Use of medicinal plants in the treatment of Polycystic Ovarian Syndrome (PCOS): An integrative review
DOI:
https://doi.org/10.33448/rsd-v11i13.35916Keywords:
Medicinal plants; Polycystic Ovary Syndrome; Phytotherapy; Antiandrogens.Abstract
Context: Polycystic Ovarian Syndrome (PCOS) is a common multisystem disease that causes reproductive, metabolic and psychological changes. Lately, the use of medicinal plants has grown considerably in the hope of reducing the side effects of synthetic drugs and in an attempt to reduce harm and costs. Objective: Analyze the use of medicinal plants that are used in PCOS from an integrative literature review, in order to verify the pharmacological effects caused by their use in PCOS. Methodology: An integrative literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through searches in PubMed, Scielo and Scopus databases to select ethnobotanical, ethnopharmacological, preclinical and clinical studies, published in full in the last 10 years (2012 – 2022), in English, Portuguese and Spanish using health descriptors. Results: The ten publications analyzed showed ten families and 11 plant species, which, in general, showed antiandrogenic activities. Conclusions: With the exception of Foeniculum vulgare, all other medicinal plants analyzed in this study have anti-androgenic effects on PCOS. However, these species need better clinical and toxicological evaluations regarding their use in order to provide a safe and effective therapy.
References
Abbott, D. H., & Bacha, F. (2013). Ontogeny of polycystic ovary syndrome and insulin resistance in utero and early childhood. Fertility and sterility, 100(1), 2-11.
Agra, L. C., Ferro, J. N., Barbosa, F. T., & Barreto, E. (2015). Triterpenes with healing activity: A systematic review Journalof Dermatological Treatment, 26(5), 465-470.
Amirkhanloo, F., Esmaeilzadeh, S., Mirabi, P., Abedini, A., Amiri, M., Saghebi, R., & Golsorkhtabaramiri, M. (2022). Comparison of Foeniculum Vulgare versus metformin on insulin resistance and anthropometric indices of women with polycystic ovary, an open-label controlled trial study. Obesity Medicine, 31, 100401.
Anand, P., Murali, K. Y., Tandon, V., Murthy, P. S., & Chandra, R. (2010). Insulinotropic effect of cinnamaldehyde on transcriptional regulation of pyruvate kinase, phosphoenolpyruvate carboxykinase, and GLUT4 translocation in experimental diabetic rats. Chemico-biological interactions, 186(1), 72-81.
Anderson, R. A., Broadhurst, C. L., Polansky, M. M., Schmidt, W. F., Khan, A., Flanagan, V. P., Schoene, N. W.,& Graves, D. J. (2004). Isolation and characterization of polyphenol type-A polymers from cinnamon with insulin-like biological activity. Journal of agricultural and food chemistry, 52(1), 65-70.
Anjos, E. G., Eduardo, G. N., Figueiredo, K. B. C. L., Brito, S. A., & Lucena, G. T. S. (2021). Prevalência da síndrome dos ovários policísticos em uma instituição de ensino superior da cidade de Cajazeiras–PB. Research, Society and Development, 10(4).
Arentz, S., Smith, C. A., Abbott, J. A., & Bensoussan, A. (2014). A survey of the use of complementary medicine by a self-selected community group of Australian women with polycystic ovary syndrome. BMC complementary and alternative medicine, 14, 472.
Ashkar, F., Eftekhari, M. H., Tanideh, N., Koohpeyma, F., Mokhtari, M., Irajie, C., & Iraji, A. (2020). Effect of hydroalcoholic extract of Berberis integerrima and resveratrol on ovarian morphology and biochemical parameters in Letrozole-induced polycystic ovary syndrome rat model: An experimental study. International journal of reproductive biomedicine, 18(8), 637–650.
Attia, G. R., Rainey, W. E., & Carr, B. R. (2001). Metformin directly inhibits androgen production in human thecal cells. Fertility and sterility, 76(3), 517-524.
Chen, T., Jia, F., Yu, Y., Zhang, W., Wang, C., Zhu, S., & Liu, X. (2022). Potential Role of Quercetin in Polycystic Ovary Syndrome and Its Complications: A Review. Molecules, 27(14), 4476.
Dehghan, A., Esfandiari, A., & Bigdeli, S. M. (2012). Alternative treatment of ovarian cysts with Tribulus terrestris extract: a rat model. Reproduction in domestic animals, 47(1), e12-e15.
Derosa, G., D'Angelo, A., Bonaventura, A., Bianchi, L., Romano, D., & Maffioli, P. (2013). Effects of berberine on lipid profile in subjects with low cardiovascular risk. Expert opinion on biological therapy, 13(4), 475-482.
Diamanti-Kandarakis, E., Baillargeon, J. P., Iuorno, M. J., Jakubowicz, D. J., & Nestler, J. E. (2003). A modern medical quandary: polycystic ovary syndrome, insulin resistance, and oral contraceptive pills. The Journal of Clinical Endocrinology & Metabolism, 88(5), 1927-1932.
Ding, Z., Dai, Y., Hao, H., Pan, R., Yao, X., & Wang, Z. (2008). Anti-inflammatory effects of scopoletin and underlying mechanisms. Pharmaceutical Biology, 46(12), 854-860.
Eldar-Geva, T., Margalioth, E. J., Gal, M., Ben-Chetrit, A., Algur, N., Zylber-Haran, E., Brooks, B., Huerta, M., & Spitz, I. M. (2005). Serum anti-Mullerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism. Human Reproduction, 20(7), 1814-1819.
Ercole, F. F., Melo, L. D., & Alcoforado, C. L. G. C. (2014). Integrative review versus systematic review. Rev Min Enferm, 18(1), 9-12.
Escobar-Morreale, H. F. (2018). Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology, 14(5), 270-284.
Escobar-Morreale, H. F., Asunción, M., Calvo, R. M., Sancho, J., & San Millán, J. L. (2001). Receiver operating characteristic analysis of the performance of basal serum hormone profiles for the diagnosis of polycystic ovary syndrome in epidemiological studies.
Federação Brasileira das Associações de Ginecologia e Obstetrícia. (2006). Projeto Diretrizes.
Firouzi, S., Malekahmadi, M., Ghayour-Mobarhan, M., Ferns, G., & Rahimi, H. R. (2018). Barberry in the treatment of obesity and metabolic syndrome: possible mechanisms of action. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 11, 699.
Gharanjik, F., Shojaeifard, M. B., Karbalaei, N., & Nemati, M. (2022). The Effect of Hydroalcoholic Calendula Officinalis Extract on Androgen-Induced Polycystic Ovary Syndrome Model in Female Rat. BioMed research international, 2022, 7402598.
Ghosh, D., Griswold, J., Erman, M., & Pangborn, W. (2009). Structural basis for androgen specificity and oestrogen synthesis in human aromatase. Nature, 457(7226), 219-223.
Hadi, A., Arab, A., Ghaedi, E., Rafie, N., Miraghajani, M., & Kafeshani, M. (2019). Barberry (Berberis vulgaris L.) is a safe approach for management of lipid parameters: A systematic review and meta‐analysis of randomized controlled trials. Complementary Therapies in Medicine,43, 117-124.
Hajimonfarednejad, M., Nimrouzi, M., Heydari, M., Zarshenas, M. M., Raee, M. J.,& Jahromi, B. N. (2018). Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double‐blind placebo controlled clinical trial. Phytotherapy Research, 32(2), 276-283.
Harvey, P. W. (2016). Adrenocortical endocrine disruption. The Journal of steroid biochemistry and molecular biology, 155, 199-206.
Hewitt, S. C., Deroo, B. J., Hansen, K., Collins, J., Grissom, S., Afshari, C. A., & Korach, K. S. (2003). Estrogen receptor-dependent genomic responses in the uterus mirror the biphasic physiological response to estrogen. Molecular endocrinology, 17(10), 2070-2083
Homa, L., Rose, J., Hovmand, P. S., Cherng, S. T., Riolo, R. L., Kraus, A., Biswas, A., Burgess, K., Aungst, H., Stange, K. C., Brown, K., Brooks-Terry, M., Dec, E., Jackson, B., Gilliam, J., Kikano, G. E., Reichsman, A., Schaadt, D., Hilfer, J., Ticknor, C., Williams, C. (2015). A participatory model of the paradox of primary care. Annals of family medicine, 13(5), 456–465.
Hoseinpour, M. J., Ghanbari, A., Azad, N., Zare, A., Abdi, S., Sajadi, E., Abbaszadeh, H. A., Farahani, R. M., & Abdollahifar, M. A. (2019). Ulmus minor bark hydro-alcoholic extract ameliorates histological parameters and testosterone level in an experimental model of PCOS rats. Endocrine Regulations, 53(3), 146-153.
Huang, H. F., He, R. H., Sun, C. C., Zhang, Y., Meng, Q. X., & Ma, Y. Y. (2006). Function of aquaporins in female and male reproductive systems. Human reproduction update, 12(6), 785-795.
Hussain, T., Tan, B., Yin, Y., Blachier, F., Tossou, M. C., & Rahu, N. (2016). Oxidative stress and inflammation: what polyphenols can do for us? Oxidative medicine and cellular longevity, 2016.
Jiang, H., Shi, J., & Li, Y. (2011). Screening for compounds with aromatase inhibiting activities from Atractylodes macrocephala Koidz. Molecules, 16(4), 3146-3151.
Kakadia, N., Patel, P., Deshpande, S., & Shah, G. (2019). Effect of Vitex negundo L. seeds in letrozole induced polycystic ovarian syndrome. Journal of Traditional and Complementary Medicine, 9(4), 336-345.
Karateke, A., Dokuyucu, R., Dogan, H., Ozgur, T., Tas, Z. A., Tutuk, O., Agturk, G., & Tumer, C. (2018). Investigation of therapeutic effects of erdosteine on polycystic ovary syndrome in a rat model. Medical Principles and Practice, 27(6), 515-522.
Kasangana, P. B., Haddad, P. S., & Stevanovic, T. (2015). Study of polyphenol content and antioxidant capacity of Myrianthus arboreus (Cecropiaceae) root bark extracts. Antioxidants, 4(2), 410-426.
Khan, S., Riaz, N., Afza, N., Malik, A., Aziz-ur-Rehman, Iqbal, L., & Lateef, M. (2009). Antioxidant constituents from Cotoneaster racemiflora. Journal of Asian natural products research, 11(1), 44-48.
Leema, G., & Tamizhselvi, R. (2018). Protective effect of scopoletin against cerulein-induced acute pancreatitis and associated lung injury in mice. Pancreas, 47(5), 577-585.
Li, J., Li, X., Li, Z., Zhang, L., Liu, Y., Ding, H., & Yin, S. (2017). Isofraxidin, a coumarin component improves high-fat diet induced hepatic lipid homeostasis disorder and macrophage inflammation in mice. Food & function, 8(8), 2886-2896.
Li, J., Liu, Z., Wang, D., & Cheng, C. H. (2011). Insulin-like growth factor 3 is involved in oocyte maturation in zebrafish. Biology of reproduction, 84(3), 476-486.
Liang, Z. H., & Guo, Z. X. (2007). Structure characteristics of water-soluble polysaccharide of Atractylodes macrocephala Koidz. J. Mol. Sci, 23, 185-188.
Liu, L., Mu, Q., Li, W., Xing, W., Zhang, H., Fan, T., Yao, H., & He, L. (2015). Isofraxidin protects mice from LPS challenge by inhibiting pro-inflammatory cytokines and alleviating histopathological changes. Immunobiology, 220(3), 406-413.
Martín, D., García-Vallejo, M. C., Pajares, J. A., López, D., & Díez, J. J. (2004). Elm bark components and their potential influence on bark beetle feeding. Forest Systems, 13(1), 227-235.
Menezes, P. E., Dornelles, L. L., de Oliveira Fogaça, A., Boligon, A. A., Athayde, M. L., & Bertagnolli, S. M. M. (2016). Composição centesimal, compostos bioativos, atividade antioxidante e caracterização fenólica da polpa de goiaba. Disciplinarum Scientia| Saúde, 17(2), 205-217.
Mvondo, M. A., Mzemdem Tsoplfack, F. I., Awounfack, C. F., & Njamen, D. (2020). The leaf aqueous extract of Myrianthus arboreus P. Beauv.(Cecropiaceae) improved letrozole-induced polycystic ovarian syndrome associated conditions and infertility in female Wistar rats. BMC Complementary Medicine and Therapies, 20(1), 1-13.
O'Brien, J. E., Peterson, T. J., Tong, M. H., Lee, E. J., Pfaff, L. E., Hewitt, S. C., Korach, K. S., Weiss, J.,& Jameson, J. L. (2006). Estrogen-induced proliferation of uterine epithelial cells is independent of estrogen receptor α binding to classical estrogen response elements. Journal of Biological Chemistry, 281(36), 26683-26692.
Ogunlakin, A. D., Sonibare, M. A., Jabeen, A., Shaheen, F., & Shah, S. F. (2021). Antiproliferative and ameliorative effects of Tetracera potatoria and its constituent. Advances in Traditional Medicine, 21(4), 815-824.
OPAS - Organização Pan-Americana da Saúde. (2022). Medicinas tradicionais, complementares e integrativas. Brasília (DF).
Özbek, H., Öztürk, M., Bayram, İ., Uğraş, S., & Çitoğlu, G. S. (2003). Hypoglycemic and Hepatoprotective Effects of Foeniculum vulgare Miller Seed Fixed Oil Extract inMice and Rats. Eastern journal of medicine, 8(2), 35-40.
Pachiappan, S., Ramalingam, K., & Balasubramanian, A. (2020). A review on phytomedicine and their mechanism of action on PCOS. Int. J. Cur. Res. Rev, 12(23), 81.
Pinto, S. V., Oliveira, A., Silva, C. S., Manso, M. C., & Ferreira da Vinha, A. (2019). Flores edíveis como recurso natural de compostos bioativos e propriedades biológicas. Egitania Sciencia, 2(25), 23-35.
Pyun, B. J., Yang, H., Sohn, E., Yu, S. Y., Lee, D., Jung, D. H., ... & Lee, H. W. (2018). Tetragonia tetragonioides (Pall.) kuntze regulates androgen production in a letrozole-induced polycystic ovary syndrome model. Molecules, 23(5), 1173.
Qu, F., Wang, F. F., Lu, X. E., Dong, M. Y., Sheng, J. Z., Lv, P. P., Ding, G. L., Shi, B. W., Zhang, D., & Huang, H. F. (2010). Altered aquaporin expression in women with polycystic ovary syndrome: hyperandrogenism in follicular fluid inhibits aquaporin-9 in granulosa cells through the phosphatidylinositol 3-kinase pathway. Human Reproduction, 25(6), 1441-1450.
Rezaei-Golmisheh, A., Sadrkhanlou, R., Malekinejad, H., & Ahmadi, A. (2017). The ameliorative effects of lupeol and flutamide on dehydroepiandrosterone-induced uterine hyperfibrosis in mice. Studies in Medical Sciences, 27(10), 923-934.
Ryuk, J. A., Ko, B. S., Lee, H. W., Kim, D. S., Kang, S., Lee, Y. H., & Park, S. (2017). Tetragonia tetragonioides (Pall.) Kuntze protects estrogen-deficient rats against disturbances of energy and glucose metabolism and decreases proinflammatory cytokines. Experimental Biology and Medicine, 242(6), 593-605.
Sabahi, Z., Farmani, F., Soltani, F., & Moein, M. (2018). DNA protection, antioxidant and xanthine oxidase inhibition activities of polyphenol-enriched fraction of Berberis integerrima Bunge fruits. Iranian Journal of Basic Medical Sciences, 21(4), 411.
Samatadze, T. E., Zoshchuk, S. A., Hazieva, F. M., Yurkevich, O. Y., Svistunova, N. Y., Morozov, A. I., Amosova, A. V., & Muravenko, O. V. (2019). Phenotypic and molecular cytogenetic variability in calendula (Calendula officinalis L.) cultivars and mutant lines obtained via chemical mutagenesis. Scientific reports, 9(1), 1-11.
Sandeep, P. M., Bovee, T. F., & Sreejith, K. (2015). Anti-androgenic activity of Nardostachys jatamansi DC and Tribulus terrestris L. and their beneficial effects on polycystic ovary syndrome–Induced rat models. Metabolic syndrome and related disorders, 13(6), 248-254.
SBPC/ML. (2016). “Precisamos falar sobre a síndrome dos ovários policísticos”. Disponível gratuitamente no site http://www.sbpc.org.br. SBPC/ML
Sharma, P., Sharma, S., Agrawal, R. P., Agrawal, V., & Singhal, S. (2012). A randomised double blind placebo control trial of cinnamon supplementation on glycemic control and lipid profile in type 2 diabetes mellitus. Australian Journal of Herbal Medicine, 24(1), 4-9.
Shaw, C. Y., Chen, C. H., Hsu, C. C., Chen, C. C., & Tsai, Y. C. (2003). Antioxidant properties of scopoletin isolated from Sinomonium acutum. Phytotherapy research, 17(7), 823-825.
Shi, Y., Kong, X., Yin, H., Zhang, W., & Wang, W. (2019). Effect of hawthorn leaf flavonoids in dehydroepiandrosterone-induced polycystic ovary syndrome in rats. Pathobiology, 86(2-3), 102-110.
Siddique HR, Mishra SK, Karnes RJ, Saleem M. (2011b). Lupeol, a novel androgen receptor inhibitor: implications in prostate cancer therapy. Clin Cancer Res 17, 5379–5391.
Siddique, H. R., & Saleem, M. (2011a). Beneficial health effects of lupeol triterpene: a review of preclinical studies. Life sciences, 88(7-8), 285-293.
Silva, H., Gomes, T., Macedo, M., Júnior, P., Luz, P., Lopes, P., Júnior, R. & Côrtes, P. (2021) “síndrome dos ovários policísticos: uma breve revisão literária.” Revista Científica Integrada , 5(1), 1–2021.
Sun, L., Ji, C., Jin, L., Bi, Y., Feng, W., Li, P., Shen, S., & Zhu, D. (2016). Effects of Exenatide on metabolic changes, sexual hormones, inflammatory cytokines, adipokines, and weight change in a DHEA-treated rat model. Reproductive Sciences, 23(9), 1242-1249
Tesser, C. D., Sousa, I. M. C. D., & Nascimento, M. C. D. (2018). Práticas integrativas e complementares na atenção primária à saúde brasileira. Saúde em debate, 42, 174-188.
Tropicos.org. Missouri Botanical Garden. 21 Sep 2022 Disponível em <https://tropicos.org>
Turcu, A. F., & Auchus, R. J. (2015). Adrenal steroidogenesis and congenital adrenal hyperplasia. Endocrinology and Metabolism Clinics, 44(2), 275-296.
Valentine, R. J., Coughlan, K. A., Ruderman, N. B., & Saha, A. K. (2014). Insulin inhibits AMPK activity and phosphorylates AMPK Ser485/491 through Akt in hepatocytes, myotubes and incubated rat skeletal muscle. Archives of biochemistry and biophysics, 562, 62-69
Vargas Laz, N. A. (2022). Estudio del tratamiento de la alopecia con las especies Serenoa repens, Cucurbita pepo L. y Pygeum africanum (Bachelor's thesis, Quito: UCE).
Verma, A., Dewangan, P., Kesharwani, D., & Kela, S. P. (2013). Hypoglycemic and hypolipidemic activity of scopoletin (coumarin derivative) in streptozotocin induced diabetic rats. Int J Pharm Sci Rev Res, 22(1), 79-83.
Vessal, M., Hemmati, M., & Vasei, M. (2003). Antidiabetic effects of quercetin in streptozocin-induced diabetic rats. Comparative Biochemistry and Physiology Part C: Toxicology & Pharmacology, 135(3), 357-364.
Victor, V. M., Rocha, M., Bañuls, C., Alvarez, A., de Pablo, C., Sanchez-Serrano, M., Gomez, M., & Hernandez-Mijares, A. (2011). Induction of oxidative stress and human leukocyte/endothelial cell interactions in polycystic ovary syndrome patients with insulin resistance. The Journal of Clinical Endocrinology & Metabolism, 96(10), 3115-3122
Yin, Y., Liu, X., Liu, J., Cai, E., Zhu, H., Li, H., Zhang, L., Li, P., & Zhao, Y. (2018). Beta-sitosterol and its derivatives repress lipopolysaccharide/d-galactosamine-induced acute hepatic injury by inhibiting the oxidation and inflammation in mice. Bioorganic & Medicinal Chemistry Letters, 28(9), 1525-1533.
Zang, M., Zuccollo, A., Hou, X., Nagata, D., Walsh, K., Herscovitz, H., Brecher, P., Ruderman, N. B., & Cohen, R. A. (2004). AMP-activated protein kinase is required for the lipid-lowering effect of metformin in insulin-resistant human HepG2 cells. Journal of Biological Chemistry, 279(46), 47898-47905
Zangeneh, F. Z., Jafarabadi, M., Naghizadeh, M. M., Abedinia, N., & Haghollahi, F. (2012). Psychological distress in women with polycystic ovary syndrome from Imam Khomeini Hospital, Tehran. Journal of reproduction & infertility, 13(2), 111.
Zheng, L. H., Rana, S., Hussain, L., Asif, M., Mehmood, M. H., Imran, I., ... & Abed, S. N. (2022). Polycystic Ovary Syndrome: A Disorder of Reproductive Age, Its Pathogenesis, and a Discussion on the Emerging Role of Herbal Remedies. Frontiers in Pharmacology, 13.
Zhou, J., Qu, F., Barry, J. A., Pan, J. X., Wang, F. F., Fu, Z. Z., Duez, P., & Hardiman, P. J. (2016). An atractylodes macrocephala koidz extract alleviates hyperandrogenism of polycystic ovarian syndrome. Int J Clin Exp Med, 9(2), 2758-67.
Zhu, H. T., Chen, J. Y., Chen, L., Tu, Z., & An, Z. B. (2006). Pharmacognosy studies on Atractylodes macrocephala Koidz. Lishizhen Med. Mater. Med. Res, 17, 1019-1020.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Franciely Nayara do Nascimento Albuquerque; Karolinny Katyleen Bezerra de Araujo; Leonardo Vitoriano dos Santos Silva; Anna Beatriz Almeida Pereira de Siqueira; Asley Thalia Medeiros Souza; Cledson dos Santos Magalhães; Karina Perrelli Randau
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
