The role of herbal medicines in the treatment of polycystic ovary syndrome in animal studies: A narrative review study

Document Type : Review Article


1 Assistant professor, Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

2 M.Sc. of Midwifery, School of Nursing and Midwifery, Kerman Azad University, Kerman, Iran.

3 Assistant professor, Department of Midwifery, School of Nursing and Midwifery, Neyshabour University of Medical Sciences, Neyshabour, Iran.

4 Instructor, Department of Midwifery, Social Research and Health Promotion Research Center, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.

5 PhD student in Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. M.Sc. of Midwifery and Reproductive Health, School of Nursing and Midwifery, Yazd University of Medical Sciences, Yazd, Iran.

6 PhD student in Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.


Introduction: Polycystic ovary syndrome is the most common endocrine disorder among women of childbearing age and the most common cause of infertility due to anovulation. To treat the side effects of this disease, a wide range of chemical drugs are prescribed. Today, due to the effectiveness of herbal medicines and their low side effects, the tendency to use herbal medicines has increased. This study was performed with aim to determine the role of herbal medicines in polycystic ovary syndrome in animal studies.
Methods: In this review study, the databases of Web of Science, Google Scholar, ScienceDirect, Scopus, PubMed, ProQuest, and EMBASE were searched using Persian and English keywords of polycystic ovary syndrome, medicinal herbs, systematic review, traditional medicine, clinical trial, case control, and female infertility in the period of 1990-2020. Initially, 875 articles were found, and finally, 38 articles which were in accordance with the objectives of the study were fully evaluated, and among them, 14 related articles were included in the study, and were reviewed.
Results: According to the results, several herbal medicines such as five-fingered plant, fennel, black cumin, chicory, licorice, yellow aloe, mountain tea, green tea, grape seed, black seed, and Caligum comosum can be effective in treatment of many problems caused by polycystic ovary syndrome.
Conclusion: The use of medicinal herbs with antioxidant, anti-inflammatory and hormonal balance can be used as a substitute or supplement for chemical drugs effective in polycystic ovary syndrome and a major factor in the treatment or reduction of complications of polycystic ovary syndrome.


  1. McGowan MP. Polycystic ovary syndrome: a common endocrine disorder and risk factor for vascular disease. Current treatment options in cardiovascular medicine 2011; 13(4):289-301.
  2. El Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Poly cystic ovarian syndrome: an updated overview. Frontiers in physiology 2016; 7:124.
  3. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology 2014; 6:1.
  4. Hashemian Z, Afsharian P. Role of Oxidative Stress in Polycystic Ovary Syndrome. SSU_Journals 2020; 28(5):2635-47.
  5. Chen Y, Zhang D. Optimal Ovulation Induction in Polycystic Ovary Syndrome Resistant to Clomiphene Citrate or Letrozole. Sichuan da xue xue bao. Yi xue ban= Journal of Sichuan University. Medical science edition 2016; 47(6):874-7.
  6. Khodarahmi SE, Eidi A, Mortazavi P. Effect of Green Tea Extract (Camellia sinensis) on Levels of Sex Hormones in Letrozole-Induced Polycystic Ovary Syndrome (PCOS) in Adult Female Wistar Rats. Journal of Animal Physiology and Development (Quarterly Journal of Biological Sciences) 2020; 13(49):51-59.
  7. Pahlevani P, Mosavi SM, Rastgoo Haghi AR, Lahotian H, Esna Ashari F, Alizadeh Z. Study of the effects of stachys lvandulifolia alcoholic extract on histomorphometry of endometrium in polycystic ovarian syndrome rat model. Avicenna Journal of Clinical Medicine 2016; 23(1):40-8.
  8. Zhang Y, Hu M, Meng F, Sun X, Xu H, Zhang J, et al. Metformin ameliorates uterine defects in a rat model of polycystic ovary syndrome. EBioMedicine 2017; 18:157-70.
  9. Horn LC, Schnurrbusch U, Bilek K, Hentschel B, Einenkel J. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14(2):348-53.
  10. Mohammadi B, Hashemi Asl E, Aliakbari F, Saghaei E, Deris F. The Effects of an Herbal Mixture on the Clinical Symptoms of Women with Polycystic Ovary Syndrome. Journal of Clinical Nursing and Midwifery 2020; 9(1):574-81.
  11. Jelodar GH, Askari K. Effect of hydroalcoholic extract of Vitex agnus-castus fruit on fertility and estrous cycle in letrozole-induced polycystic ovary (PCOS) in rat. Razi Journal of Medical Sciences 2017; 24(156):42-8.
  12. Askari K. Effect of hydroalcoholic extract of Vitex agnus-castus fruit on fertility and estrous cycle in letrozole-induced polycystic ovary (PCOS) in rat. Razi Journal of Medical Sciences 2017; 24(156):42-8.
  13. Shahverdi SA, ZIA JN, Ruhi L. Evaluation of Anti-Inflammatory Effect of Chicory Extract on Inflammatory Factors of Interleukin 8 and TNFα in Rats with Polycystic Ovary Syndrome. J Fasa Univ Med Sci 2020; 10(2):2387-95.
  14. Sadoghi SD, Rahbariyan R. Investigation the effect of glycyrrhizic acid on ovarian follicle in polycystic ovarian syndrome mice model. Scientific journal of Ilam University of medical sciences 2017; 24(6):138-48.
  15. Hemayatkhah-Jahromi V, Rahmanian-Koushkaki M. Effect of hydro-alcoholic extract of Aloe vera L. on polycystic ovary syndrome in rat. KAUMS Journal (FEYZ) 2016; 20(3):221-7.
  16. Montazeri H, Safavi M, Ebrahim-Habibi A, Yaghmaei P. The Effects of Betanin of Beetroot in Polycystic Ovary Syndrome Induced Rat. Journal of Medicinal Plants 2018; 17(68):74-81.
  17. Shamsi M, Nejati V, Najafi G. Therapeutic effects of Licorice extract on in vitro maturation and in vitro fertilization in Mice model of polycystic ovary syndrome. Journal of Mazandaran University of Medical Sciences 2016; 25(132):113-21.
  18. Amini L, Tehranian N, Movahedin M, Ramezani Tehrani F. Effect of Calligonum Comosum on Ovarian Histology of Polycystic Ovary Mouse Model. Journal of Medicinal Plants 2015; 14(56):115-22.
  19. Karampoor P, Azarnia M, Mirabolghasemi G, Alizadeh F. The effect of hydroalcoholic extract of fennel (foeniculum vulgare) seed on serum levels of sexual hormones in female wistar rats with polycystic ovarian syndrome (PCOS). Journal of Arak University of Medical Sciences 2014; 17(5):70-8.
  20. Sadoughi SD, Rahbarian R. Comparing the effect of aqueous extract of green tea and catechin on gonadotropins, β-estradiol, Progesterone, testosterone and ovarian follicle in polycystic ovarian syndrome rat model. Journal of Birjand University of Medical Sciences 2017; 24:62-74.
  21. Mohseni KH, Parivar K, Salmabadi Z. Effect of hydroalcoholic grape seed extract (Vitis vinifera L.) on polycystic ovarian syndrome in female Wistar rat. Journal of Cell & Tissue 2015; 6(2):153-164
  22. Naseran S, Mokhtari M, Abedinzade M, Shariati M. Evaluation of the Effect of Nigella Sativa Hydro-alcoholic Extract and Honey on Gonadotropins and Sex Hormones Level in the Polycystic Ovarian Syndrome Model of Wistar Rat. Scientific Journal of Kurdistan University of Medical Sciences 2020; 25(1):117-29.
  23. Newall CA, Anderson LA, Phillipson JD. Herbal medicines. A guide for health-care professionals. The pharmaceutical press; 1996.
  24. Russo M, Galletti GC. Medicinal properties and chemical composition of Vitex agnus-castus L.: a review. InInternational Symposium on Medicinal and Aromatic Plants 426 1995:105-12.
  25. Webster DE, Lu J, Chen SN, Farnsworth NR, Wang ZJ. Activation of the μ-opiate receptor by Vitex agnus-castus methanol extracts: implication for its use in PMS. Journal of ethnopharmacology 2006; 106(2):216-21.
  26. Gerhard I, Patek A, Monga B, Blank A, Gorkow C. Mastodynon® bei weiblicher Sterilität. Complementary Medicine Research 1998; 5(6):272-8.
  27. Shahani S, Zakeri N, Hamzkanlu N, Hosseinimehr SJ. The Protective Effects of Cichorium intybus L. seed Extract against Cell Toxicity Induced by Bleomycin on Human Non-malignant Fibroblast and Ovarian Cancer Cells. Journal of Mazandaran University of Medical Sciences 2015; 24(121):39-47.
  28. Süntar I, Akkol EK, Keles H, Yesilada E, Sarker SD, Baykal T. Comparative evaluation of traditional prescriptions from Cichorium intybus L. for wound healing: stepwise isolation of an active component by in vivo bioassay and its mode of activity. Journal of ethnopharmacology 2012; 143(1):299-309.
  29. Malarz J, Stojakowska A, Kisiel W. Long-term cultured hairy roots of chicory—a rich source of hydroxycinnamates and 8-deoxylactucin glucoside. Applied biochemistry and biotechnology 2013; 171(7):1589-601.
  30. Gandía-Herrero F, García-Carmona F. Biosynthesis of betalains: yellow and violet plant pigments. Trends in plant science 2013; 18(6):334-43.
  31. Khan MI, Giridhar P. Plant betalains: Chemistry and biochemistry. Phytochemistry 2015; 117:267-95.
  32. Gandía-Herrero F, Cabanes J, Escribano J, García-Carmona F, Jiménez-Atiénzar M. Encapsulation of the most potent antioxidant betalains in edible matrixes as powders of different colors. Journal of agricultural and food chemistry 2013; 61(18):4294-302.
  33. Dhananjayan I, Kathiroli S, Subramani S, Veerasamy V. Ameliorating effect of betanin, a natural chromoalkaloid by modulating hepatic carbohydrate metabolic enzyme activities and glycogen content in streptozotocin–nicotinamide induced experimental rats. Biomedicine & Pharmacotherapy 2017; 88:1069-79.
  34. Kapadia G, A Azuine M, Subba Rao G, Arai T, Iida A, Tokuda H. Cytotoxic effect of the red beetroot (Beta vulgaris L.) extract compared to doxorubicin (Adriamycin) in the human prostate (PC-3) and breast (MCF-7) cancer cell lines. Anti-Cancer Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry-Anti-Cancer Agents) 2011; 11(3):280-4.
  35. Sutariya B, Saraf M. Betanin, isolated from fruits of Opuntia elatior Mill attenuates renal fibrosis in diabetic rats through regulating oxidative stress and TGF-β pathway. Journal of ethnopharmacology 2017; 198:432-43.
  36. Khan MI. Stabilization of betalains: A review. Food Chemistry 2016; 197:1280-5.
  37. Janiszewska E. Microencapsulated beetroot juice as a potential source of betalain. Powder Technology 2014; 264:190-6.
  38. Biasibetti R, Tramontina AC, Costa AP, Dutra MF, Quincozes-Santos A, Nardin P, et al. Green tea (−) epigallocatechin-3-gallate reverses oxidative stress and reduces acetylcholinesterase activity in a streptozotocin-induced model of dementia. Behavioural brain research 2013; 236:186-93.
  39. Etus V, Altug T, Belce A, Ceylan S. Green tea polyphenol (−)-epigallocatechin gallate prevents oxidative damage on periventricular white matter of infantile rats with hydrocephalus. The Tohoku journal of experimental medicine 2003; 200(4):203-9.
  40. Rezai-Zadeh K, Shytle D, Sun N, Mori T, Hou H, Jeanniton D, et al. Green tea epigallocatechin-3-gallate (EGCG) modulates amyloid precursor protein cleavage and reduces cerebral amyloidosis in Alzheimer transgenic mice. Journal of Neuroscience 2005; 25(38):8807-14.
  41. Shariatzadeh MA, Mohammadi M. Protective role of green tea (Camellia sinensis) hydroalcholic extract on sperm parameters and testicular tissue in NMRI mice exposed to sodium arsenite. Journal of Birjand University of Medical Sciences 2015; 21(4):432-43.
  42. Spadiene A, Savickiene N, Ivanauskas L, Jakstas V, Skesters A, Silova A, et al. Antioxidant effects of Camellia sinensis L. extract in patients with type 2 diabetes. Journal of food and drug analysis 2014; 22(4):505-11.
  43. Choi SJ, Park SY, Park JS, Park SK, Jung MY. Contents and compositions of policosanols in green tea (Camellia sinensis) leaves. Food chemistry 2016; 204:94-101.
  44. Chokor R, Lamy S, Annabi B. Transcriptional targeting of sphingosine-1-phosphate receptor S1P2 by epigallocatechin-3-gallate prevents sphingosine-1-phosphate-mediated signaling in macrophage-differentiated HL-60 promyelomonocytic leukemia cells. OncoTargets and therapy 2014; 7:667-77.
  45. Basu A, Betts NM, Mulugeta A, Tong C, Newman E, Lyons TJ. Green tea supplementation increases glutathione and plasma antioxidant capacity in adults with the metabolic syndrome. Nutrition Research 2013; 33(3):180-7.
  46. Thielecke F, Boschmann M. The potential role of green tea catechins in the prevention of the metabolic syndrome–a review. Phytochemistry 2009; 70(1):11-24.
  47. Banitalebi E, Razavi T, Norian M, Bagheri L. The effect of combined aerobic exercise training and green tea extract on serum TNF-α and IL-6 levels in obese women with type 2 diabetes. Daneshvar Med 2016; 23(123):11-20.
  48. Khorsandi LS, Javadnia F, Orazizadeh M, Abdolahi M. Effect of green tea (Camellia sinensis L.) extract on acetaminophen induced acute hepatotoxicity in mice. Iranian Journal of Medicinal and Aromatic Plants 2010; 26(1):22-9.
  49. Morshedi M, Khaleghi M, Azarmi M, Mohammadzadeh A, Gol A. The effect of green tea on serum concentrations of estrogen, progesterone and gonadotropins in female rats. Journal of Advances in Medical and Biomedical Research 2016; 24(102):69-78.
  50. Najafi Ashtiani A, Lebaschi MH. Evaluation the Seed Yield of Fennel (Foeniculum vulgare Mill.) in Different Orients Slopes of Damavand Region. Iranian Journal of Medicinal and Aromatic Plants Research 2006; 22(1):17-21.
  51. Moura LS, Carvalho Jr RN, Stefanini MB, Ming LC, Meireles MA. Supercritical fluid extraction from fennel (Foeniculum vulgare): global yield, composition and kinetic data. The Journal of supercritical fluids 2005; 35(3):212-9.
  52. Ostad SN, Soodi M, Shariffzadeh M, Khorshidi N, Marzban H. The effect of fennel essential oil on uterine contraction as a model for dysmenorrhea, pharmacology and toxicology study. Journal of ethnopharmacology 2001; 76(3):299-304.
  53. Haghirossadat F, Bernard F, Kalantar M, Sheikhha MH, Hokmollahi F, Azimzadeh M, et al. Bunium persicum (Black Caraway) of Yazd province: chemical assessment and Evaluation of its antioxidant effects. SSU_Journals 2010; 18(3):284-91.
  54. Salarinia Z, Eidi A, Zarringhalam J. Effects of Bonium persicum B. Fedtsch fruit ethanolic extract on morphine tolerance and dependence in adult male NMRI mice. Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch 2015; 25(3):190-7.
  55. Dana N, Haghjoy Javanmardi SH, Asgari S, Asnaashari H, Abdian N. Anti-atherosclerosis effects os Aloe vera gel on rabbit hypercholesterolemia. J Babol Univ Med Sci 2012: 37-44.
  56. Ahmadi R, Tavakoli P, Mafi M. The combined effect of Aloe vera extract and immobilization stress on serum levels of LH, FSH and testosterone in male rats. Bimonthly J Med Daneshvar/University shahed 2012; 19:98.
  57. Erfanimajd N, Bahrami M, Morovati H. Study the protective effect of Aloe vera and histometrical testicular histopathological changes induced diabetic rats. J Iran Veterinary 2013; 9(2):78-88.
  58. Saks Y, Barkai-Golan R. Aloe Vera gel activity against plant pathogenic fungi. Postharvest Biology and Technology 1995; 6(1-2):159-65.
  59. Barkai-Golan R, Phillips DJ. Postharvest heat treatment of fresh fruits and vegetables for decay control. Plant Disease 1991; 75(11):1085-9.
  60. Barmak MJ, Khaksar Z, Sharifi A, Mahmoudi R, Yasuj I. Effect of aloe vera extract on ovaries development in during gestational age of 18 day embryo of diabetic rats. Life Science Journal 2013; 10(2s).
  61. Ayubi A, Omidi A, Valizade R, Mosaee A. Compare the effect of Aloe vera extract and Teucrium polium lipid metabolism in streptozotocin-induced diabetic rats. J Birjand Univ Med Sci 2013; 20(2):144-52.
  62. Jalilian N, Modarresi M, Rezaie M, Ghaderi L, Bozorgmanesh M. Phytotherapeutic management of polycystic ovary syndrome: role of aerial parts of wood betony (Stachys lavandulifolia). Phytotherapy Research 2013; 27(11):1708-13.
  63. Jafarzadeh L, Asgari A, Golshan-Iranpoor F, Kheiri S, Parvin N, Rafieian M, et al. Abortificient effects of Stachys lavandulifolia Vahl in mice. Journal of Shahrekord University of Medical Sciences 2010; 11(4):26-31.
  64. Mirabi P, Alamolhoda SH, Esmaeilzadeh S, Mojab F. Effect of medicinal herbs on primary dysmenorrhoea-a systematic review. Iranian journal of pharmaceutical research: IJPR 2014; 13(3):757.
  65. Oner G, Ozcelik B, Ozgun MT, Serin IS, Ozturk F, Basbug M. The effects of metformin and letrozole on endometriosis and comparison of the two treatment agents in a rat model. Human reproduction 2010; 25(4):932-7.
  66. Hertog MG, Hollman PC, Katan MB. Content of potentially anticarcinogenic flavonoids of 28 vegetables and 9 fruits commonly consumed in the Netherlands. Journal of agricultural and food chemistry 1992; 40(12):2379-83.
  67. Morteza‐Semnani K, Akbarzadeh M, Changizi S. Essential oils composition of Stachys byzantina, S. inflata, S. lavandulifolia and S. laxa from Iran. Flavour and fragrance journal 2006; 21(2):300-3.
  68. Le Bail JC, Varnat F, Nicolas JC, Habrioux G. Estrogenic and antiproliferative activities on MCF-7 human breast cancer cells by flavonoids. Cancer letters 1998; 130(1-2):209-16.
  69. Arora P, Ansari SH, Nazish I. Bio-functional aspects of grape seeds-a review. International Journal of Phytomedicine 2010; 2(3):177-85.
  70. Ziaei T, Moharreri N, Hosseinzadeh H. Review of pharmacological and toxicological effects of Nigella sativa and its active constituents. Journal of Medicinal Plants 2012; 11(42):16-42.
  71. Buriro MA, Tayyab M. Effect of Nigella sativa on lipid profile in albino rats. Gomal journal of medical sciences 2007; 5(1):28-31.
  72. Kamarzaman S, Shaban M, Abdul Rahman S. The prophylactic effect of Nigella Sativa against cyclophosphamide in the ovarian follicles of matured adult mice: A preliminary study. J Anim Plant Sci 2014; 24:81-8.
  73. Marotti M, Piccaglia R. The Influence of Distillation Conditions on the Essential Oil Composition of Three Varieties of Foeniculum vulgare Mill. Journal of Essential Oil Research 1992; 4(6):569-76.
  74. Sugano M, Kamao F, Ikeda I, Morik H. Lipid-Lowering of phytostands in rats. Atherosclerosis 1976; 24:301-39.
  75. Pathak V, Shirota O, Sekita S, Hirayama Y, Hakamata Y, Hayashi T, et al. Antiandrogenic phenolic constituents from Dalbergia cochinchinensis. Phytochemistry 1997; 46(7):1219-23.
  76. Marx TL, Mehta AE. Polycystic ovary syndrome: pathogenesis and treatment over the short and long term. Cleveland Clinic journal of medicine 2003; 70(1):31-45.
  77.  Telefo PB, Moundipa PF, Tchouanguep FM. Inductive effect of the leaf mixture extract of Aloe buettneri, Justicia insularis, Dicliptera verticillata and Hibiscus macranthus on in vitro production of estradiol. Journal of ethnopharmacology 2004; 91(2-3):225-30.
  78. Borrione P, Di Luigi L, Maffulli N, Pigozzi F. Herbal supplements: cause for concern?. Journal of sports science & medicine 2008; 7(4):562-64.
  79. Homburg R, Ray A, Bhide P, Gudi A, Shah A, Timms P, et al. The relationship of serum anti-Mullerian hormone with polycystic ovarian morphology and polycystic ovary syndrome: a prospective cohort study. Human Reproduction 2013; 28(4):1077-83.
  80. Tahmasebi F, Movahedin M, Mazaheri Z. Preventive effects of Calligonum Comosum on polycystic ovary model mouse (Doctoral dissertation, MSc thesis 2015).
  81. Aly AM, Al-Alousi L, Salem HA. Licorice: a possible anti-inflammatory and anti-ulcer drug. Aaps Pharmscitech 2005; 6(1):E74-82.
  82. Armanini D, Mattarello MJ, Fiore C, Bonanni G, Scaroni C, Sartorato P, et al. Licorice reduces serum testosterone in healthy women. Steroids 2004; 69(11-12):763-6.
  83. Abel-Salam BK. Immunomodulatory effects of black seeds and garlic on alloxan-induced diabetes in albino rat. Allergologia et immunopathologia 2012; 40(6):336-40.
  84. Armanini D, Fiore C, Mattarello MJ, Bielenberg J, Palermo M. History of the endocrine effects of licorice. Experimental and clinical endocrinology & diabetes 2002; 110(06):257-61.
  85. Sun BY, Zhang B, Lin ZJ, Li LY, Wang HP, Zhou J. Chicory extract's influence on gut bacteria of abdominal obesity rat. Zhongguo Zhong yao za zhi= Zhongguo zhongyao zazhi= China journal of Chinese materia medica 2014; 39(11):2081-5.
  86. Judžentienė A, Būdienė J. Volatile constituents from aerial parts and roots of Cichorium intybus L.(chicory) grown in Lithuania. Chemija 2008; 19(2):25-28.
  87. Hahn S, Janssen OE, Tan S, Pleger K, Mann K, Schedlowski M, et al. Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome. European Journal of Endocrinology 2005; 153(6):853-60.
  88. Wong DH, Villanueva JA, Cress AB, Duleba AJ. Effects of resveratrol on proliferation and apoptosis in rat ovarian theca-interstitial cells. Molecular human reproduction 2010; 16(4):251-9.
  89. Armanini D, Castello R, Scaroni C, Bonanni G, Faccini G, Pellati D, et al. Treatment of polycystic ovary syndrome with spironolactone plus licorice. European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 131(1):61-7.
  90. Dumesic DA, Padmanabhan V, Abbott DH. Polycystic ovary syndrome and oocyte developmental competence. Obstetrical & gynecological survey 2008; 63(1):39-48.
  91. Senanayake SN. Green tea extract: Chemistry, antioxidant properties and food applications–A review. Journal of functional foods 2013; 5(4):1529-41.