A review on Iranian Traditional Medicine about Leech Therapy in Polycystic Ovary Syndrome

Document Type : Review Article


1 Ph.D of Traditional Medicine, School of Traditional Medicine, Qom University of Medical Sciences, Qom, Iran.

2 Assistant Professor, Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.


Introduction: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Complementary medicine with a comprehensive and holistic approach in treating the diseases has become more popular in many countries. Since ancient times, leech therapy has been used to treat many diseases in Iranian traditional medicine. The present study was conducted with aim to review Iranian traditional medicine about leech therapy in polycystic ovary syndrome.
Methods: In this review study, the issues related to polycystic ovary syndrome and leech therapy were studied in Iranian traditional medicine sources such as Qanun, kholasat al-hekmeh, Exir-e-aazam and Mofarrah al-gholub. Then, searching was performed in databases of PubMed, Google Scholar, Scopus, SID, and Magiran using the keywords such as “leech”, “leech therapy”, “Hirudo medicinalis”, “Hirudins” with “polycystic ovary syndrome”, “uterus”, and “oligoamenorrhea”. The review papers and clinical trial studies were searched in Persian and English languages without any time limitation, and the related materials were extracted and categorized.
Results: The symptoms of PCOS such as the enlargement and stiffness of the ovaries and oligoamenorrhea were reported in ITM references entitled as “Ehtebas tams”. Leech therapy is useful in treatment of these patients by reducing the ovarian swelling, causing menstruation, eliminating waste material, as well as antioxidant and anti-inflammatory effects.
Conclusion: Leech therapy can be used as a complementary treatment in patients with polycystic ovarian syndrome.


  1. Tehrani HG, Mostajeran F, Shahsavari S. The effect of calcium and vitamin D supplementation on menstrual cycle, body mass index and hyperandrogenism state of women with poly cystic ovarian syndrome. J Res Med Sci 2014; 19(9):875-80.
  2. Franks S, Kiddy DS, Hamilton-Fairley D, Bush A, Sharp PS, Reed MJ. The role of nutrition and insulin in the regulation of sex hormone binding globulin. J Steroid Biochem Mol Biol 1991; 39(5B):835-8.
  3. Genazzani AD, Ricchieri F, Lanzoni C. Use of metformin in the treatment of polycystic ovary syndrome. Womens Health 2010; 6(4):577-93.
  4. Novak E. Berek & Novak's gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. P. 1080-6.
  5. Cooper EL, Mologne N. Exploiting leech saliva to treat osteoarthritis: a provocative perspective. J Tradit Complement Med 2017; 7(3):367-9.
  6. Azam Khan M, Aksir A. The institute of medical history-Islamic and complementary medicine. 2nd ed. Tehran, Iran: Iran University of Medical Sciences; 2004. P. 8.
  7. Heidari M, Valipoor-Dehkordi S. Hirudo medicinalis in coagulopathies and cardiovascular diseases. Cardiovasc Nurs J 2016; 5(2):54-65.
  8. Sig AK, Guney M, Uskudar Guclu A, Ozmen E. Medicinal leech therapy-an overall perspective. Integr Med Res 2017; 6(4):337-43.
  9. Abdullah S, Dar LM, Rashid A, Tewari A. Hirudotherapy/leech therapy: applications and indications in surgery. Arch Clin Exp Surg 2012; 1(3):172-80.
  10. Pandyal K, Jalpa J. Jalauka (leech)…the para surgical instrument. World J Pharm Life Sci 2018; 4(6):79-86.
  11. Pan SY, Gao SH, Zhou SF, Tang MK, Yu ZL, Ko KM. New perspectives on complementary and alternative medicine: an overview and alternative therapy. Altern Ther Health Med 2012; 18(4):20-36.
  12. Liu C, Barkley TW Jr. Medicinal leech therapy: new life for an ancient treatment. Nursing 2015; 45(11):25-30.
  13. Lone AH, Ahmad T, Anwar M, Habib S, Sofi G, Imam H. Leech therapy- a holistic approach of treatment in unani (greeko-arab) medicine. Anc Sci Life 2011; 31(1):31-5.
  14. Aghili Khorasani M. Kholasat-alhekmeh. 1st ed. Qom: Ismaillian; 2006. P. 461.
  15. Shamseddin A. Khazaen al-moluk. Tehran: Tehran Univercity of Medical Sciences; 2008. P. 330.
  16. Chaghmini M. Mofarrah al-gholub. 1st ed. Lahor: Motabaat al Eslamiyat Publication; 2010. P. 474.
  17. Barzegar A, Azizi A, Faridi P, Mohagheghzadeh A. Complement Med Res 2015; 22(1):50-3.
  18. Das BK. An overview on hirudotherapy/leech therapy. Ind Res J Pharm Sci 2014; 1(1):33-45.
  19. Stokoz KY, Bystritskaya T. Leech therapy in women with a history of primary oligomenorrhea. Amur Med J 2016; 3-4:106-8.
  20. Macias D, Kwon DI, Walker PC, Peterson NR. Microvascular replantation of a composite facial avulsion in a 24-month-old child after dog bite. Microsurgery 2018; 38(2):218-21.
  21. Joslin J, Biondich A, Walker K, Zanghi N. A comprehensive review of hirudiniasis: from historic uses of leeches to modern treatments of their bites. Wilderness Environ Med 2017; 28(4):355-61.
  22. Rahnema M. The effect of medicinal leech therapy on brain edema and neurological deficits in rat stroke model. J Zabol Univ Med Sci Health Serv 2015; 7(3):1-9.
  23. Kotick JD, Taghinia A. Prolonged bleeding after a single leech application in pediatric hand surgery. J Hand Microsurg 2017; 9(2):98-100.
  24. Fritz MA, Speroff L. Clinical gynecologyic endocrinology and infertility. 8th ed. Philadelphia: Lippincot Willims & Wikins & Wolters Kluwer; 2011. P. 501.
  25. Nagarathna P, Rajan PR, Koneri R. A detailed study on poly cystic ovarian syndrome and it’s treatment with natural products. Int J Toxicol Pharmacol Res 2014; 5(4):109-20.
  26. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89(6):2745-9.
  27. Chen X, Yang D, Li L, Feng S, Wang L. Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome. Hum Reprod 2006; 21(8):2027-32.
  28. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013; 6:1-13.
  29. Ma X, Fan L, Meng Y, Hou Z, Mao YD, Wang W, et al. Proteomic analysis of human ovaries from normal and polycystic ovarian syndrome. Mol Hum Reprod 2007; 13(8):527-35.
  30. Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004; 18(5):671-83.
  31. Danforth DN. Danforth's obstetrics and gynecology. Philadelphia: Lippincott Williams & Wilkins; 2008. P. 655.
  32. Johnson NP. Metformin use in women with polycystic ovary syndrome. Ann Transl Med 2014; 2(6):56.
  33. Saleh WA, Burlanan RT, Zacur HA, Kimball AW, Kwiterovich P, Bell WK. A randomized trial of three oral contraceptives: comparison of bleeding patterns by contraceptive types and steroid levels. Am J Obstet Gynecol 1993; 168(6):1740-5.
  34. Cardigno P. Homeopathy for the treatment of menstrual irregularities: a case series. Homeopathy 2009; 98(2):97-106.
  35. Bieniasz J, Zak T, Laskowska-Zietek A, Noczynska A. Causes of menstrual disorders in adolescent girls--a retrospective study. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2006; 12(3):205-10.
  36. Falahat F, Tavakkoli M, Mokaberinejad R, Ayati S, Feyzabadi Z. Natural treatments of oligomenorrhea based on persian medicine. Iran J Obstet Gynecol Infertil 2018; 21(Supple):55-66. (Persian).
  37. Zafarghandi N, Jafari F, Moradi F, Alizadeh F, Karimi M, Alizadeh M. Frequency of positive symptoms of dystemperament in patients with excess uterine hemorrhage from the Iranian medicine perspective. Iran J Obstet Gynecol Infertil 2012; 15(24):8-16. (Persian).
  38. Avicenna AH. Qanun fi-Tibb. 1st ed. Beirut: Dar Ehia Al-Tourath Al-Arabi; 2005. P. 469-74.
  39. Meyari A, Tansaz M, Yavari M, Bahman M, Memarzadeh Zavareh H, Nabi Meybodi R, et al. Nutritional recommendations for patients with uterine discharge in Iranian traditional medicine. Iran J Obstet Gynecol Infertil 2017; 20(Suppl):68-77. (Persian).
  40. Bahman M. Comparison of the effect of a product from Traditional medicine with Metformin on oligomenorrhea in polycystic ovary syndrome. Tehran: Shahid Beheshti University of Medical Science; 2017. (Persian).
  41. Arani MT, Bioos S, Tansaz M, Mokaberinejad R, Dehkordi EJ, Akhtari E, et al. Uterus complications of amenorrhea and oligomenorrhea (Ehteebas Tams) in Iranian traditional medicine. Med Hist J 2012; 4(12):125-38. (Persian).
  42. Yavari M, Shirooye P, Nabi Meybodi R, Meyari A, Bahman M, Memarzadeh Zavareh H, et al. Treatment approach to leucorrhea in traditional Iranian medicine and conventional medicine. Iran J Obstet Gynecol Infertil 2016; 19(30):26-36. (Persian).
  43. Majusi A. Kamil al- sanaae al- tibbiya. 1st ed. Egypt: Dar Rekaby; 2009. P. 158.
  44. Ali Zareian M, Hafizi S, Faryabi R, Tabarraei M. Review on invasive and semi-invasive procedures to treat abnormal uterine bleeding in Iranian traditional medicine. Iran J Obstet Gynecol Infertil 2017; 20:46-55. (Persian).
  45. Chashti M. Exir-e-aazam. 2nd ed. Tehran: The Institute for Medical History-Islamic and Complementary Medicine, Tehran University of Medical Sciences; 2004. P. 692-9. (Persian).
  46. Kermani HM. Daghaegh-Alalaj (Minutes of treatment). 1st ed. Kerman: Saadat; 1983. P. 469.
  47. Avicenna AH. Qanun fi-Tibb. 1st ed. Beirut: Dar Ehia Al-Tourath Al-Arabi; 2005. P. 171.
  48. Arzani H. Tibb akbari. 1st ed. Qom: Jalal al-Din; 2008. P. 910.
  49. Mohammadbygi R, Yousefi SR, Shahghaybi S, Zandi S, Sharifi K, Gharibi F. Effects of Cabergoline administration on uterine perfusion in women with polycystic ovary syndrome. Pak J Med Sci 2013; 29(4):919-22.
  50. Buote NJ. The use of medical leeches for venous congestion. A review and case report. Vet Comp Orthop Traumatol 2014; 27(3):173-8.
  51. Kravariti M, Naka KK, Kalantaridou SN, Kazakos N, Katsouras CS, Makrigiannakis A, et al. Predictors of endothelial dysfunction in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(9):5088-95.
  52. Dong H, Ren JX, Wang JJ, Ding LS, Zhao JJ, Liu SY, et al. Chinese medicinal leech: ethnopharmacology, phytochemistry, and pharmacological activities. Evid Based Complement Alternat Med 2016; 2016:7895935.
  53. Velazquez EM, Mendoza SG, Wang P, Glueck CJ. Metformin therapy is associated with a decrease in plasma plasminogen activator inhibitor-1, lipoprotein(a), and immunoreactive insulin levels in patients with the polycystic ovary syndrome. Metabolism 1997; 46(4):454-7.
  54. Diamanti-Kandarakis E, Spina G, Kouli C, Migdalis I. Increased endothelin-1 levels in women with polycystic ovary syndrome and the beneficial effect of metformin therapy. J Clin Endocrinol Metab 2001; 86(10):4666-73.
  55. Orio F Jr, Palomba S, Cascella T, Di Biase S, Manguso F, Tauchmanova L, et al. The increase of leukocytes as a new putative marker of low-grade chronic inflammation and early cardiovascular risk in polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(1):2-5.
  56. Yildiz BO, Haznedaroglu IC, Kirazli S, Bayraktar M. Global fibrinolytic capacity is decreased in polycystic ovary syndrome, suggesting a prothrombotic state. J Clin Endocrinol Metab 2002; 87(8):3871-5.
  57. Manneras-Holm L, Baghaei F, Holm G, Janson PO, Ohlsson C, Lonn M, et al. Coagulation and fibrinolytic disturbances in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96(4):1068-76.
  58. Markwardt F. Historical perspective of the development of thrombin inhibitors. Pathophysiol Haemost Thromb 2002; 32(Suppl 3):15-22.
  59. Harsfalvi J, Stassen JM, Hoylaerts MF, Van Houtte E, Sawyer RT, Vermylen J, et al. Calin from Hirudo medicinalis, an inhibitor of von Willebrand factor binding to collagen under static and flow conditions. Blood 1995; 85(3):705-11.
  60. Chopin V, Salzet M, Baert J, Vandenbulcke F, Sautiere PE, Kerckaert JP, et al. Therostasin, a novel clotting factor Xa inhibitor from the rhynchobdellid leech, Theromyzon tessulatum. J Biol Chem 2000; 275(42):32701-7.
  61. Salzet M. Anticoagulants and inhibitors of platelet aggregation derived from leeches. FEBS Lett 2001; 492(3):187-92.
  62. Seymour JL, Henzel WJ, Nevins B, Stults JT, Lazarus RA. Decorsin. A potent glycoprotein IIb-IIIa antagonist and platelet aggregation inhibitor from the leech Macrobdella decora. J Biol Chem 1990; 265(17):10143-7.
  63. Corral-Rodriguez MA, Macedo-Ribeiro S, Pereira PJ, Fuentes-Prior P. Leech-derived thrombin inhibitors: from structures to mechanisms to clinical applications. J Med Chem 2010; 53(10):3847-61.