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PCOS, Yoga and Naturopathy: A review

By Lawrence Tredrea Naturopath & Nutritionist

Firstly, what is PCOS?

Polycystic ovary syndrome (PCOS) clinically presents as a multi hormone/endocrine disorder effecting approximately 2%-26% of women, depending on age and ethnicity. PCOS presents with a mix of symptoms such as ovarian cysts, insulin resistance, type 2 diabetes mellitus, and dyslipidaemia. Other symptoms may include infertility, enlarged ovaries, menstrual irregularity, menstrual pain, reproductive hormone imbalances, excess facial and body hair, acne and obesity.

Here is a little review of the research that supports the use of yoga and naturopathic medicine/intervention for PCOS and its presenting symptoms. Because I like to provide evidence based treatments, I’m wanting to show that there is research out there to support complementary medicine for certain conditions. It might be a bit bland, but I get nerdy/excited about this kind of info.

Study 1- Effect of a Yoga Program on Glucose Metabolism and Blood Lipid Levels in Adolescent Girls with Polycystic Ovary Syndrome.

This study was conducted to assess the efficacy of yoga therapy on glucose metabolism and blood lipid levels in 90 adolescent girls with diagnosed PCOS aged between 15-18 years old. In the yoga group, they practiced suryanamaskara, asanas, pranayama, and meditation 1 hour per day each day for 12 weeks, while the other control group practiced conventional physical exercises.

At the end of the study, yoga was found to be more effective than conventional physical exercises in improving glucose, lipids, insulin levels, in adolescent girls with PCOS independent of body compositional changes. The changes in body mass index, waist circumference, hip circumference, and waist-to-hip ratio, however, were not significantly different between the groups.

Study 2- Effect of Holistic Yoga Program on Anxiety Symptoms in Adolescent Girls with Polycystic Ovarian Syndrome: A Randomized Control Trial

As yoga has been shown to reduce symptoms of anxiety, this was assessed in adolescents with PCOS, which previously hadn’t been analysed. In this study, a holistic yoga program was compared against a conventional exercise program on anxiety levels in 90 adolescent girls with PCOS. They were randomised into their assigned groups and either practiced a holistic yoga module or a matching set of physical exercises for 1 hr per day, for 12 weeks.

Anxiety levels were assessed at the beginning of study and after 12 week intervention. wherein yoga group. Although the physical exercise group did see improvements, the yoga group was significantly better at reducing trait anxiety scores.

Study 3- Improvement in Biochemical and Psychopathologies in Women Having PCOS through Yoga Combined with Herbal Detoxification

In this study, 64 women with PCOS within the age range 18 to 40 years who visited an Ayurveda centre for PCOS treatment were included. Subjects were randomly assigned to two groups, either receiving Ayurvedic treatment only (AY), or Ayurvedic treatment with yoga (AY+Y). Women in AY group received cleansing therapy based on Ayurveda prescription which was followed by oral herbal medication intake for three months. Women in AY + Y group received the same Ayurvedic treatment plus 3 months of yoga intervention which was 1 hr per daily, 5 days a week. The assessment of the study was for endocrine variables, ovary mass and monitoring perceived stress scale, anxiety and depressive symptoms.

In the AY + Y Group a significant decrease was observed for 9 variables including prolactin, LH, testosterone, HbA1C, AMH, T4, TSH, right ovary mass. In the AY Group, significant reduction was found for only 3 variables including AMH, HbA1C, and T4. Anxiety, depression, & perceived stress was significant improved in in Y+A group.

Therefore this study showed that the addition of yoga supported Ayurvedic treatment, however unfortunately the Ayurvedic treatment provided is not specifically mentioned and was possibly different woman to woman. I’m also not sure if T4 levels ‘normalised’ or just decreased. Please note Ayurveda is different to naturopathy, but some of the herbs and philosophies do overlap.

Study 4- Yoga Effects on Anthropometric Indices and Polycystic Ovary Syndrome Symptoms in Women Undergoing Infertility Treatment: A Randomized Controlled Clinical Trial

The aim of this study was to investigate the effects of yoga exercises on anthropometric parameters (body composition) and clinical signs of PCOS among 61 women undergoing infertility treatment. The patients were randomly assigned into either the control group that received routine care only, or into the intervention group who received yoga exercises for 6 weeks. After the intervention, there was a significant reduction in hirsutism, abdominal circumference, and hip circumference scores in the intervention group compared to the control group.

Study 5- Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial

As lifestyle modification should be a first‐line intervention for PCOS, there can be barriers to success for self‐care, and women often seek adjunct therapies including herbal medicines. This Australian randomized controlled trial, compared the effectiveness and safety of a lifestyle intervention plus herbal medicine against lifestyle alone in 106 overweight women with PCOS for 3 months. All participants were helped to construct a personalized lifestyle plan. The herbal intervention consisted of two tablets. Tablet 1 contained Cinnamomum verum, Glycyrrhiza glabra, Hypericum perforatum and Paeonia lactiflora. Tablet 2 contained Tribulus terrestris. At 3 months, women in the combination group recorded a reduction in oligomenorrhoea compared with controls. Other significant improvements were found for body mass index, insulin, luteinizing hormone, blood pressure, quality of life, depression, anxiety, stress and pregnancy rates. This trial therefore provides evidence of improved effectiveness and safety for lifestyle intervention when combined with naturopathic herbal medicines in women with PCOS.

Study 6- Effect of Yoga Nidra on Resting Cardiovascular Parameters in Polycystic Ovarian Syndrome Women

Yoga nidra is a practice for physical, mental, and emotional relaxation. It has been used in patients of menstrual abnormalities, post-traumatic stress disorder, diabetes, anxiety, and depression but the aim and objective of this study was to assess 12 weeks of yoga nidra on resting cardiovascular parameters among 40 PCOS women. Yoga nidra intervention was given by yoga and naturopathy physician to the participants once daily for 40 min. Resting cardiovascular parameters such as systolic blood pressure, diastolic blood pressure, heart rate and body composition improvements were seen post intervention.

Study 7- Insulin Resistance Improvement by Cinnamon Powder in Polycystic Ovary Syndrome: A Randomized Double-Blind Placebo Controlled Clinical Trial

Cinnamon is a common herb used for blood sugar regulation and is one of the herbs many naturopaths consider for PCOS patients. 66 women diagnosed with PCOS were enrolled in this randomized double-blind placebo-controlled clinical trial. The participants were randomly allocated to 2 groups. The women in the first group were provided cinnamon powder capsules x3 500mg caps for 12 weeks and the second group received similar placebo capsules. Anthropometric measurements, fasting blood glucose, fasting insulin, blood glucose 2 hr after taking 75 g oral glucose, HbA1c, testosterone, DHEA-s, homeostatic model assessment for insulin resistance, triglycerides and cholesterol profile where test before and after the intervention. Fasting insulin, insulin resistance, and LDH were reduced after 12 weeks in the cinnamon group compared with the placebo. Changes in other outcome measurements did not lead to statistically significant difference with placebo. Therefore cinnamon in this study shows more benefits for insulin resistance than for hormonal change in women with PCOS. Interestingly, all these women were also on prescription progesterone. The study also does not reveal the species of cinnamon, as some are more medicinal it would be interesting to know which one they used for a proper comparison.

Study 8- Cinnamon Improves Metabolic Factors Without Detectable Effects on Adiponectin in Women with Polycystic Ovary Syndrome

The objectives of this double-blind randomized controlled clinical trial study was to investigate the effects of cinnamon in patients with PCOS. The study included 84 overweight or obese PCOS patients. Participants in the cinnamon group were given x3 500mg cinnamon capsules while the control group received a placebo. Fasting blood samples, anthropometric measurements and dietary intake data were collected at the baseline and at the end of the trial. It was found that cinnamon significantly decreased serum fasting blood glucose, insulin, homeostatic model assessment for insulin resistance, total cholesterol and low-density lipoprotein cholesterol and weight and increased HDL cholesterol compared with placebo. Serum triglyceride and body mass index significantly decreased in the cinnamon group, in comparison with baseline values. No significant changes were seen in serum adiponectin in either group. Adiponectin is a hormone that may play a role in protecting against insulin resistance and diabetes. I also cannot see which species of cinnamon was used in this trial, but the results are very promising!

Study 9- Preliminary Evidence that Cinnamon Improves Menstrual Cyclicity in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial

To determine the effect of cinnamon on menstrual cyclicity and metabolic dysfunction in women with polycystic ovary syndrome (PCOS).

Study Design

This prospective, placebo controlled, double-blinded randomized trial included 45 women with PCOS. They were randomized to receive either cinnamon supplements (1.5 g/d) or placebo for 6 months. Menstrual cyclicity (average cycles/month) and insulin resistance were compared between the 2 groups. Unfortunately in this study on 26 completed the first 3 months and only 17 finished the total 6 months. However, patients taking cinnamon, had improved menstrual cyclicity from baseline compared to women taking placebo. Measures of insulin resistance or serum androgen levels did not change for either group.

Study 10- Effects of Cinnamon Supplementation on Antioxidant Status and Serum Lipids in Women with Polycystic Ovary Syndrome

This double-blind randomized controlled clinical trial was conducted on 84 overweight or obese PCOS patients aged 20–38 years. Subjects either received x3 500mg cinnamon powder capsules daily or placebo for 8 weeks. Fasting blood samples, anthropometric measurements and dietary intake data were gathered at the beginning and at the end of the study. It was found that cinnamon significantly increased serum total antioxidant capacity with oxidative stress markers decreased. Cinnamon supplementation significantly improved serum levels of total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. No significant effect was detected on serum triglyceride level.

Study 11- Study to Evaluate the Changes in Polycystic Ovarian Morphology after Naturopathic and Yogic Interventions

The aim of the present study is to observe the morphological changes in polycystic ovaries in patients following 12 weeks of Yoga and Naturopathic (Y&N) intervention. The study was a single blinded prospective, pre-post clinical trial, including 50 PCOS patients aged between 18 and 35 years. The intervention group underwent Y&N therapy for 12 weeks. The naturopathic protocol involved hydrotherapy, mud therapy, manipulative therapy, fasting, and natural diet therapy. Yoga practice was given for 20 min for 6 days, every week throughout the study period, excluding days of menstruation. Change in polycystic ovarian morphology, anthropometric measurements and frequency of menstrual cycle were studied before and after the intervention and significant improvements were seen in those that received the Y&N interventions.

Study 12- Effect of Probiotics and Synbiotics on Selected Anthropometric and Biochemical Measures in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Eight randomised control trials were included in this review to examine the effects of probiotic supplementation on anthropometric and biochemical measurements in women with PCOS. The review came to the conclusion that probiotics significantly reduced fasting blood sugar, insulin, insulin resistance, C-reactive protein (inflammation) and total testosterone in women with PCOS. However, noticed differences in weight and BMI weren’t seen as significant. Therefore probiotics may be useful to improve glucose homeostasis, hormone profiles and inflammation in women with PCOS.

Study 13- Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome

Without going into too much detail, but to show some other approaches that may be effective, this review of research shows evidence to suggests that vitamin B12, inositol, folate, vitamins D, vitamin E, vitamin K, bioflavonoids, α-lipoic acid, calcium, zinc, selenium, chromium picolinate, melatonin, ω-3 fatty acids, probiotics, and cinnamon as well as some complementary approaches such as acupuncture and yoga may be beneficial in PCOS.

And there you have it!


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