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PCOS: Herbal Supplements


As a functional nutrition practitioner, it is possible to manage PCOS through a combination of a healthy balance of nutrition and lifestyle and some specific supplementation which focuses on balancing blood sugar levels and hormones, reducing insulin resistance, stress, and chronic inflammation, and optimizing gut health.

There are some known herbal therapies that have been scientifically studied and used in the treatment of PCOS and other hormonal related imbalances.

Vitex

Vitex agnus-castus is a plant used in herbal medicine. Also known as chaste tree or chasteberry. Vitex is often taken for a wide range of women’s health conditions such as breast tenderness, improving ovulation, premenstrual syndrome (PMS), low progesterone, menopause and PCOS.

Menstrual Regularity

One study concluded that the ability of vitex to regulate menstrual cycles could be comparable to oral contraceptives (birth control pills). Another study found women with PCOS who took vitex saw improved cycle length, an increase of mid-luteal phase levels of progesterone, less amenorrhea, and improved luteal phase basal body temperature (indicative of healthy ovulation).

Reduced Androgens

Vitex has also been shown to help reduce high androgen (testosterone) levels, which leads to less unwanted androgen-related symptoms like acne and unwanted facial hair (hirsutism) among women with PCOS.

Dosing of Vitex

The recommended vitex dose can typically range from 200mg -1,000mg a day. If well tolerated, it is best to take Vitex for a minimum of 3-6 months for optimal PCOS outcomes.

Interactions and contraindications of vitex Vitex may interact with oral contraceptives, hormone therapy and is not recommended when pregnant. You should also avoid vitex if you’re taking any type of medications that alter dopamine levels (such as in cases of Parkinson’s disease).


Berberine:

Berberine has a long history of medicinal use in Chinese and Ayurvedic medicine with promising research of its use in PCOS. Found in many different plants including Hydrastis Canadensis (goldenseal), Coptis chinensis (Coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric).


Studies show that berberine possesses a wide range of biochemical and pharmacological activities in conditions such as:

  • Diabetes

  • Heart disease

  • High cholesterol

  • Hypertension (high blood pressure)

  • Immune challenges

  • Breast Cancer

  • Intestinal infections

  • Joint problems

  • Low bone density

How Does Berberine Work?

Berberine stimulate the uptake of glucose into the cells, improves insulin sensitivity, reduces glucose production in the liver, slows the release of free fatty acids, which lowers lipid levels and prevents harmful fat deposits, boosts fat burning in the mitochondria and stimulates the release of nitric oxide (NO), a signaling molecule that relaxes the arteries, increases blood flow and lowers blood pressure, and protects against atherosclerosis.

Berberine and PCOS

In a 2012 study, researchers evaluated the effects of berberine in comparison to metformin in women with PCOS. The study showed that subjects who were on metformin or berberine both had significant improvement in insulin sensitivity than the control group. The berberine group also had a significant decrease in their triglycerides and increase in HDL cholesterol (good cholesterol) levels compared to the metformin group.

In a recent 2014 study, researchers compared the effectiveness of berberine and metformin in PCOS women scheduled for IVF treatment. Both berberine and metformin treatments prior to IVF, improved the pregnancy outcomes. What was also recorded was that berberine had much more pronounced therapeutic effect and achieved statistically significant more live births with fewer side effects than metformin.

Dosing of Berberine

There is currently no consensus regarding the most appropriate dosage of berberine for PCOS; however, several studies have safely used daily doses between 500–1,500 mg divided into 2–3 servings, ideally taken with meals.

Interactions and Contraindications of Berberine

As with any drug/ botanicals it is important to be vigilant about its dose and duration. Repeated use of berberine down-regulates several important liver enzymes that the body uses to eliminate drugs. Some of the drugs that these enzymes detoxify are tricyclics, MAOIs, SSRIs, opiates, anti-arrhythmics, beta-blockers, Cimetidine, Coumadin, sulfonylureas and most steroid hormones. The use of berberine during pregnancy is contraindicated.

Berberine can result in hypoglycemic episodes, especially if taken with other medications or supplements that also lower glucose and insulin.


Ashwagandha

Ashwagandha is an ancient herb used for centuries in Ayurvedic medicine for stress reduction, boosting energy, and improving sleep.

Balances cortisol levels

Cortisol is a stress hormone produced by the adrenal glands. Many individuals with PCOS present with higher than normal cortisol levels, which can contribute to various PCOS symptoms. For example, cortisol raises your blood sugar and decreases your body’s ability to respond to insulin (this is called insulin resistance). Unfortunately, insulin resistance can cause difficulty losing weight, sugar cravings, irregular periods, and more. As an adaptogen, ashwagandha is primarily known for its ability to balance cortisol levels and reduce overall perceived stress.

Lowers anxiety

Women with PCOS are three times more likely to suffer from anxiety than the general population. PCOS may cause anxiety due to the hormonal imbalances seen in this condition. A large review of studies found that ashwagandha significantly reduces anxiety scores, in some cases by over 50 percent. This herb is thought to reduce anxiety due to its cortisol lowering effects and ability to mimic a calming neurotransmitter in our brain called GABA.

Improves sleep

Sleep dysfunction can have devastating effects on PCOS and worsens many of the root causes of this condition, like insulin resistance. Sleeping less than six hours a night may also increase levels of CRP (C-Reactive Protein), a marker for inflammation. A recent review study found that individuals taking ashwagandha extract reported improved sleep and increased mental alertness in the morning. This effect was strongest when taking at least 600mg of extract per day for at least eight weeks.

Supports thyroid health

Women with PCOS are three times more likely to suffer from Hashimoto’s thyroid disease than women without PCOS. Hashimoto’s is an autoimmune disease and the most common cause of hypothyroidism in the United States.

Ashwagandha supports optimal thyroid function and may be an effective tool for individuals with hypothyroidism. One randomized controlled trial found that taking 600mg of ashwagandha root extract effectively normalized levels of thyroid stimulating hormone (TSH), T3, and T4.

May lower blood sugar levels

Up to 70 percent of women with PCOS have some degree of insulin resistance. This occurs when your cells become resistant to insulin, a hormone responsible for normalizing blood sugar levels after a meal. Unfortunately, insulin resistance can lead to many common PCOS symptoms like difficulty losing weight, weight gain, and irregular periods. One review study found that treatment with ashwagandha significantly reduced blood sugar, hemoglobin A1c, and insulin levels.

Dosing of Ashwagandha

Most research studies indicate an effective dose is around 600mg daily. However, doses up to 1,250mg per day were found to be safe and well tolerated. Keep in mind, ashwagandha is not recommended for women who are pregnant.


It is always recommended to seek the advice of a medical professional before starting any supplements to review any contraindications or interactions with other medications. If you are ready to improve your hormonal health, feel to contact our office and discuss your options with our functional nutritionist/dietitian, Tina Alexander RDN.

If you are ready to order your herbal supplements, you can check out my recommendations through Fullscript which also provides you with an ongoing 10% discount off MSRP.

References:

  1. Anti-inflammatory properties. NCBI. 2018. “Ashwagandha root extract exerts anti-inflammatory properties”. https://pubmed.ncbi.nlm.nih.gov/29620265/

  2. Blood sugar-altering abilities of Ashwagandha. NCBI. 2000. “Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry root”. https://pubmed.ncbi.nlm.nih.gov/11116534/

  3. Study with induced diabetes in rats. NCBI. 2009. “Hypoglycaemic and Hypolipidaemic Effects of Withania somnifera Root and Leaf Extracts on Alloxan-Induced Diabetic Rats”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695282/

  4. Ashwagandha blocks the stress signal pathway. NCBI. 2015. “Direct evidence for GABAergic activity of Withania somnifera on mammalian ionotropic GABAA and GABAρ receptors”. https://pubmed.ncbi.nlm.nih.gov/26068424/

  5. Daily consumption reduced cortisol levels. NCBI. 2019. “An investigation into the stress-relieving and pharmacological actions of an ashwagandha extract”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750292/

  6. Ashwagandha reduces cholesterol levels. NCBI. 2007. “Hypocholesteremic and antioxidant effects of Withania somnifera (Dunal) in hypercholesteremic rats”. https://pubmed.ncbi.nlm.nih.gov/16713218/

  7. Reduced LDL levels. NCBI. 2012. “Exploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania somnifera) in healthy volunteers”. https://pubmed.ncbi.nlm.nih.gov/23125505/

  8. Improvement in Thyroid levels. NCBI. 2018. “Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial”. https://pubmed.ncbi.nlm.nih.gov/28829155/

  9. Reduces inflammation. NCBI. 2009. “In vivo effects of Ashwagandha (Withania somnifera) extract on the activation of lymphocytes”. https://pubmed.ncbi.nlm.nih.gov/19388865/

  10. Die MV, Burger H, Teede H, Bone K. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Medica. 2012;79(07):562-575. doi:10.1055/s-0032-1327831

  11. Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2017;217(2):150-166. doi:10.1016/j.ajog.2017.02.028

  12. Csupor D, Lantos T, Hegyi P, et al. Vitex agnus-castus in premenstrual syndrome: a meta-analysis of double-blind randomised controlled trials. Complementary Therapies in Medicine. 2019;47:102190. doi:10.1016/j.ctim.2019.08.024

  13. Molaie M, Darvishi B, Jafari Azar Z, et al. Effects of a combination of Nigella sativa and vitex agnus-castus with citalopram on healthy menopausal women with hot flashes: results from a subpopulation analysis. Gynecological Endocrinology. 2019;35(1):58-61. doi:10.1080/09513590.2018.1499086

  14. van Die MD, Burger HG, Bone KM, et al. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. 2009;16(1):156-163. doi:10.1097/gme.0b013e31817fa9e0

  15. Westphal LM, Polan ML, Trant AS. Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women. Clin Exp Obstet Gynecol. 2006;33(4):205-208.

  16. Tayebi N, Emamghoreishi M, Akbarzadeh M. Effect of vitex agnus-castus on depression of postmenopausal women: A randomized clinical trial. Shiraz E-Med J. 2021 Jan;22(6):103381. doi:10.5812/semj.103381

  17. Owolabi M, Abass M, Emeka P, Jaja S, Nnoli M, Dosa BenjaminOS. Biochemical and histologic changes in rats after prolonged administration of the crude aqueous extract of the leaves of vitex grandifolia. Phcog Res. 2010;2(5):273. doi:10.4103/0974-8490.72322Wei W1, Zhao H, Wang A, Sui M, Liang K, Deng H, Ma Y, Zhang Y, Zhang H, Guan Y.

  18. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. Eur J Endocrinol. 2012 Jan;166(1):99-105.

  19. Li Y1, Ma H, Zhang Y, Kuang H, Ng EH, Hou L, Wu X. Effect of berberine on insulin resistance in women with polycystic ovary syndrome: study protocol for a randomized multicenter controlled trial. Trials. 2013 Jul 18;14:226.

  20. An Y1, Sun Z, Zhang Y, Liu B, Guan Y, Lu M. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clin Endocrinol (Oxf). 2014 Mar;80(3):425-31. doi: 10.1111/cen.12294.




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