Polycystic Ovarian Syndrome in lean patients

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder, related to irregular menstruation and increased androgenic hormones (El Hayek et al., 2016). According to the ‘International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018’ (Misso et al., 2018) its incidence is in 8-13% of women in reproductive age. Furthermore, this guideline describes psychological, reproductive and metabolic features for PCOS.

The prevalence of obese women with PCOS is up to 88% (Barber et al., 2006), depending on the setting of the research. However, one large Chinese study with more than 15000 women of reproductive age suggested the incidence of PCOS is 5,6 % in Han Chinese women with almost two – third non-obese patients (Li et al., 2013). This lecture on PCOS will focus on non-obese patients.

The different phenotypes of PCOS provide a variety of symptoms, which leads to heterogeneity in published RCTs and SRs. The combination of acupuncture and herbal medicine has positive effects in PCOS-patients (Yu et al., 2013). For instance, a Chinese RCT with combination of acupuncture, herbal medicine and CC showed increasing pregnancy rates (Jiang et al., 2015).

From the point of Traditional Chinese Medicine (TCM) the in PCOS presented different phenotypes are matching perfect with the so-called syndrome-diagnostic. Especially lean patients are suffering from anovulation, are stressed and tensed- a lot of times symptoms of liver-qi-stagnation. While for women with obesity or overweight changes in lifestyle and nutrition as well as losing weight are very important, for lean patients support with TCM seems to be even more important. Due to the fact that also lean PCOS patients are presenting a higher body fat distribution (Barber et al., 2006, Battaglia et al., 2011), TCM-practitioner should also be aware of a hidden spleen-qi-deficiency.

The aim of this speech is, to give an overview on diagnostic criteria of PCOS and distinctions in obese and lean patients. Furthermore, diagnosis and treatment options of the whole system TCM will be presented.

References:

Barber, T.M., McCarthy, M.I., Wass, J.A.H. and Franks, S., 2006. Obesity and polycystic ovary syndrome. Clinical Endocrinology, [online] 65(2), pp.137–145. Available at: <http://doi.wiley.com/10.1111/j.1365-2265.2006.02587.x> [Accessed 31 Jul. 2019].

Battaglia, C., Battaglia, B., Mancini, F., Paradisi, R., Fabbri, R. and Venturoli, S., 2011. Ultrasonographic extended-view technique for evaluation of abdominal fat distribution in lean women with polycystic ovary syndrome. Acta Obstetricia et Gynecologica Scandinavica, [online] 90(6), pp.600–608. Available at: <http://doi.wiley.com/10.1111/j.1600-0412.2011.01124.x> [Accessed 14 Jul. 2019].

Conway, G.S., Agrawal, R., Betteridge, D.J. and Jacobs, H.S., 1992. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clinical Endocrinology, [online] 37(2), pp.119–125. Available at: <http://doi.wiley.com/10.1111/j.1365-2265.1992.tb02295.x> [Accessed 31 Jul. 2019].

El Hayek, S., Bitar, L., Hamdar, L.H., Mirza, F.G. and Daoud, G., 2016. Poly Cystic Ovarian Syndrome: An Updated Overview. Frontiers in physiology, [online] 7, p.124. Available at: <http://www.ncbi.nlm.nih.gov/pubmed/27092084> [Accessed 26 Dec. 2018].

Jiang, D.S., Zhang, Y.C., Wu, X.Q. and Wu, S., 2015. Clinical study on infertility due to polycystic ovary syndrome of Kidney Deficiency and Blood Stasis Type treated with integrated Chinese and western medicine. Liaoning journal of traditional chinese medicine [liao ning zhong yi za zhi], [online] 42(4 CC-Complementary Medicine), pp.803–805. Available at: <https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01436490/full>.

Li, R., Zhang, Q., Yang, D., Li, S., Lu, S., Wu, X., Wei, Z., Song, X., Wang, X., Fu, S., Lin, J., Zhu, Y., Jiang, Y., Feng, H.L. and Qiao, J., 2013. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Human Reproduction, [online] 28(9), pp.2562–2569. Available at: <https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/det262> [Accessed 31 Jul. 2019].

Misso, M., Costello, M., Dokras, A., Laven, J., Moran, L., Piltonen, T. and Norman, R., 2018. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. [online] National Health and Medical Research Council (NHMRC) on, Available at: <https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf> [Accessed 4 Jan. 2019].

Yu, L., Liao, Y., Wu, H., Zhao, J., Wu, L., Shi, Y. and Fang, J., 2013. Effects of electroacupuncture and Chinese kidney-nourishing medicine on polycystic ovary syndrome in obese patients. Journal of traditional chinese medicine = chung i tsa chih ying wen pan, [online] 33(3 CC-Gynaecology and Fertility CC-Complementary Medicine), pp.287–293. Available at: <https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00876025/full>.