Acupuncture for PCOS – 5 Unbelievable Facts You Must Know!

Diet, Exercise and Needles?
acupuncture thicken uterine lining fast pcos blood flow to ovaries increase circulation

Acupuncture for PCOS. If you have not tried, we will spit out all the facts you need to know as you scroll down below. Reach out to us if you want to find out more!

Acupuncture can be a very effective method to enhance reproductive function in women with PCOS, which is a specific case of ovulatory dysfunction. Acupuncture can be used alone to enhance female reproductive function; it can also be used in tandem with other therapies, e.g. supplements, herbs and even clomid/letrozole.

The points made below do not just apply if you have a diagnosis of PCOS. It is proof that acupuncture can help if:

  • Your menstrual cycle is not regular.
  • You have delayed cycles or amenorrhea.
  • Your lining is thin.
  • Your period is scant and much lighter than previously.
  • You have mid-cycle bleeding, metromenorrhagia, or long duration of spotting prior to your period.

PCOS is an endocrine and metabolic disorder affecting up to 10% of women of childbearing age. While pharmaceutical drugs and surgery are effective, they also carry with them obvious side effects and hence cannot be used over a long duration of time.

For example, hormonal medication may reduce hirsutism and acne, but has an adverse effect of glucose tolerance, coagulability and fertility (Lanham et al).

Acupuncture has been chosen by women with PCOS as an alternative treatment for the management of PCOS. Read more below to find out why!

Acupuncture Treats Poor Response to Clomid

Clomiphene Citrate is otherwise known as Clomid or Serophene. Clomiphene is considered the first line of treatment for inducing ovulation in women with PCOS. This oral medication is a weak estrogen-like hormone that acts on the hypothalamus, pituitary gland, and ovary to increase levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH, which is also important in the process of ovulation). The increased level of FSH hormones improves the chances of growing an ovarian follicle that can then trigger ovulation.

Findings from previous clinical and experimental studies indicate that a woman with PCOS who responds poorly to clomiphene and does not ovulate may benefit from acupuncture. Inability of clomiphene to induce ovulation is more likely in patients who are obese, insulin resistant, and hyperandrogenic compared with those who do respond (Imani et al, 1998). Knowing this, there are other studies that suggest the viability of acupuncture treatments to treat obesity, insulin resistance and hyperandrogenism.

At our clinic, we have also been successful when including Chinese herbs as part of the treatment for those who respond poorly to Clomid.

acupuncture for pcos poor responder clomid stener victorin

Acupuncture Reduces Hormonal Side Effects of Clomid

Side effects from Clomid include hot flushes, breast distension, abdominal distension, nausea/vomiting, nervousness, sleeplessness, headache, mood swings, dizziness, hair loss and disturbed vision. Acupuncture is able to attenuate these side effects.

One major side effect of Clomid is that it often causes the uterine lining to thin, which is detrimental to becoming pregnant. Acupuncture causes the uterine lining to thicken and become more uniform by increasing blood flow to the uterine arteries.

Stener-Victorin in 1996 did a pilot study measuring the pulsatility index (PI) fo 10 participants undergoinG IVF. After acupuncture, the PI fell, leading to lower blood flow impedance and higher success in IVF. Yu et al in 2006 did a study examining the effect of Viagra and acupuncture on the uterine linings of women who had a history of thin linings (<8mm) in previous IVF cycles.

They followed a consistent protocols which improve blood flow to the ovaries and uterus. The researchers found that after acupuncture treatment, the thickness of the lining improved to 10 mm or more in all participating patients.

Acupuncture Enhances the Effects of Letrozole

acupuncture for pcos ovulation conception clomid letrozole metformin

Clomiphene is the current first-line infertility treatment in women with the polycystic ovary syndrome, but aromatase inhibitors, including letrozole, might result in better pregnancy outcomes.

Legro et al in 2014 associated letrozole with higher live-birth and ovulation rates (as compared to Clomid) among infertile women with the polycystic ovary syndrome. Letrozole appears to be a good option, with its oral route of administration, cost, shorter half-life and negligible side effects being the main pluses (Sujata Kar 2013).

There is one ongoing trial (Li, Ng and Stener-Victorin et al) which is the first randomized controlled trial to compare acupuncture pretreatment followed by letrozole with letrozole alone on live births in anovulatory infertile women with PCOS. The hypothesis is that acupuncture pretreatment improves insulin sensitivity and leads to a higher ovulation rate and live birth rate, which is different from the available evidence suggesting that acupuncture influences ovulation by affecting the levels of various hormones. We await the results of this study.

At our clinic, we use acupuncture (and sometimes Chinese herbal treatment) while the patient is also on clomid or letrozole.

Acupuncture Treats Digestive Side Effects from Metformin

Acupuncture is worth considering if you are also using Metformin (Glucophage) to treat insulin resistance in PCOS. Like Clomiphene, Metformin does come with side effects. About one third of women on Metformin experienced digestive upset, including symptoms such as nausea, occasional vomiting and loose, more frequent bowel movements, or diarrhea.

At our clinic, while using acupuncture to facilitate ovulation, we often add extra points that treat nausea and vomiting. Large trials and studies (Cheong at al 2013 and Ezzo 2006) had confirmed its efficacy.

Acupuncture Prevents OHSS / Ovarian Hyperstimulation

In cases of poor responders to Clomiphene, an even stronger approach would be to use gonadotropin injections, which are associated with a higher risk of multiple pregnancies and development of Ovarian Hyper-stimulation Syndrome (OHSS). OHSS is more prevalent in PCOS patients, and is a potentially serious side effect of drugs used during IVF.

Mild OHSS results in some ovarian enlargement with slight abdominal pain and swelling and the standard medical treatment is pain relief. Moderate OHSS results in more noticeable pain and swelling with nausea and vomiting. Severe OHSS can result in the leakage of hormones and fluid from both ovaries and this in turn may cause accumulation of fluid both in the abdominal cavity and in the chest.

Ovarian hyperstimulation syndrome (OHSS) is a serious complication to expect during the IVF cycle. Any patient undergoing artificial induction of ovulation is at risk of developing OHSS, although some are more at risk than others. The symptoms usually begin four to five days after the egg collection.

While up to 33 percent of women experience the mild forms of OHSS, 3-8 percent has reported severe OHSS. Despite significant advances in assisted reproductive technology over the years, there are currently no effective strategies to eliminate this disorder.

If detected early, acupuncture can help eliminate the symptoms of mild OHSS or relieve the discomfort in the severe cases. According to a study done by Nanjing Medical University in 2016, it concluded that electroacupuncture may provide a simple and effective method for the prevention and treatment of OHSS. The results indicate that electroacupuncture can modulate endocrine hormone secretion and affect the secretion of inflammatory cytokines and vascular endothelial growth factor, and thus prevent the progress of OHSS.

In another study conducted in 2014, 53 out of 109 women undergoing IVF/ICSI were assigned to electroacupuncture during the cycle. Compared with the non-EA group, the occurrence of OHSS and the canceling rate of transplant cycles were significantly lower in the EA group.

Acupuncture is usually recommended after egg collection to help recovery from anesthetic, local tissue trauma, and most importantly, the prevention of OHSS. The timing and number of acupuncture treatments will vary between women and their individual conditions to best support their recovery before embryo transfer.

References:

  1. Hongying Kuang, Yan Li, Xiaoke Wu, Lihui Hou, Taixiang Wu, Jianping Liu, Ernest Hung Yu Ng, Elisabet Stener-Victorin, Richard S. Legro, Heping Zhang, “Acupuncture and Clomiphene Citrate for Live Birth in PCOS: Study Design of a RCT,” Evid Base Complement Alternat Med. 2013; 2013: 527303.
  2. Kousta E, White DM, Franks S. “Modern use of clomiphene citrate in induction of ovulation.” Hum Reprod Update. 1997 Jul-Aug;3(4):359-65.
  3. Impicciatore GG, Tiboni GM. “Ovulation inducing agents and cancer risk: review of literature.” Curr Drug Saf. 2011 Sep 1;6(4):250-8.
  4. Li Chen, Hai-Xiang Sun, You-Bing Xia, Liu-Cai Sui, Ji Zhou, Xuan Huang, Jing-Wei Zhou, Yi-Dan Shao, Tao Shen, Qin Sun, Yuan-Jiao Liang, Bing Yao, “Electroacupuncture decreases the progression of ovarian hyperstimulation syndrome in a rat model,” Reprod Biomed Online. 2016 May;32(5):538-44.
  5. Chen Jun et al, “Investigation on effect of electroacupuncture intervention on in vitro fertilization and embryo transfer of patients with polycystic ovarian syndrome,” Maternal and Child Health Care of China 2009; 30 pg 28 Maternal and Child Health Care of China.
  6. Hong YL, Tan Y, Yin YY, Zou YJ, Guo YH, Nie XW. “Effect of electro-acupuncture on clinical outcomes and ovarian hyperstimulation syndrome in in vitro fertilization and embryo transplantation.” Reproductive Medical Center, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China;
  7. Legro RS et al.”Letrozole versus clomiphene for infertility in the polycystic ovary syndrome.” N Engl J Med. 2014 Jul 10;371(2):119-29. doi: 10.1056/NEJMoa1313517.
    Biljan MM, Hemmings R, Brassard N. “The outcome of 150 babies following the treatment with letrozole or letrozole and gonadotropins.” Fertil Steril. 2005;84(Suppl 1):S95.
  8. Sujata Kar.”Current evidence supporting “letrozole” for ovulation induction” J Hum Reprod Sci. 2013 Apr-Jun; 6(2): 93–98.
  9. Hajishafiha M, Dehghan M, Kiarang N, Sadegh-Asadi N, Shayegh SN, Ghasemi-Rad M. “Combined letrozole and clomiphene versus letrozole and clomiphene alone in infertile patients with polycystic ovary syndrome.” Drug Des Devel Ther. 2013 Dec 3;7:1427-31.
  10. Stener-Victorin, et al “Reduction of blood flow impedance in the uterine arteries of infertile women with Electro Acupuncture”, Human Reproduction, Vol 11, no6. pp. 1311-17, 1996.
  11. Yu W et al. “A Pilot Study Evaluating the Combination of Acupuncture with Sildenafil on Endometrial Thickness” Presented at the Pacific Coast Reproductive Society Annual Conference 2007.
  12. Velazquez EM, Mendoza S, Hamer T, Sosa F, Glueck CJ “Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy.”Metabolism. 1994 May; 43(5):647-54.
  13. Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, Steinkampf MP, Coutifaris C, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Giudice LC, Leppert PC, Myers ER; “Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome.” Cooperative Multicenter Reproductive Medicine Network. N Engl J Med. 2007 Feb 8;356(6):551-66.
  14. Zain MM, Jamaluddin R, Ibrahim A, Norman RJ. “Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction, achievement of pregnancy, and live birth in Asian women with polycystic ovary syndrome: a randomized controlled trial.” Fertil Steril. 2009 Feb;91(2):514-21.
  15. Ezzo J, Streitberger K, Schneider A.”Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting.” J Altern Complement Med. 2006 Jun;12(5):489-95.
    Cheong KB, Zhang JP, Huang Y, Zhang ZJ “The effectiveness of acupuncture in prevention and treatment of postoperative nausea and vomiting–a systematic review and meta-analysis.” 2013 Dec 13;8(12):e82474.

Acupuncture for PCOS – Increased Blood Flow to Ovaries!

Multiple studies had been done by Stener-Victorin showing an increase in ovarian blood flow (OBF) in both humans and animals as a result of acupuncture. Pulsatility Index (PI) was used as a measure of blood flow resistance in the uterine arteries and according to Chiang et al in 2000, the higher the PI, the lower the pregnancy rate.

In order to bring down the PI level, Stener-Victorin tested the efficacy of acupuncture and found that blood flow impedance was reduced after 4 consecutive weeks of twice-weekly acupuncture sessions. 10 infertile but otherwise healthy women with a PI of more than 3.0 achieved a PI of less than 0.0001 after the eighth electroacupuncture session.

When experimented on anaesthetized rats, low frequency electroacupuncture significantly lowered OBF. These OBF measurements were tracked using ultrasound doppler flow meter on the surface of the left ovary. In other words, it may be that acupuncture could increase pregnancy rate by increasing blood flow in the uterine arteries. The response appears to be mediated by the ovarian sympathetic nerves as a reflex response.

Acupuncture may help to modulate sympathetic outflow to the ovaries. Again in 2003, Stener-victorin’s study established that ovarian concentrations of vasoconstrictor ET-1 were significantly lower in the PCO group receiving acupuncture as opposed to the healthy control group. The results indicate that EA modulates the neuroendocrinological state of the ovaries, most likely by modulating the sympathetic nerve activity in the ovaries, which may be a factor in the maintenance of steroid-induced PCO.

Sources:

  1. E. Stener-Victorin, T. Lundeberg, S. Cajander et al., “Steroid-induced polycystic ovaries in rats: effect of electro-acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system,” Reproductive Biology and Endocrinology, vol. 1, article 33, 2003.
  2. Stener-Victorin, Waldenstrom, Andersson, Wikland, “Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture,” Hum Reprod. 1996 Jun;11(6):1314-7.
    Chiang CH, Hsieh TT, Chang MY, Shiau CS, Hou HC, Hsu JJ, et al, “Prediction of pregnancy rate of in vitro fertilization and embryo transfer in women aged 40 and over with basal uterine artery pulsatility index,” J Assist Reprod Genet 2000; 17:409-14.
  3. Stener-Victorin E, Kobayashi R, Kurosawa M, “Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats,” Auton Neurosci. 2003 Oct 31;108(1-2):50-6.
  4. Stener-Victorin E, Fujisawa S, Kurosawa M., “Ovarian blood flow responses to electroacupuncture stimulation depend on estrous cycle and on site and frequency of stimulation in anesthetized rats,” J Appl Physiol (1985). 2006 Jul;101(1):84-91.

Acupuncture for PCOS – Regulates Your Menstrual Cycle!

acupuncture for pcos regulate ovulation tcm for delayed menses ovulation dysfunction hpo axis hpa axis

Acupuncture Promotes Ovulation

In a longitudinal prospective study at Gothenburg University in Sweden, 24 women diagnosed with PCOS underwent repeated acupuncture treatments were able to bring about regular ovulation in more than a third of the group. However, acupuncture was only successful for those women with significantly lower BMI, Waist-Hip-Ratio, serum testosterone concentration, serum T/SHBG ratio, serum basal insulin concentration.

In subsequent random controlled trials (Stener-Victorin, 2011 & 2013), menstrual frequency was demonstrated to increase with regular acupuncture session, and its effect was more significant compared with thrice-weekly exercise.

Another small prospective trial published in the American Journal of Physiology, followed 32 women with PCOS for around 3 months. Acupuncture, say the researchers, has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with PCOS.

It is widely accepted that that acupuncture normalizes ovulatory function by regulating hormones (Chen, 1997). This was earlier demonstrated in a study where 6 out of 13 anovulatory cases responded to acupuncture treatment (Chen and Yu, 1991). There was also one pilot study of acupuncture as a substitute for hCG to induce ovulation (Cai, 1997). Of the 11 menstrual cycles, marked effect was shown in 5 cycles, significant effect in 5 cycles but no effect in 1 cycle.  Furthermore, in 9 of the 10 cycles treated with acupuncture for ovulation induction without using HCG and other drugs, the symptoms of OHSS were significantly reduced or even disappeared.

References:

  1. Chen BY, Yu J, “Relationship between blood radioimmunoreactive beta-endrophin and hand skin temperature during the electro-acupuncture induction of ovulation,” Acupunct Electrother Res,” 1991; 16(1-2):1-5.
  2. Chen BY, “Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis,” Institute of Acupuncture and Department of Neurobiology, Shanghai Medical University.
  3. Cai X, “Substitution of acupuncture for hCG in ovulation induction,” J Tradit Chin Med 1997; 17:119-21.
  4. Stener-Victorin et al, “Effects of electro-acupuncture on anovulation in women with PCOS,” Acta Obstet Gynecol Scand. 2000 Mar;79(3):180-8.
  5. Jedel et al, “Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amernorrhea in women with PCOS: a RCT,” Am J Physiol Endorinol Metab. 2011 Jan;300(1):E37-45.
  6. Johansson et al, “Acupuncture for ovulation induction in PCOS: a RCT,” Am J Physio Endocrinol Metab. 2013 May 1; 304(9): E934-E943.

Acupuncture Regulates the HPO axis

HPO axis dysfunction can lead to persistently high levels of LH and androgens, which are strongly associated with PCO.

According to Stener-Victorin (2008), acupuncture is able to modulate central beta-endorphin production and secretion, thereby influencing the release of hypothalamic GnRH and pituitary secretion of gonadotropin.

Both animal studies with sows (Lin, 1988) and rabbits (Yang, 1994) demonstrated how acupuncture normalizes GnRH secretion and affects peripheral gonadotropin levels. Because acupuncture treatment impacts the ß-endorphin levels, which in turn affect GnRH secretion and the menstrual cycle, it is logical to hypothesize that acupuncture may influence ovulation of women with PCOS.

Other investigations show that in both anovulatory and normo-ovulatory women, acupuncture was able to influence plasma levels of FSH, LH, E2 and P.

The results are coherent with the other studies that ovulation may be induced by electroacupuncture via a regulation on hypothalamic-pituitary function which means EA could influence some gene expression of brain, thereby, normalizing secretion of hormones such as GnRH, LH and E2.

In summary, acupuncture is excellent at regulating your HPO axis and improving fertility outcomes.

References:

  1. Lin JH, Liu SH, Chan WW, Wu LS, Pi WP, “Effects of electroacupuncture and GnRH treatments on hormone changes in anoestrous sows,” Am J Chin Med 1988; 16: 117-26.
  2. Yang SP, Yu J, He L, “Release of GnRH from the medio-basal hypothalamus induced by electroacupuncture in conscious female rabbits,” Acupunct Electrother Res 1994; 19: 19-27.
  3. Aso T, Motohashi T, Murata M, Nishimura T, Kakizaki K, “The influence of acupuncture stimulation on plasma levels of LH, FSH, P and E2 in normally ovulating women,” Am J Chin Med 1976;4:391-401.
  4. Yu J, Zheng HM, Ping SM, “Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation,” Chung Hsi I Chieh Ho Tsa Chih 1989;9:199-202.
  5. Mo X, Li D, Pu Y, Xi G, Le X, Fu Z, “Clinical studies on the mechanism of acupuncture stimulation of ovulation,” J Trad Chin Med 1993;13:115-9.
  6. Stener-Victorin et al, “Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence,” J Neuroendocrinol 2008 Mar;20(3):290-8.
  7. Chen. (1997) Acupuncture Normalizies Dysfunction of Hypothalamic-Pituitary-Ovarian Axis. Acupuncture & Electro-Therapeutics Research, Volume 22, Number 2, 97-108(12).

Acupuncture for PCOS – Reduces Flight or Flight!

Acupuncture Enhances Reproductive Function by Reducing Cortisol Levels!

acupuncture for pcos reduce stress reduce fight or flight reduce sympathetic nervous system

We already know that infertility causes stress. We also know that stress can have a major impact on the hypothalamic-pituitary-adrenal axis, which decreases the reproductive function.

Stress reduction may improve fertility (Domar et al, 1990) and can be achieved through a variety of means. Acupuncture works by inhibiting the sympathetic nervous system and increases the beta-endrophin levels, bringing down the blood cortisol concentrations (Harbach et al, 2007), a marker for stress. It can consequently be beneficial in improving reproductive function. Whilst acupuncture in reducing stress are often view as a placebo effect, many investigators had already done coherent studies to counteract its true efficacy.

It was deduced that sham electroacupuncture did not prevent elevations of adrenocorticotropic hormone and cortisol whereas true acupuncture was effective. The testing reveals that electroacupuncture at a single acupoint is likely to act through the central regulation of corticotropin-releasing hormone and not directly through cortisol nor ACTH  feedback. ACTH is produced in the pituitary gland in response to CRH, which is released by the hypothalamus.

Sources:

  1. Mahlstedt PP, Macduff S, Bernstein J, “Emotional factorsin in vitro fertilization and embryo transfer process,” J In Vitro Fert Embryo Transf 1987;4:232-5.
  2. Domar AD, Zuttermeister PC, Friedman R, “The psychological impact of infertility: a comparison with patients with other medical conditions,” J Psychosom Obstet Gynaecol 1993;14:45-52.
  3. Dong JT, “Research on the reduction of anxiety and depression with acupuncture,” Am J Acupunct 1993;21:327-30.
  4. Eugster A, Vingerhoets AJ, “Psychological aspects of in vitro fertilization: a review,” Soc Sci Med 1999; 48:575-89.
  5. Eshkevari, Ladan, Susan E. Mulroney, Rupert Egan, and Lixing Lao. “Effects of Acupuncture, RU-486 on the Hypothalamic-Pituitary-Adrenal Axis in Chronically Stressed Adult Male Rats.” Endocrinology (2015): EN-2015. School of Nursing and Health Studies (L.E.), Department of Pharmacology and Physiology (L.E., S.E.M., R.E.), Georgetown University Medical Center, Washington, DC 20007; and School of Chinese Medicine (L.L.), The University of Hong Kong, Pokfulam, Hong Kong.

Acupuncture Reduces Muscle Sympathetic Nerve Activity

According to Lansdown et al in 2012, PCOS patients have a generalized increase in sympathetic nerve activity. Experiments on rodent models have shown that ovarian sympathetic outflow may be increased, and this is accompanied by elevated intra-ovarian synthesis of nerve growth factor (NGF) which may be involved in initiation of ovarian pathology.

There exists a close relationship between NGF and the sympathetic nervous system as it relates to the steroid-induced PCO model. We know that excessive ovarian production of NGF facilitates development of cystic ovarian morphology in mice, and is a feature of PCOS in humans (Dissen et al, 2009).

Studies done by Stener-Victorin et al in 2000 and 2003 demonstrates how acupuncture lowers high ovarian concentration of NGF. These results support the theory that acupuncture inhibits hyperactivity in the sympathetic nervous system.

In a randomized controlled trial (Stener-Victorin, 2009), it was demonstrated that both acupuncture and exercise have a lowering effect on high sympathetic nerve activity in women with PCOS. High sympathetic nerve activity is highly correlated to metabolic and hormonal imbalance in women with PCOS. Acupuncture may work the same way physical exercise does in reducing muscle sympathetic nerve activity. Interestingly, a connection was also found earlier (Sverrisdottir, 2008) that high testosterone level associate closely with high sympathetic nerve activity.

References:

  1. Jedel et al, “Impact of electro-acupuncure and physical exercise on hyperandrogenism and oligo/amernorrhea in women with PCOS: a RCT,” Am J Physiol Endorinol Metab. 2011 Jan;300(1):E37-45.
  2. Sverrisdottir, Mogren, Kataoka, Janson, Stener-Victorin, “Is PCOS associated with high sympathetic nerve activity and size at birth?” Am J Physiol Endocrinol Metab 294: E576-E581, 2008.
  3. Stener-Victorin, T. Lundeberg, S. Cajander et al., “Steroid-induced polycystic ovaries in rats: effect of electro-acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system,” Reproductive Biology and Endocrinology, vol. 1, article 33, 2003.
  4. Stener-Victorin, T. Lundeberg, U. Waldenstrom et al., “Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries,” Biology of Reproduction, vol. 63, no. 5, pp. 1497–1503, 2000.
  5. GA. Dissen, C. Garcia-Rudaz, A. Paredes, C. Mayer, A. Mayerhofer, and S. R. Ojeda, “Excessive ovarian production of nerve growth factor facilitates development of cystic ovarian morphology in mice and is a feature of polycystic ovarian syndrome in humans.
  6. Andrew Lansdown; D. Aled Rees. The Sympathetic Nervous System in Polycystic Ovary Syndrome: A Novel Therapeutic Target? Clin Endocrinol. 2012;77(6):791-801.

Acupuncture for PCOS – If You Are Overweight

acupuncture for pcos acupuncture weight loss acupuncture lipid metabolism appetite diet insulin resistance

Acupuncture Regulates Lipid Metabolism in PCOS Women

Women suffering from PCOS have a higher disposition toward coronary arterial disease (CAD). The prevalence of Metabolic syndrome in PCOS women is as high as 40% with increased prevalence of hypertension, dyslipidemia and abnormal glucose metabolism, all before age 30 (El-Mazny et al, 2010). PCOS women aged 20-40 already demonstrate poor vascular function measured by brachial artery vascular flow (Dokras et al, 2006).

Several studies reported that acupuncture can resolve lipid metabolism in different pathogenic conditions. Women with obesity who under went acupuncture treatment showed a decrease in total cholesterol, LDL cholesterol and triglyceride serum levels.

One suggestion as to how that happens is the increase serum levels of beta-endorphin as a result of the treatment. Other studies suggested that acupuncture modulates cholesterol concentrations by promoting lipid metabolism and suppressing inflammation via modulating mRNA expression.

Ling Li et al (2012) concluded that acupuncture lowers both cholesterol and triglycerides. The laboratory research measured biochemical responses to electro acupuncture at acupoint ST40 (Fenglong) to map the mechanisms by which acupuncture reduces hyperlipidemia.

This study documents that electro acupuncture induces expression of nNOS and Mt1. The nNOS enzyme mediates nitric oxide signaling and plays an important role in cellular signaling, vascular tone, blood pressure, insulin secretion, airway tone, angiogenesis and peristalsis. Mt1 plays an important role in the protection against oxidative stress.

Based on these, the researchers conclude that electroacupuncture and its effect on nitric oxide signaling transduction can bring down levels of plasma total cholesterol, LDL cholesterol and proinflammatory macrophages in cases of hyperlipidemia.

Sources:

  1. Wang F, Tian DR, Han JS. Electroacupuncture in the treatment of obesity. Neurochem Res. 2008; 33: 2023 – 2027.
  2. Ang Y, Li M, Yan W, Li X, Kang J, Zhang Y. Electroacupuncture alters the expression of genes associated with lipid metabolism and immune reaction in liver of hypercholesterolemia mice. Biotechnol Lett 2007; 29: 1817 – 1824.
  3. Cabioglu MT, Ergene N. Electroacupuncture therapy for weight loss reduces serum total cholesterol, triglycerides, and LDL cholesterol levels in obese women. Am J Chin Med 2005; 33: 525–533.
  4. Modulated expression of genes associated with NO signal transduction contributes to the cholesterol-lowering effect of electro-acupuncture. Ling Li, Guang-Hong Tan and Yi-Zheng Zhang. Biotechnology letters. 2012, doi: 10.1007/s10529-012-0892-9.

Acupuncture Reduces Body Weight in PCOS Women

Women with PCOS are unable to produce normal insulin levels. Instead, their bodies over-produce insulin to maintain a normal blood sugar level. This frequently leads to increased androgen productions and weight gain.

Acupuncture can help to regulate fat metabolism with the outcome of significantly reducing body weight and weight-hip circumference. A study done in 2012 showed that chinese medicine and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar efficacy as the Western anti-obesity drugs but with fewer reported adverse effects.

In 2008, Wang et al published an article stating evidence from a rat experiment that low frequency electroacupuncture for 30 minutes produced a significant reduction of both food intake and the body weight. High frequency electroacupuncture is also able to reduce of plasma levels of total cholesterol and triglycerides. An open trial in 16 over-weighted persons showed that acupuncture 3 times a week for 4 weeks produced a steady and significant decrease of body weight.

Sources:

  1. A systematic review on use of Chinese medicine and acupuncture for treatment of obesity. Obes Rev. 2012 May;13(5):409-30. Sui Y, Zhao HL, Wong VC, Brown N, Li XL, Kwan AK, Hui HL, Ziea ET, Chan JC.
  2. Wang F, Tian DR, Han JS. Electroacupuncture in the treatment of obesity. Neurochem Res. 2008; 33: 2023 – 2027.

Acupuncture Treats Insulin Resistance in PCOS Women

Acupuncture has been reported to improve insulin sensitivity, possibly due to the enhanced responsiveness to insulin via excitation of somatic afferent fibres. Furthermore, in using electroacupuncture for acupoints on the tibialis muscle, Lin et al (2009) tests the hypothesis that electroacupuncture can improve insulin resistance by lowering plasma free fatty acids in SBRs male rats. Shapira et al (2000) demonstrated in diabetic Psammomys obesus that 3 applications of EA on the abdomen within 5 days of an intervention period resulted in a sustained improvement in insulin resistance for up to 3 weeks.

Because insulin resistance (IR) is strongly implicated in the pathogenesis of PCOS, patients will benefit from being treated as a whole, taking the endocrine and metabolic conditions into account. Acupuncture takes on a holistic view in both diagnosis and treatment.

Sources:

  1. Higashimura Y, Shimoju R, Maruyama H, Kurosawa M. Electro- acupuncture improves responsiveness to insulin via excitation of somatic afferent fibers in diabetic rats. Auton Neurosci. 2009; 150: 100 – 103.
  2. Electrical vs Manual Acupuncture Stimulation in a Rat Model of Polycystic Ovary Syndrome: Different Effects on Muscle and Fat Tissue Insulin Signaling.
  3. Julia Johansson, Louise Mannerås-Holm, Ruijin Shao, AnneLiese Olsson, Malin Lönn, Håkan Billig,and Elisabet Stener-Victorin.
  4. Lin RT, Tzeng CY, Lee YC et al. Acute effect of electroacupuncture at the Zusanli acupoints on decreasing insulin resistance as shown by lowering plasma free fatty acid levels in steroid-background male rats. BMC Complement Altern Med 2009; 9: 26.
  5. Manneras L, Jonsdottir IH, Holmang A, Lonn M, Stener-Victorin E. Low frequency electro-acupuncture and physical exercise improve metabolic disturbances and modulate gene expression in adipose tissue in rats with dihydrotestosterone-induced polycystic ovary syndrome. Endocrinology 2008; 149: 3559–3568.
  6. Shapira MY, Appelbaum EY, Hirshberg B, et al. A sustained, non– insulin related, hypoglycaemic effect of electroacupuncture in diabetic Psammomys obesus. Diabetologia 2000;43:809-13.

Acupuncture Reduces Leptin Resistance in PCOS Women

acupuncture for pcos overeating leptin resistance weight loss chinese medicine

PCOS is also associated with insulin resistance and hyperinsulinemia, which is linked to weight gain. Obesity is associated with increased levels of leptin and low leptin sensitivity. Cabioglu et al showed in 2006 that acupuncture and diet restriction increased peripheral beta-endorphin levels while reducing in serum leptin levels, consistent with a significant loss in weight. Clearly, acupuncture with diet restriction was more effective than the diet restriction alone.

You et al  (2005) discovered that high frequency electroacupuncture produced a significant decrease in plasma leptin in obese rats. Whereas Kim et al applied 100 Hz electroacupuncture to ad libitum-fed normal rats and reported a significant increase in plasma leptin levels. These results suggest that electroacupuncture does have an effect in reducing plasma leptin levels.

Sources:

  1. Cabioglu MT, Ergene N. Changes in serum leptin and beta endorphin levels with weight loss by electroacupuncture and diet restriction in obesity treatment. Am J Chin Med 2006; 34: 1–11.
  2. You JS, Hung CC. Effect of electroacupuncture on plasma of leptin and insulin in diet-induced obese rats. J Chin Med 2005; 16: 101–109.
  3. Kim SK, Lee G, Shin M et al. The association of serum leptin with the reduction of food intake and body weight during electroacupuncture in rats. Pharmacol Biochem Behav 2006; 83: 145 – 149.

If you find all this information useful, do read about reference to our clinic in Vogue Magazine.

All the above information does not only apply to PCOS, it also shows how acupuncture may help with anovulation, delayed ovulation, reproductive hormonal imbalance as well as unexplained infertility.

At our clinic, we treat patients coming in for Preconception, Pregnancy as well as Postpartum using Chinese Medicine as well as other treatment modalities.

Summary of Acupuncture for PCOS

PCOS is an endocrine and metabolic disorder affecting up to 10% of women of childbearing age. While pharmaceutical drugs and surgery are effective, they also carry with them obvious side effects and hence cannot be used over a long duration of time.

For example, hormonal medication may reduce hirsutism and acne, but has an adverse effect of glucose tolerance, coagulability and fertility (Lanham et al). Acupuncture has been chosen by women with PCOS as an alternative treatment for the management of PCOS.

Below are some of the research studies specific to the use of acupuncture in the treatment of PCOS. The results of some of these studies are also relevant to other gynecological conditions that relate to ovulatory dysfunction, e.g. oligomenorrhea (delayed ovulation), hypomenorrhea (scant menses), amenorrhea as well as ART techniques like IUI and IVF.

Studies on Animals:

The murine rat model is employed, using continuous release of DHT, continuous injections of DHEA or single injection of Estradiol Valerate (EV) to induce formation of polycystic ovaries as well as PCOS-like symptoms. Repetitive electro-acupuncture is then given and the effects are noted. From the research, it seems that acupuncture is successful at reversing most of these PCOS-like symptoms. Most agree it does so by down-regulating sympathetic output, which is associated with a reduction in abnormal levels of nerve growth factor (NGF), endothelin-1 (ET-1) and corticotrophin-releasing factor (CRF), as well as the enhancement of lowered levels of hypothalamic beta-endorphin concentration. It also seems from similar studies on murine models that repetitive use of acupuncture can lower increased leptin and cholesterol levels while modulating insulin resistance.

  • Johannson et al, 2010 (http://onlinelibrary.wiley.com/doi/10.1113/expphysiol.2011.063131/pdf): Use of electro-acupuncture normalized insulin sensitivity, lowered cholesterol levels, and increased expression of GLUT4 in skeletal muscle when compared to control.
  • Feng et al, 2009 (http://onlinelibrary.wiley.com/doi/10.1113/expphysiol.2011.063131/pdf): GnRH and androgen receptor expression levels were reduced with electro-acupuncture.
  • Manneras et al, 2009 (http://www.ncbi.nlm.nih.gov/pubmed/19158405): Electro-acupuncture and exercises seemed to modulate sympathetic outflow to adipose tissue and ovaries, resulting in higher proportions of healthy antral follicles and a thinner theca interna.
  • Manneras et al, 2008 (http://www.ncbi.nlm.nih.gov/pubmed/18388196): Electro-acupuncture and exercise improved insulin sensitivity. Electro-acupuncture restored leptin and coupling protein 2 levels, while exercise restored leptin and IL-6 levels.
  • Manni et al, 2005 (http://www.ncbi.nlm.nih.gov/pubmed/15941472): EV-induced changes were normalized using electro-acupuncture. It is probable that acupuncture normalizes the sympathetic response that increases ovarian NGF.
  • Bai et al, 2004 (http://www.ncbi.nlm.nih.gov/pubmed/14671415): Electro-acupuncture partially reversed NGF abundance in ovaries.
  • Stener-Victorin et al, 2004 (http://www.ncbi.nlm.nih.gov/pubmed/14561641): EV-induced reduction in beta-endorphin concentrations in the hypothalamus were reversed with electro-acupuncture.
  • Stener-Victorin at al, 2003 (http://www.ncbi.nlm.nih.gov/pubmed/14614964): Electro-acupuncture increases ovarian blood flow as a reflex response via the ovarian sympathetic nerves.
  • Stener-Victorin et al, 2003 (http://www.ncbi.nlm.nih.gov/pubmed/12725645): Electro-acupuncture significantly reduces ovarian concentrations of endothelin-1, a potent vasoconstrictor involved in ovarian functions.
  • Stener-Victorin et al, 2001 (http://www.ncbi.nlm.nih.gov/pubmed/12030806): Electro-acupuncture may improve PCOS symptoms by decreasing concentrations of corticotropin-releasing factor in the ovaries.
  • Stener-Victorin et al, 2000 (http://www.ncbi.nlm.nih.gov/pubmed/11058557): Acupuncture significantly decreased NGF concentrations in the ovaries.

Studies involving Women with PCOS:

  • Lai et al, 2010 (http://www.cnki.net/kcms/detail/detail.aspx?dbcode=cjfq&dbname=cjfqtotal&filename=XCYJ201004015&uid=&p=): Both the acupuncture-only group (daily acupuncture) and the control group (metformin usage) showed improvement in PCOS symptoms after 6 months of use. Daily acupuncture also significantly normalized menstrual frequency, free testosterone levels and BMI levels.
  • Jedel et al, 2011 (http://www.ncbi.nlm.nih.gov/pubmed/20943753): Electro-acupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effective than no intervention.
  • Stener-Victorin et al, 2009 (http://www.ncbi.nlm.nih.gov/pubmed/19494176): Electro-acupuncture and physical exercise lowers high sympathetic nerve activity in women with PCOS.
  • Chen et al, 2007: Both the acupuncture group and clomid/hCG group showed blood hormone profile and ultrasound examination status after 3 cycles of treatment, but normal menstruation and ovulation was maintained in the acupuncture group.
  • Stener-Victorin et al, 2000 (http://www.ncbi.nlm.nih.gov/pubmed/10716298): This “before-after” study showed that 38% of sample group experienced good effect and more ovulations after acupuncture as opposed to before treatment.

Reviews:

  • Stener-Victorin et al, 2013 (http://www.ncbi.nlm.nih.gov/pubmed/23416841): For each aspect of PCOS, it is important to pursue new treatment strategies that have fewer negative side effects than drug treatments, as women with PCOS often require prolonged treatment. Increased sympathetic activity contributes to the development and maintenance of PCOS, and the effects of acupuncture are partly mediated by modulation of sympathetic outflow.
  • Lansdown et al, 2012 (http://www.ncbi.nlm.nih.gov/pubmed/22882204): Patients with PCOS have evidence of increased muscle sympathetic nerve activity (MSNA), altered heart rate variability and attenuated heart rate recovery post-exercise, compared with age- and BMI-matched controls, suggesting a generalized increase in sympathetic nerve activity. Active weight loss can reduce MSNA and whole body noradrenaline spillover, whereas low-frequency electroacupuncture decreased MSNA in overweight women with PCOS.
  • Raja-Khan et al, 2011 (http://www.ncbi.nlm.nih.gov/pubmed/21487075): Acupuncture reduces hyperandrogenism and improves menstrual frequency in PCOS. Acupuncture’s clinical effects are mediated via activation of somatic afferent nerves innervating the skin and muscle, which, via modulation of the activity in the somatic and autonomic nervous system, may modulate endocrine and metabolic functions in PCOS.
  • Lim et al, 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20230329): Acupuncture therapy may have a role in PCOS by: increasing of blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia.
  • Stener-Victorin et al, 2008 (http://www.ncbi.nlm.nih.gov/pubmed/18047551): Acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exerts long-lasting beneficial effects on metabolic and endocrine systems and ovulation.

In Conclusion:

Especially in this new millennium, we are starting to see more research coming out on the beneficial effects of an ancient form of treatment. Acupuncture helps by “regulating the terrain” of the body. By doing so, it enhances general health but also can be used to treat medical condition e.g. to complement and enhance artificial reproductive technologies. Acupuncture as treatment for amenorrhea (originally termed “obstructed menses”) has been documented in the classic texts, but only today are we finding out that these small needles affect not just the endocrine system, but also the circulatory, nervous and metabolic systems in helping ladies regain proper ovulatory function.