The role of the endogenous opioid system in polycystic ovary syndrome

Eyvazzadeh, Aimee D.; Pennington, Kathryn P.; Pop‐Busui, Rodica; Sowers, MaryFran; Zubieta, Jon Kar; Smith, Yolanda R.

doi:10.1016/j.fertnstert.2009.05.012

Cited by 48 publications

(44 citation statements)

References 153 publications

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“…Thus, although we did not observe an effect on LH pulsatility or secretion pattern, it remains possible that the effect on sex steroid secretion could be mediated via the brain. In PCOS, both central and peripheral opioid activities seem to be altered, although the data are conflicting (9). Experimental and clinical data indicate involvement of the central opioid system in the regulation of ovulation and sex steroid secretion by acupuncture in PCOS, although not included in this study (2, 9 -11).…”

Section: E940mentioning

confidence: 85%

Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial

Johansson

Redman

Veldhuis

et al. 2013

American Journal of Physiology-Endocrinology and Metabolism

114

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Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). Our aim was to investigate whether acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS. This prospective, randomized, controlled clinical trial was conducted between June 2009 and September 2010. Thirty-two women with PCOS were randomized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10 -13 wk. Main outcome measures were changes in LH secretion patterns from baseline to after 10 -13 wk of treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the secretion of sex steroids, anti-Müllerian hormone, inhibin B, and serum cortisol. Ovulation frequency during treatment was higher in the acupuncture group than in the control group. After 10 -13 wk of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, testosterone, free testosterone, dihydrotestosterone, androsterone glucuronide, androstane-3␣,17␤-diol-3-glucuronide, and androstane-3␣,17␤-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except androstenedione. We conclude that repeated acupuncture treatments resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion. polycystic ovary syndrome; acupuncture; ovulation; lh pulsatility; sex steroids THE MAIN CHARACTERISTICS of polycystic ovary syndrome (PCOS) are polycystic ovaries (34), oligo/anovulation, and elevated serum levels of sex steroid precursors, estrogens, androgens, and glucuronidated androgen metabolites (38). PCOS is related to hyperinsulinemia and insulin resistance and is exacerbated by obesity (7). Numerous studies have reported hypersecretion of luteinizing hormone (LH) in women with PCOS (3). Together with an exaggerated ovarian response, hypersecretion of LH drives excessive ovarian androgen production and causes anovulation (13). In PCOS, altered sex steroid production, metabolic dysfunction, and obesity all contribute to changes in LH secretion patterns and to anovulation (6,12,29,30).Clomiphene citrate, exogenous gonadotropin therapy, and laparoscopic ovarian drilling are commonly used to induce ovulation in women with PCOS (1). These treatments often have negative side effects, thus indicating the importance of evaluating alternative treatments such as acupuncture. Acupuncture is used worldwide to achieve fertility, but its efficacy is supported by only limited scientific evidence. In a randomized controlled trial (RCT), we previously demonstrated that acupuncture w...

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Section: E940mentioning

confidence: 85%

Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial

Johansson

Redman

Veldhuis

et al. 2013

American Journal of Physiology-Endocrinology and Metabolism

114

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“…In PCOS, growing evidence suggests that the opioid system is dysregulated both centrally and peripherally, with complex interactions (24). Indeed, opioid receptor antagonists improve menstrual cyclicity, induce ovulation, and decrease testosterone, insulin, and LH levels and the LH/FSH ratio (1,15,28).…”

Section: Acupuncturementioning

confidence: 99%

The physiological basis of complementary and alternative medicines for polycystic ovary syndrome

Raja-Khan

Stener-Victorin

et al. 2011

American Journal of Physiology-Endocrinology and Metabolism

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Raja-Khan N, Stener-Victorin E, Wu X, Legro RS. The physiological basis of complementary and alternative medicines for polycystic ovary syndrome. Am J Physiol Endocrinol Metab 301: E1-E10, 2011. First published April 12, 2011 doi:10.1152/ajpendo.00667.2010.-Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is characterized by chronic hyperandrogenic anovulation leading to symptoms of hirsutism, acne, irregular menses, and infertility. Multiple metabolic and cardiovascular risk factors are associated with PCOS, including insulin resistance, obesity, type 2 diabetes, hypertension, inflammation, and subclinical atherosclerosis. However, current treatments for PCOS are only moderately effective at controlling symptoms and preventing complications. This article describes how the physiological effects of major complementary and alternative medicine (CAM) treatments could reduce the severity of PCOS and its complications. Acupuncture reduces hyperandrogenism and improves menstrual frequency in PCOS. Acupuncture's clinical effects are mediated via activation of somatic afferent nerves innervating the skin and muscle, which, via modulation of the activity in the somatic and autonomic nervous system, may modulate endocrine and metabolic functions in PCOS. Chinese herbal medicines and dietary supplements may also exert beneficial physiological effects in PCOS, but there is minimal evidence that these CAM treatments are safe and effective. Mindfulness has not been investigated in PCOS, but it has been shown to reduce psychological distress and exert positive effects on the central and autonomic nervous systems, hypothalamic-pituitary-adrenal axis, and immune system, leading to reductions in blood pressure, glucose, and inflammation. In conclusion, CAM treatments may have beneficial endocrine, cardiometabolic, and reproductive effects in PCOS. However, most studies of CAM treatments for PCOS are small, nonrandomized, or uncontrolled. Future well-designed studies are needed to further evaluate the safety, effectiveness, and mechanisms of CAM treatments for PCOS. acupuncture; mindfulness meditation; herbs; dietary supplements; traditional Chinese medicine POLYCYSTIC OVARY SYNDROME (PCOS), a common endocrine disorder that affects 5-10% of reproductive-age women, is characterized by chronic hyperandrogenic anovulation leading to symptoms of hirsutism, acne, irregular menses, and infertility (86). The exact etiology of PCOS remains unclear, but it is believed to result from complex interactions between genetic, behavioral, and environmental factors. Multiple metabolic and cardiovascular risk factors are associated with PCOS, including insulin resistance (IR), obesity, type 2 diabetes (DM-2), hypertension, dyslipidemia, inflammation, and subclinical cardiovascular disease (32,62,63,87,107). Anxiety, depression, and reduced quality of life are also common in PCOS (5,19,45,107).Current treatments for PCOS are only moderately effective at controlling symptoms and preventing complications. In fact, when 648 women w...

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“…Therapies 1 and 3 are widely used. In contrast, although N has been demonstrated to normalize insulin levels in women with PCOS (2)(3)(4), as recently reviewed (5), its effects on ovarian function have not been extensively studied.…”

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confidence: 99%

Metformin, naltrexone, or the combination of prednisolone and antiandrogenic oral contraceptives as first-line therapy in hyperinsulinemic women with polycystic ovary syndrome

Hadziomerovic-Pekic

Wildt

Weiß

et al. 2010

Fertility and Sterility

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The role of the endogenous opioid system in polycystic ovary syndrome

Cited by 48 publications

References 153 publications

Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial

Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial

The physiological basis of complementary and alternative medicines for polycystic ovary syndrome

Metformin, naltrexone, or the combination of prednisolone and antiandrogenic oral contraceptives as first-line therapy in hyperinsulinemic women with polycystic ovary syndrome

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