Acupuncture as alternative to Metformin for PCOS?

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age 1, 2.  The signs and symptoms of PCOS are vast, but include disturbances in metabolic parameters (insulin resistance and increased risk for cardiovascular disease), sex hormone imbalances (elevated testosterone, estrogen and LH/FSH ratio), ultrasound diagnosis of cysts on the ovaries, acne, excess facial or body hair growth, irregular or absent menstrual cycles, anovulation and difficulty conceiving 2.

In recent years, treatment approaches have evolved from a focus on targeting reproductive hormones to a shift towards healthy weight management and restoring insulin sensitivity as a first line treatment for PCOS. The mechanisms for restoring ovulation and improving hormone profiles in women with PCOS have been previously described in our previous blog on this topic. In this article, we will elaborate on the metabolic disturbances that characterize women with PCOS, as well as shed light on a novel approach for correcting these imbalances.

Insulin resistance, a major causative factor in the pathophysiology of PCOS, is a condition where the cells and tissues of the body fail to respond normally to the presence of insulin. As a result, the pancreas will secrete additional insulin after a meal in order to take up glucose from the bloodstream. These ongoing heightened levels of insulin worsen the symptoms of PCOS, as they maintain imbalances in the sex hormones, which in turn lead to irregular menstruation, acne, facial hair growth, and difficulty getting pregnant.

While even women of healthy BMI are frequently diagnosed with PCOS, up to 50% of women with PCOS are overweight, and commonly exhibit an accumulation of fat around the abdomen 3. This pattern of weight gain actually worsens the underlying insulin resistance, thereby contributing directly to the maintenance of symptoms such as acne, irregular cycles, abdominal weight gain, hirsutism, and male pattern hair loss.  Interestingly, even lean women with PCOS may exhibit an impaired insulin response and other cardiovascular risks. For this reason, healthy weight management and cardiovascular health is a treatment priority in all women with PCOS.

In addition to abdominal weight gain and insulin resistance, women with PCOS commonly exhibit unhealthy blood lipid panels, along with elevated markers of inflammation 4. In fact, an up to a two-fold increased risk of metabolic syndrome has been reported in women with irregular menstrual periods 5. Hence, the early detection and treatment of cardiovascular risk factors is essential in all women with PCOS. In our clinic, we routinely assess the following parameters of cardiovascular health: fasting insulin and glucose, HbA1c, hs-CRP, cholesterol panel, weight, BMI, waist –to-hip ratio, and blood pressure.

Updates on the Use of Acupuncture in PCOS: Implications for Weight Loss and Cardiovascular Health

Lifestyle modifications are always recommended as first-line therapy in PCOS 6. In clinical practice, we find that restoring insulin sensitivity will often allow menstrual cycling to resume a more regular pattern, as well as improve the other signs and symptoms of PCOS. We address insulin sensitivity through a comprehensive treatment approach comprised of normalizing weight, carefully adjusting the diet, and recommending appropriate exercise and specific supplementation. In addition, a significant body of evidence to support the use of acupuncture in PCOS and other endocrine disorders has emerged. The reasons we recommend acupuncture for PCOS in particular are as follows:

Clinical research studies have supported the use of acupuncture to reduce weight 7, improve acne 8, improve hormone profiles 8, 9, restore normal menstrual cycles 8, 9, 10 and promote ovulation 9, 10 in women with PCOS. A research study lends further evidence towards the use of acupuncture for overweight women with PCOS 7. The effects of acupuncture were compared to metformin; the most commonly prescribed insulin-sensitizing medication 11.  The results of this study were impressive: both the group receiving metformin and the group receiving acupuncture where shown to have significant improvements in many health markers of PCOS, including improvements in sex hormones levels (LH/FSH, testosterone), cholesterol panels, blood sugar regulation, ovarian volume, menstrual regularity, BMI and abdominal weight 7. The acupuncture treatment, however, was shown to produce a statistically significant greater reduction in weight, and a reduction in the waist-to-hip ratioindicating a significant loss of abdominal weight. Furthermore, the acupuncture treatment outperformed metformin at regulating menstrual cycles in these women 7.

Being an evidence-based clinic, we rely on research-based protocols to deliver the best of natural health care to our patients. While lifestyle modifications including a low glycemic index diet, nutritional supplements, and an exercise regime are mainstay to any naturopathic treatment of PCOS, regular acupuncture treatments are another viable treatment to correct the metabolic, endocrine and reproductive abnormalities associated with this complex syndrome.

References

  1. Ravn PHaugen AGGlintborg D. Overweight in polycystic ovary syndrome. An update on evidence based advice on diet, exercise and metformin use for weight  loss. Minerva Endocrinol. 2013 Mar;38(1):59-76.
  2. Hardy TSNorman RJ. Diagnosis of adolescent polycystic ovary syndrome. Steroids. 2013 Apr 24. pii: S0039-128X(13)00093-7. doi: 10.1016/j.steroids.2013.04.011.
  3. Zabuliene LTutkuviene J. [Body composition and polycystic ovary syndrome]. Medicina (Kaunas). 2010;46(2):142-57.
  4. Pasquali R, Stener-Victorin E, Yildiz BO, Duleba AJ, Hoeger K, Mason H, Homburg R, Hickey T, Franks S, Tapanainen JS, Balen A, Abbott DH, Diamanti-Kandarakis E, Legro RS. PCOS Forum: research in polycystic ovary syndrome today and tomorrow. Clinical Endocrinology. 2011;74, 424–433.
  5. Oh JYSung YALee HJ. Clinical implications of menstrual cycle length in oligomenorrhoeic young women. Clin Endocrinol (Oxf). 2013 May 13. doi: 10.1111/cen.12243.
  6. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95: 2038–2049.
  7. Zheng Y-H, Wang X-H, Lai M-H, Yao H, Liu H, Ma H-X. Effectiveness of Abdominal Acupuncture for Patients with Obesity-Type Polycystic Ovary Syndrome: A Randomized Controlled Trial. Journal of Alternative and Complementary Medicine. 2013;18(0):1-6.
  8. Jedel ELabrie FOdén AHolm GNilsson LJanson POLind AKOhlsson CStener-Victorin E. 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. 2011 Jan;300(1):E37-45. doi: 10.1152/ajpendo.00495.2010.
  9. Johansson JRedman LVeldhuis PPSazonova ALabrie FHolm GJohannsson GStener-Victorin E. Acupuncture for ovulation induction in polycystic ovary syndrome: A randomized controlled trial. J Cell Biol. 2013 May 1;304(9):E934-43. doi: 10.1152/ajpendo.00039.2013.
  10. Stener-Victorin EWaldenström UTägnfors ULundeberg TLindstedt GJanson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000 Mar;79(3):180-8.
  11. Bozdag GYildiz BO. Interventions for the metabolic dysfunction in polycystic ovary syndrome. Steroids. 2013 Apr 24. pii: S0039-128X(13)00090-1. doi: 10.1016/j.steroids.2013.04.008.

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