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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
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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
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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
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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
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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)
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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
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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)
