PCOS and Acupuncture: Sham versus True

Bottom line, no difference. Both help the LH to FSH ratio

True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome.
Pastore LM, Williams CD, Jenkins J, Patrie JT.J Clin Endocrinol Metab. 2011 Oct;96(10):3143-50. Epub 2011 Aug 3.
Source

Department of Obstetrics/Gynecology, University of Virginia, Charlottesville, Virginia 22908, USA. lpastore@virginia.edu
Acupuncture may represent a nonpharmaceutical treatment for women with polycystic ovary syndrome (PCOS), based on four studies.
OBJECTIVE:

The objective of the study was to determine whether true, as compared with sham, acupuncture normalizes pituitary gonadotropin hormones and increases ovulatory frequency in women with PCOS.
DESIGN:
This was a randomized, double-blind, sham-controlled clinical trial (5 month protocol).
Intervention included 12 sessions of true or sham acupuncture (Park sham device) for 8 wk.
MAIN OUTCOME MEASURES:
Serum LH and FSH at baseline, after intervention, and 3 months later were measured. Ovulation was measured with weekly urine or blood samples.
RESULTS:Both arms demonstrated a similar mean ovulation rate over the 5 months (0.37/month among n = 40 true acupuncture and 0.40/month among n = 44 sham participants, P = 0.6), similar LH to FSH ratio improvement (-0.5 and -0.8 true and sham, respectively, P < 0.04 after intervention vs. baseline) and a similar decline in LH over the 5-month protocol (P < 0.05). Neither arm experienced a change in FSH. There were seven pregnancies (no difference by intervention, P = 0.7). Lower fasting insulin and free testosterone were highly correlated with a higher ovulation rate within the true acupuncture group only (P = 0.03), controlling for prestudy menstrual frequency and body mass index.
CONCLUSION:
We were unable to discern a difference between the true and sham acupuncture protocols for these women with PCOS, and both groups had a similar improvement in their LH/FSH ratio.

Again, depends on your model whether it was a real sham or not.
more on my practice here

Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth?

This article is back up information about PCOS and high sympathetic tone. They were measuring sympathetic nerve activity to the muscle vascular bed (MSNA.) They found that the heightened MSNA may account for the higher cardiovascular risk in PCOS patients, and postulate that the higher sympathetic tone may account for many of the abnormalities encountered in PCOS. They cite one previous study that explored HRV and PCOS, which I will try to track down. I'm excerpting almost in its entirety for those who might be as interested as I am in this topic.
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Yrsa Bergmann Sverrisdo´ttir,1 Tove Mogren,1 Josefin Kataoka,1 Per Olof Janson,2
and Elisabet Stener-Victorin Institute of Neuroscience and Physiology, Department of Physiology, and 2Department of Obstetrics and Gynecology,Sahlgrenska Academy, Go¨teborg University, Go¨teborg, Sweden
Am J Physiol Endocrinol Metab 294: E576–E581, 2008.

Is polycystic ovary syndrome associated with high sympathetic
nerve activity and size at birth?
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disturbance among women ofreproductive age and is proposed to be linked with size at birth and
increased prevalence of cardiovascular disease. A disturbance in the
sympathetic nervous system may contribute to the etiology of PCOS.
This study evaluates sympathetic outflow in PCOS and its relation to
size at birth. Directly recorded sympathetic nerve activity to the
muscle vascular bed (MSNA) was obtained in 20 women with PCOS
and in 18 matched controls. Ovarian ultrasonographic evaluation,
biometric, hormonal, and biochemical parameters were measured, and
birth data were collected. Women with PCOS had increased MSNA compared with
controls. MSNA was positively related to testosterone and cholesterol levels in PCOS, which, in turn, were not related to each other. Testosterone level was a stronger predictor of MSNA than cholesterol. Birth size did not differ between the study groups. This is the first study to directly address sympathetic nerve activity in women with PCOS and shows that PCOS is associated with high MSNA. Testosterone and cholesterol levels are identified as independent predictors of MSNA in PCOS, although testosterone has a stronger impact. The increased MSNA in PCOS may contribute to the increased cardiovascular risk and etiology of the condition. In this study, PCOS was not related to size at birth.

Polycystic Ovary Syndrome, Electroacupuncture and Exercise

After posting about PCOS and alternative medicine, (see here,) I was able to contact Elisabet Stener-Vitorin and she was kind enough to send a few reprints of other studies of hers. One of the more recent ones looks at low frequency electroacupuncture, exercise, and Polycystic Ovarian Syndrome. The low frequency acupuncture is the most beneficial in reducing androgen levels, acne, and increasing menstrual frequency. That's the good news. The (somewhat) bad news was that the study was carried out over 16 weeks. That's pushing it for most patients in my practice, but perhaps with such evidence on my side, the patience in my patients will improve?
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Impact of electroacupuncture and physical exercise on hyperandrogenism and
oligo/amenorrhoea in women with polycystic ovary syndrome: A randomized controlled trial
3 Elizabeth Jedel 1, Fernand Labrie 2, Anders Odén 3, Göran Holm 4, Lars Nilsson 5, Per Olof Janson 5,
4 Anna-Karin Lind 5, Claes Ohlsson 6, Elisabet Stener-Victorin 7,8 *
Am J Physiol Endocrinol Metab (October 13, 2010).
ABSTRACT
Background: Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, oligo/amenorrhea, and polycystic ovaries. We aimed to determine whether low-frequency electro-acupuncture (EA) decreases hyperandrogenism and improves oligo/amenorrhea more effectively than physical exercise or no intervention.

Results: After 16 weeks of intervention, circulating T decreased by –25%, androsterone glucuronide by –30%, and androstane-3α, 17β-diol-3glucuronide by –28% in the EA group (P=0.038, 0.030, and 0.047, respectively vs. exercise); menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group (P=0.018 vs. exercise). After the 16-week follow-up, the acne score decreased by –32% in the EA group (P=0.006 vs. exercise). Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-week follow-up, compared to no intervention.
Conclusion/Significance: Low-frequency EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.

Polycystic Ovary Syndrome and Acupuncture

There is a review article in the most recent issue of the American Journal of Physiological Endocrinology looking at Complementary Medical methods of approaching Polycystic Ovarian Syndrome. The authors postulate that acupuncture is useful through its "modulation of the activity in the somatic and autonomic nervous system may modulate endocrine and metabolic functions in PCOS." As readers of this blog are aware, the autonomic nervous system is of utmost interest to me, so am always heartened when other researchers and practitioners acknowledge the autonomic nervous system's role in acupuncture effectiveness. They were wary of endorsing herbal treatment for PCOS, because they were unstudied and unproven.
I was also directed to a study from 2008 concerning the evidence and physiology behind acupuncture and Polycystic Ovary Syndrome by the same author Elisabet Stener-Victorin. Stener-Vitorin has established herself as an authority on OB GYN and Acupuncture. (I shared a cab with her after the last Society for Acupuncture Research meeting a year ago and we shared our enthusiasm for the "Girl with the Dragon Tatoo" series. In Swedish the name of the first book is "Men Who Hate Women" instead of "Girl with the Dragon Tatoo." She mused that Swedes are quite realistic and dark compared to Americans. Apparently so, since would guess very few Americans would pick up a book called "Men who Hate Women.")
Excerpts from the two studies follow.
(For more information about my practice please click here.)

The Physiological Basis of Complementary and Alternative Medicine for Polycystic Ovary Syndrome.
Am J Physiol Endocrinol Metab. 2011 Apr 12. [Epub ahead of print]

Raja-Khan N, Stener-Victorin E, Wu X, Legro R.

1Penn State College of Medicine.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is characterized by chronic hyperandrogenic anovulation leading to symptoms of hirsutism, acne, irregular menses and infertility. Multiple metabolic and cardiovascular risk factors are associated with PCOS, including insulin resistance, obesity, type 2 diabetes, hypertension, inflammation, and subclinical atherosclerosis. However, current treatments for PCOS are only moderately effective at controlling symptoms and preventing complications. This article describes how the physiological effects of major complementary and alternative medicine (CAM) treatments could reduce the severity of PCOS and its complications. Acupuncture reduces hyperandrogenism and improves menstrual frequency in PCOS. Acupuncture's clinical effects are mediated via activation of somatic afferent nerves innervating the skin and muscle, which via modulation of the activity in the somatic and autonomic nervous system may modulate endocrine and metabolic functions in PCOS. ..

Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence.
J Neuroendocrinol. 2008 Mar;20(3):290-8.
Stener-Victorin E, Jedel E, Mannerås L.

Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. elisabet.stener-victorin@neuro.gu.se

This review describes the aetiology and pathogenesis of polycystic ovary syndrome (PCOS) and evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS. PCOS is the most common female endocrine disorder and it is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity...The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Therefore, nonpharmacological treatment strategies need to be evaluated. Clearly, acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation.