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- Black Cohosh (Actaea racemosa syn. Cimicifuga racemosa)
- Polycystic Ovarian Syndrome (PCOS)
- Ovulation Induction
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Date:
08-30-2013 | HC# 041352-479
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Re: Black Cohosh Stimulates Ovulation Induction in Women with Polycystic Ovarian Syndrome (PCOS)
Kamel
HH. Role of phyto-oestrogens in ovulation induction in women with polycystic
ovarian syndrome. Eur J Obstet Gynecol
Reprod Biol. May 2013;168(1):60-63.
Polycystic
ovarian syndrome (PCOS) is characterized by hyperandrogenism and polycystic
ovaries, which contribute to menstrual irregularities, hyperinsulinemia, and
long-term metabolic disturbances (e.g., diabetes mellitus, cardiovascular
disease, and dyslipidemia). Occurring in 6.5% of women, PCOS is the most common
cause of endocrinopathy in women of reproductive age, as it impedes the
induction of ovulation. Clomiphene
citrate is a selective estrogen-receptor modulator, and it is a first-line
pharmaceutical treatment to induce ovulation. Clomiphene has numerous adverse
side effects, and ovulation-inducing agents with better side-effect profiles
are needed. Black cohosh (Actaea racemosa
syn. Cimicifuga racemosa) has been
demonstrated to have an estrogen-like effect on the central nervous system, and
therefore may induce ovulation in women with PCOS. Hence, the purpose of this
randomized, controlled study was to evaluate the effect of black cohosh on
ovulation induction, hormonal profile correction, and pregnancy rate in women
with PCOS.
Women
(n = 100) with PCOS were recruited at the Gynaecology Clinic at Minia
University Hospital; Minia, Egypt. Inclusion and exclusion criteria were not
reported. Women were randomly assigned to receive either 40 mg/day of black
cohosh (Klimadynon®; Bionorica SE; Neumarkt i.d.OPf., Germany) for
10 days or 100 mg/day of clomiphene for 5 days.
The
treatments started on the second day of the cycle and were repeated for 3 successive
cycles. Blood was drawn to assess levels of follicle-stimulating hormone (FSH),
luteinizing hormone (LH), and progesterone. Transvaginal ultrasound was
conducted to document the number and size of the growing follicles and
endometrial thickness. Human chorionic gonadotropin (HCG) was given when the
leading follicle reached ≥ 18 mm, at which time intercourse was advised.
At
baseline, both groups were similar in terms of FSH, LH, and the FSH/LH ratio. The
black cohosh group had a significantly greater reduction in the LH level and
FSH/LH ratio (P = 0.007 and P = 0.06, respectively). Also, the black cohosh
group had significantly greater progesterone levels (P = 0.0001) and endometrial
thickness (P = 0.0004). Accordingly, the black cohosh group had a higher pregnancy
rate than the clomiphene group (7 and 4 pregnancies, respectively); however,
the difference was not statistically significant. There were 2 twin pregnancies
in the black cohosh group and 1 twin pregnancy in the clomiphene group; the
difference was not statistically significant. The black cohosh group had 1 case
of abortion and 1 mild case of hyperstimulation. The clomiphene group had no
abortions, 1 mild case of hyperstimulation, and 1 moderate case of
hyperstimulation. This difference in hyperstimulation was not statistically significant
between groups. Additional safety/tolerability parameters were not reported.
The
effect of black cohosh on LH and the LH/FSH ratio indicates that black cohosh induces
the hypothalamus to reduce the release of gonadotropin-releasing hormone (GnRH).
A reduction in LH in women with PCOS is associated with better ovulation and
implantation rates. The authors acknowledge that although black cohosh induced
ovulation in women with PCOS and had fewer adverse effects, additional studies
are needed to determine the optimal dose of black cohosh and to confirm the findings.
In addition, larger studies are needed to detect whether better ovulation is
also associated with a significant difference in the pregnancy rates.
—Heather S. Oliff,
PhD
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