Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among women of reproductive age. Current standard treatment includes lifestyle change, oral pharmacological agents, and surgical modalities. However, the efficacy of current therapies is less than satisfactory. Clinical evidence has shown that acupuncture is effective for regulating hormone levels, promoting ovulation, and attenuating insulin resistance in patients with PCOS. Acupuncture may affect the production of β‐endorphin, which may lead to gonadotropin-releasing hormone secretion and then affect ovulation, menstrual cycle, and fertility. The mechanism of acupuncture for patients with PCOS has not been comprehensively reviewed so far. Better understanding of the mechanisms of acupuncture would help popularize the use of acupuncture therapy for patients with PCOS. In this narrative review, we aimed to overview the potential mechanisms and evidence-based data of acupuncture on PCOS, and analyze the most frequently used acupoints based on animal and clinical studies. The results of this study will contribute to a better understanding of the current situation in this field.

Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrinopathies. Evidence suggest that flavonoids have beneficial effects on endocrine and metabolic diseases, including PCOS. However, high-quality clinical trials are lacking. We aimed to conduct a systematic review and meta-analysis of experimental studies to determine the flavonoids’ effects in animal models of PCOS. Three electronic databases including PubMed, Scopus, and Web of Science were systematically searched from their inception to March 2022. The Systematic Review Center for Laboratory Animal Experimentation’s risk of bias tool was used to assess methodological quality. The standardized mean difference was calculated with 95% confidence intervals as the overall effects. R was used for all statistical analyses. This study was registered in PROSPERO (registration number: CRD42022328355). A total of eighteen studies, including 300 animals, met the inclusion criteria. Our analyses demonstrated that, compared to control groups, flavonoid groups showed a significantly lower count of atretic follicles and cystic follicles and the count of corpus luteum was higher. A significant reduction in the luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), and free testosterone were observed in intervention groups. Nevertheless, there was no significant difference in the effects of flavonoids on the level of FSH, estradiol, and progesterone. Subgroup analyses indicated that the type of flavonoid, dose, duration of administration, and PCOS induction drug were relevant factors that influenced the effects of intervention. Current evidence supports the positive properties of flavonoids on ovarian histomorphology and hormonal status in animal models of PCOS. These data call for more randomized controlled trials and further experimental studies investigating the mechanism in more depth.

Lifestyle intervention is the first-line treatment for PCOS. Numerous studies have investigated the effect of various lifestyle factors, including dietary habit, smoking, and alcohol consumption on PCOS women. These studies have found that such factors may be associated with physiological parameters such as androgen, and emotional states like anxiety or depression. Smoking, a harmful lifestyle habit widely recognized to contribute to various diseases, has also been found to be related to PCOS. Current research has not adequately compared the effects of smoking with other lifestyle habits on PCOS, and there is little mention of its relationship with the emotional states of patients with PCOS. To further elucidate the association between smoking and other lifestyle factors with clinical symptoms in patients with PCOS, we conducted a cross-sectional evaluation using data from Peking University Third Hospital, with a special focus on analyzing smoking habits and comparing it with a variety of lifestyle factors. This cross-sectional study included 601 PCOS women and 184 healthy controls who underwent physical examinations, hormone profiles and psychological measures. We assessed the association between smoking and the clinical symptoms in PCOS women. We found a significant correlation between smoking and the degree of depression in PCOS women among the three emotional states: anxiety, depression, and stress. Smoking was also significantly associated with testosterone level in PCOS participants, suggesting that PCOS women who smoke exhibited more severe depressive symptoms and higher testosterone level. In addition, compared to the control group, PCOS women had notably higher testosterone (T) and luteinizing hormone (LH) levels. Smoke and alcohol were statistically significantly more common in women with PCOS than the Control. Women with PCOS who smoke were found to have elevated testosterone levels and more severe depression. These findings suggest that clinicians should monitor smoking women with PCOS for symptoms of depression and assess their hyperandrogenic status.

Objective. This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) on ovarian mass, weight, sex hormone disorders, and insulin resistance in animal models of polycystic ovary syndrome (PCOS). Methods. This systematic review and meta-analysis was conducted through a comprehensive search in three databases to find studies testing CHM in animal models of PCOS. Two researchers independently reviewed the retrieval, extraction, and quality assessment of the dataset. The pooled effects were calculated using random-effect models; heterogeneity was explored through subgroup analysis; and stability was assessed through sensitivity analysis. In addition, publication bias was assessed using the Eggers bias test. Results. Fifteen studies with twelve mice and 463 rats published from 2016 to 2021 met the inclusion criteria. The results of primary outcomes revealed that CHM therapy was significantly different with control animals in ovarian mass and testosterone (SMD, 1.01 (95 CI, 1.58, 1.45); SMD, 1.62 (95 CI, 2.07, 1.16), respectively). The secondary outcomes as well showed an overall positive effect of CHM compared with control animals in weight (SMD, 1.02 (95 CI, 1.39, 0.65)), follicle-stimulating hormone (FSH) (SMD, 0.58 (95 CI, 0.19, 0.97)), luteinizing hormone (LH) (SMD, 0.94 [95 CI, 1.25, 0.64)), homeostasis model assessment-insulin resistance (HOMA-IR) (SMD, 1.24 (95 CI, 1.57, 0.92)). Subgroup analyses indicated that PCOS induction drug, formula composition, random allocation, and assessment of model establishment were relevant factors that influenced the effects of interventions. The stability of the meta-analysis was showed robust through sensitivity analysis. The publication bias was substantial. Conclusions. Administration with CHM revealed a statistically positive effect on ovarian mass, weight, sex hormone disorders, and insulin resistance. Moreover, these data call for further high-quality studies investigating the underlying mechanism in more depth.

Background: Polycystic ovary syndrome (PCOS), a prevalent endocrine disorder, is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. In light of the critical role of bile acids in metabolic regulation and the therapeutic potential of acupuncture for endocrine–metabolic disorders, this study aims to explore the effects of acupuncture on bile acid metabolism and insulin sensitivity in both PCOS patients and rat models. Methods: 33 PCOS participants and 28 age/BMI-matched controls were enrolled in a clinical trial (NCT04193371). PCOS participants received 4 month acupuncture plus lifestyle (A&L) or a sham acupuncture plus lifestyle (SA&L) intervention followed by 4 month observation. Serum bile acids were profiled by LC–MS/MS. Multiple hormones and inflammatory markers were analyzed by enzyme-linked immunosorbent assay and insulin sensitivity was evaluated through oral glucose tolerance test and insulin tolerance test. A dihydrotestosterone -induced PCOS rat model was established and treated with acupuncture. The estrous cycle and ovarian morphology were assessed using HE staining, insulin resistance was evaluated and hormone levels were measured. Transcriptome profiling of hepatic tissues was conducted in a PCOS rat model to delineate molecular alterations associated with acupuncture intervention, with particular emphasis on genes involved in bile acid biosynthesis. Results: The homeostasis assessment of insulin resistance (HbA1c, HOMA, AUC) of PCOS is significantly reduced after acupuncture compared to the pre-intervention (p < 0.05). Surprisingly, simultaneously ameliorated outcomes included the body mass index (BMI), sex hormone-binding globulin (SHBG), free androgen index (FAI) and anti-Müllerian hormone (AMH). The potency lasted for another 4 months, indicating the enduring effects of the acupuncture regimen. Metabolic improvements were associated with changes in specific bile acids (e.g., taurocholic acid, lithocholic acid). In PCOS rat models, acupuncture restored regular estrous cycles, reduced the incidence of ovarian cysts and improved the insulin resistant. Transcriptomic analysis of rat liver revealed that acupuncture significantly reversed the expression of genes associated with bile acid metabolism and the FXR signaling pathway. Conclusions: Acupuncture therapy offers potential therapeutic benefits to PCOS women, with mechanisms involving the bile acid–FXR axis potentially contributing to improvements in insulin resistance and other disease-related symptoms.