Polycystic ovarian syndrome (PCOS) is a frequent disorder commonly found in reproductive-aged women. The disease PCOS in women is considered to be complex heterogeneity, which indicates the combined combination of genetics and environmental interaction factors. Insulin resistance, type 2 diabetes mellitus, and obesity are known to be the risk factors for the development of PCOS. The prevalence of obesity in Saudi Arabia is ripening equally in both men and women. Herbal Medicines are often used for the treatment of human diseases by traditional medicine. Herbal remedies are often used to treat PCOS women due to the similar effectiveness exists as Western anti-obesity drugs. This study aimed to acknowledge the usage of herbal medicines for the prevention of obesity in PCOS women. This is a cross-sectional study carried out in reproductive-aged women in the Saudi population. PCOS women were provided with the questionnaire form if they are using the herbal products for the treatment of obesity. In this study, 85 PCOS women with obesity have been selected. The clinical and usage of herbal details have been recorded. In this study, 70.5% of women were using green tea, 19.8% and 11.7% were using the ginger and flax seeds. Turmeric, Capsicum and fenugreeks were used by 25.8%, 4.7% and 18.8% respectively. In conclusion, the PCOS women has high usage of green tea rather than other herbal medicines.
Polycystic Ovarian Syndrome, Herbals, Obesity, Green-Tea
Polycystic Ovarian Syndrome (PCOS) in women is recognized as an endocrine disorder in reproductive-aged women1. PCOS is characterized by irregular menses, hyperandrogenism, micro-polycystic ovaries and metabolic abnormalities2. PCOS is known to be a common cause of anovulatory infertility; however, the mechanisms of anovulation endure not known3. Based on Rotterdam criteria, PCOS was diagnosed by confirming clinical features of three out of two; (i) oligo-anovulation, (ii) hyperandrogenism and (iii) appearance of polycystic ovaries in ultrasound . Every 16-20% of reproductive women are facing both infertility and menstrual problems5. PCOS is associated with pancreatic β-cell dysfunction; also increased the risk of metabolic syndrome (MetS)6. Insulin-resistance (IR), obesity, and type 2 Diabetes Mellitus (T2DM) are the major complications for PCOS women7. PCOS women with obesity tend to have probabilities of emerging MetS by hovering abnormal values in fasting, lipid profile, and IR8. The complete understanding of aetiology in PCOS women is not updated; this disease in women is considered as multifactorial disorder in genetic, endocrine, environmental, metabolic anomalies9. There is no active treatment is available for PCOS women. However, lowering of Body Mass Index (BMI) in PCOS women is one the therapies for restoring regular menses and improve response towards ovulation, involve medication of fertility10. Various pharmaceutical treatments were developed with side-effects such as long-term treatments with lower efficiency and contraindications in PCOS women and simultaneous is complementary treatment. Common selection is opting oral contraceptives towards the treatment in PCOS women11. The majority of PCOS women with hyperandrogenic will select life style intervention and oral contraceptives towards the treatment; which involves estrogen, progestins for release of luteinizing hormones12. Metformin usage is associated with high dose of gastrointestinal adverse effects13. Apart from these, several herbal medicine studies have been documented in PCOS women11,14-18.
Since the antient times, herbal drugs are used as medicines for treating human diseases and medicinal plants play an important role as natural products have known to be the major source of medicines19. Herbs can be used for weight loss therapy in obesity population and crude plants were used in the form of herbs globally to treat obesity20. Zingiber officinale Roscoe (ginger) from the family of Zingeiberaceae family lowers serum levels in fasting glucose, insulin, low- and high-density lipoprotein-cholesterols21. PCOS is connected with T2DM through obesity and insulin resistance and lower serum levels can lowers the disease22. Liao et al.23 performed herbs and herbal treatment in PCOS women through Jia-Wei-Xiao-Yao-San and Xing-Fu; were commonly used herb and these showed the positiveness towards the treatment in Taiwanese PCOS women. Multiple studies have been investigated for the worth of safe herbal drugs in treating excessive weight gain. However, a clinical trial has been conducted in Chinese population on traditional Chinese medicine on 140 obese patients and using herbal products for 6 months and positive results were obtained without any side-effects24. The prevalence of obesity in Saudi Arabia is epidemic and simultaneously with the PCOS women. There are no studies have been conducted in the Saudi population women diagnosed with PCOS and using the herbal medicines. Therefore, the present study aimed to investigate usage of herbal medicines for the prevention of obesity in PCOS women.
In this study, 85 PCOS women with obesity have been opted and selected from Capital city of Kingdom of Saudi Arabia. Based on Rotterdam criteria25, PCOS women were selected. All the women involved in this study were Saudi citizens. The inclusion criteria of the cases were PCOS women with obesity and exclusion criteria were PCOS women with non-obesity, non-PCOS women with or without obesity. The selected women in this study has filled questionnaire form. The data collection form consists of anthropometric details, such as age, BMI and family histories of PCOS. The baseline characteristics involved types of herbal medicines used for treatment of obesity in PCOS women, green tea, capsicum, ginger, turmeric, flax seeds and fenugreeks. BMI was calculated using weight in kilograms and height in centimeters26. Ethical grant was obtained for this study (Grant number-19-4344). Statistical analysis include mean±standard deviation, frequencies and percentages was performed with Openepi software as described in Khan et al27.
In this study, 85 PCOS-obesity women were involved. The anthropometric details were involved in Table 1. The mean age of the PCOS women are 32.1±11.2 and their BMI was found to be 33.1± 8.6. In this study, 100% Saudi women were involved with 71.7% as known to be their family history of obesity. However, family history of PCOS was not documented and this could be the one of the limitations of this study.
Anthropometric features of involved PCOS women.
|S. No||Anthropometric Features||PCOS cases|
|3||Gender (Female)||100% (n=85)|
|4||Nationality (Saudi)||100% (n=85)|
|5||Family History of Obesity||71.7% (n=61)|
The list of use of herbal medicines have been listed in Table 2. None of the women have used the herbal medicine for weight loss for obesity in PCOS women. However, 70.5% of women use green tea in their routine life. Only 19.8% of women used ginger in the early morning. The frequency usage of flax seeds was 11.7% and 25.8% have used the turmeric. In this study, the overall lower frequency of used by PCOS women are capsicum which is 4.7% and 18.8% were using fenugreek seeds to lowers the BMI.
Herbal medicine used for obesity treatment in PCOS women.
|S. No||Plant medicines||PCOS women|
|1||Herbal medicines usage||0 (0%)|
|2||Green tea||60 (70.5%)|
|4||Flax seeds||10 (11.7%)|
PCOS is known as common gynecological with endocrine and metabolic disorders and its prevalence rate in childbearing aged women are in between 3.4%-13% respectively. PCOS patients are found to be obese when compared with healthy women and the incidence of PCOS is mounting randomly throughout the world. One of the reasons for this could be modified lifestyle with uncontrolled diet. However, based on genetics point of view, a relationship has been built between obesity associated genes with susceptibility to PCOS with combined combination of results28. Obesity is confirmed as one of the risk factors in PCOS women which exacerbates reproductive and metabolic effects. Obesity is known to induces mild-chronic inflammation in adipose tissues which increases insulin resistance further leads to T2DM, dyslipidemia and cardiovascular diseases29. Obesity is commonly appearing in all formats of human diseases but not in the thin healthy organisms. However, PCOS is clearly observes in non-obese women30. The accurate of prevalence of PCOS has not been documented but based on city wide studies it was known to be high prevalences.
There are limited studies have been documented in PCOS in Saudi population and current study was known to be the initial study implemented in Saudi PCOS and obesity women using the herbal medicines. Unfortunately, none of the PCOS women is using the herbal medicines for weight loss. However, flaxseeds, ginger, green tea, capsicum, turmeric and fenugreek seeds were using to maintain or lose weight. There are limited studies have been used the complimentary medicine and amongst them herbal medicines are precise type of medicines. Herbal medicines necessitate pharmacologically active constituents through physiological effects in women with endocrinological disorders. It has been significantly associated with lowering the incidences of human health complications and the diseases. Pharmacological treatment for PCOS women for menstrual issues are using the oral contraceptive pills and ovulation induction with clomiphene citrate as per the fertility requirement. Tribulus terrestris, Glycyrrhiza spp, Paeonia lactiflora and Cinnamomum cassia determines the morphological modifications in PCO31. In this study, Zingiber officinale Roscoe (ginger) has been used by 19.8% PCOS women to lowers the BMI and ginger is from Zingeiberaceae family reduces serum levels of fasting glucose, insulin, low-high levels of density lipoprotein levels. Other studies have confirmed as ginger upraises the antioxidant capacity in blood as well as augments the serum levels for GPx, SOD and CAT21.
The limitations of this study are opting the low sample size, not documenting the family history of PCOS and not involving the control subjects. The strength of this study was recruiting 85 Saudi women diagnosed with PCOS based on Rotterdam criteria25. In conclusion, PCOS women has high usage of green tea rather than the herbal medicines. Further studies should be carried out in large sample size and awareness program should be implemented towards the herbal medicines. Similar studies should be implemented worldwide.
This article does not contain any studies with human participants or animals performed by any of the authors.
AVAILABILITY OF DATA
All datasets analyzed during this study are included in the manuscript.
- Zhao J, Li D, Tang H, Tang L. Association of vascular endothelial growth factor polymorphisms with polycystic ovarian syndrome risk: a meta-analysis. Reproductive Biology and Endocrinology : RB & E. 2020;18(1):18.
- Cannarella R, Condorelli R, Mongioi L, La Vignera S, Calogero AJJoei. Does a male polycystic ovarian syndrome equivalent exist? J Endocrinol Invest. 2018;41(1):49-57.
- Dunaif AJE, America mcoN. Insulin action in the polycystic ovary syndrome. Endocrinol Metab Clin North Am. 1999;28(2):341-59.
- Haidari F, Banaei-Jahromi N, Zakerkish M, Ahmadi K. The effects of flaxseed supplementation on metabolic status in women with polycystic ovary syndrome: a randomized open-labeled controlled clinical trial. Nutrition Journal. 2020;19(1):8.
- Ajmal N, Khan SZ, Shaikh RJEjoo, gynecology, X rb. Polycystic ovary syndrome (PCOS) and genetic predisposition: A review article. Eur J Obstet Gynecol Reprod Biol X. 2019;8(3):100060.
- Ben-Salem A, Ajina M, Suissi M, Daher H, Almawi W, Mahjoub TJG. Polymorphisms of transcription factor-7-like 2 (TCF7L2) gene in Tunisian women with polycystic ovary syndrome (PCOS). Gene. 2014;533(2):554-7.
- Amisi CA, Ciccozzi M, Pozzilli PJWJoD. Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome. World J Diabetes. 2020;11(2):42-51.
- Alissa EM, Algarni SA, Khaffji AJ, Al Mansouri NM. Impact of interlukin-6 on central obesity measures in women with polycystic ovarian syndrome. Journal of Obstetrics and Gynaecology. 2020;11:1-5.
- De Leo V, Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F. Genetic, hormonal and metabolic aspects of PCOS: an update. Reproductive biology and endocrinology. Reprod Biol Endocrinol. 2016;14(1):38.
- Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and Pcos Society Disease State Clinical Review: Guide to The Best Practices in The Evaluation and Treatment of Polycystic Ovary Syndrome – Part 2. Endocr Pract. 2015;21(12):1415-26.
- Moini Jazani A, Nasimi Doost Azgomi H, Nasimi Doost Azgomi A, Nasimi Doost Azgomi R. A comprehensive review of clinical studies with herbal medicine on polycystic ovary syndrome (PCOS). Daru. 2019;27(2):863-77.
- Kwon CY, Lee B, Park KS. Oriental herbal medicine and moxibustion for polycystic ovary syndrome: A meta-analysis. Medicine (Baltimore). 2018;97(43):e12942.
- Morley LC, Tang T, Yasmin E, Norman RJ, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2017;11:Cd003053.
- Ainehchi N, Khaki A, Farshbaf-Khalili A, Hammadeh M, Ouladsahebmadarek E. The Effectiveness of Herbal Mixture Supplements with and without Clomiphene Citrate in Comparison to Clomiphene Citrate on Serum Antioxidants and Glycemic Biomarkers in Women with Polycystic Ovary Syndrome Willing to be Pregnant: A Randomized Clinical Trial. Biomolecules. 2019;9(6).
- Deng Y, Xue W, Wang YF, et al. Insulin Resistance in Polycystic Ovary Syndrome Improved by Chinese Medicine Dingkun Pill (): A Randomized Controlled Clinical Trial. Chin J Integr Med. 2019;25(4):246-51.
- Liao WT, Su CC, Lee MT, et al. Integrative Chinese herbal medicine therapy reduced the risk of type 2 diabetes mellitus in patients with polycystic ovary syndrome: A nationwide matched cohort study. J Ethnopharmacol. 2019;243:112091.
- Yang H, Lee YH, Lee SR, Kaya P, Hong EJ, Lee HW. Traditional Medicine (Mahuang-Tang) Improves Ovarian Dysfunction and the Regulation of Steroidogenic Genes in Letrozole-Induced PCOS Rats. J Ethnopharmacol. 2020;248:112300.
- Yuan BC, Ma K, Zhang CH, Yuan Y. [Bushen Huoxue herbal medicine in subfertile women with polycystic ovary syndrome: a Meta-analysis]. Zhongguo Zhong yao za zhi. 2019;44(6):1080-6.
- Ahmad W, Ahmad A, Ali MD, et al. A questionnaire-based study for weight loss by using herbal drugs in Dammam (Eastern Region), Kingdom of Saudi Arabia. J Pharm Bioallied Sci. 2019;11(3):248-53.
- Alonso-Castro AJ, Ruiz-Padilla AJ, Ramirez-Morales MA, et al. Self-treatment with herbal products for weight-loss among overweight and obese subjects from central Mexico. J Ethnopharmacol. 2019;234:21-6.
- Ainehchi N, Farshbaf-Khalili A, Ghasemzadeh A, et al. The Effect of Herbal Medicine Supplementation on Clinical and Para-clinical Outcomes in Women With PCOS: A Systematic Review and Meta-analysis. Intrn Jour of Womn Healt and Reprod Sci. 2019;7:423-33.
- Parker M, Warren A, Nair S, Barnard MJPo. Adherence to treatment for polycystic ovarian syndrome: A systematic review. PLoS One. 2020;15(2):e0228586.
- Liao WT, Chiang JH, Li CJ, Lee MT, Su CC, Yen HR. Investigation on the Use of Traditional Chinese Medicine for Polycystic Ovary Syndrome in a Nationwide Prescription Database in Taiwan. J Clin Med. 2018;7(7).
- Zhou Q, Chang B, Chen X-Y, et al. Chinese herbal medicine for obesity: a randomized, double-blinded, multicenter, prospective trial. Am J Chin Med. 2014;42(06):1345-56.
- Azziz RJTJoCE, Metabolism. Diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91(3):781-5.
- Khan IA, Jahan P, Hasan Q, Rao P. Genetic confirmation of T2DM meta-analysis variants studied in gestational diabetes mellitus in an Indian population. Diabetes Metab Syndr. 2019;13(1):688-94.
- Khan IA, Jahan P, Hasan Q, Rao P. Angiotensin-converting enzyme gene insertion/deletion polymorphism studies in Asian Indian pregnant women biochemically identifies gestational diabetes mellitus. J Renin Angiotensin Aldosterone Syst. 2014;15(4):566-71.
- Zhao Y, Xu Y, Wang X, et al. Body Mass Index and Polycystic Ovary Syndrome: A Two-sample Bidirectional Mendelian Randomization Study. J Clin Endocrinol Metab. 2020;105(6).
- Albezrah NKA, Arein FRJSJfHS. Knowledge, attitude, and practice toward weight reduction among polycystic ovary syndrome women at Taif city. Saud J Health Sci. 2019;8(2):112.
- Legro RS. Obesity and PCOS: implications for diagnosis and treatment. Semin Reprod Med. 2012;30(6):496-506.
- Arentz S, Abbott JA, Smith CA, Bensoussan AJBc, medicine a. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings. BMC Complement Altern Med. 2014;14(1):511.
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