Thirty-two hirsute women with polycystic ovary syndrome (PCOS) were studied in an open-label clinical trial. All the women were given 100 mg of spironolactone per day while sixteen of them also received 3.5 g/day of a licorice root extract standardized to 7.6% glycyrrhetinic acid. Study duration was two months. Systolic blood pressure significantly decreasd at 30 and 60 days in the women taking spironolactone (SP), but not in the SP plus licorice group. Diastolic blood pressure did not change in either group. Twenty percent of the women in the SP only group had fatigue, orthostatic symptoms and polyuria. These were most significant in the first two weeks of treatment but diminished over the course of the study. Women in the SP and licorice group did not report any of these side effects. Plasma rennin activity and aldosterone were more increased in the SP only group compared with the other group. There were no changes in SHBG in either the SP only group or the SP plus licorice. Plasma cortisol increased in both groups after 30 and 60 days.
Armanini D, Castello R. Scaroni C, et al. Treatment of polycystic ovary syndrome with spironolactone plus licorice. Eur J Obstet Gynecol 2007;131:61-67.
Commentary: It’s very useful to find a second study on licorice and it’s role in PCOS. Glycyrrhetinic acid has been shown to reduce serum testosterone and induce regular ovulation. (Yaginuma T, Izumi R, Yasui H, et al. Effect of traditional herbal medicine on serum testosterone levels and its inductions of regular ovulation in hyperandrogenic and oligomenorrheic women. Nippon Sanka Fujinka Gakkai Zasshi 1982;34:939-944) ( Takahashi K, Yoshino K, Shirai T, et al. Effect of a traditional herbal medicine on testosterone secretion in patients with polycystic ovary syndrome detected by ultrasound. Nippon Sanka Fujinka Gakkai Zasshi 1988;789-92.)
Spironolactone is often used as part of a treatment plan in PCOS women with bothersome hirsutism. While Spironolactone can be helpful, fatigue and polyuria are a frequent side effect. It may be that licorice and glycyrrhetinic acid have a potential synergistic effect on the androgen receptors, reduce the side effects associated with Spironolactone, as well as reducing serum testosterone and inducing regular ovulation. Licorice extract along with a lower carbohydrate/higher protein diet, therapies that increase SHBG such as nettles root, green tea, flax seeds and soy and insulin sensitizing strategies such as daily aerobic exercise, fenugreek powder, cinnamon extract, d-pinitol, chromium (and possibly glucophage) offer a comprehensive approach for women with PCOS.