ArticlePDF Available

A Review on Phytomedicine and Their Mechanism of Action on PCOS

Authors:

Abstract

Polycystic ovary syndrome (PCOS) is characterized by gynaecological endocrine and metabolic abnormality of women at reproductive ages. It is established that hyperandrogenism, insulin resistance, menstrual abnormalities, and chronic absence of ovulation of polycystic ovary are commonly associated with symptoms. It might indicate the multidisciplinary approach for the therapeutic management of PCOS. Conventional medical management concentrated single symptom, is often associated with the side effect, maybe contraindicated and ineffective in some conditions. So far women with PCOS have expressed a desire for alternative medicine. Ayurvedic medicine has been emerging as one of the commonly practised medicines for different health problems, including PCOS. In this review, an attempt has been made to study the use and mode of action of potential Ayurvedic drugs for the treatment of PCOS. This review is mainly based on the scientific literature search. The first search on plant possesses multiple effects against PCOS reproductive and metabolic complications. Selected plants from the first search were used as a keyword for the second search. They include Cinnamomum zeylanium, Gymnema sylvestre, Mentha spicata, Pergularia daemia, Saraka indica, Saw palmetto, Tribulus terrestis, and Withania somnifera. The second search sought the reproductive endocrinal and metabolic demonstrated mechanism of the selected plants.This review supports the alternative Ayurvedic medication as a standard effective and safe drug in the management of PCOS.
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020 81
Corresponding Author:
Dr. R. Kothai, M.Pharm., Ph.D., Department of Pharmacology, Vinayaka Mission’s College of Pharmacy, Vinayaka Mission’s Research
Foundation (Deemed to be University), Salem-636008, Tamil Nadu, India; Phone: +91 9600966775; Email: kothaiarul@yahoo.co.in
ISSN: 2231-2196 (Print) ISSN: 0975-5241 (Online)
Received: 10.08.2020 Revised: 25.09.2020 Accepted: 22.10.2020 Published: 07.12.2020
Research Article
International Journal of Current Research and Review
DOI: http://dx.doi.org/10.31782/IJCRR.2020.122322
INTRODUCTION
Polycystic ovary syndrome (PCOS) is a complex endocrinal
reproductive disorder in a coalition with metabolic abnor-
malities of women at reproductive stages. PCOS character-
ized by hypergonadotropism, hirsutism, irregular and painful
menstrual cycles, amenorrhea, multiple cysts in ovaries, ano-
vulation which is commonly associated with infertility.1 It is
also character ized by multiple metabolic abnormalities, such
as insulin resistance, hyperinsulinemia, high incidence of
impaired glucose tolerance, obesity, inflammation, endothe-
lial dysfunction, hypertension, and dys lipidemia resulting in
an increased risk for dia betes and cardiovascular disease.2-4
Besides, compromised quality of life, anxiety, and depres-
sion is also observed in PCOS.5
Existing treatment approaches to PCOS are limited due to
the prevalence of contraindication in PCOS women, treat-
ment failure in some circumstances, and may cause some
severe side effects. This challenging drawback of current
therapy for PCOS in women making an interest in an alterna-
tive treatment called Ayurvedic treatment. It is a natural way
to treat the diseased condition without causing any serious
side effects.6-7 The usage and acceptability of complemen-
tary medicine by women has increased from 26% to 91%
during the past ten years.8 9. Recent day global health de-
bates getting significant attention towards traditional herbal
medicines. However herbal medicines are fighting to be rec-
ognized as a standard medication with its own identity. It
is become necessary to show that herbal therapy can match
.
ABSTRACT
Introduction: Polycystic ovary syndrome (PCOS) is characterized by gynaecological endocrine and metabolic abnormality of
women at reproductive ages. It is established that hyperandrogenism, insulin resistance, menstrual abnormalities, and chronic
absence of ovulation of polycystic ovary are commonly associated with symptoms. It might indicate the multidisciplinary ap-
proach for the therapeutic management of PCOS. Conventional medical management concentrated single symptom, is often
associated with the side effect, maybe contraindicated and ineffective in some conditions. So far women with PCOS have ex-
pressed a desire for alternative medicine. Ayurvedic medicine has been emerging as one of the commonly practised medicines
for different health problems, including PCOS.
Objective: In this review, an attempt has been made to study the use and mode of action of potential Ayurvedic drugs for the
treatment of PCOS.
Method: This review is mainly based on the scientific literature search. The first search on plant possesses multiple effects
against PCOS reproductive and metabolic complications. Selected plants from the first search were used as a keyword for the
second search.
Result: They include Cinnamomum zeylanium, Gymnema sylvestre, Mentha spicata, Pergularia daemia, Saraka indica, Saw
palmetto, Tribulus terrestis, and Withania somnifera. The second search sought the reproductive endocrinal and metabolic dem-
onstrated mechanism of the selected plants.
Conclusion: This review supports the alternative Ayurvedic medication as a standard effective and safe drug in the manage-
ment of PCOS.
Key Words: Medicinal Plants, PCOS, Anti-androgenic, Insulin resistance, Menstrual irregularity, Mechanism of action
A Review on Phytomedicine and Their Mechanism
of Action on PCOS
Sudhakar Pachiappan, Kothai Ramalingam, Arul Balasubramanian
-

IJCRR
Section: Healthcare
Sci. Journal Impact
Factor: 6.1 (2018)
ICV: 90.90 (2018)
Copyright@IJCRR
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
82
other fields of medicine in the thoroughness of its pharma-
cology and standardization of its practical use. Hence the fo-
cus of this study was to investigate plants possess multiple
pharmacological actions in relevance to PCOS complication
and to review its mechanism of action in PCOS condition, to
improve its therapeutic wide acceptability and exploration
of some standard herbal/ polyherbal formulations in PCOS.
MATERIALSD AND METHODS
In this study, we carried out two searches of the scientific
literature. The first search on plants reported with multiple
reproductive endocrine effects in hyperandrogenism, men-
strual irregularity, and multiple cysts in ovaries, and also on
metabolic effects in insulin resistance and hyperlipidemia.
In the second search sought the reproductive endocrinal and
metabolic demonstrated mechanism of the effect of the se-
lected plants.
From the first search, we selected eight plants with multiple
pharmacological effects on PCOS. These were Cinnamomum
zeylanium, Gymnema Sylvestre, Mentha spicata, Pergularia
daemia, Saraka indica, Saw palmetto, Tribulus terrestis, and
Withania somnifera. The selected plants with a demonstrated
mechanism of action were entered as key terms in the second
search.
We searched from the following electronic databases: MED-
LINE, EMBASE, PubMed, Google Scholar, Research gate
and Science direct from the date of database inception to Oc-
tober 2019. Also, a search was made manually on the refer-
ences of reviewed articles. First search key terms are title
or abstract included ‘herbal medicine’ or ‘herbal extract’ or‘
phytotherapy’ or ‘phytomedicine’ and title or abstract con-
tains ‘androgen’ or ‘Estrogen’ or ‘follicle stimulating hor-
mone’ or ‘luteinizing hormone’ or ‘prolactin’ or ‘insulin’ or
‘glucose’ or ‘polycystic ‘ovary’ or ‘PCOS’. Search terms
for the second search included the following keywords in
the title or abstract, contains; ‘Mechanism’ ‘menstrual ir-
regularity’ or ‘oligomenorrhoea’ or ‘amenorrhoea’ or ‘hy-
perandrogenism’ or ‘hirsutism’ or ‘acne’, or ‘polycystic
ovary syndrome’ or ‘PCOS’ and ‘Cinnamomum zeylanium
or ‘Gymnema sylvestre or ‘Mentha spicata or ‘Pergularia
daemia’ or ‘Saraka indica’ or ‘Saw palmetto or ‘Tribulus
Terrestris or ‘Withania somnifera’.
Medicinal plants and their mechanism of ac-
tion on PCOS
A. Cinnamomum zeylanicum
Cinnamomum zeylanicum found to be an effective therapeu-
tic agent for PCOS because it has been shown to improve
both the reproductive and metabolic aspects of PCOS. An-
tiandrogenic mechanism: Oral administrations of cinnamon
extract (10mg/100g) downregulate testosterone in dehydroe-
piandrosterone induced PCOS mice. Insulin resistance in
PCOS women with compensatory hyperinsulinemia induces
overproduction of androgen in the ovary. This action is me-
diated through the activation of insulin-like growth factor-1
(IGF-1) receptors on theca and stroma cells. In granulosa
cells, IGF-1 stimulates estrogen production and regulates
aromatase concentration. IGF-1 also acts synergistically
with Luteinizing hormone (LH) to stimulate androgen pro-
duction on theca cells. Increased serum level of insulin and
IGF-1amplifies the effect of LH on granulosa cell leads to
anovulation and affect follicular maturation. Hence the pro-
posed anti- androgenic mechanism of cinnamon is medi-
ated by the downregulation of insulin, insulin-like growth
factor-1 (IGF-1), and testosterone serum levels. This down-
regulation of IGF-1 is associated with an increased level of
insulin-like growth factor-binding protein -1 (IGFBP-1) in
plasma and ovary.10-12
Effect on insulin resistance: Oral administration of the cin-
namon extract (one capsule containing 333 mg, three times
per day for 8 weeks) would improve insulin sensitivity in
PCOS women. The insulin resistance reduction mechanism
mediated through an increase in glucose utilization and po-
tentiating phosphatidylinositol 3-kinase (PI-3 kinase) insulin
signalling pathway at the post-receptor level. It leads to the
translocation of glucose transporter type-4 (GLUT-4) recep-
tor culminate and improved glucose utilization by aiding
intercellular glucose transport and increasing glycogen syn-
thesis.13-14
Effect on Menstrual irregularity: A clinical study suggests
that cinnamon supplementation (1500 mg/day for 6 months)
may be a useful adjunct for menstrual dysfunction in women
with PCOS. The suspected mechanism is it regulates men-
strual irregularity by improving insulin sensitivity.15 Effect
on obesity: Oral supplementation of cinnamon (1500 mg/
day for 8 weeks) significantly decreased serum levels of to-
tal cholesterol (TC) and low-density lipoprotein cholesterol
(LDL-C) and increased high-density lipoprotein cholesterol
(HDL-C) levels in women with PCOS 16. The hypolipidemic
effect of cinnamon might be due to its polyphenol and cin-
namaldehyde content, which inhibits intestinal cholesterol
absorption and increases lipolysis in adipose tissues respec-
tively.17,18 Anti-hyperlipidemic mechanism of cinnamon me-
diated through the up-regulation of peroxisome proliferator-
activated receptor alpha (PPAR α) expression increased
cellular uptake of fatty acid and the expression of lipoprotein
lipase gene.19
B. Gymnema sylvestre
Gymnema sylvestre is the most widely used ayurvedic medi-
cine for diabetes mellitus and the lowering of serum choles-
terol.20 It also effective in reducing the elevated androgen and
regulate the menstrual irregularity in PCOS. Antiandrogenic
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
83
mechanism: The ethanolic leaf extract of Gymnema sylvestre
decreases the elevated androgen level in estradiol valerate
induced PCOS rats. Till there is no possible anti-androgenic
mechanisms were explored.21 Effect on insulin resistance:
The leaf extract of Gymnema sylvestre (400mg/kg) was re-
ported to reduce hyperglycemia in both insulin-dependent
and non-insulin-dependent diabetic patients.22 Gymnema
sylvestre posse multiple antihyperglycemic mechanisms like
increases in insulin secretion and glucose utilization through
the insulin-dependent pathway by increased the activity of
phosphorylase and decrease in gluconeogenic enzymes and
sorbitol dehydrogenase. It also promotes the regeneration of
islet cells. Gymnemic acid in Gymnema sylvestre prevents
excess glucose absorption in the intestine by binds with glu-
cose receptor.23,24
Effect on Menstrual irregularity: A preclinical study dem-
onstrated that ethanolic leaves extract of Gymnema sylves-
tre 400mg/kg/ day regularizes the menstrual irregularity in
estradiol valerate induced PCOS rats. But the study fails to
explain the mechanistic approach.25
Effect on obesity: The different solvents leave extract of G.
Sylvestre reported to possess significant hypolipidemic ac-
tivities in experimentally induced obesity models. Hexane
extract at 250 mg/kg/day for 28 days 26, hydroalcoholic ex-
tract at 200 mg/kg/ day for 7 days27 and methanolic extract
1gm/kg/day for 4 weeks significantly decreased the body
weight gain and lowered serum total cholesterol, triglycer-
ides (TG), very low-density lipoprotein cholesterol (VLDL),
LDL, leptin and increases HDL levels.28
C. Mentha spicata
Mentha spicata indicated for PCOS women. Because of
M. spicata effective in both the reproductive and metabolic
complications of PCOS.
Antiandrogenic effect: Mentha spicata essential oil (spear-
mint oil) 300mg/kg treatment daily for 20 days effectively
reduced the body weight, serum testosterone level, number
of atretic follicles, ovarian cyst and also increased the Graaf-
ian follicle in letrozole induced PCOS rats.29 Clinical studies
also demonstrated that spearmint tea (a cup of M. Spicata
5gm/250ml) taking twice a day for 30 days decreased the free
and total testosterone and increase LH and FSH. It might be
concluded that M. spicata acts as an effective antiandrogenic
agent in female patients with PCOS by decreasing free and
total androgens and reduces the number of ovarian cysts.30,31
Hypoglycemic & Hypolipidemic effect: M. spicata aqueous
leaf extract (300 mg/kg for 21 days) has efficient hypogly-
cemic, hypolipidemic, and lipid peroxidation activities in al-
loxan-induced diabetic rats.32 Similarly, 14-day treatment of
aqueous ethanolic fresh leaf extracts of M. spicata 400 mg/
kg showed an efficient anti-diabetic and moderate hypolipi-
demic effect in alloxan-induced diabetic rats. Those study
results suggested that the anti-diabetic effect of M. spicata is
mainly due to its secondary metabolites. Flavonoids, phenol,
glucoside terpenoids, and steroids in M. spicata reduce the
serum glucose level by stimulating the beta cells for insulin
production and utilization. Carbohydrate increases glucose
tolerance and release, alkaloids reduces intestinal glucose
transport by inhibiting the alpha- glycosidase.33 Hence M.
spicata acts as anti-diabetic medication by stimulating insu-
lin production, and increase the release and utilization, also
acts by reduces the intestinal glucose absorption.
D. Pergularia daemia
The fresh leaf extract of the Pergularia daemia is an effective
medicine in normalizing the hormonal levels of the PCOS
induced rats. It acts by normalizing the elevated Testoster-
one and Luteinizing hormone level and decreases Proges-
terone and Follicle-stimulating hormone (FSH) in induced
PCOS.34 P. daemia has the potential to normalize menstrual
irregularities and regularize the estrous cycle. Subsequently,
the restoration of the estrous cycle reduces the development
of follicular cyst.35 Besides, P. daemia also possess effective
hypoglycemic and hypolipidemic properties in PCOS in-
duced conditions.36,37 The mechanisms of action of P. daemia
are not clear at this time; more work is required on a molecu-
lar level to delineate the process on PCOS.
E. Saraka indica
Saraka indicia dried barks and flowers are one of the most
widely using Unani and Ayurvedic medications for several
female disorders principally in gynaecological disorders and
menorrhagia. S.indica bark has an excellent uterine and en-
dometrial tissue stimulant effect. It is also useful in treat-
ing female disorders like painful periods, internal bleeding,
haemorrhoids, menometrorrhagia, amenorrhea, menorrhagia
particularly due to uterine fibroids, leucorrhoea and pim-
ples.38,39
S. indica methanolic extract (200 mg/kg) in female rats re-
ported to possessing anti-estrogenic properties because of its
phytoestrogens constituents. Hence it is effective in PCOS
hormonal and reproductive complications by block the over-
expression of estrogen in PCOS women.40 Phenolic glyco-
side P2 isolate from S. indica also reported producing oxyto-
cic activity in both animal and human myometrial tubes.41 S.
indica leaves, flowers, and bark extract reported to possess
hypoglycemic and hypolipidemic activity in induced diabet-
ic conditions. Lack of molecular level findings to explore its
exact mechanisms.42-44
F. Saw palmetto (Serenoa repens)
Saw palmetto indicated for PCOS, hormone imbalances (es-
trogen/testosterone), and benign prostatic hyperplasia. It also
used to improve the genitourinary health in both sexes; this
means it promotes the sexual vigour and chronic nonbacterial
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
84
prostatitis and pelvic pain syndrome.45,46 The saw palmetto
berries containing fatty acids liposterols indicated to produce
significant anti-androgenic action in PCOS condition. It pro-
duces anti-androgenic action by inhibiting the 5-α reductase
enzyme responsible for the conversion of testosterone into its
active form dihydrotestosterone (DHT) in the adrenal gland.
It also reduces the 40% tissue uptake of androgens including
DHT and testosterone.47,48 These mechanisms illustrated that
Saw palmetto may aid in PCOS hyperandrogenism by reduc-
ing the 5-α reductase activity inhibits DHT production and
increases DHT breakdown.
Animal studies showed that Saw palmetto regularizes the el-
evated prolactin-induced suppression of follicle maturation,
ovulation, and formation of cysts in the PCOS ovary. Saw
palmetto suppresses the elevated prolactin-induced ovarian
changes by inhibiting the ovarian prolactin receptor by re-
ducing the K+ channels and protein kinase C basal activity
involved in the prolactin transduction signals.46 Additionally,
the anti-inflammatory properties of Saw palmetto extract
can also be helpful to combat bloating, pelvic pain, and low-
grade systemic inflammation in women with PCOS.49
G. Tribulus terrestis
The aerial parts and fruits of Tribulus terrestris indicated in
PCOS to promote regular ovulation and reduce the ovarian
cyst.50 The hydroalcoholic extract of T. terrestris 10 mg treat-
ment normalizes the menstrual irregularity, hormonal altera-
tions, and efficiently removes the ovarian cysts and resumes
the ovarian normal activity in the estradiol valerate induced
PCOS rats. It might be due to its luteinizing effect related
to it gonadotropin like activity or luteinization of follicular
cysts.51,52 The proposed mechanism of T. terrestris on nor-
malizing the hormonal level and induction of ovulation in
PCOS is mainly due to its antiestrogenic action. The phy-
toestrogens (diosgenin, gitogenin, chlorogenin, ruscogenin,
and essential oil) present in T. terrestris binds with estrogen
receptor ERα and ERβ, and act as a pure estrogen antagonist
by stimulating the Gonadotropin-releasing hormone secre-
tion.53 A randomized control study reported that 1000 mg/
day treatment of hydroalcoholic T. terrestris extract showed
promising hypoglycemic effect and significantly reduced
the total cholesterol and low-density lipoprotein in women
with diabetes mellitus type 2. These results further add up its
therapeutic efficacy in PCOS.54
H. Withania somnifera
Stress is one of the major factors that affect female repro-
ductive health by modulating ovarian physiology and repro-
ductive hormones. This may lead to menstrual irregularity,
amenorrhea, and anovulation.55,56 Many of preclinical and
clinical studies proved the potent anti-stress property of
Withania somnifera. It also poses a positive influence on the
endocrine system.57 Withania somnifera root indicated to sup-
port all endocrine functions in PCOS women. The proposed
mechanism links the antioxidant features and its positive ef-
fect on hormonal imbalances of testosterone, LH, and FSH.
However, the gamma-aminobutyric acid (GABA) mimetic
feature of Withania somnifera extract plays a major role in
the inducing gonadotropin-releasing hormone secretion and
improving hormonal balance.58 W. somnifera root hydroalco-
holic extract treatment increases the number of days in the
estrus phase and decreases the duration of the diestrus phase.
Also, it increases the FSH and decreases LH, testosterone,
and estradiol in letrozole induced PCOS rats.53 Supporting
finding such as hypoglycemic potency by increased insulin
secretion and improved insulin sensitivity in muscles and hy-
polipidemic effect mediated through an increased bile acid
synthesis for the elimination of body cholesterol shows the
efficiency of W. somnifera in PCOS.59,60
CONCLUSION
Based on the available previous preclinical and clinical re-
ported data we have selected eight plants with multiple
promising effects on PCOS complications. All the selected
plants were not completely screened for all PCOS complica-
tions. Still the available preliminary data revealed the thera-
peutic potential of the selected herbs in PCOS. The selected
list of herbs is merely outnumbered in the unexplored do-
main of medicinal herbs having pharmacological potential.
There is a need for therapeutic standardization to improve
its acceptability and applications on PCOS. Further rational
investigations are needed to explore deeper and extensive
mechanisms of selected herbs on both reproductive and
metabolic PCOS complications. This extensive review will
support the researchers and phytotherapist to explore more
standard herbal polyherbal formulations/remedies for PCOS.
ACKNOWLEDGEMENT
The authors are acknowledged to the Chancellor, Vinayaka
Mission’s Research Foundation (Deemed to be University),
Salem for providing necessary support for writing this arti-
cle.
Conflict of interest- Nil
Source of funding - Nil
REFERENCES
1. Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ova-
ry syndrome. Lancet 2007; 370:685–697.
2. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW,
Nestler JE. Glucose intolerance in polycystic ovary syndrome-a
position statement of the Androgen Excess Society. J Clin Endo-
crinol Metab 2007; 92:4546–4556.
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
85
3. Ni RM, Mo Y, Chen X, Zhong J, Liu W, Yang D. Low prev-
alence of the metabolic syndrome but the high occurrence of
various metabolic disorders in Chinese women with polycystic
ovary syndrome. Eur J End 2009; 161:411–418.
4. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Esco-
bar-Morreale HF, Futterweit W, et al. Assessment of cardiovas-
cular 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.
5. Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, Depression,
and Quality of Life in Women with Polycystic Ovarian Syn-
drome. Indian J Psychol Med 2018; 40(3):239–246.
6. Hywood NDA, Bone K. Phytotherapy for the polycystic ovarian
syndrome. Medi Herb A Physioth Pers 2004; 1:46.
7. Arentz S, Abbott JA, Smith CA, Bensoussan A. Herbal medi-
cine for the management of polycystic ovary syndrome (PCOS)
and associated oligo/amenorrhoea and hyperandrogenism; a re-
view of the laboratory evidence for effects with corroborative
clinical findings. BMC Complementary Alt Med 2014; 14:511.
8. Lunny CA, Fraser SN. The Use of Complementary and Alterna-
tive Medicines among a Sample of Canadian Menopausal Aged
Women. J Midwifery Womens Health 2010; 55(4):335–343.
9. Bishop JL, Northstone K, Green JR, Thompson EA. The use
of complementary and alternative medicine in pregnancy: data
from the Avon Longitudinal Study of Parents and Children (AL-
SPAC). Complement Ther Med 2011; 19(6):303–310.
10. Dou L, Zheng Y, Li L, Gui X, Chen Y, Yu M, Guo Y. The effect
of cinnamon on polycystic ovary syndrome in a mouse model.
Repro Bio Endoc 2018; 16:1-10.
11. Bergh C, Carlsson B, Olsson JH, Selleskog U, Hillensjo T. Reg-
ulation of androgen production in cultured human thecal cells
by insulin-like growth factor I and insulin. Fertil Steril 1993;
59:323–31.
12. Nagamani M, Stuart CA. Specific binding sites for insulin-like
growth factor I in the ovarian stroma of women with polycystic
ovarian disease and stromal hyperthecosis. Am J Obstet Gynecol
1990; 163:1992–1997.
13. Wang JG, Anderson RA, Graham GM, Chu MC, Sauer
MV, Guarnaccia MM, Lobo RA. The effect of cinnamon extract
on insulin resistance parameters in polycystic ovary syndrome:
a pilot study. Fertil Steril 2007; 88(1):240-243.
14. Qin B, Nagasaki M, Ren M, Bajotto G, Oshida Y, Sato Y. Cin-
namon extract (traditional herb) potentiates in vivo insulin-regu-
lated glucose utilization via enhancing insulin signalling in rats.
Diab Res Clin Pract 2003; 62:139-148.
15. Kort DH, Lobo RA. Preliminary Evidence that Cinnamon Im-
proves Menstrual Cyclicity in Women with Polycystic Ovarian
Syndrome: a Randomized Controlled Trial. Am J Obstet Gy-
necol 2014; 211(5):487e1–487e6.
16. Borzoei A, Rafraf M, Niromanesh S, Farzadi L, Narimani F,
Doostan F. Effects of cinnamon supplementation on antioxidant
status and serum lipids in women with polycystic ovary syn-
drome. J Trad Compl Med 2018; 8(1):128-133.
17. Shalaby MA, Saifan HY. Some pharmacological effects of cin-
namon and ginger herbs in obese diabetic rats. J Int Ethnophar-
macol 2014; 3:144-149.
18. Khare P, Jagtap S, Jain Y, Bishnoi M. Cinnamaldehyde supple-
mentation prevents fasting-induced hyperphagia, lipid accumu-
lation and inflammation in high-fat diet-fed mice. Article Bio
Factors 2016; 42:77.
19. Sheng X, Zhang Y, Gong Z, Huang C, Zang YQ. Improved insu-
lin resistance and lipid metabolism by cinnamon extract through
activation of peroxisome proliferator-activated receptors. PPAR
Res 2008; 58:1348.
20. Packialakshmi B, Sowndriya SR. Anti-cancer effect of Gymne-
ma sylvestre Leaf Extract against MG63, Human Osteosarco-
ma cell line - An in vitro analysis. Int J Curr Res Rev 2019;
11(11):18-24.
21. Sreesaila NP, Nirmala P. Effect of Ethanolic extracts of Amor-
phophallus paeoniifolius and Gymnema sylvestre on female
wistar rats with estradiol induced polycystic ovarian syndrome.
World J Pharma Res 2013; 7(13):1053-1060.
22. Shanmugasundaram ERB, Rajeswar G, Baskaran K, Kumar
BRR, Shanmugasundaram KR, Ahmath BK. Use of Gymnema
sylvestre leaf extract in the control of blood glucose in insulin-
dependent Diabetes Mellitus. J Ethnopharmacol 1990; 30:281-
294.
23. Baskaran K, Ahamath BK, Shanmugasundaram KR, Shanmu-
gasundaram ERB. Antidiabetic effect of a leaf extracts from
Gymnema sylvestre in non-insulin-dependent Diabetes mellitus
patients. Journal of Ethnopharmacology 1990; 30:295-305.
24. Laha S, Paul S. Gymnema sylvestre (Gurmar): A Potent Herb
with Anti-Diabetic and Antioxidant Potential. Pharmacognosy J
2019; 11(2):201-206.
25. Sudhakar P, Suganeswari M, Poorana Pushkalai S, Haripriya S.
Regulation of Estrous cycle using Combination of Gymnema
sylvestre and Pergularia daemia in estradiol valerate induced
PCOS rats. Asian J Res Pharma Sci 2018; 8(1):4-8.
26. Kaushik M, Kaushik A, Arya R, Singh G, Malik P. Antiobesity
property of hexane extract from the leaves of Gymnema sylves-
tre in high fed cafeteria diet induced obesity rats. Int Res J Phar-
macy 2011; 2:112–116.
27. Rachh PR, Rachh MR, Ghadiya NR, Modi DC, Modi KP, Patel
NM, et al. Anti-hyperlipidemic activity of Gymenma sylvestreR.
Br. leaf extract on rats fed with high cholesterol diet. Int J Phar-
macol 2010; 6(2):138–141.
28. Kim HJ, Hong SH, Chang SH, Kim S, Lee AY, Jang Y, et al.
Effects of feeding a diet containing Gymnemasylvestre extract:
Attenuating progression of obesity in C57BL/6J mice. Asian Pac
J Trop Med 2016; 9(5):437–444.
29. Ataabadi MS, Alaee S, Bagheri MJ, Bahmanpoor S. Role of
Essential Oil of Mentha spicata (Spearmint) in Addressing Re-
verse Hormonal and Folliculogenesis Disturbances in a Poly-
cystic Ovarian Syndrome in a Rat Model. Adv Pharm Bull 2017;
7(4):651-654.
30. Akdogan M, Tamer MN, Cure E, Cure MC, Koroglu BK, Deli-
bas N. Effect of spearmint (Mentha spicata Labiatae) teas on
androgen levels in women with hirsutism. Phytother Res 2007;
21:444–447.
31. Grant P. Spearmint herbal tea has significant anti-androgen ef-
fects in polycystic ovarian syndrome. A randomized controlled
trial. Phytother Res 2010; 24:186-188.
32. Bayani M, Ahmadi-hamedani M, Javan AJ. Study of Hypogly-
cemic, Hypocholesterolemic and Antioxidant Activities of Ira-
nian Mentha Spicata Leaves Aqueous Extract in Diabetic Rats.
Iranian J Pharma Res 2017; 16:75-82.
33. Mushtaq A, Iqbal N, Jamil M, Khawaja NR, Gohar UF, Me-
hmood MA. Anti-diabetic and Anti-hyperlipidemic action of
aqueous ethanolic extracts of Mentha spicata (Leaves), Plumer-
ia alba (Leaves) and Nymphaeaalba (Flowers and Rhizomes).
IJBPAS 2017; 6(1):108-124.
34. Bhuvaneshwari S, Poornima R, Averal HI. Comparative study of
Pergulariadaemia and Citrulluscolocynthis in polycystic ovar-
ian syndrome induced albino wistar rats. Int J Multidisc Res
Dev 2015; 2(9):207-212.
35. Nivetha S, Poornima R, Horne Iona Averal. Regularization of
Estrous Cycle Using Pergularia daemia and Metformin in the
PCOS Induced Rats. Int J Pharma Res Scholars 2016; 5(3):99-
103.
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
86
36. Doss A, Anand SP. Antihyperglycemic activity of methanol and
aqueous extracts of Pergularia daemia Linn. African J Biotech
2014; 13(1):170-174.
37. Bhuvaneshwari S, Poornima R, Averal HI. Management of obe-
sity in polycystic ovary syndrome induced albino rats with Per-
gularia daemia. Int J Appl Res 2015; 1(9):779-783.
38. Nyeem MAB, Haque MS, ObaydulHaq MD, Nuruzzaman M,
Uddin H, Rabiul Islam BM. Ashoka (Saraca indica) as women
friendly plant: A review. Nat J Adv Res 2017; 3(2):03-07.
39. Singh S, Krishna THA, Kamalraj SS, Kuriakose GC, Valayil
JM, Jayabaskaran C. Phytomedicinal importance of Saraca aso-
ca (Ashoka): an exciting past, an emerging present and a prom-
ising future. Curr Sci 2015; 109(10):1790-1801.
40. Shahid AP, Salini S, Sasidharan N, Padikkala J, Raghavamenon
AC, Babu TD. Effect of Saraca asoca (Asoka) on estradiol in-
duced keratinizing metaplasia in rat uterus. J Basic Clin Physiol
Pharmacol2015; 26(5):509-516.
41. Satyavati GV, Prasad DN, Sen SP, Das PK. Oxytocic activity of a
pure phenolic glycoside (P2) from Saracaindica Linn (Ashoka):
a short communication. Indian J Med Res 1970; 58:660–663.
42. Kumar S, Narwal S, Kumar D, Singh G, Narwal S, Arya R.
Evaluation of antihyperglycemic and antioxidant activities of
Saracaasoca (Roxb.) De Wild leaves in streptozotocin induced
diabetic mice. Asian Pac J Trop Dis 2012; 2(3):170-176.
43. Preethi F, Fernandes J, Pricilla K. Hypoglycemic activity of Sa-
raca indica Linn barks. J Pharmacy Res 2010; 3(3):491-493.
44. Mishra SB, Vijayakumar M. Anti-Hyperglycemic and Antioxi-
dant Effect of Saraca asoca (Roxb. De Wilde) Flowers in Strep-
tozotocin Nicotinamide Induced Diabetic Rats: A Therapeutic
Study. J Bioanal Biomed 2014; 12:1-5.
45. Liepa GU, Sengupta A, Karsies D. Polycystic ovary syndrome
(PCOS) and other androgen excess-related conditions: can
changes in dietary intake make a difference. Nutr Clin Pract
2008; 23(1):63-71.
46. Stansbury J. Saw Palmetto May Reduce Elevated Androgens
and Prolactin in Women with PCOS. Restorative Med 2016.
47. Meletis CD, Nieske Zabriskie N. Natural Approaches for Treat-
ing Polycystic Ovary Syndrome. Altern Complement Therap
2006; 15:157-164.
48. Silverio DF, Monti S, Sciarra A, Varasano PA, Martini C, Lan-
zara S, et al. Effects of long-term treatment with Serenoa repens
(Permixon) on the concentrations and regional distribution of
androgens and epidermal growth factor in benign prostatic hy-
perplasia. Prostate 1998; 37:77–83.
49. Behl MS, Saw Palmetto for PCOS: Reduce Excess Male Hor-
mones Naturally. Available from: http://www.https://www.sepa-
lika.com/pcos/saw-palmetto-for-pcos.
50. Barton D, Doula CH. How to use fertility herbs to enhance your
fertility naturally. Available from http://E;/pcod/fertility Herbs
Infertility Treatment Pregnancy Herbs.htm. Accessed June,
2020.
51. Dehghan A, Esfandiari A, Momeni S. Bigdeli, Alternative treat-
ment of ovarian cysts with Tribulus terrestris extract: A rat mod-
el. Reprod Domest Ani 2012; 47(1):12-15.
52. Esfandiari A, Dehghan A, Sharifi S, Najafi B, Vesali E. Effect of
Tribulus terrestris extract on ovarian activity in immature Wistar
rat: a histological evaluation. J Anim Vet Adv 2011; 10(7):883–
886.
53. Saiyed A, Jahan N, Ahmed Makbul SA, Ansari M, Bano H, Ha-
bib SH. Effect of combination of Withaniasomnifera Dunal and
Tribulus terrestris Linn on letrozole induced polycystic ovarian
syndrome in rats. Integr Med Res 2016; 5:293-300.
54. Samani NB, Jokar A, Soveid M, Heydari M, Mosavat SH. Ef-
ficacy of the Hydroalcoholic Extract of Tribulus terrestris on the
Serum Glucose and Lipid Profile of Women with Diabetes Mel-
litus: A Double-Blind Randomized Placebo-Controlled Clinical
Trial. J Evid Based Complement Altern Med 2016; 21(4):91-97.
55. Ebbesen SMS, Zachariae R, Mehlsen MY, Thomsen D, Hoj-
gaard A, Ottosen L, et al. Stressful life events are associated with
a poor in-vitro fertilization (IVF) outcome: a prospective study.
Hum Reprod 2009; 24:2173–2182.
56. Allsworth JE, Clarke J, Peipert JF, Hebert R, Cooper A, Board-
man LA. The influence of stress on the menstrual cycle among
newly incarcerated women. Womens Health Issues 2007;
17:202–209.
57. Ashok GA, Shende MB, Chothe DS. Antistress activity of ash-
wagandha (Withania somnifera Dunal) - a review. Int Ayu Med
J 2014; 2(3):386-393.
58. Azgomi RND, Zomorrodi A, Nazemyieh H, BagherFazljou
SM, Bazargani HS, Nejatbakhsh F, et al. Effects of Withania
somnifera on Reproductive System: A Systematic Review of
the Available Evidence. Bio Med Research International 2018;
4076430:1-17.
59. Gorelick J, Rosenberg R, Smotrich A, Hanus L, Bernstein N.
Hypoglycemic activity of withanolides and elicitated Withania
somnifera. Phytochemistry 2015; 116:283-289.
60. Visavadiya NP, Narasimhacharya AVRL. Hypocholesteremic
and antioxidant effects of Withania somnifera (Dunal) in hyper-
cholesteremic rats. Phytomedicine 2007; 14:136–142.
61. Rao PV, Gan SH. Cinnamon: A Multifaceted Medicinal Plant.
Evidence-Based Complement Altern Med 2014; 2014: 1-12.
62. Ranasinghe P, Pigera S, Premakumara GAS, Galappaththy P,
Constantine GR, Katulanda P. Medicinal properties of ‘true’ cin-
namon (Cinnamomum zeylanicum): a systematic review. BMC
Complement Altern Med 2013; 13:275.
63. Anand V, Varalakshmi, Prasana, Sampath Kumar, Pushpa,
AgaathHedina. Cinnamomum zeylanicum Linn. The spice with
multi potential. Syste Rev Pharmacy 2016; 7(1):24-29.
64. Tiwari P, Mishra BN, Sangwan NS. Phytochemical and Pharma-
cological Properties of Gymnema sylvestre: An Important Me-
dicinal Plant. BioMed Res Int 2014; 2014:1-18.
65. Tetik F, Civelek S, Cakilcioglu U. Traditional uses of some
medicinal plants in Malatya (Turkey). J Ethnopharmacol 2013;
146:331-346.
66. Kee LA, Shori AB, Baba AS. Bioactivity and health effects of
Mentha spicata. Integr Food Nutr Metab 2017; 5(1):1-2.
67. Karthishwaran K. Mirunalini S. Therapeutic potential of Pergu-
laria daemia (Forsk.): The Ayurvedic wonder. Int J Pharmacol
2010; 6(6):836-843.
68. Bhaskar VH, Balakrishnan N. Veliparuthi (Pergularia daemia
(Forsk.) Chiov.) - As a phytomedicine: A review. Int J Pharm
Tech Res 2009; 1(4):1305-1313.
69. Pachiappan S, Matheswaran S, Saravanan PP, Muthusamy G.
Medicinal plants for polycystic ovary syndrome: A review of
phytomedicine research. Int J Herb Med 2017; 5(2):78-80.
70. Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants
used in Ayurveda, Central Council for Research in Ayurveda and
Siddha, Department of ISM&H, Ministry of Health and Family
Welfare (Govt. of India), New Delhi. 2005; 3:76-8.
71. Mishra A, Kumar A, Rajbhar N, Kumar A. Phytochemical and
Pharmacological Importance of Saraca indica. Int J Pharma
Chem Sci 2013; 2(2):1009-1013.
72. Suzuki M, Ito Y, Fujino T, Abe M, Umegaki K, Onoue S, et al.
Pharmacological effects of saw palmetto extract in the lower uri-
nary tract. Acta Pharmacol Sin 2009; 30(3): 271–281.
73. Fagelman E, Lowe FC. Saw Palmetto Berry as a Treatment for
BPH. Rev Urol 2001; 3(3):134–138.
74. Kalwat JI. The Use of Serenoa repens (Saw Palmetto) in Hair
Care Products. Biomed J Sci Tech Res 2019; 13(1):9725-9728.
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
87
75. Zhu W, Du Y, Meng H, Dong Y, Li L. A review of traditional
pharmacological uses, phytochemistry, and pharmacological ac-
tivities of Tribulus terrestris. Chem Cent J 2017; 11:60.
76. Akram M, Asif HM, Akhtar N, Shah PA, Uzair M, Shaheen G, et
al. Tribulu sterrestris Linn.: A review article. J Med Plants Res
2011; 5(16):3601-3605.
77. Amin A, Lotfy M, Shafiullah M, Adeghate E. The Protective Ef-
fect of Tribulus terrestris in Diabetes. Ann NY Acad Sci 2006;
1084:391–401.
78. Narinderpal K, Junaid N, Raman B. A Review on Pharmacologi-
cal Profile of Withania somnifera (Ashwagandha). Res Rev J
Bot Sci 2013; 2(4):6-14.
79. Singh N, Bhalla M, De Jager P, Gilca M. An overview on Ash-
wagandha: A Rasayana (Rejuvenator) of Ayurveda. Afr J Tradit
Complement Altern Med 2011; 8:208-213.
Table 1: Phytopharmacological data of the selected plants
Medicinal plants
& Scientific name
Family Commonly
used Plant
Parts
Traditional climes Reported activities References
Cinnamomum
zeylanicum L. (Cin-
namon)
Lauraceae Steam bark,
Leaves
Increases the blood circulation
in the uterus and advances tissue
regeneration, As tooth powder to
treat toothaches, dental problems,
oral microbiota, and bad breath. It
can also improve the health of the
colon, thereby reducing the risk of
colon cancer.
Antidiabetic, Cardio-
protective, Anti-
oxidant, Neuroprotec-
tive, Anti Alzheimer’s,
Anti-inflammatory,
Hepatoprotective,
Antimicrobial, and
Anticancer activity.
61, 62, 63
Gymnema sylvestre Asclepiadaceae Leaves,
Flowers and bark
Diabetes, Malaria, antihelminthic,
antipyretic, astringent, cardiot-
onic, digestive, diuretic, cough,
dyspepsia, hemorrhoids, hepatos-
plenomegaly, laxative, stimulant,
stomachic, uterine tonic, intermit-
tent fever, jaundice, leucoderma.
Snakebites, urinary disorders, and
respiratory diseases.
Anti-arthritic,
Antihyperlipidemic,
Antidiabetic, Im-
munostimulatory,
Hepatoprotective,
Wound Healing, An-
tiarthritic, Anti-in-
flammatory Antican-
cer, and Cytotoxic.
64, 24, 22
Mentha spicata L.
(spearmint)
Labiatae Fresh or dried
plant, Leaves,
spearmint oil
Colds, fever and flu, respiratory
tract problems, gastralgia, hemor-
rhoids, and stomachache, also used
as carminative to treat digestive
disorders
Antispasmodics, anti-
platelets, antioxidant,
anti-microbial,
Hypoglycemic, Hypo-
cholesterolemic,
Anti-androgen,
Reverse hormonal,
and folliculogenesis
disturbances in PCOS.
65, 66, 29,
31, 32
Pergularia daemia
(Forsk.)
Apocynaceae Arial parts, Stem
bark, Leaves,
Roots, fruit,
Latex
Gastric ulcer, uterine and menstrual
complaints (Amenorrhea, dysmen-
orrhea), hemorrhoids, abortifacient,
Uterine tonic infantile diarrhoea,
bronchitis, whooping cough, cold,
heals cuts and wounds, antipyretic
and appetizer.
Uterine stimulant,
analgesic, antipyretic,
anti-inflammatory,
CNS depressant,
hepatoprotective,
Anti-fertility, anti-
oxidant, anti-cancer,
Antidiabetic,
anti-bacterial, anti-
fungal and
anti-malarial activity.
67, 68, 69
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
88
Medicinal plants
& Scientific name
Family Commonly
used Plant
Parts
Traditional climes Reported activities References
Saraca indica L. Leguminosae Leaves, Flowers,
Barks,
Seeds
Useful in several feminine disorders
like internal bleeding, hemorrhoids,
ulcers, uterine affections, menor-
rhagia especially due to uterine
fibroids, menometrorrhagia, leucor-
rhoea, and pimples.
Anti-inflammatory,
Analgesic, Antipy-
retic, Antioxidant,
Immunomodulatory,
Antimenorrhagic,
Uterine tonic, Anti-
oxytocic, Antidiabetic,
CNS depressant,
Cardioprotective and
Anticancer activity.
38, 70,71
Saw palmetto
(Serenoarepens)
Arecaceae Berries, oil To cure genitourinary
disturbances, relieve mucous mem-
brane irritations, increase
testicular function, the breast size.
Antiandrogen,
anti-proliferative and
anti-inflammatory,
Effective in Androge-
netic alopecia, Pros-
tate hypertrophy.
72, 73, 74
Tribulu sterrestris
L.
Zygophyllaceae Arial parts, Fruits Used in infertility,
impotence, erectile dysfunction, low
libido, tonic, aphrodisiac, diuretic,
urinary disorders, hyperuricemia,
expectorant, improves eyesight and
to relieve rheumatic pain.
Libido enhancing
activity, Effective in
erectile dysfunction,
Fertility improver,
Hypoglycemic, Hy-
polipidemic, Anti
urolithiatic, analgesic,
antioxidant, anti-
inflammatory,
Anti-aging, cardio-
protective, neuropro-
tective, diuretic and
uricosuric.
75, 76, 77
Withania somnifera
Dunal
(Ashwagandha)
Solanaceae Root
Leaves,
Flowers, seeds
Treatment of tumors and tubercu-
lar glands, a tonic for vitality and
longevity, Adaptogen, aphrodisiac,
narcotic, diuretic, anthelmintic,
astringent, ulcers and painful swell-
ings, thermogenic and stimulant.
Abortifacient, aphro-
disiac, Anti-hypergly-
cemic, Hypolipidemic,
Immunomodulatory,
Cardioprotective,
Antiparkinsonian,
Nootropic, Anticon-
vulsant, Anti-aging,
Antioxidant, Anti-
stress, anti-arthritic
and anti-inflamma-
tory
60,78, 79
Table 1: (Continued)
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
89
Table 2: Selected medicinal plants and their mechanism of action on PCOS
Medicinal plants Reported activities in relation to
PCOS
Mechanism of action References
Cinnamomum zeylanicum Antiandrogenic,
Normalize the disrupts folliculogen-
esis and menstrual cyclicity
Improves insulin sensitivity
Antihyperlipidemic
Cinnamomum acts by down-regulate
serum levels of testosterone, insulin
and decreases IGF-1 level while increase
IGFBP-1level in plasma as well as in the
ovary of patients with PCOS.
Reduced insulin resistance mediated
through an increase in glucose utilization,
by potentiating insulin signaling at the
post-receptor level, increasing PI-3 kinase
activity. This leads to the translocation of
GLUT-4 receptors and the attenuation of
the tonic inhibition on glycogen syn-
thase, culminating in improved glucose
utilization by facilitating intracellular
glucose transport and increasing glycogen
synthesis.
Cinnamon regulated lipid metabolism via
the up-regulation of Peroxisome prolif-
erator-activated receptor alpha (PPAR α)
expression increased the cellular uptake
of fatty acids liberated from fat tissues.
PPARα ligands also increased the expres-
sion of the lipoprotein lipase gene, result-
ing in the anti-hyperlipidemia effect.
11, 12
13, 14
19
Gymnema sylvestre Antiandrogenic and regularize the
menstrual irregularity
Improves insulin sensitivity
Hypolipidemic
Decrease the elevated androgen level in
induced PCOS. But the possible mecha-
nism was not explored.
It increases glucose utilization shown by
increase the activities of enzymes re-
sponsible for the utilization of glucose by
insulin-dependent pathways, an increase
in phosphorylase activity, a decrease in
gluconeogenic enzymes and sorbitol
dehydrogenase. It also increases insulin
secretion and promotes the regeneration
of islets cells.
It possesses significantly reduces the total
cholesterol, TG, LDL, VLDL, and leptin in
induced condition.
21
23, 24
26, 27, 28
Mentha spicata Anti androgenic,
Reduce atretic follicles, ovarian cyst
and also increased the Graafian fol-
licle in PCOS
Hypoglycemia, Hypolipidemia and
lipid peroxidation activities
By decrease the free and total testosterone
and an increase in luteinizing hormone
and follicle-stimulating hormone.
The present secondary metabolites flavo-
noids reduce the serum glucose level and
stimulate beta cells for insulin produc-
tion. Phenol and flavonoids increase the
utilization of insulin and reduce glucose
level, alkaloids inhibit α-glucosidase by
decreasing glucose transport through the
intestinal epithelium.
29, 30, 31
32, 33
Int J Cur Res Rev | Vol 12 • Issue 23 • December 2020
Pachiappan et al.: A review on phytomedicine and their mechanism of action on Pcos
90
Medicinal plants Reported activities in relation to
PCOS
Mechanism of action References
Pergularia daemia Normalizing the hormonal levels in
PCOS
Normalizing menstrual irregularities
and regularizing the estrous cycle
Hypoglycemic and Hypolipidemic
Decrease elevated Testosterone and LH
level and Increase the decreased Proges-
terone and FSH level in PCOS.
By restoration of the estrous cycle, Pergu-
laria daemia reduces the development of
follicular cysts.
Possess hypoglycemic and hypolipidemic
in PCOS induced condition.
34
35
36, 37
Saraca indica Antiestrogenic,
Oxytocic
Hypoglycemic and Hypolipidemic
Phytoestrogens in Saraca indica sup-
press the estrogen-induced endocrine
and reproductive systems associated with
malfunctions of reproductive organs.
38, 39
Saw palmetto Anti androgenic
Inhibit prolactin level
Anti-inflammatory
Liposterols in Saw palmetto produce
anti-androgenic effects by inhibits 5
α-reductase to reduce the uptake of andro-
gens, also by increases DHT breakdown
and inhibits DHT production and binding
to androgen receptor sites.
Saw Palmetto inhibits prolactin receptors
on ovarian cells and reduces the basal
activity of K (+) channels and protein
kinase C involved with the transduction of
prolactin signals.
Reduce low-grade systemic inflammation
in women with PCOS.
47, 48
46
49
Tribulu sterrestis Normalize the hormonal level, Pro-
mote regular ovulation and reduce
ovarian cyst in PCOS
Phytoestrogens present in Tribulus terres-
tis binds with estrogen receptors ERα and
ERβ and acts as a pure estrogen antagonist
by stimulating Gonadotropin-releasing
hormone secretion. Such this mechanism
it normalizes the hormonal level and
induction of ovulation in PCOS.
53
Withania somnifera Anti stressor,
Antioxidant,
Anti androgenic,
Improves follicular development
Hormone regulation in PCOS
Hypoglycemic activity
Hypocholesterolemic effect
Increase the level of stress hormone corti-
sol may reduce estradiol-17β biosynthesis
in the ovary. It results in amenorrhea,
anovulation, and menstrual irregularities
in females. WS regulate this condition by
reducing this stress hormone.
GABA mimetic feature of WS extract is
thought to play the main role in inducing
gonadotropin-releasing hormone secre-
tion and improving hormonal balance.
Increased insulin secretion and improved
insulin sensitivity in muscle cells.
Mediated through an increased bile acid
synthesis for the elimination of body cho-
lesterol in PCOS.
56, 57
58
59
60
Table 2: (Continued)
... Polycystic ovarian syndrome (PCOS), going by the name of Stein-Leventhal [1] syndrome, is characterized by gynecological, endocrine, and metabolic abnormalities in women at reproductive ages [2,3]. A "string of pearls" [4] like structure is seen in polycystic ovaries due to an abnormal number of eggs developing in the ovarian periphery. ...
... These plants help improve hyperandrogenism, insulin sensitivity, fertility, and menstrual cycles. Some of the herbs used for treating PCOS and associated disorders are-Panax ginseng, Tribulus terrestris, Gymnema [1,2,[23][24][25][26][27]. ...
Article
Full-text available
Polycystic ovarian syndrome (PCOS) is characterized by gynecological, endocrine, and metabolic abnormalities in women of reproductive ages. Symptoms include hypergonadotropism, amenorrhea, oligomenorrhea, multiple cysts in ovaries, hirsutism, obesity, and commonly associated with infertility. Presently the standard treatment for PCOS includes lifestyle modifications, pharmacological treatments, and surgical procedures. However, these treatments are not promising for the complete elimination of PCOS. Therefore, natural sources have been a highly valued source of medicine and help improve and manage PCOS conditions. Ganoderma lucidum (G.lucidum) is an oriental fungus possessing a wide range of medicinal properties. Ganoderic acids (GAs) have been reported to show antioxidant, anti-cancer, anti-diabetic, anti-inflammatory, anti-hyperlipidemic, immunomodulatory, and antiandrogenic effects. Molecular docking studies for 22 GAs and clomiphene with human androgen receptor (PDB ID: 1E3G) were carried out using AutoDock Vina and PyRx 0.8 tool. ADMET analysis was carried out for the top 5GAs using pkCSM to predict small molecule pharmacokinetic and toxicity properties. The stability of protein-ligand complex GAA-1E3G was analyzed using DESMOND. The binding affinity of Ganoderma triterpenes with 1E3G ranged from-6.9 to-8.7 kcal mol-1. Ganoderic acid A showed a maximum affinity with a score of-8.7, unlike standard drugs with a score of-6. The in silico predicted pharmacokinetic properties of the top 5 ganoderic acids were better when compared to standard drugs with minimum toxicity. The stability of GAA at 1E3G binding pockets was validated using molecular dynamics. Hence, GAA can be further evaluated for the successful treatment of PCOS.
... This combination thus has been hypothesized to be a potent alternative treatment regimen in the management of PCOS. The plant ingredients that have been proposed in novel herbal combination like Myrica esculenta, Symplocos racemosa, Mimosa pudica, Cyperus rotundus, Aegle marmelos, Saraca asoca and Berberis aristata have already been reported for their potential therapeutic effects in PCOS conditions [15][16][17][18][19][20][21]. ...
... Estudos prévios demonstram a ação antioxidante e anti-inflamatória dos derivados do compostos bioativos β-sitosterol na lesão hepática aguda (Yin et al., 2018). Este bioativo realiza a inibição sobre a 5-α redutase (Vargas, 2022), enzima responsável pela conversão da testosterona em dihidrotestosterona na glândula adrenal (Pachiappan, Ramalingam & Balasubramanian, 2020). ...
Article
Full-text available
Contexto: A Síndrome do Ovário Policístico (SOP) é uma doença multissistêmica comum, que causa alterações reprodutivas, metabólicas e psicológicas. Ultimamente, o uso de plantas medicinais vêm crescendo consideravelmente na esperança de reduzir os efeitos colaterais das drogas sintéticas e na tentativa de redução dos danos e custos. Objetivo: Analisar o uso de plantas medicinais que são utilizadas na SOP a partir de uma revisão integrativa da literatura, com a finalidade de verificar os efeitos farmacológicos ocasionados a partir do uso na SOP. Metodologia: Foi realizada uma revisão integrativa da literatura utilizando as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) através de pesquisas nas bases de dados PubMed, Scielo e Scopus para seleção de estudos etnobotânicos, etnofarmacológicos, pré-clínico e clínico, publicados na íntegra nos últimos 10 anos (2012 – 2022), nos idiomas Inglês, Português e Espanhol a partir de descritores em saúde. Resultados: As dez publicações analisadas evidenciaram dez famílias e 11 espécies de plantas, que, de modo geral, apresentaram atividades antiandrogênicas. Conclusões: Com exceção de Foeniculum vulgare, todas as demais plantas medicinais analisadas neste estudo possuem efeitos anti androgênicos na SOP. Porém, essas espécies necessitam de melhores avaliações clínicas e toxicológicas quanto ao seu uso para que seja possível proporcionar uma terapia segura e eficaz.
... Similarly, other research groups (Bilal Bin-Hafeez et al. and Sneha J. Anarthe et al.) demonstrated a dose-dependent immunomodulatory activity of methanolic extract of fenugreek (149,150). It has also been demonstrated that phytonutrients such as ashwagandha, amla, apigenin, and cinnamon bark extract furnish promising immunomodulatory effects for the management of PCOS, the details are summarized in Table 2 (171,172). Moreover, in Kuniaki Ota et al. demonstrated that vitamin D has shown an immunomodulatory effect inhibiting the proliferation of Th1 cells and limit their cytokine production, such as IFN-γ, IL-2, and TNF-α. ...
Article
Full-text available
Conveyance of pathogens between organisms causes communicable diseases. On the other hand, a non-communicable disease (NCD) was always thought to have no causative transmissible infective agents. Today, this clear distinction is increasingly getting blurred and NCDs are found to be associated with some transmissible components. The human microbiota carries a congregation of microbes, the majority and the most widely studied being bacteria in the gut. The adult human gut harbors ginormous inhabitant microbes, and the microbiome accommodates 150-fold more genes than the host genome. Microbial communities share a mutually beneficial relationship with the host, especially with respect to host physiology including digestion, immune responses, and metabolism. This review delineates the connection between environmental factors such as infections leading to gut dysbiosis and NCDs and explores the evidence regarding possible causal link between them. We also discuss the evidence regarding the value of appropriate therapeutic immunomodulatory nutritional interventions to reduce the development of such diseases. We behold such immunomodulatory effects have the potential to influence in various NCDs and restore homeostasis. We believe that the beginning of the era of microbiota-oriented personalized treatment modalities is not far away.
... Saraca indica is found to be useful in treating fibroids induced menorrhagia, leucorrhoea, and has a positive effect on the endometrium and ovarian tissue. Its phenolic glycosides have revealed strong oxytocic action (Pachiappan et al., 2020;Pankaj 2003;Singh et al., 2015). ...
Article
Full-text available
Around fifteen percent women of reproductive age have been effected by Polycystic Ovarian Syndrome (PCOS); a complicated disorder; and apparently there is no standard therapy available. Considering this lack, we design present work; for the assessment of a herbal medicine (Femitex-SP4) in managing PCOs. During 2016-17; this study was carried out at Abbasi Shaheed hospital, Karachi, Pakistan. A total of 150 patients aged between 18-44 years were included as per Rotterdam criteria. Patients received 500 mg of powdered herbs in capsule form twice daily. The primary outcomes were regular menstruation and ovulation plus change in fasting blood sugar levels. Changes in free testosterone levels and ovarian morphology was secondary outcome measures. Continuous outcomes before and after treatment were compared by Student's t-test (one tailed, independent). P = 0.05 was considered as significant. Women menstrual cycle was considerably improved. Fasting blood sugar levels did not change (p=0.103392). Progesterone levels were same at the starting point and after treatment (P=0.318322). With complete recovery in 6 patients; a notable change was found in ovarian size. Free testosterone levels were also dropped significantly (p<0.00001). Our main success was drastic improvement in normalizing menstrual cycle during therapy. Herbal treatment is proven to be clinically effective in most of the patients; particularly PCOs patients with menstrual irregularities. Hence, Femitex-SP4 can be taken as a better treatment for PCOs.
... Saraca indica is found to be useful in treating fibroids induced menorrhagia, leucorrhoea, and has a positive effect on the endometrium and ovarian tissue. Its phenolic glycosides have revealed strong oxytocic action (Pachiappan et al., 2020;Pankaj 2003;Singh et al., 2015). ...
Article
Full-text available
Around fifteen percent women of reproductive age have been effected by Polycystic Ovarian Syndrome (PCOS); a complicated disorder; and apparently there is no standard therapy available. Considering this lack, we design present work; for the assessment of a herbal medicine (Femitex-SP 4) in managing PCOs. During 2016-17; this study was carried out at Abbasi Shaheed hospital, Karachi, Pakistan. A total of 150 patients aged between 18-44 years were included as per Rotterdam criteria. Patients received 500 mg of powdered herbs in capsule form twice daily. The primary outcomes were regular menstruation and ovulation plus change in fasting blood sugar levels. Changes in free testosterone levels and ovarian morphology was secondary outcome measures. Continuous outcomes before and after treatment were compared by Student's t-test (one tailed, independent). P = 0.05 was considered as significant. Women menstrual cycle was considerably improved. Fasting blood sugar levels did not change (p=0.103392). Progesterone levels were same at the starting point and after treatment (P=0.318322). With complete recovery in 6 patients; a notable change was found in ovarian size. Free testosterone levels were also dropped significantly (p<0.00001). Our main success was drastic improvement in normalizing menstrual cycle during therapy. Herbal treatment is proven to be clinically effective in most of the patients; particularly PCOs patients with menstrual irregularities. Hence, Femitex-SP 4 can be taken as a better treatment for PCOs.
Article
Full-text available
Objective: Glucose being the fuel of body and brain needs the availability of insulin around the clock. Any impairment in the functionality of insulin leads to long lasting metabolic disorder called diabetes mellitus which can be described as a group of disorders i.e. hyperlipidemia, cardiomyopathy, nephritis, fatty liver and weight loss. Patients need such therapy which maintains the blood glucose level according to the needs of body. None of the commercially available anti-diabetic medicines are hundred percent efficacious and free of side effects. This study was conducted to explore the beneficial effects of three indigenous plants in lowering glucose and lipid levels. Methodology: In this study aqueous ethanolic extracts of Mentha spicata (leaves), Plumeria alba (leaves) and Nymphaea alba (flowers and rhizomes) were evaluated individually in 200mg/kg and 400mg/kg doses against alloxan (130mg/kg i.p.) induced hyperglycemic rats. Blood glucose levels were determined periodically on 1 st , 3 rd , 5 th , 7 th , 9 th , 11 th and 13 th day of study and at 15 th day, animals were sacrificed to get blood for determination of serum cholesterol, triglycerides, LDL, HDL and VLDL. Results: The results indicated that the crude extracts reduced blood glucose level, serum cholesterol, triglycerides, LDL and VLDL while body weights and HDL levels were increased. Two way ANOVA test was applied which declared that extracts in dose of 400mg/kg produced significant (P<0.001) results. Conclusion: Based on results it was concluded that the crude extracts possess not only anti-diabetic activity but also show marked anti-hyperlipidemic potential. However, extensive studies are needed to be conducted to identify the active moieties of extracts and to explore the molecular basis of their mechanism of action.
Article
Full-text available
Background: Polycystic ovary syndrome (PCOS) is the most prevalent cause of anovulatory infertility and hyperandrogenism. Evidence favors insulin resistance and compensatory hyperinsulinemia as the predominant, perhaps primary, defects in PCOS. The use of insulin-sensitizing drugs has been shown to improve both the reproductive and the metabolic aspects of PCOS. Cinnamon has been found to have insulin sensitizing effect and improve menstrual cyclicity in women with PCOS. The aim of this study was to determine the effect and mechanism of cinnamon on PCOS using a dehydroepiandrosterone (DHEA) induced PCOS mouse model. Methods: Prepubertal C57BL/6 mice (age 25 days) were raised to developed into control group, DHEA group and DHEA plus cinnamon group for 20 days. The stages of the estrous cycle were determined based on vaginal cytology; metabolic characteristics were examined by intraperitoneal glucose tolerance test and insulin tolerance test, the serum levels of hormones (testosterone, insulin, LH, FSH, IGF-1, IGFBP-1) were checked using enzyme-linked immunosorbent assay (ELISA) method, the ovarian morphology was observed by stained with hematoxylin and eosin. IGF-1 and IGFBP-1 expression in ovary were detected by immunohistochemical stain. Results: Cinnamon restores the cyclicity and ovary morphology in PCOS mice model induced by DHEA. There are significant differences of serum level of total testosterone (0.033 ± 0.009 ng/ml), among control group, DHEA and cinnamon group (0.052 ± 0.011 ng/ml), and DHEA group (0.079 ± 0.015 ng/ml); There was an increasing tendency of serum FSH level from DHEA group (5.02 ± 0.31 ng/ml), DHEA and cinnamon group (5.81 ± 0.51 ng/ml), to control group (7.13 ± 0.74 ng/ml); and there was a decreasing trend of serum LH level from DHEA group (3.75 ± 0.57 ng/ml), DHEA and cinnamon group (1.35 ± 0.61 ng/ml), or control group (0.69 ± 0.34 ng/ml); serum insulin level is significantly higher in DHEA treated mice (1.61 ± 0.31 ng/ml) than control group (0.93 ± 0.19 ng/ml), or DHEA and cinnamon effect (1.27 ± 0.23 ng/ml) (p < 0.05). The DHEA group also has a higher serum IGF-1 level (0.35 ± 0.06 ng/ml) than control group (0.17 ± 0.04 ng/ml) or DHEA and cinnamon group (0.21 ± 0.05 ng/ml) (p < 0.05). While DHEA group has a lower IGFBP-1 level (5.5 ± 1.6 ng/ml) than control group (15.8 ± 2.1 ng/ml) or DHEA and cinnamon group (10.3 ± 2.5 ng/ml) (p < 0.05). Cinnamon also attenuates DHEA induced a higher IGF-1 and lower IGFBP-1 expression in ovary by immunohistochemistry. Conclusions: These preliminary data suggest that cinnamon supplementation improves insulin resistance and may be a potential therapeutic agent for the treatment of PCOS.
Article
Full-text available
Background Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Symptoms include amenorrhea, hirsutism, infertility, obesity, acne vulgaris, and androgenic alopecia. PCOS is a stigmatizing condition that affects a woman's identity, mental health and quality of life (QOL). This aspect has not received adequate attention in India. Aims and Objectives (1) To study the prevalence of anxiety and depression among women suffering from PCOS (2) To determine if symptoms of PCOS were associated with psychiatric morbidity, and (3) To determine the impact of psychiatric morbidity on the QOL. Materials and Methods Seventy females in the reproductive age group (18–45 years) diagnosed with PCOS as per Rotterdam criteria and without any preexisting psychiatric illness were clinically interviewed for anxiety and depressive disorders which were then rated according to the Hamilton scales. QOL was assessed using the World Health Organization-QOL-BREF. Binary logistic regression was performed to study the association of the symptoms with the psychiatric morbidity. QOL scores of patients with and without psychiatric morbidity were compared using Mann–Whitney U-test. Results and Conclusions The prevalence of anxiety and depression in our sample was 38.6% and 25.7%, respectively. Infertility and alopecia were associated with anxiety, while acne was associated with depression. Hirsutism was associated with a lower psychological QOL. Patients with psychiatric morbidity had a significantly lower QOL than those without.
Article
Full-text available
Polycystic Ovarian Syndrome (PCOS) is a complex endocrinological and metabolic disorder associated with menstrual dysfunction. In this study, the herbal plant Gymnema sylvestre and Pergularia daemia is used treat the menstrual irregularity by using female albino wistar rat as a model. The experimental animals were divided into five groups each group consisting of six rats. Group I received normal control, Group II received estrodiol valerate 4mg/kg dissolved in 0.4ml sesame oil i.p. on first day considered as a PCOS control, Group III received a Gymnema sylvestre (400mg/kg) for 14 days, Group IV received a Pergularia daemia (200mg/kg) for 14 days, and Group V received a combination of Gymnema sylvestre (400mg/kg) and Pergularia daemia (200mg/kg) for 14 days. The vaginal smear was collected every day to find changes in estrous cycle. The control group showed no changes in the estrous cycle when the EV induced PCOS group had an altered estrous cycle. The Gymnema sylvestre, Pergularia daemia and Gymnema sylvestre+Pergularia daemia treated groups showed better improvement when compared to individual treatment combination treated group potentiality to regain the estrous cycle in the PCOS induced rats.
Article
Full-text available
Introduction Withania somnifera (WS) also known as ashwagandha is a well-known medicinal plant used in traditional medicine in many countries for infertility treatment. The present study was aimed at systemically reviewing therapeutic effects of WS on the reproductive system. Methods This systematic review study was designed in 2016. Required data were obtained from PubMed, Scopus, Google Scholar, Cochrane Library, Science Direct, Web of Knowledge, Web of Science, and manual search of articles, grey literature, reference checking, and expert contact. Results WS was found to improve reproductive system function by many ways. WS extract decreased infertility among male subjects, due to the enhancement in semen quality which is proposed due to the enhanced enzymatic activity in seminal plasma and decreasing oxidative stress. Also, WS extract improved luteinizing hormone and follicular stimulating hormone balance leading to folliculogenesis and increased gonadal weight, although some animal studies had concluded that WS had reversible spermicidal and infertilizing effects in male subjects. Conclusion WS was found to enhance spermatogenesis and sperm related indices in male and sexual behaviors in female. But, according to some available evidences for spermicidal features, further studies should focus on the extract preparation method and also dosage used in their study protocols.
Article
Diabetes Mellitus is a metabolic disorder with high blood sugar level. Type 2 is the common form. The herbal remedies for diabetes treatment is an area of research with a huge potential for the progress in the growth of inexpensive alternative medicine with low or no side effects. In this paper, reviews mainly focused on traditionally used medicinal herb, Gymnema sylvestre and its bioactive components and their mode of actions. Method: Relevant information was collected from scientific journals, research papers, books and various medicinal reviews. Result: This review provides a comprehensive report on Gymnema sylvestre having antidiabetic and antioxidant activity due to its bioactive compounds like oleanines (Gymnemic acid, Gymnema saponins), dammarenes (Gymnemasides), anthraquinones, flavones, hentriacontane, pentatriacontane, phytin, resin, tartaric acid, formic acid, butyric acid, lupeol, β-amyrene related glycosides and anthraquinones, alkaloid like gymnamine, flavonoids, cinnamic acid, folic acid, ascorbic acid etc. Conclusion: Considering the presence of bioactive compounds present in Gymnema sylvestre, this review is aimed to summarize the information of the chemical constituents and their antidiabetic activities and specially to detect the relation between antioxidants and antidiabetic compounds regarding blood sugar reduction in diabetes.