Polycystic ovary syndrome (PCOS) is a complex hormonal condition that affects the metabolic and reproductive physiological functions of a woman’s system. It is associated with a multitude of symptoms and issues and includes: irregular menstrual cycle, reduced fertility, hyperinsulinemia, insulin resistance, obesity, hyperandrogenism (hirsutism, acne, hair loss) and skin discolorations.
Conventional medicine typically offers anti-androgenic drugs, cyclic progestin/combined oral contraceptives, metformin or thiazolidinediones, all used alone or in combination. They all can cause side effects although certainly not in all women, and they should be considered by knowledgeable practitioners. However, natural medicine has some significant researched therapies. Natural medicine has offered many significant options that can address the underlying causes of insulin resistance and hyperandrogenism, which then can have the outcome of improving the day to day issues that women experience. Lifestyle modification is considered one of the initial treatment options to improve insulin sensitivity, which then results in weight loss in those who are overweight, improved glucose/insulin mechanism, reduced testosterone and improved ovulatory function. Lifestyle modifications generally focus on low sugar, low starch carb diets, and regular aerobic exercise as well as strength training. Besides these, several nutritional supplements and botanicals have shown evidence to either improve insulin sensitivity and reduce hyperinsulinemia, and/or lower androgens. I will not go into the research here, but the research is dominated by N-acetyl-cysteine (NAC), and myo-inositol but others include cinnamon, chromium, licorice root, marjoram tea, spearmint tea, curcumin, green tea and chamomile.
Recently, probiotics have gained attention due to their ability to correct gut microbiota dysbiosis, reduce inflammatory markers and improve various metabolic diseases. Several studies have suggested the involvement of compromised gut health in the etiology of PCOS. One study showed that PCOS women had fewer types of gut microbes as compared to normal women and this was related to an increase in androgens. Because of this, supplemental probiotics might be a tool to modify gut microbiota in the treatment of women with PCOS.
A multi-strain probiotic formulation was used in the current study, and included Lactobacillus acidophilus UBLA-34, L. rhamnosus UBLR-58, L. reuteri UBL Ru-87, L. plantarum UBLP-40, L. casei UBLC-42, L. fermentum UBLF-31, Bifidobacterium bifidum UBBB-55 and Fructo-oligosaccharides. Each of these was formulated with the acidophilus, rhamnosus and reuteri having 2 billion colony forming units (CFU) each with plantarum, casei, fermentum and Bifidobacterium at 1 billion each and fructo-oligosaccharides of 100 mg. One group received the 10 billion total of probiotics daily for 2 months and then 20 billion per day for 4 months. The other group received placebo. Both groups received healthy diet plans and exercise plans. A total of 104 women with PCOS were randomized to either the probiotic or the placebo group for 6 months. Evaluations included hormonal testing, pelvic ultrasound of the ovaries, insulin resistance testing, weight, weight-hip ratio and assessing menstrual cycle regularity.
The probiotic supplement along with dietary and exercise modifications significantly regulated the menstrual cycle, improved levels of total testosterone and the menstrual related quality of life evaluation.
Commentary: PCOS is one of the most widely reported hormonal disorders in reproductive aged women. While contraceptives, metformin and anti-androgenic medications have an important selective role, natural medicine is a strong contender when used with adequate knowledge about PCOS and when one is familiar with the research and dosages with the nutraceuticals and botanicals. In addition to the current study using probiotics as an intervention for PCOS, a systematic review and meta-analysis also suggest that at least 12 weeks of supplementation with select probiotic combinations may result in improvement in weight, insulin, insulin resistance, total testosterone, and menstrual regularity.
Reference: Kaur I, Suri V, Sachdeva N, et al. Efficacy of multi-strain probiotic along with dietary and lifestyle modifications on polycystic ovary syndrome: a randomized, double-blind placebo-controlled study. European J of Nutrition July 2022
