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Abstract

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by irregular menstrual cycles, hyperandrogenism, and polycystic ovaries. It is a leading cause of ovulatory infertility, with a global prevalence ranging from 4% to 21%, and up to 36% in adolescents. PCOS is often associated with metabolic disturbances, including insulin resistance and hyperinsulinemia, which contribute to an increased risk of metabolic syndrome. Obesity, affecting about 50% of women with PCOS, worsens these metabolic issues. The condition is marked by hormonal imbalances, such as elevated androgens and altered gonadotropin ratios, leading to anovulation and hyperandrogenism. Genetic studies suggest an autosomal dominant inheritance pattern, while psychological factors like mood disorders are also common. Dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis may further impact reproductive function. The exact cause of PCOS remains unclear, though epigenetic, environmental, and behavioral factors are believed to contribute to its development.

Keywords

Polycystic Ovary Syndrome, PCOS, endocrine disorder, hyperandrogenism, anovulation, menstrual irregularity, polycystic, HPA axis dysregulation, epigenetic factors, environmental factors, psychological factors, mood disorders, infertility.

Introduction

Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder marked by irregular menstrual periods, hyperandrogenism, and the presence of polycystic ovaries (PCO). It is one of the most common causes of ovulatory infertility in women of reproductive age. The worldwide prevalence of PCOS ranges from 4 to 21%, while in adolescents this number ranges between 9.1 and 36% (depending upon the diagnostic criteria used) . Various features of the metabolic syndrome like insulin resistance and hyperinsulinemia are present in the majority of women with PCOS. Hyperandrogenism, the principle symptom in PCOS, has physical and physiological health implications in young and fertile women.  Obesity, affecting 50% of women, is a common clinical feature of PCOS . The women with history of weight gain often proceed with the onset. Polycystic Ovary Syndrome (PCOS) is a chronic illness, and while the precise etiology remains unidentified, it is thought to have epigenetic beginnings, shaped by the uterine environment and behavioral variables. Being overweight exacerbates all aspects of PCOS due to underlying metabolic disturbances. Signs and symptoms are mediated by hormonal dis- order including elevated androgens and fasting insulin, and abnormal relative ratio of the gonadotropins luteinis- ing hormone (LH) and follicle stimulating hormone (FSH). Endocrine imbalances occur within the framework of disordered ovarian folliculogenesis, chronic anovula- tion, clinical signs of hyperandrogenism and metabolic syndrome. Several research on PCOS in specific ethnic groups indicated a genetic inheritance pattern that is autosomal dominant, suggesting that the hyperinsulinemia associated with PCOS may be influenced by genetic anomalies. By contrast, the study conducted by Rasgon and Weiner showed the presence of mood disorder in patients with PCOS. Kalantarindou and Kirschbaum suggested that Hypothalamus-Hypophysis-Adrenal (HHA) system which would become active when one was depressed would generate suppressive effect on the women’s reproductive system.

1.1. Etiology: -

Genetic, hormonal, and environmental factors are all involved in the multifactorial etiology of PCOS, a complex disorder. Given that a family history has been demonstrated to increase susceptibility to the syndrome, genetic predisposition is important. The pathophysiology of PCOS is largely attributed to hormonal imbalances, specifically insulin resistance and an excess of androgens. Insulin resistance, which is frequently associated with hyperinsulinemia, causes an excess of androgen to be produced, which in turn causes ovulatory dysfunction. A sedentary lifestyle, obesity, and a poor diet are examples of environmental factors that worsen the condition. Furthermore, it's believed that persistent low-grade inflammation plays a role in PCOS development as well as progression. In the end, this fusion of hereditary and environmental factors results in the typical signs of PCOS, which include hyperandrogenism, irregular menstrual cycles, and infertility.

       
            fig 1.jpg
       

1.2. Pathophysiology: -

Insulin resistance and excess androgen production are the primary causes of the complex hormonal imbalances that underlie the pathophysiology of Polycystic Ovary Syndrome (PCOS). One of the main characteristics of PCOS is hyperandrogenism, which impairs ovarian function by preventing follicular maturation and leading to anovulation. Insulin resistance causes compensatory hyperinsulinemia and is common in PCOS-afflicted obese and lean women. Hyperandrogenism is exacerbated by this elevated insulin level, which causes the ovaries to produce more androgens. Furthermore, insulin increases the amounts of free circulating androgens by blocking the hepatic synthesis of sex hormone-binding globulin (SHBG). The dysregulation of gonadotropin secretion, which is characterized by high levels of luteinizing hormone (LH) and either normal or low levels of follicle-stimulating hormone (FSH), impairs normal follicle development and prolongs anovulation, is another contributing factor. Additionally, persistent low-grade inflammation is noted.

Importance of herbal drugs in PCOS: -

1) Herbal medications are used to lower the body's androgen levels.

2) It also maintains hormone balance.

3) Herbal medications cause insulin resistance.

4) It lessens the body's internal inflammation.

5) Herbal medicines increase the body's metabolism.

Herbal drugs used in PCOS/PCOD

1. Cinnamon: Cinnamon is a spice made from the inner bark of a number of tree species in the genus Cinnamomum. Cinnamon is mainly used as an aromatic condiment and flavoring additive in a wide variety of cuisines, including sweet and savory dishes, breakfast cereals, snack foods, bagels, teas, hot chocolate, and traditional foods.

The primary component and essential oil of cinnamon, cinnamon aldehyde, is combined with a variety of other ingredients, including eugenol,

are in charge of the flavor and aroma of the spice.

•Alternative names for cinnamon include Chinese cassia, Ceylon cinnamon, Saigon cinnamon, Cortex cinnamon, and Cinnamomum aromaticum.

       
            fig 2.jpg
       

Supports the control of blood sugar and insulin levels: - In five studies looking at cinnamon's effects on PCOS patients, it was discovered to significantly reduce patients' fasting insulin and blood sugar levels. demonstrating the advantages of cinnamon as a type 2 diabetes and PCOS adjunctive therapy or anti-diabetic This is necessary for the movement of glucose into our cells from our blood. Cinnamon contains substances called insulin sensitizers that mimic the effects of insulin.

Reduce cholesterol: - It has been found that giving PCOS patients supplements containing cinnamon can significantly lower their total cholesterol and improve their bad-to-good cholesterol ratio.Although the precise mechanisms underlying this are still unknown, lowering total blood cholesterol has many health benefits, one of which being a decreased risk of heart disease.

Promote the restoration of a regular cycle: -Hormone imbalances (e.g., low progesterone and high testosterone) often cause irregular periods in PCOS patients. Cinnamaldehyde has been found to increase progesterone and decrease androgens like testosterone, which aid in maintaining a regular cycle and balancing hormones. Moreover, high insulin levels exacerbate these hormone imbalances by stimulating the ovaries to produce more testosterone Thus, cinnamon supports regular cycles and fertility by improving insulin sensitivity.

2. Shatavari: -Asparagus racemosus, a species of asparagus native to Africa, grows in southern Asia, including the Indian subcontinent, and northern Australia. It is also referred to as Satavar, Shatabari, or Shatabull, Shatabarii. It grows in rocky, gravelly soils at elevations of 1,300–1,400 m (4,300–4,600 ft) in the piedmont plains. Its height ranges from 1-2 m (3 ft 3 in – 6 ft 7 in). In 1799, a botanical description of it was published. Because of all of its uses, asparagus racemosus is always in great demand. The plant is currently listed as ?endangered? in its natural habitat because of destructive harvesting methods, habitat degradation, and deforestation. The shatavari: Asparagu Satmuli is the synonym(s) for shatavari.

Astragalus racemosus The biological source is the dried tuberous roots of wild plants.

       
            fig 3.jpg
       

Liliaceae is a family.

Dried roots are a part of the usage.

Shatabari and PCOS: As was previously mentioned, PCOS is caused by an imbalance in a woman's hormones. Previous research has shown that taking 5 grams of shatavari balances women's hormones. Shatavari in women naturally lowers fertility, improves menstruation, and raises antioxidant levels.

The effect of Shatavari on the reproductive system

1. Regulates the menstrual cycle The average menstrual cycle lasts 28 to 35 days, during which the body prepares for conception. By maintaining the proper balance of hormones and target cells, shatavari effectively controls irregular menstruation.

Between

2. Follicle development and growth As a vrishya and shukra vardhak aushadhi, Shatavari promotes and supports the growth and development of follicles, which is the main factor in the development of the ovumwhich is necessary

for conception.

3. Hormone balance between FSH and LH The monthly release of eggs from the ovaries occurs during a process called ovulation, which is triggered by the hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone). Conversely, FSH stimulates the creation of sacs while LH releases the egg. Shatavari helps the human body retain them.

4. The equilibrium of progesterone and estrogen is the fundamental factor governing all ovarian processes, such as conception, gestation, and pain. Both the reproductive system and normal organ function are supported by these two hormones. For instance, they maintain HDL levels, encourage bone formation and growth, and support thyroid gland function.

Shatavari's impact on the nervous system

1. The herb shatavari affects the nervous system.

2. It aids in sustaining and boosting the body's hormone levels.

3. Shatavari also supports the preservation of the motor and sensory nervous systems.

4. Because asparagus has a cooling effect, it eases tension and soothes the mind. • It is a general health tonic for women, making it beneficial for fatiguelessness, weakness, and debility.

•It is a nervine tonic, hence beneficial in various neurological disorders.

•It is a commonly used medication to encourage milk production and ejection following pregnancy because it encourages lactation.

3.Turmeric: The flowering plant known as turmeric, or Curcuma longa, is a member of the ginger family, Zingiberaceae. This perennial herbaceous plant, which is native to Southeast Asia and the Indian subcontinent, requires high annual rainfall and temperatures between 20 and 30 °C (68 and 86 °F) in order to thrive. Plants are harvested for their rhizomes each year; some are used as food, while others are multiplied for the following growing season.

       
            fig 3.jpg
       

1. It could help lower the level of insulin resistance. Insulin resistance affects between sixty-seven and fifty percent of PCOS patients, and it can significantly impact quality of life and general wellness.

2. It is packed with antioxidants.

Research has shown that curcumin, the active ingredient in turmeric, has strong anti-inflammatory and antioxidant properties. Antioxidants such as vitamins C and E protect the body from the damage that free radicals can do. Diseases including diabetes, inflammatory joint disease, and cancer can all develop more quickly when there is damage from free radicals

3.It might aid in the fight against depression.

Not only does turmeric enhance physical health, but there is a growing body of research suggesting that it may also have antidepressant and stress-relieving properties. In summary, there is mounting evidence that depression and inflammation

may be related, and since turmeric has anti-inflammatory properties, it may be able to alleviate some of the symptoms associated with depression.

4. Ashwaghndha:- Known by many names, including winter cherry or ashwagandha, Withania somnifera is an evergreen shrub that grows in parts of Africa, the Middle East, and India. It is a member of the Solanaceae family. Numerous other species in the Withania genus share a similar morphology.

Related terms:- withania root, ashwagandha, and clustered wintercherry.

The dried roots and stem bases of Withania somnifera Dunal are the source of the biological material.

Family Solanaceae.

Roots, barks, leaves, fruits, seeds, and ashwagandha powder were the part(s) used.

Ashwagandha powder is one such traditional herb that has long been recognized for its potent adaptogenic properties. Herbs known to balance hormone levels in the body can help reduce stress and symptoms of PCOS.

The herb ashwagandha regulates hormones.

Ashwagandha has the potential to assist women with PCOS with their hormonal imbalance in a number of ways. Similar to testosterone, androgens are male hormones that are frequently overexpressed in PCOS-affected women. Symptoms such as acne, irregular menstrual cycles, infertility, and excessive hair growth could arise from this. Ashwagandha has been shown to reduce testosterone levels in women with PCOS. One study found that women who took ashwagandha for five months had significantly lower testosterone levels than those who did not take the herb. Therefore, by lowering testosterone levels, ashwagandha may help lessen some of the symptoms associated with PCOS. Maintaining the HPA axis's balance: The regulation of the body's hormone synthesis is contingent upon the HPA axis. Research has shown that ashwagandha influences the hypothalamic-pituitary-adrenal (HPA) axis by increasing the levels of thyroid-stimulating hormone (TSH) and follicle-stimulating hormone (FSH) and decreasing cortisol. This regulation may aid in the preservation of hormonal balance in women with PCOS.

       
            fig 5.jpg
       

Ashwagandha: an anti-inflammatory

Persistent low-grade inflammation in the body, which increases the risk of insulin resistance, cardiovascular disease, and other harmful health outcomes, is the hallmark of PCOS.

Ashwagandha's anti-inflammatory qualities could ease the irritation that PCOS-affected women experience. It accomplishes this using the following techniques:

1. Cutting down on cytokines that encourage inflammation

Ashwagandha has been shown to decrease the generation of pro-inflammatory cytokines, which are elevated in women with PCOS. Among these cytokines are IL-6 and TNF-alpha. Because it reduces the production of these cytokines, ashwagandha may help reduce inflammation in the body.

•Using ashwagandha as a fertility remedy

Preliminary studies suggest that ashwagandha may help with infertility and irregular menstrual cycles.

One last thing about ashwagandha and PCOS

Ashwagandha has shown encouraging results in helping women with PCOS control their symptoms. It can reduce stress and anxiety, which are often associated with the hormonal imbalances that define PCOS. In addition, it can promote ovulation, regulate the HPA axis, and improve hormonal balance. But it's crucial to remember that ashwagandha is still a topic of ongoing research and that there are currently limitations to its usefulness. Before taking ashwagandha, women with PCOS should consult their doctor to make sure it's safe for them.

On the other hand, ashwagandha is a herbal remedy that might improve the quality of life for women with PCOS.

5.Glycyrrhiza glabra:

Source: The dried roots and rhizomes of the licorice plant, Glycyrrhiza glabra, are used to make it.

Family: Leguminosae (Fabaceae)

       
            fig 5.jpg
       

Uses in PCOS:

1. Hormonal regulation: Research has demonstrated that licorice can help lower androgen levels, which are often higher in women with PCOS.

2. Anti-inflammatory: The active ingredient, glycyrrhizin, has anti-inflammatory properties that could aid in PCOS metabolic abnormalities.

3. Increasing insulin sensitivity: This could help with insulin resistance, which is a common problem in PCOS.

4. Menstrual regulation: By promoting adrenal function and hormone balance, licorice may aid in the regulation of menstrual cycles.

6.German chamomile:

The biological source :- Matricaria chamomilla, is derived from the dried flower heads of the German chamomile plant.

Family: Among the Compositae, Asteraceae

Chemical Composition :

German chamomile contains the following active ingredients:

1. Essential oils: bisabolol, bisabolol oxide, and chamazulene.

2. Flavonoids, including luteolin, quercetin, and apigenin.

3. Coumarins: Herniarin and umbelliferone.

4. Additional substances: Phenolic acids, tannins, and mucilage.

       
            fig 7.jpg
       

Uses in PCOS:

1. Anti-inflammatory Properties: The compounds chamazulene and bisabolol, which are found in chamomile, have potent anti-inflammatory properties and can help lessen inflammation that is frequently linked to PCOS.

2. Antioxidant Activity: The flavonoids in chamomile have antioxidant properties that can help guard against oxidative stress, which has been connected to insulin resistance and metabolic problems associated with PCOS.

3. Menstrual Regulation: Traditionally, chamomile has been used to control menstrual cycles. Its mild estrogenic effects may improve cycle regularity by assisting in the management of hormonal imbalances in PCOS.

4. Anti-Anxiety and Stress Relief: Hormonal imbalances in women with PCOS frequently cause anxiety and stress. The calming effects of chamomile can indirectly support hormonal balance by lowering cortisol levels and enhancing emotional health.

CONCLUSION: -

Polycystic Ovary Syndrome (PCOS) is a multifactorial condition characterized by hormonal imbalances, including insulin resistance and hyperandrogenism, which lead to anovulation, menstrual irregularities, and metabolic disturbances. Conventional treatment approaches aim to manage symptoms, but increasing attention is being directed toward herbal therapies due to their natural and multifaceted benefits. Herbal remedies such as cinnamon, shatavari, turmeric, ashwagandha, licorice, and chamomile have shown promise in managing PCOS symptoms. These herbs offer various therapeutic effects, including reducing insulin resistance, regulating androgen levels, restoring menstrual regularity, and alleviating inflammation. For instance, cinnamon enhances insulin sensitivity and lowers cholesterol levels, while shatavari supports hormonal balance and reproductive health. Turmeric provides anti-inflammatory and antioxidant effects, and ashwagandha helps regulate the HPA axis and reduce stress-induced hormonal imbalances. Additionally, licorice aids in androgen reduction, and chamomile supports menstrual regularity and emotional well-being. The integration of herbal treatments with lifestyle changes and conventional therapies may offer a holistic approach to managing PCOS. However, further research is needed to establish standardized dosages and long-term safety. Personalized treatment plans incorporating these herbs can significantly improve the quality of life and overall health outcomes for women with PCOS.

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Reference

  1. Shahin, A. Y., Ismail, A. M., Zahran, K. M., & Makhlouf, A. M. (2008). Herbal medicine in the treatment of polycystic ovarian syndrome: a randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 34(3), 403-410. https://doi.org/10.1111/j.1447-0756.2008.00726.x
  2. Arentz, S., Smith, C. A., Abbott, J., Fahey, P., & Bensoussan, A. (2017). Herbal medicine for the treatment of polycystic ovary syndrome: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine, 23(2), 164-177. https://doi.org/10.1089/acm.2016.0310
  3. Gao, Y., Gao, Y., Huang, X., & Wang, P. (2018). Effects of cinnamon supplementation on metabolic profiles and menstrual cyclicity in women with polycystic ovary syndrome: a systematic review and meta-analysis. BMC Complementary and Alternative Medicine, 18(1), 299. https://doi.org/10.1186/s12906-018-2361-0
  4. Yadav, N., & Kaur, R. (2018). Herbal remedies and their potential role in the treatment of polycystic ovary syndrome: a review. Asian Pacific Journal of Reproduction, 7(2), 55-64. https://doi.org/10.4103/2305-0500.230270
  5. Jia, Q., Liu, X., Wu, X., Wang, Y., & Cai, Y. (2019). A review on the role of herbal medicine for polycystic ovarian syndrome. Evidence-Based Complementary and Alternative Medicine, 2019,  https://doi.org/10.1155/2019/6428696
  6. Banaszewska, B., Duleba, A. J., Spaczynski, R. Z., Pawelczyk, L. (2016). Inositols and polycystic ovary syndrome: Systematic review of randomized trials. Fertility and Sterility, 105(3), 766-775.e2. https://doi.org/10.1016/j.fertnstert.2015.12.007
  7. Sami, W., Ansari, T., Butt, N. S., & Hamid, M. R. (2017). Effect of cinnamon extract on blood glucose level and lipid profile in alloxan-induced diabetic rats. Pakistan Journal of Pharmaceutical Sciences, 30(2), 483-487.
  8. Stener-Victorin, E., Waldenström, U., Tagnfors, U., Lundeberg, T., & Janson, P. O. (2000). Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstetricia et Gynecologica Scandinavica, 79(3), 180-188. https://doi.org/10.1034/j.1600-0412.2000.079003180.x
  9. El-Nabarawy, S. K., Ahmed, M. A., El-Dien, N. A. M., & El-Shaikh, K. A. (2021). Role of Berberine in Improving the Symptoms and Metabolic Parameters of PCOS: A Systematic Review. Natural Product Communications, 16(4), 1-9. https://doi.org/10.1177/1934578X21991069
  10. Li, X., Zhao, L., Shi, Y., & Zeng, L. (2020). Therapeutic efficacy of Berberine combined with Metformin in patients with polycystic ovarian syndrome: A meta-analysis. Endocrine, 68(2), 251-261. https://doi.org/10.1007/s12020-019-02089-0
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Ajinkya Holkar
Corresponding author

Dr.Vedprakash Patil Pharmacy College,Chh.Sambhajinagar

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Dnyaneshwari Mali
Co-author

Dr.Vedprakash Patil Pharmacy College,Chh.Sambhajinagar

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Samiksha Sonule
Co-author

Dr.Vedprakash Patil Pharmacy College,Chh.Sambhajinagar

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Ashwini Jadhav
Co-author

Shri Goraksha College Of Pharmacy & Research Centre Khamgaon Chh.Sambhajinagar

Dnyaneshwari D. Mali, Ajinkya S. Holkar, Samiksha S. Sonule, Ashwini V. Jadhav, Herbal Drugs for The Treatment of Polycystic Ovary Syndrome (PCOS) And Its Complications, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 11, 1189-1198. https://doi.org/10.5281/zenodo.14211709

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