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.
Studies excluded from this review.
The aim of this review was to synthesise the pre-clinical and clinical evidence explaining the
mechanism of effect for herbal medicines in PCOS and associated oligo/amenorrhoea and
hyperandrogenism. Clinical studies investigating herbal medicines were excluded based on the
absence of evidence for a mechanism of effect in oligo/amenorrhoea, hyperandrogenism and PCOS
(Table 3) and or investigation of incomplete herbal extracts (isolated herbal chemicals) (Table 5) or
the absence of clinical data corroborating mechanism of effects (Table 4).
Table 3. Herbal medicines excluded from this review for which there was clinical evidence for effect
but no pre-clinical evidence demonstrating mechanism for effect and/or evidence for the specified
clinical conditions.
Herbal medicine
Clinical evidence (or potential)
for PCOS and associated
oligo/amenorrhoea or
hyperandrogenism
Reason for non-inclusion – insufficient
pre-clinical evidence for mechanism of
effects for whole herbal extract
Camellia sinensis
(green tea)
Hormone concentration in obese
women with PCOS [1].
Mentha spicata
(spearmint tea)
Lowered testosterone in women
with PCOS [3, 4].
Ginkgo Biloba
(ginkgo)
Metabolic hormone management
in type two diabetes [5].
Grifola frondosa
(miatake mushroom)
Linum usitatissimum
(flax seed)
Ovulation rates in PCOS [6].
Isolated constituent (epigallocatechin gallate 1)
examined [2]. No evidence found for effects for
whole herbal extract in PCOS,
oligo/amenorrhoea and hyperandrogenism.
No evidence for mechanism of effect found for
PCOS, oligo/amenorrhoea or
hyperandrogenism.
No evidence for mechanism of effect in PCOS,
oligo/amenorrhoea or hyperandrogenism
found.
No evidence for mechanism of effect in PCOS,
oligo/amenorrhoea or PCOS revealed.
No mechanism of effect in PCOS,
oligo/amenorrhoea or hyperandrogenism
found.
No evidence for mechanism of effect found in
PCOS, oligo/amenorrhoea or
hyperandrogenism (in female cell cultures or
animals).
No mechanism of effect in PCOS,
oligo/amenorrhoea or hyperandrogenism (in
female cell cultures or animals).
No mechanism of effect in PCOS,
oligo/amenorrhoea or hyperandrogenism.
No mechanism of effect studies found different
clinical outcome to those specified.
Pygeum africanum
(pygeum)
Menstrual regulation [7, 8] and
hormonal concentration [8-10] in
post-menopausal women.
Anti-androgen effects in prostatic
hypertrophy [11].
Serrenoa repens
(saw palmetto)
Anti-androgen effects in chronic
pelvic pain and prostatitis [12-14].
Silybum marianum
(St Mary’s thistle)
Stachys lavandulifolia
(wood betony)
Fatty liver disease in type two
diabetes [15].
Compared with progesterone
supplementation for dysfunctional
uterine bleeding in women with
PCOS [16].
Anti-androgen effects in women
[17].
Urtica dioca
(nettle root)
Anti-androgen effects through interaction with
SHBG in prostate cells [18-20]. Antiinflammatory and anti-nociceptive effects[21]
No evidence for effects of Urtica dioca in
female cell cultures or animals.
Other excluded studies investigated the herbal medicines included in this review examining conditions other than
PCOS, oligo/amenorrhoea and hyperandrogenism. These included investigations into effectiveness for Vitex
agnus-castus for pre-menstrual syndrome [22-27]and mastalgia [28, 29], Cimicifuga racemosa for menopausal
symptoms [30]and Glycorrhiza spp with Paeonia lactiflora libido in males [31].
Clinical studies examining the effectiveness of complex herbal formulas for PCOS and associated
oligo/amenorrhoea and hyperandrogenism, without demonstration of a mechanism of effect for the whole
complex formula were also excluded as were studies investigating complex formulae for different outcomes
(PMS, endometriosis etc ).
Table 4. Herbal medicines with pre-clinical evidence in PCOS, oligo/amenorrhoea and
hyperandrogenism without clinical evidence for effectiveness.
Herbal medicine
Curcuma longa
(turmeric)
Pre-clinical evidence for (potential)
effects in reproductive endocrinology in
PCOS and associated oligo/amenorrhoea
and hyperandrogenism
Anti-androgen effects [32].
Reason for exclusion
No clinical evidence examining
effectiveness in women was
found.
No clinical data found.
Matricaria
Reduced luteinising hormone and
chamomilla
improved ovarian morphology in animals
(Chamomile)
with PCOS [33].
Mentha piperita
Anti-androgen effects in animals [34].
No clinical data for women.
(peppermint)
Silybum marianum
Anti-proliferative antioxidant and
No clinical evidence including
(St Marys thistle
biochemical effects in the liver [35].
women was found.
Studies investigating chemical compounds derived from the herbal medicines, included in this review
but investigating different outcomes were found for Vitex agnus-castus [36] and Cimicifuga racemosa
[37].
Table 5. Studies excluded due to the investigation of chemicals isolated from herbal medicines.
Isolated chemicals
Phytoestrogens
Berberine
Catechin derived from
Camellia sinensis
Sapponins (derived
from Tribulus
terrestris)
Paeoniflorin,
glycyrrhizin and
glycyrrhetic acid
Evidence for effects
Hormonal effects in ovarian granulosa cells [38].
Comparison with metformin in PCOS [39]; ovarian theca cell hormone
production [40].
Effects of epigallocatechin gallate 1 on cellular metabolic endocrinology [2].
Effects on reproductive endocrinology [41].
Ovarian androgen production [42].
Isoflavones (isolated Selective oestrogen receptor activity (competitive inhibition via beta
oestrogen receptors) [43].
from Vitex agnuscastus)
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17.
18.
19.
Chan, C.C., et al., Effects of Chinese green tea on weight, and hormonal and biochemical
profiles in obese patients with polycystic ovary syndrome—a randomized placebo-controlled
trial. Journal of the Society for Gynecologic Investigation, 2006. 13(1): p. 63-68.
Kao, Y.-H., R.A. Hiipakka, and S. Liao, Modulation of endocrine systems and food intake by
green tea epigallocatechin gallate 1. Endocrinology, 2000. 141(3): p. 980-987.
Akdoğan, M., et al., Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in
women with hirsutism. Phytotherapy Research, 2007. 21(5): p. 444-447.
Grant, P., Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian
syndrome. A randomized controlled trial. Phytotherapy Research, 2010. 24(2): p. 186-188.
Kudolo, G.B., et al., The effect of the ingestion of Ginkgo biloba extract (EGb 761) on the
pharmacokinetics of metformin in non-diabetic and type 2 diabetic subjects--A double blind
placebo-controlled, crossover study. Clinical Nutrition, 2006. 25(4): p. 606-616.
Chen, J.-T., et al., Maitake mushroom (Grifola frondosa) extract induces ovulation in patients
with polycystic ovary syndrome: a possible monotherapy and a combination therapy after
failure with first-line clomiphene citrate. The Journal of Alternative and Complementary
Medicine, 2010. 16(12): p. 1295-1299.
Phipps, W.R., Martini, M.C., Lampe, J.W., Slavin, J.L. Kurzer, M. S., Effect of flax seed
ingestion on the menstrual cycle. The Journal of Clinical Endocrinology & Metabolism, 1993.
77(5): p. 1215-1219.
Lampe, J., et al., Urinary lignan and isoflavonoid excretion in premenopausal women
consuming flaxseed powder. The American journal of clinical nutrition, 1994. 60(1): p. 122128.
Hutchins, A.M., et al., Flaxseed consumption influences endogenous hormone concentrations
in postmenopausal women. Nutrition and cancer, 2001. 39(1): p. 58-65.
Frische, E.J., et al., Effect of flaxseed and wheat bran on serum hormones and lignan
excretion in premenopausal women. Journal of the American College of Nutrition, 2003.
22(6): p. 550-554.
Melo, E., et al., Evaluating the efficiency of a combination of Pygeum africanum and stinging
nettle (Urtica dioica) extracts in treating benign prostatic hyperplasia (BPH): double-blind,
randomized, placebo controlled trial. Int Braz J Urol, 2002. 28(5): p. 418-425.
Yang, J. and A.E. Te, Saw palmetto and finasteride in the treatment of category-III
prostatitis/chronic pelvic pain syndrome. Current urology reports, 2005. 6(4): p. 290-295.
Morgia, G., et al., Treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
with Serenoa repens plus selenio and licopene (Profluss®): a randomized multicenter placebocontrolled study. The Journal of Urology, 2008. 179(4): p. 32.
Casner, P.R., et al., Saw palmetto for benign prostatic hyperplasia. N Engl J Med, 2006.
354(18): p. 1950-1951.
Huseini, H.F., et al., The efficacy of Silybum marianum (L.) Gaertn.(silymarin) in the treatment
of type II diabetes: a randomized, double‐blind, placebo‐controlled, clinical trial.
Phytotherapy research, 2006. 20(12): p. 1036-1039.
Jalilian, N., et al., Phytotherapeutic Management of Polycystic Ovary Syndrome: Role of
Aerial Parts of Wood Betony (Stachys lavandulifolia). Phytotherapy Research, 2013. 27(11):
p. 1708-1713.
Najafipour, F., et al., Therapeutic effects of stinging nettle (Urtica dioica) in women with
Hyperandrogenism.
Hryb, D., et al., The Effect of Extracts of the Roots of the Stinging Nettle. Planta medica,
1995. 61(01): p. 31-32.
Schöttner, M., D. Ganßer, and G. Spiteller, Lignans from the Roots of Urtica spp. Planta
medica, 1997. 63(06): p. 529-532.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
Zhang, Q., et al., Effects of the polysaccharide fraction of Urtica fissa on castrated rat
prostate hyperplasia induced by testosterone propionate. Phytomedicine, 2008. 15(9): p.
722-727.
Hajhashemi, V. and V. Klooshani, Antinociceptive and anti-inflammatory effects of Urtica
dioica leaf extract in animal models. Avicenna Journal of Phytomedicine, 2013. 3(2): p. 193200.
Loch, E., K. Böhnert, and M. Peeters, The treatment of menstrual disorders with Vitex agnuscastus tincture. Der Frauenarzt, 1991. 32(8): p. 867-70.
Loch, E., H. Selle, and N. Boblitz, Treatment of premenstrual syndrome with a
phytopharmaceutical formulation containing Vitex agnus castus. Journal of Women's Health
& Gender-Based Medicine, 2000. 9(3): p. 315-320.
Ma, L., et al., Evaluating therapeutic effect in symptoms of moderate-to-severe premenstrual
syndrome with Vitex agnus castus (BNO 1095) in Chinese women. Australian & New Zealand
Journal of Obstetrics & Gynaecology, 2010. 50(2): p. 189-193.
Schellenberg, R. Treatment for the premenstrual syndrome with agnus castus fruit extract:
prospective, randomised, placebo controlled study. BMJ (Clinical research ed.), 2001. 134-7.
Lauritzen, C.H., et al., Treatment of premenstrual tension syndrome with Vitex agnus castus
controlled, double-blind study versus pyridoxine. Phytomedicine, 1997. 4(3): p. 183-189.
He, Z., et al., Treatment for premenstrual syndrome with Vitex agnus castus: A prospective,
randomized, multi-center placebo controlled study in China. Maturitas, 2009. 63(1): p. 99103.
Wuttke, W.S., G. Gorkow, C. Sieder, C., Treatment of cyclical mastalgia: Results of a
randomised, placebo- controlled, double-blind study: Objective. Obstetrics and Gynecology,
1997. 57(10): p. 569-574.
Halaska, M., et al., Treatment of cyclical mastalgia with a solution containing a Vitex agnus
castus extract: results of a placebo-controlled double-blind study. The Breast, 1999. 8(4): p.
175-181.
Wuttke, W., D. Seidlova-Wuttke, and C. Gorkow, The Cimicifuga preparation BNO 1055 vs.
conjugated estrogens in a double-blind placebo-controlled study: effects on menopause
symptoms and bone markers. Maturitas, 2003. 44: p. S67-S77.
Yamada, K., et al., Herbal medicine (Shakuyaku-kanzo-to) in the treatment of risperidoneinduced amenorrhea. Journal of clinical psychopharmacology, 1999. 19(4): p. 380.
Ohtsu, H., et al., Antitumor agents. 217. Curcumin analogues as novel androgen receptor
antagonists with potential as anti-prostate cancer agents. Journal of medicinal chemistry,
2002. 45(23): p. 5037-5042.
Zangeneh, F.Z., et al., Effects of chamomile extract on biochemical and clinical parameters in
a rat model of polycystic ovary syndrome. Journal of Reproduction & Infertility, 2010. 11(3):
p. 169.
Akdogan, M., et al., Effects of peppermint teas on plasma testosterone, follicle-stimulating
hormone, and luteinizing hormone levels and testicular tissue in rats. Urology, 2004. 64(2): p.
394-398.
Gebhardt, R., Antioxidative, antiproliferative and biochemical effects in HepG2 cells of a
homeopathic remedy and its constituent plant tinctures tested separately or in combination.
Arzneimittel Forschung, 2003. 53(12): p. 823-830.
Webster, D., et al., Activation of the μ-opiate receptor by Vitex agnus-castus methanol
extracts: Implication for its use in PMS. Journal of Ethnopharmacology, 2006. 106(2): p. 216221.
Burdette, J.E., et al., Black cohosh acts as a mixed competitive ligand and partial agonist of
the serotonin receptor. Journal of agricultural and food chemistry, 2003. 51(19): p. 56615670.
38.
39.
40.
41.
42.
43.
Whitehead, S.A. and M. Lacey, Phytoestrogens inhibit aromatase but not 17β hydroxysteroid
dehydrogenase (HSD) type 1 in human granulosa luteal cells: evidence for FSH induction of
17β HSD. Human Reproduction, 2003. 18(3): p. 487-494.
Wei, W.Z., H. Wang, A. Sui, M. Liang, K. Deng, H. Ma, Y. Zhang, Y. Zhang, H. Guan, Y. , A
clinical study on the short-term effect of berberine in comparison to metformin on the
metabolic characteristics of women with polycystic ovary syndrome. European Journal of
Endocrinology, 2012. 166(1): p. 99-105.
Zhao, L., Li, Wei, Han, Fengjuan, Hou, Lihui, Baillargeon, Jean-Patrice, Kuang, Haixue, Wang,
Yongyan, Wu, Xiaoke, Berberine reduces insulin resistance induced by dexamethasone in
theca cells in vitro. Fertility and sterility, 2011. 95(1): p. 461-463.
Kostova, I. and D. Dinchev, Saponins in Tribulus terrestris - Chemistry and bioactivity.
Phytochemistry Reviews, 2005. 4(2-3): p. 111-137.
Takeuchi, T., et al., Effect of paeoniflorin, glycyrrhizin and glycyrrhetic acid on ovarian
androgen production. American Journal of Chinese Medicine, 1991. 19(1): p. 73-78.
Jarry, H., et al., Evidence for Estrogen Receptor β-Selective Activity Agnus castus and isolated
flavones Planta medica, 2003. 69(10): p. 945-947.