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-3α,17β-diol-3-glucuronide, and androstane-3α,17β-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.
Women in the acupuncture group were treated for 30 min twice weekly for 10–13 wk by two therapists educated in Western medical acupuncture. Subjects rested and listened to relaxing music during treatment. The acupuncture protocol was based on a previous study of acupuncture for ovulation induction in PCOS (15), an experimental study (37), and clinical experience. Sterile stainless steel needles (Hegu Xeno, Hegu Svenska; length 30 or 50 mm, diameter 0.30 mm) were inserted to a depth of 15–35 mm at acupuncture points located in abdominal and leg muscles that have innervations corresponding to the ovaries and in acupuncture points that do not innervate the ovaries. Two sets of 11 and 13 acupuncture points were alternated every other treatment due to the intensity of the treatment (Table 1). All needles were rotated manually to evoke needle sensation (de qi) when inserted. Needles in the leg and abdominal muscles were then connected to an electrical stimulator (CEFAR ACUS 4; Cefar-Compex Scandinavia, Landsbro, Sweden) and stimulated with low-frequency (2 Hz) bursts. The intensity was adjusted to produce local muscle contractions without pain or discomfort. Needles not connected to the electrical stimulator were stimulated by manual rotations every 10 min to evoke de qi.
Authors: Julia Johansson,1Leanne Redman,2Paula P. Veldhuis,3Antonina Sazonova,4Fernand Labrie,5,6Göran Holm,7Gudmundur Johannsson,8 and Elisabet Stener-Victorin1,9
Published in Am J Physiol Endocrinol Metab. 2013 May 1; 304(9): E934–E943.