Written by Angeline A. De Leon, Staff Writer. Of the one hundred participating women with PCOS and infertility problems, those who supplemented with Cimicifuga racimosa (black cohosh) had significantly higher levels of luteinizing hormone and progesterone and a higher rate of pregnancy than those who supplemented with clomiphene citrate.
Polycystic ovarian syndrome (PCOS) is a hormonal disorder most common among women of reproductive age. Caused by an imbalance of reproductive hormones due to enlargement of the ovaries and the presence of cysts 1, PCOS typically features long-term metabolic disturbances, and menstrual irregularities, which may lead to infertility, as well as acne, excessive and/or thinning hair, and weight gain 2. Although no cure for PCOS currently exists, symptom management is possible. In the treatment of PCOS-related infertility, pharmacological efforts have focused on promoting ovulation through the use of estrogen modulators, such as clomiphene citrate (CC) 3, which has a relatively high success rate in helping women achieve pregnancy 4 but is associated with many negative side effects, including mood swings, visual disturbances, and pelvic discomfort 5. Although its receptor selectivity is not yet well understood, evidence suggests that Cimicifuga may function similarly to an estrogen modulator. Several studies indicate that C. racimosa extract may be effectively used as an alternative to hormonal therapy in the treatment of menopausal symptoms, such as hot flashes, mood disturbances, and palpitations 6. To better understand the role of C. racimosa as a potential phyto-estrogen (estrogen-like compound derived from plants), Egyptian researchers at Minia University examined the effects of the herbal extract on ovulation induction, hormone profile, and pregnancy rate in women with PCOS.
In a prospective, randomized, controlled study, a total of 100 women (aged 21-27) diagnosed with PCOS with primary or secondary infertility were randomized into one of two groups: one group received 20 mg of standardized C. Racimosa extract twice daily for 10 days, and the other 50 mg of CC twice daily for 5 days (treatment for both groups started from the second day of the cycle and was repeated for three successive cycles). Patients were assessed for changes in follicle-stimulating hormone (FSH, hormone involved in regulating menstrual cycle and production of eggs by ovaries), luteinizing hormone (LH, involved in triggering ovulation), FSH/LH ratio, progesterone (involved in regulating menstrual cycle and maintaining early stages of pregnancy), and endometrial thickness (uterine lining, increased thickness favorable for egg fertilization). Pregnancy rate was also measured.
At the end of three treatment cycles, a significant, favorable change was observed in the patients in the C. Racimosa group, relative to those of the CC group for LH levels (3.45 +/- 0.14 vs. 4.55 +/- 0.16 IU/ml, respectively; p = 0.007) and FSH/LH ratio (0.582 +/- 0.21 vs. 0.805 +/- 0.82; p = 0.06). Progesterone level was higher for the C. Racimosa group than CC, particularly in the first cycle (10.12 +/- 0.14 vs. 9.54 +/- 0.15 ng/ml; p = 0.0001), indicative of improved ovulation, and endometrial thickness was also comparatively better for the C. Racimosa group (first cycle: 8.34 vs. 6.89 mm; second: 9.67 vs. 6.34 mm; third: 9.11 vs. 7.32 mm; p = 0.0004). Pregnancy rate was higher with C. Racimosa, but was not significantly different between groups.
Findings indicate that phyto-estrogens such as C. Racimosa extract may be used as an alternative means of inducing ovulation in women with PCOS. Further studies are needed, however, to determine optimum dosage and duration of treatment.
Source: Kamel HH. Role of phyto-oestrogens in ovulation induction in women with polycystic ovarian syndrome. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2013; 168: 60-63. DOI: 10.1016/j.ejogrb.2012.12.025.
© 2013 Elsevier Ireland Ltd. All rights reserved.
Posted January 9, 2018.
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