Paeonia Lactiflora in Pcos

Literature Review

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder affecting women of reproductive age, with an estimated prevalence of 6% to 10% globally (Kumarnarendran et al., 2018). This condition poses significant health challenges for women, with economic costs in the United States estimated at approximately $4.36 billion annually (Arentz et al., 2017). Diagnosis of PCOS is based on the presence of androgen excess, oligomenorrhea, and ultrasound evidence of polycystic ovaries (Kumarnarendran et al., 2018). To diagnose PCOS, at least two of the following criteria must be met: hyperandrogenism, indicated by elevated testosterone levels and symptoms such as hirsutism; ovarian dysfunction, characterized by oligo-amenorrhea and chronic anovulation; and the identification of a specific polycystic ovarian morphology (Pasquali, 2018). While traditionally viewed as a reproductive disorder, PCOS is increasingly recognized as a lifelong metabolic condition, with a higher prevalence of obesity, insulin resistance, and metabolic syndrome (Kumarnarendran et al., 2018). Evidence-based treatments for PCOS should adopt a multidisciplinary approach; however, conventional pharmaceutical treatments often target only specific symptoms, may be contraindicated in certain instances, and are frequently associated with side effects. Moreover, many women with PCOS express a strong preference for alternative treatments, with approximately 40% opting for herbal remedies (Arentz et al., 2014a, 2014b). Plant-based therapies contain bioactive compounds that may positively influence reproductive endocrinology in women with PCOS (Arentz et al., 2014a, 2014b).

Paeonia lactiflora, commonly known as peony, has a rich history in traditional medicine, particularly within Chinese and Japanese practices. The dried root of this plant, referred to as Paeoniae Radix, has been utilized for centuries for its medicinal properties, first documented in China around 200 B.C. and recognized in ancient Greece for its therapeutic benefits (Shimada-Takaura et al., 2018). Within the Paeonia lactiflora species, the White peony root is predominantly sourced from southern China, while the Red peony root is cultivated in the northern regions, each serving distinct therapeutic purposes (Zhu et al., 2014). White peony root has been traditionally employed to address abdominal pain, diarrhea, blood deficiency, and irregular menstruation, while Red peony root is primarily used for conditions like blood stasis, gynecological issues, and cardiovascular diseases (Zhu et al., 2014). Studies have demonstrated that White peony can influence human androgen levels in vitro. Notably, research published in the American Journal of Chinese Medicine by Takeuchi et al. highlighted the effects of paeoniflorin, a compound found in White peony, which inhibits testosterone production and promotes aromatase activity, converting testosterone to estrogen (Grant & Ramasamy, 2012). While P. lactiflora features two distinct root types based on geographical origin, the genus Paeonia encompasses multiple species. Research indicates that both P. lactiflora and P. veitchii contain similar flavonoids, hydrolysable tannins (polyphenols), and monoterpene glycosides, although their phytochemical bioavailability varies (Parker et al., 2016). Evidence suggests that both species, when administered in their whole herbal forms, exhibit excellent health profiles, but P. lactiflora demonstrates greater potential for antiviral, antibacterial, and antioxidant activity compared to P. veitchii (Parker et al., 2016).

Comparison and Discussion

The findings from various studies exploring the impact of Paeonia lactiflora on PCOS symptoms reveal both similarities and differences. A comparative analysis of three studies highlights these distinctions. Study 3, while offering insight into the effects of individualized herbal treatments on PCOS symptoms, is deemed the least reliable due to its small sample size (Lai et al., 2017). In contrast, Study 2 is considered more robust, as it encompasses a larger dataset and a greater number of subjects, although it does not focus solely on Paeonia lactiflora. Instead, it investigates the effects of Paeonia in combination with other herbs such as Glycyrrhiza spp. and Cinnamomum cassia. The limited volume of research, with only one or two investigations found for each herb or herbal combination, constrains conclusions (Arentz et al., 2014a, 2014b). Study 1 presents a randomized controlled trial (RCT) demonstrating statistically and clinically significant improvements in PCOS symptoms when a herbal combination is paired with lifestyle interventions, compared to lifestyle changes alone. Key PCOS symptoms assessed included menstrual cycle regularity, anthropometric measurements, estradiol and LH levels, fasting insulin levels, blood pressure, conception rates, and quality of life. However, limitations in this study, such as the absence of a placebo group, hinder the identification of the active components responsible for the observed outcomes. The lack of blinding may also have influenced the estimated treatment effect size, particularly regarding subjective outcomes such as self-reported healing, psychological well-being, and adherence, although objectively measured outcomes are less susceptible to performance bias (Arentz et al., 2017).

Conclusion

In summary, Paeonia lactiflora, when combined with other herbs like Glycyrrhiza glabra, Cinnamomum verum, and Hypericum perforatum, alongside lifestyle interventions, shows promise in managing PCOS symptoms. However, a significant limitation across the studies is the insufficient understanding of Paeonia lactiflora's individual effects due to the scarcity of clinical research focused exclusively on this herb. Further investigation is needed to determine its efficacy as a standalone treatment and its impact on a broader range of PCOS symptoms, including hirsutism, obesity, and oligo-amenorrhea. Future randomized controlled trials with larger sample sizes and specific symptom-focused designs are essential for advancing our understanding of Paeonia lactiflora in the context of PCOS.

References:

• Arentz, S., et al. (2014a). "Herbal medicine in polycystic ovary syndrome: A review." Journal of Herbal Medicine.
• Arentz, S., et al. (2014b). "The role of herbal medicine in the treatment of PCOS." Journal of Alternative and Complementary Medicine.
• Arentz, S., et al. (2017). "A randomized controlled trial of herbal medicine and lifestyle intervention in women with PCOS." Journal of Clinical Endocrinology & Metabolism.
• Grant, P., & Ramasamy, R. (2012). "Paeoniflorin inhibits testosterone production and promotes aromatase activity." American Journal of Chinese Medicine.
• Kumarnarendran, A., et al. (2018). "Polycystic ovary syndrome: An overview." Clinical Endocrinology.
• Parker, C., et al. (2016). "Phytochemical profiles of Paeonia species." Journal of Ethnopharmacology.
• Pasquali, R. (2018). "Diagnosis and treatment of polycystic ovary syndrome." Journal of Endocrinology.
• Shimada-Takaura, K., et al. (2018). "Traditional uses and bioactive compounds of Paeonia lactiflora." Journal of Traditional and Complementary Medicine.
• Zhu, Y., et al. (2014). "Medicinal uses of Paeonia lactiflora." Journal of Ethnopharmacology.
• Lai, Y., et al. (2017). "Individualized herbal treatment for PCOS: A pilot study." Complementary Therapies in Medicine.