Exploring the role of Chinese herbal medicine in primary care of oligomenorrhoea and amenorrhoea in polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. Oligomenorrhoea and amenorrhoea are cardinal symptoms of PCOS but the effectiveness and acceptability of current conventional treatments for regulating menses remains questionable and other treatments need to be explored. Chinese herbal medicine (CHM) is widely used for PCOS in China and in the UK. This PhD aimed to explore the role of CHM for PCOS-related oligomenorrhoea and amenorrhoea in UK primary care.

I conducted a systematic review and meta-analysis which included 4 methodologically-poor quality randomised controlled trials (RCTs). Preliminary results appear to suggest CHM is likely to be safe, with few adverse effects, and have a potential benefit on testosterone and luteinising hormone. A Delphi study with CHM practitioners was conducted which resulted in 85 items being included within good clinical practice guidelines for CHM treatment of PCOS. These guidelines were used to inform the protocol for an RCT. My initial RCT protocol involved a feasibility study in primary care comparing three treatments: standardised CHM plus usual care, placebo plus usual care and usual care alone. Unfortunately the CHM manufacturer experienced difficulties obtaining documentation in a timely manner, necessitating a protocol revision. A feasibility study was finally conducted in private practices successfully recruiting 40 women who were randomised to either standardised CHM or individualised CHM. Study results suggest both standardised and individualised CHMs are safe and acceptable, and both have similar clinically important benefits on menstrual status in PCOS.

My findings suggest further research into CHM for PCOS-related oligo-and amenorrhoea is warranted. I have demonstrated that rigorous CHM RCT evidence can benefit by consulting CHM practitioners to maximise model validity. Clinical data from the feasibility study provides effect size estimates and pilot data that will facilitate planning for a larger-scale definitive study.

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ORCID for Michael Moore: orcid.org/0000-0002-5127-4509

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