Polycystic ovarian syndrome (PCOS) is characterised by the clinical signs of infrequent or very light menstruation, failure to conceive, and excessive hair growth. The current standard western medical treatments for women with PCOS are prescription medications, surgery and lifestyle changes, whether or not they want to become pregnant. However, problems associated with current western therapies are the cost, increased risk of multiple pregnancies, undesirable side effects and inconsistency in their effectiveness. On the other hand, various non-randomised studies of acupuncture in PCOS have suggested low rates of associated adverse events, no increased risk of multiple pregnancy and that it is comparatively inexpensive to administer.

Scientific studies have investigated the acupuncture meridians and the neuro-endocrinological aspects of the meridians. Mayer 1977 proposed that acupuncture may stimulate the production of endorphin, an effect antagonised (counteracted) by the narcotic antagonist naloxone, in order to provide an analgesic effect. Ku 2001, Petti 1998, and Ulett 1998 have carried out further research in this area and postulated that beta-endorphin and various neuropeptides (like protein pro-opiomelanocortin) within the nervous system may be implicated in producing the effects of acupuncture.

Aleem1987 identified the presence of beta-endorphin in the follicular fluid from both normal and polycystic ovaries. Petraglia 1987 demonstrated that the beta-endorphin level in ovarian follicular fluid of otherwise healthy women who were undergoing ovulation were much higher than the levels measured in plasma. Given that acupuncture has an impact on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion, it is postulated that acupuncture may have a role in ovulation induction and fertility.

Different non-randomised preliminary observational studies have shown that acupuncture may normalise the production of luteinising hormone (LH) and follicle stimulating hormone (FSH) (Aso 1976; Cai 1997; Mo 1993).

Currently the first-line conventional therapy for infertile women with PCOS is the administration of oral anti-oestrogen agents (for example, clomiphene citrate). However, 50% of women with PCOS who take clomiphene citrate still fail to conceive. For these women, often classified as having ’clomiphene-resistance’, clinicians typically prescribe exogenous gonadotrophin preparations or alternatively a surgical option such as laparoscopic ovarian drilling.

For those individuals who respond to clomiphene citrate therapy, a higher risk of developing hyperstimulation of the ovaries (ovarian hyperstimulation syndrome) and multiple pregnancies has been noted. In the last few decades, insulin sensitising agents such as metformin have been used as alternative therapeutic agents for women with PCOS. The theoretical explanation is that increasing the insulin sensitivity in PCOS patients eases the hyperinsulinaemia and will be associated with a reduction in serum androgen levels and an improvement in serumlipids, plasminogen activator inhibitor type I (PAI-1) levels, and gonadotropins. Currently the role of metformin in managing PCOS is under further investigation.

In traditional Chinese medicine, all diseases are classified into different syndromes (for example, deficiency or excess) according to the patient’s clinical presentations (signs and symptoms). It was believed that kidney deficiency is the major concern relating to the reproductive function of women with PCOS.

Lim DCE, Chen W, Cheng LNC, Xue CC, Wong FWS, O’Sullivan AJ, Liu JP

   published in The Cochrane Library 2011, Issue 8     

   http://www.thecochranelibrary.com

   Acupuncture for polycystic ovarian syndrome (Review)

E. Stener-Victorin, E. Jedeland L. Mannera°s, 2008 Journal of

   Neuroendocrinology 20, 290–298 (2008) Acupuncture in Polycystic

   Ovary Syndrome: Current Experimental and Clinical Evidence.