Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial

Abstract

Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 300: E37-E45, 2011. First published October 13, 2010; doi:10.1152/ajpendo.00495.2010.-Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, oligo/amenorrhea, and polycystic ovaries. We aimed to determine whether low-frequency electroacupuncture (EA) would decrease hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention. We randomized 84 women with PCOS, aged 18 -37 yr, to 16 wk of low-frequency EA, physical exercise, or no intervention. The primary outcome measure changes in the concentration of total testosterone (T) at week 16 determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat. Secondary outcome measures were changes in menstrual frequency; concentrations of androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites; and acne and hirsutism. Outcomes were assessed at baseline, after 16 wk of intervention, and after a 16-wk follow-up. After 16 wk of intervention, circulating T decreased by Ϫ25%, androsterone glucuronide by Ϫ30%, and androstane-3␣,17␤-diol-3-glucuronide by Ϫ28% in the EA group (P ϭ 0.038, 0.030, and 0.047, respectively vs. exercise); menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group (P ϭ 0.018 vs. exercise). After the 16-wk follow-up, the acne score decreased by Ϫ32% in the EA group (P ϭ 0.006 vs. exercise). Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention. Low-frequency EA 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. acupuncture; androgens; estrogens; exercise; glucuronidated androgen metabolites; oligomenorrhea; sex steroid precursors POLYCYSTIC OVARY SYNDROME (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by clinical or biochemical hyperandrogenism, oligo/amenorrhea, and polycystic ovaries with or without increased ovarian volume (4). The most constant and prominent feature is hyperandrogenism, manifested by hirsutism, persistent acne, and biochemical abnormalities (4), including elevated levels of androgens, sex steroid precursors, and glucuronidated androgen metabolites as well as estrogens (22).There is no gold standard for the long-term treatment of women with PCOS who do not attempt to conceive (1). Treatments for hyperandrogenism and menstrual disturbances include oral contraceptives, insulin sensitizers, and lifestyle interventions. Combined low-dose oral contraceptives are recommended as the primary treat...

Acupuncture for treating polycystic ovary syndrome: guidance for future randomized controlled trials

“…A total of 31 RCTs that included 2371 women with PCOS met our inclusion criteria (Yang et al, 2005;Zhao et al, 2007;Shi et al, 2009;StenerVictorin et al, 2009;2013;Lai et al, 2010;Li and Han, 2010;Cui W. et al, 2011;Jedel et al, 2011;Li and Zhang, 2011;Li Y.L. et al, 2011;Pastore et al, 2011;Cui Y. et al, 2012;Franasiak et al, 2012;Liu et al, 2012;Liang et al, 2013a;2013b;Rashidi et al, 2013;Wang and Gu, 2013;Wang and Li, 2013;Zhang, 2013;Zheng et al, 2013;He, 2014;Jin et al, 2014;Leonhardt et al, 2014;Li L. et al, 2014;Lin, 2014;Liang, 2015a;2015b;Qiu et al, 2015;Sheng, 2015;Wang, 2015).…”

“…A short description of the studies included in this review was shown in Table 1. Of the 31 included trials, three were performed in Sweden (Stener-Victorin et al, 2009;2013;Jedel et al, 2011;Leonhardt et al, 2014), one in the USA (Pastore et al, 2011;Franasiak et al, 2012), one in Iran (Rashidi et al, 2013), and all other trials were conducted in China. After the studies were divided into four categories according to interventions, five were identified as "acupuncture vs. sham/no intervention," fifteen as "acupuncture+conventional therapy vs. conventional therapy," nine as "acupuncture vs. conventional therapy," and two as "comparison between different groups containing two or more of the above situations.…”

“…In this review, menstrual frequency, hormones, anthropometrics, insulin sensitivity, blood lipids, and fertility were used as the main measurements to assess the effects of acupuncture in treating PCOS. Menstrual frequency and hormones (follicle stimulating hormone (FSH), luteotropic hormone (LH), LH/FSH, and testosterone (T)) were the most common measurements used in evaluating the effect of a therapy on PCOS, and they were available in 25 of the 31 included trials (Zhao et al, 2007;Shi et al, 2009;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Li and Han, 2010;Jedel et al, 2011;Li and Zhang, 2011;Li Y.L. et al, 2011;Pastore et al, 2011;Cui Y. et al, 2012;Franasiak et al, 2012;Liu et al, 2012;Liang et al, 2013a;2013b;Wang and Gu, 2013;Wang and Li, 2013;Zhang, 2013;Zheng et al, 2013;He, 2014;Jin et al, 2014;Leonhardt et al, 2014;Li L. et al, 2014;Lin, 2014;Liang, 2015a;2015b;Qiu et al, 2015;Wang, 2015).…”

“…et al, 2011;Pastore et al, 2011;Cui Y. et al, 2012;Franasiak et al, 2012;Liu et al, 2012;Liang et al, 2013a;2013b;Wang and Gu, 2013;Wang and Li, 2013;Zhang, 2013;Zheng et al, 2013;He, 2014;Jin et al, 2014;Leonhardt et al, 2014;Li L. et al, 2014;Lin, 2014;Liang, 2015a;2015b;Qiu et al, 2015;Wang, 2015). Anthropometric measurements, such as body weight, body mass index (BMI), waist, waist-hip ratio (WHR), and the FerrimanGallwey score were available in 10 of the 31 included trials (Zhao et al, 2007;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Jedel et al, 2011;Liu et al, 2012;Zheng et al, 2013;Jin et al, 2014;Leonhardt et al, 2014;Liang, 2015a;2015b). Measurements about insulin sensitivity including fasting insulin (FINS), fasting plasma glucose (FPG), and homeostasis model assessment for insulin resistance (HOMA-IR) were available in 9 of the 31 trials (Zhao et al, 2007;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Jedel et al, 2011;Liu et al, 2012;Zheng et al, 2013;Leonhardt et al, 2014;Liang, 2015a;…”

Coagulation and Fibrinolytic Indices During the First Trimester of Pregnancy in Women With Polycystic Ovary Syndrome: A Preliminary Study

“…28,29 Also, this study employs a cross-sectional study design; thus, we cannot infer that the changes of the coagulation and fibrinolytic indices in obese and nonobese pregnant women with PCOS will directly result in significant complications later in pregnancy. Additionally, the small sample size used for comparison in this study may not detect any real difference between the various groups of women.…”