not known when or where the pathology actually begins, several different hypotheses have been presented. Two of them are ‘prenatal androgenization’ and ‘prepubertal exposure to androgens’.

2. Hyperinsulinemia

• Insulin allows the body to absorb glucose (blood sugar) into the cells for energy. In PCOS, the body is not as responsive to insulin as it should be (increased insulin resistance). This can lead to elevated blood glucose levels and cause the body to make more insulin. Having too much insulin can cause the body to make more androgens.
• Although it is not a part of the diagnosis, PCOS is strongly associated with insulin resistance and compensatory hyperinsulinemia, type 2 diabetes, and dyslipidemia and the prevalence of women with PCOS being overweight or obese.
• Hyperinsulinemia inhibits the liver production of sex hormone binding globulin (SHBG), thereby further contributing to levels of free circulating androgens.
• Similar to androgens, insulin resistance and hyperinsulinemia enhance ovarian gonadotropin stimulated sex steroid production and may contribute to the abnormal gonadotropin secretion although the mechanism is not clear. 

 3. Increased LH secretion and decreased FSH

• Disturbed hypothalamic-pituitary-ovarian (HPO) axis has been extensively reviewed. The most evident neuroendocrine feature regulating abnormal ovarian follicular development in PCOS is increased LH pulsatility regarding both frequency and amplitude with relatively low FSH secretion. Increased LH pulse frequency increases theca cell production of androgens, while lower FSH levels impair follicle maturation and consequently ovulation.
• One probable cause of increased LH secretion is due to enhanced pituitary sensitivity to GnRH.
• Another possible cause of LH hypersecretion is change of GnRH pulse pattern. It appears to be a result of acquired impaired sensitivity of the hypothalamic pulse generator to the negative feedback of estrogen and progesterone in PCOS.
• Levels of FSH in PCOS appear to be low or within the lower follicular range.

 4. Abnormal follicle developments

• The ovulatory dysfunction in PCOS can be ascribed to disturbed follicular development with excessive early follicle growth and abnormal later stages of arrested follicle growth well before expected maturation. This pattern of follicular growth with failure in the selection of a dominant follicle for ovulation results in PCO morphology. The ovulatory dysfunction of PCOS involves

1. Morphological features of polycystic ovaries and
2. Clinical consequences of oligo-/anovulation.

• The prevalence of menstrual irregularities, oligo-/amenorrhoea, in PCOS depends on used diagnostic criteria but is approximately 75%.
• Most consistent feature of abnormal follicle development is impaired and increased androgen steroidogenesis.

5. Increased AMH levels

• AMH is expressed in the granulosa cells of early antral and pre-antral follicles, but not in the later stages of development, and reflects the size and activity of the follicular pool.
• There is evidence of its involvement in the regulation of recruitment of primordial follicles into the growing pool, presumably by decreasing the granulosa cell sensitivity to FSH.
• In both circulation and antral follicular fluid of PCOS women, AMH levels are increased. These high circulating levels may be a reflection of the increased pool of granulosa cells instead of an increased expression. Since high levels of AMH are associated with lower levels of FSH and estradiol, it has been suggested that the AMH excess is involved in the lack of FSH-induced granulosa cell activity (aromatase cycle: conversion of androgen to estradiol) that is characteristic of follicular arrest (arrested follicular development) in PCOS.

6. Increased sympathetic activity

• In a normal healthy state, a fine balance between sympathetic nervous system and parasympathetic nervous system ensures homeostasis.
• Women with PCOS have an increased sympathetic nerve activity that is correlated to high levels of testosterone.
• Increased sympathetic innervations of the ovaries might contribute to the impaired follicular development in PCOS resulting in increased androgen production and PCO morphology.
• Many of the components of PCOS such as polycystic ovaries, insulin resistance with related hyperinsulinemia, central obesity, hypertension and increased cardiovascular risk are associated with increased sympathetic activity.
• Measures in PCOS women indicate that they have decreased dynamic activity in their autonomic function, possibly by decreased activity in parasympathetic component and increased sympathetic component.
• Researches on the effect of acupuncture and physical exercise to lower MSNA (muscle sympathetic nerve activity) in women with PCOS demonstrated that “low-frequency electro-acupuncture (EA) and physical exercise decrease high sympathetic nerve activity in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS.”

 Treatment of PCOS

No direct treatment to clear PCOS syndrome has been presented. However, there are many ways you can decrease or eliminate PCOS symptoms and feel better. Your doctor may offer different medicines that can control symptoms such as irregular periods, acne, excessive hair growth, and elevated blood sugar. Fertility treatments are available to help women get pregnant.
In women of obesity, losing as little as 5% excess weight can help women ovulate more regularly and lessen other PCOS symptoms. The ideal way to do this is through exercise and nutrition.
You may feel that it is difficult to lose excess weight and keep it off, but it is important to continue the effort. Your efforts help reduce the risk for developing serious health complications that can impact women with PCOS much sooner than women without PCOS. The biggest health concerns are diabetes, heart disease, and stroke because PCOS is linked to having high blood pressure, pre-diabetes, and high cholesterol.

1. Hirsutism and acne

• Contraceptive pills help to control the effect the pituitary gland has on the ovaries. If a woman is not seeking to become pregnant, hormonal birth control (most often birth control pills) is a standard treatment. Birth control pills regulate periods and improve excess hair growth and acne by lowering androgen levels and protect the endometrium (inner lining of the uterus) against abnormal cell growth by regularly removing endometrial tissue through menstrual flow. Ginet 84 is especially good, because it also controls the effects of the androgens.
• Anti-androgen drugs such as spironolactone or cyproterone acetate slow down androgen related symptoms such as hair growth by lowering androgen levels. They take up to six months to take effect, and the effect gradually wears off if they are stopped.   Spironolactone is most often used: A 6 month trial is needed to show effects on unwanted hair. Unwanted hair doesn’t disappear, but grows in finer and lighter. Improvement of acne generally comes more quickly. Unfortunately, this drug is unlikely to help with androgen-related hair loss (aka androgenic alopecia) which is more difficult to treat.

•   Spironolactone: Diuretic, cardiovascular system. Aldosterone antagonist, use for hypertension.
•   Cyproterone acetate: Antiandrogen, use for inoperable prostate cancer in men and for severe androgenism in women.
•   Ginet-84 / Diane-35ED: Cyproterone acetate 2mg + ethinyloestradiol 0.035mg: 21 tabs + inactive 7 tabs. Contraceptive agents.

•  Treatments targeting the skin or hair directly are also available to help with hair problems. These include the prescription cream eflornithine hydrochloride (Vaniqa), acne products, and cosmetic treatments such as laser therapy and electrolysis.
• Vitamins, supplements, and other complementary treatments are popular among women with PCOS. Researchers are studying the effectiveness of such treatments. Popular treatments include cinnamon, myo-inositol, vitamin D, B complex vitamins, and acupuncture.

 
2. Infertility

• Clomiphene (Clomid) is an oral medication that is the most common treatment used to induce ovulation. The use of both metformin and clomiphene has about the same fertility results as clomiphene use alone. 15% of PCOS women do not successfully respond to ovulation induction with clomiphene.
• Other treatments to stimulate ovulation include another oral medication called letrozole (Femara).
• Gonadotropin injection: if clomiphene does not work, gonadotropin injection might be tried. This is more powerful treatment and needs to be carefully monitored.
• In vitro fertilization (IVF) may be other fertility treatment options.
• In women of overweight, losing weight and exercising will also improve infertility.

• Clomiphene citrate: women take it for five consecutive days, beginning on day 2~5 of menstrual cycle. Ovulation usually occurs after 7~8 days after finish taking clomiphene. LH surge occurs about 7 days after finish clomiphene. Ovulation usually occurs about 10~12 hours after the peak of LH surge or 32~36 hours after the start of LH surge.
• Letrozole: Nonsteroidal aromatase inhibitor, neoplastic drugs. It is also used to induce ovulation in the same way as clomiphene. Research is underway to compare effectiveness and side effects between clomiphene and Letrozole.
  

 
3. Insulin resistance and hyperinsulinemia

• Many doctors prescribe Metformin (insulin sensitising agent) for PCOS patients. It has been used for many years to treat diabetes and is also used to treat PCOS. Metformin is a medicine that makes the body more sensitive to insulin. This can help lower elevated blood glucose levels, insulin levels, and androgen levels. People who use metformin may lose some weight as well. Metformin can improve menstrual patterns, but metformin doesn’t help as much for unwanted excess hair.
• Metformin probably works by reducing the amount of insulin in the blood stream, which means ovaries make less of androgens (metformin directly inhibits human theca cell androgen synthesis). Thereby it might also make the periods more regular and increase the chances clomiphene will lead to ovulation.
• In overweight women, losing weight can also improve insulin resistance, make periods more regular and improve hormone balances.
• In research results, lifestyle intervention, focusing on predominantly on diet and physical exercise, is considered the first-line treatment for metabolic complication in overweight and obese women with PCOS and may have the potential to improve ovulatory function and infertility.

 
4. Operations

Surgical treatment is sometimes used for women with infertility caused by PCOS who does not start ovulating after taking medications and other treatments. Ovarian function is improved by reducing the number of small cysts during surgery.

·       Ovarian wedge resection is the surgical removal of part of an ovary. This is done to help regulate menstrual cycles and start normal ovulation. It is rarely used now because of the possibility of damaging the ovary and creating scar tissue.

·       Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have PCOS and who have not responded to weight loss and fertility medicine. Electrocautery or a laser is used to destroy portions of the ovaries.

Surgery for PCOS may be recommended only if you have not responded to any other treatment for PCOS. Each woman will want to discuss the risks and benefits of this surgery with her doctor. Surgery is less likely to lead to multiple pregnancies than taking fertility medicines. It is not known how long the benefits from surgery will last. There is some concern that ovarian surgery can cause scar tissue, which can lead to pain or more fertility problems.

 
 - Korean - 

PCOS 한방치료

PCOS는 本은 신허에 있고 標는 습담, 간울화화, 기체혈어증으로 분별되며 標本은 서로 因果관계이다. 장부는 간, 비, 신이 연관되어 있고, 병소는 임충맥에 있다. 치법은 補腎을 그 本으로 하고, 건비이기화담, 소간해울사화, 활혈화어조경을 標로 한다. 『상해중의대 판 중의부과학』

"PCOS의 한의학적 변증은 대체로 신허, 담습조체, 간울기체, 음허내열의 4가지 유형으로 분류할 수 있으나 신허와 습담을 기본으로 삼고, 부가적으로 허실이 협잡된 것으로 인식할 수 있다. 변증처방으로 금궤신기환, 定經湯, 창부도담탕, 瓜石散가감 등을 활용할 수 있으며, 통경을 위해 산사, 계내금, 익모초, 우슬, 단삼, 택란, 홍화 등의 활혈통경약을 적절히 가미한다."
『원안나 등. 다낭성 난소증후군의 난임치료에 대한 한약임상연구 경향 분석. 대한한방부인과학회지. 2014; 27(4): 43-56』

"한의학에서 다낭성 난소 증후군이라는 병명은 찾아볼 수 없지만 증상에 의거하여 ‘經閉, 月經不調, 無子, 不姙, 肥滿, 多毛’ 등의 범주에 해당한다. 특히 비만과 동반하여 나타나는 불임, 무월경에 대하여 기술된 문헌들이 있는데 肥人의 병리적인 측면에 대하여
《내경》에서는 ‘비인은 多虛하여 氣不能運行固痰生’한다고 하였고,
《경악전서》에서는 ‘비인은 氣虛의 증상이 많아서 多濕多滯固氣道多有不利’하다고 기술했으며,
《동의보감》에서는 ‘비인은 血實氣虛多痰, 腠理緻密, 多鬱滯氣血하여 難而通利’하다고 하였는데, 총괄하면 기허습담으로 병인을 요약할 수 있다."
『김세화 등. 다낭성 난소증후군의 침치료 연구에 관한 체계적 문헌고찰. 대한한방부인과학회지. 2014; 27(2): 71-82』

Hyperandrogenism열로 변증할 수 있으며, 열과 어혈을 겸한 간신음허 변증이 제일 많다. 귀판이 자음에 아주 좋은 효과가 있다.『Rona Wang』

사암침법으로는 월경병이라는 면에서 소장정격(삼음교 加)이 기본일까 한다.

PCOS의 동양의학적 치료는 배란의 정상적 회복을 통한 조경, 그리고 이를 통한 자연적 임신을 목표로 한다.

아래의 변증별 한약처방은 상해중의대 판 부과학 교재에서, 침치료는 Rona Wang의 handout에서, 사암침은 나의 의견임.

1. 신허증

• 기타병증: 두훈, 이명, 요슬산연, 사지냉증, 소변청장, 연변, 성욕부진, 비만, 다모증, 舌淡, 薄白苔, 침세맥.
• 치법: 보신익정, 조보충임
• 방약: 우귀환 가감: 숙지황10, 산약20, 산수유10, 구기자10, 녹각교10, 토사자12, 두충10, 당귀10, 육계6, 제부자6

• 희박월경, 월경지연, 무월경시: 加 택란12, 천우슬12, 계혈등20
• 사춘기환자, 자궁발육불량시: 加 자하거(先煎)10, 하수오10, 육종용10, 음양곽10.
  
• 침치료 예: 신정격, 소장승격, 소장정격, 삼음교 가
• 침치료 예: BL23, BL52, Ren4, Ren6, SP6, KID3, ST29

 2. 습담증

• 기타병증: 대하, 두훈, 두중, 흉민, nausea(욕지기/속매스꺼움), 사지권태, 후중담음, 연변, 비만, 다모증. 白膩苔. 활맥.
• 치법: 조습하담, 이기조경
• 방약: 창부도담탕 가감: 창출10, 향부자10, 복령12, 법반하10, 진피10, 감초3, 담남성10, 지각10, 신곡10, 생강3편
• 비만, 다모증: 加 산자고10, 하고초10, 조각자15, 석창포10  (화담활락)
• 소복결괴형성: 加 곤포15, 해조15, 하고초10, 아출12 (연견산결소징)
• 치치료 예: 대장정격, 비승격, 증극 가
• 침치료 예: Ren12, Ren3, BL20, BL22, ST40, SP6, SP8, LIV3

 3. 간울化火증

• 기타병증: 근육형, thick hair, 얼굴여드름, 월경전 유방흉협창통, 유즙주출, 구건, 희냉음, 대변비결, 황박태, 현삭맥.
• 치법: 소간해울, 청열사화
• 방약: 단치소요산 가감: 목단피10, 치자10, 당귀10, 백작약15, 시호6, 백출10, 자감초5, 천우슬10
• 대변비결: 加 대황 적당량 (청열사화통변)
• 유즙누출(lactorrhoea): 加 초맥아60, 苦丁茶10,
• 유방흉협창만: 加 울금15, 왕불유행15, 로로통10 (소간통락산결)
• 침치료 예: 간정격, 간한격, 담정격, 삼음교 가
• 침치료 예: SP6, SP8, SP10, BL17, LIV2, LIV3, KID2

 4. 기체혈어증

• 기타병증: 월경중 심한 복통, blood clots in flow, depression, 흉협창통, 자색이나 자반설, 침현맥.
• 치법: 이기활혈, 화어조경
• 방약: 격하축어탕 가감: 당귀10, 천궁5, 적작약10, 도인10, 홍화6, 지각10, 연호색10, 오령지10, 목단피10, 백작약10, 향부자10, 감초5.
• 월경전 흉협 유방 소복 창통, 심번이노: 加 청피10, 목향9, 시호6 (서간해울, 행기지통)
• 복중결괴: 加 삼릉10, 아출10, 몰약10, 로로통10 (활혈화어소징)
• 침치료 예: 소장정격, 간정격, 삼음교 가
• 침치료 예: LIV4, LIV3, SP10, SP6, SP8, ST30

 5. 음허내열

 
기타 한약치료와 침치료 리서치 결과.

Repeated acupuncture treatments in women with PCOS and women with undefined ovulatory dysfunction have been shown to exert long-lasting beneficial effects on endocrinological parameters and anovulation with no negative side effects. Repeated acupuncture treatments decrease total testosterone and other sex steroid levels, reduce the LH to FSH ratio, and improve menstrual frequency without adverse effects.
Physical exercise has also been shown to have positive effects on ovulation and cardiopulmonary function in women with PCOS.

용담사간탕, 조경종옥탕, 정경탕, 창부도담탕 등의 처방과 향부자, 당귀, 조각자 등의 단미 약물이 실험적(흰쥐)으로 유효한 효과를 나타낸다고 보고되었으며, 침치료와 관련하여 삼음교, 자궁혈 전침자극이 다낭성 난소에 유의한 효과가 있음이 실험적으로(흰쥐) 규명된바 있다.
 

■ 『Jedel E, Labrie F, Oden A, Holm G, Nilsson L, Janson PO, Lind AK, Ohlsson C, Stener-Victorin E. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhoea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physicol Endocrinol Metab. 2011. 300: E37-E45』

Interventions
Acupuncture: a total of 14 treatments over 16 weeks (twice a week for 2 weeks, once weekly for 6 weeks and once every other week for 8 weeks). Each treatment lasted 30 min.
CV3, CV6, ST29, SP6 and SP9 were stimulated with EA of 2 Hz, and
LI4 and PC6 were stimulated manually by hand with needle rotation every 10 min.

Physical exercise: 16 weeks of regular exercise including brisk walking, cycling, or any other aerobic exercise at a self-selected pace described as “faster than normal walking but a pace that could be sustained for at least 30min at least 3 days a week”. Physical exercise was self-monitored with a heart rate monitor to ensure a heart rate of ≥120 beats/min.

Conclusion: “Low frequency EA (electro-acupuncture) and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.” (first demonstration in an RCT on the effect of electro-acupuncture on the ovarian function)

■ 『Johansson J, Redman L, Veldhuis PP, Sazonova A, Labrie F, Holm G, Johansson G, Stener-Victorin E. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2013. 304: E934-E943』

Interventions

Acupuncture

                  2Hz: electro-acupuncture with 2 Hz

                  MA: manual stimulation every 10 minutes to evoke de qi.

                  Set1 and Set2 were alternated in every other treatment.
 

Attention control: visiting the same physical therapists. The therapeutic meeting was held for an equal amount of time (twice weekly for 10-13 weeks). Time was spent resting and listening relaxing music.

 Conclusion: “Repeated acupuncture treatments result  in a higher ovulation frequency in lean/overweight women with PCOS and are more effective than the attention and time involved in the meeting with a therapist. Acupuncture may represent an alternative or complementary therapy to standard pharmacological or surgical treatments, but clinical trials comparing acupuncture with these approaches need to be performed to determine the efficacy of such treatment”

■ 『Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009. 297: R387-R395』

 Interventions
Acupuncture: a total of 14 treatments over 16 weeks (twice a week for 2 weeks, once weekly for 6 weeks, and once every second week for 8 weeks). Each treatment lasted 30 min.
CV3, CV6, ST29, SP6 and SP9 were stimulated with EA of 2 Hz, and
LI4 and PC6 were stimulated manually by hand with needle rotation every 10 min.

 Physical exercise: Regular exercise comprising brisk walking, cycling, or any other aerobic exercise at a selected pace described as “faster than normal walking but a pace that could be sustained for at least 30min”. they were instructed to do their exercise at least 3 days a week, each of 30-45 min duration, with a pulse frequency above 120/min during 16 weeks.

Conclusion: “For the first time we demonstrate that low-frequency electro-acupuncture (EA) and physical exercise decrease high sympathetic nerve activity (MSNA) in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS.”

■『Yu L, Liao Y, Wu H, Zhao J, Wu L, Shi Y, Fang J. Effects of electro-acupuncture and Chinese kidney-nourishing medicine on polycystic ovary syndrome in obese patients. J Tradit Chin Med. 2015. 33(3): 287-293』

Interventions
Acupuncture-medicine group:

• Group1 (supine position): SP6, SP10, SP15, ST25, Zigong, KI12, KI3, GB26, ST36, CV12, CV6, CV4
• Group2 (prone position): SP6, SP9, KI3, BL17, BL18, BL20, BL23, BL32
• Points with underline are stimulated with EA with 2Hz. Other points are stimulated manually every 10 minutes. Needles retained for 40 minutes. 3 times a week for 3 months or 3 menstrual cycles.
• For phlegm blockage and blood stasis: added LI4, SP4, ST40, and SP8
• For damp-heat accumulation: added SJ6, LI11, LR3, and GB34.
• Chinese Medicine: Tiankui capsules, 6 capsules a time, 2 times a day for 3 months. It consists of 숙지황, 지모, 仙靈脾(음양곽), 호장, 마편초, 당귀, 도인, 황정, 석창포, 귀판, 보골지

Acupuncture only group: Same as acupuncture-medicine group.

 Conclusion: “Acupuncture combined with medicine is better than just electro-acupuncture for obese PCOS patients by improving obesity-related indexes, insulin sensitivity, and APN (adiponectin) level. This indicates that acupuncture-medicine therapy is worth clinical popularization.”   

Acknowledgement
This research article on PCOS is largely based on the following sources

• Johansson J, Stener-Victorin E. Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction: a Review Article. Evidence-Based Complementary and Alternative Medicine. 2013:762615, 2013.
• A Visual Guide to PCOS. http://www.webmd.com/women/ss/slideshow-pcos-overview.

■ “Low frequency EA (electro-acupuncture) and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.”

『Jedel E, Labrie F, Oden A, Holm G, Nilsson L, Janson PO, Lind AK, Ohlsson C, Stener-Victorin E. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhoea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physicol Endocrinol Metab. 2011. 300: E37-E45』

■ “Repeated acupuncture treatments result  in a higher ovulation frequency in lean/overweight women with PCOS and are more effective than the attention and time involved in the meeting with a therapist. Acupuncture may represent an alternative or complementary therapy to standard pharmacological or surgical treatments, but clinical trials comparing acupuncture with these approaches need to be performed to determine the efficacy of such treatment”

『Johansson J, Redman L, Veldhuis PP, Sazonova A, Labrie F, Holm G, Johansson G, Stener-Victorin E. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2013. 304: E934-E943』

■ “For the first time we demonstrate that low-frequency electro-acupuncture (EA) and physical exercise decrease high sympathetic nerve activity (MSNA) in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS.”

『Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009. 297: R387-R395』

■ “The viscous circle of PCOS features aggravating each other may be driven by androgens, insulin, or other factors but must be broken to improve the health status of women with PCOS. Although pharmacological treatment may be effective, they are also associated with negative side-effects. This review addresses acupuncture as a potential treatment option for reproductive and endocrine disturbances in women with PCOS. Several clinical and animal experimental studies indicate that acupuncture is beneficial for ovulatory dysfunction in PCOS.”

『Johansson J, Stener-Victorin E. Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction: a Review Article. Evidence-Based Complementary and Alternative Medicine. 2013:762615』

■ “Acupuncture combined with medicine is better than just electro-acupuncture for obese PCOS patients by improving obesity-related indexes, insulin sensitivity, and APN (adiponectin) level. This indicates that acupuncture-medicine therapy is worth clinical popularization.”   

『Yu L, Liao Y, Wu H, Zhao J, Wu L, Shi Y, Fang J. Effects of electro-acupuncture and Chinese kidney-nourishing medicine on polycystic ovary syndrome in obese patients. J Tradit Chin Med. 2015. 33(3): 287-293』

Eastern Medicine Practitioner

AUCKLAND CITY ACUPUNCTURE 

Blood levels of AMH to age