Generic placeholder image

Current Traditional Medicine

Editor-in-Chief

ISSN (Print): 2215-0838
ISSN (Online): 2215-0846

Systematic Review Article

Does Vitamin E Supplementation Alter Hormonal Levels in Polycystic Ovary Syndrome: A Systematic Review of Randomized Controlled Trials

Author(s): Rukaiah Fatma Begum, Swathi Suresh, V Sharmila Devi, Murali Krishna Moka and Sumithra Mohan*

Volume 10, Issue 6, 2024

Published on: 17 October, 2023

Article ID: e280823220435 Pages: 10

DOI: 10.2174/2215083810666230828113447

Price: $65

Abstract

Background: Vitamin E influences hormonal parameters in women, but the evidence concerning its effectiveness in polycystic ovarian syndrome (PCOS) are constrained.

Objective: The objective of this systematic review is to perceive the mechanism behind the hormonal effects of vitamin E in PCOS and explore the effectiveness of vitamin E by analyzing the clinical studies.

Methods: Electronic bibliographic databases, such as PubMed, Scopus, ProQuest, DOAJ, ScienceDirect, and Cochrane Library, were searched for clinical studies scrutinizing the effect of vitamin E supplementation on PCOS. The systematic review protocol is registered in PROSPERO (CRD42021272963) and was performed as per the PRISMA guidelines. Records analyzing the hormonal parameters were included. For individual study, the risk of bias was ascertained with NHLBI protocol for controlled randomized studies.

Results: There were 1438 records identified, of which seven records were retrieved which met the inclusion criteria. Bibliographic details, number of participants, the dose of vitamin E, duration of the treatment and trial, parameters analyzed, and outcome of each study were extracted comprehensively. In the review, the majority of the studies embraced high-quality studies, which included double-blinded controlled trials, open-label controlled studies, and cohort studies.

Conclusion: Vitamin E implies having a progesterone-like impression with estrogenic and androgenic properties. Furthermore, the ability of vitamin E as an antioxidant is also advantageous in PCOS women. However, there is a lack of empirical evidence on its mechanism, and the inadequacy of large-scale concerns about different age groups against PCOS is requisite.

Keywords: Polycystic ovarian syndrome, vitamin E, hormonal effects, progesterone, rotterdam criteria, polycystic morphology.

[1]
Pundir CS, Deswal R, Narwal V, Dang A. The prevalence of polycystic ovary syndrome: A brief systematic review. J Hum Reprod Sci 2020; 13(4): 261-71.
[http://dx.doi.org/10.4103/jhrs.JHRS_95_18] [PMID: 33627974]
[2]
Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91(2): 456-88.
[http://dx.doi.org/10.1016/j.fertnstert.2008.06.035] [PMID: 18950759]
[3]
Talbott EO, Guzick DS, Sutton-Tyrrell K. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle aged women. Arterioscler Thromb Vasc Biol 2000; 20(11): 2414-1.
[http://dx.doi.org/10.1161/01.ATV.20.11.2414]
[4]
Boomsma CM, Eijkemans MJ, Hughes EG. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006; 12(6): 673-83.
[http://dx.doi.org/10.1093/humupd/dml036]
[5]
Jeelani H, Ganie MA, Amin S, Kawa IA, Fatima Q, Drabu Z, et al. Polycystic ovary syndrome(PCOS) and related diseases. PMJ 2017; 2: 23e9.
[6]
Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P&T 2013; 38(6): 336-55.
[PMID: 23946629]
[7]
Ramezani Tehrani F, Amiri M. Polycystic ovary syndrome in adolescents: Challenges in diagnosis and treatment. Int J Endocrinol Metab 2019; 17(3): e91554.
[http://dx.doi.org/10.5812/ijem.91554] [PMID: 31497042]
[8]
Witchel SF, Burghard AC, Tao RH, Oberfield SE. The diagnosis and treatment of PCOS in adolescents. Curr Opin Pediatr 2019; 31(4): 562-9.
[http://dx.doi.org/10.1097/MOP.0000000000000778] [PMID: 31299022]
[9]
Nadjarzadeh A, Dehghani Firouzabadi R, Vaziri N, Daneshbodi H, Lotfi MH, Mozaffari-Khosravi H. The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: A randomized clinical trial. Iran J Reprod Med 2013; 11(8): 665-72.
[PMID: 24639805]
[10]
Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol 2004; 24(2): e13-8.
[PMID: 14766739]
[11]
Fauser BCJM, Tarlatzis BC, Rebar RW, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97(1): 28-38.e25.
[http://dx.doi.org/10.1016/j.fertnstert.2011.09.024] [PMID: 22153789]
[12]
Fleischman A, Mansfield J. Diagnosis and treatment of polycystic ovarian syndrome and insulin resistance. Pediatr Ann 2005; 34(9): 733-8.
[http://dx.doi.org/10.3928/0090-4481-20050901-13]
[13]
Evans JL, Maddux BA, Goldfine ID. The molecular basis for oxidative stress-induced insulin resistance. Antioxid Redox Signal 2005; 7(7-8): 1040-52.
[http://dx.doi.org/10.1089/ars.2005.7.1040] [PMID: 15998259]
[14]
Schrieber M, Chandel N. ROS function in redox signaling and oxidative stress. Curr Biol 2014; 24: 453e62.
[15]
Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol 2005; 3(1): 28.
[http://dx.doi.org/10.1186/1477-7827-3-28] [PMID: 16018814]
[16]
Mohan SK, Priya V. Lipid peroxidation, glutathione, ascorbic acid, vitamin E, antioxidant enzyme and serum homocysteine status in patients with polycystic ovary syndrome. BLM 2009; 1(3): 44-9.
[17]
Mehrabian F, Khani B, Kelishadi R, Ghanbari E. The prevalence of polycystic ovary syndrome in Iranian women based on different diagnostic criteria. Endokrynol Pol 2011; 62(3): 238-42.
[PMID: 21717406]
[18]
Shah S, Shiekh Y, Lawrence JA, et al. A Systematic review of effects of vitamin e on the cardiovascular system. Cureus 2021; 13(6): e15616.
[http://dx.doi.org/10.7759/cureus.15616] [PMID: 34277234]
[19]
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4(1): 1.
[http://dx.doi.org/10.1186/2046-4053-4-1] [PMID: 25554246]
[20]
National Heart Lung and Blood Institute Study Quality Assessment Tools. National Heart Lung and Blood Institute. 2021. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
[21]
Shirazi SH, Pourghassem Gargari B, Izadi A, Taghizadeh SH, Parizad M. Effect of Vitamin E on serum levels of vascular endothelial growth factor and angiopoietin-1 in women with polycystic ovary syndrome: A pilot randomized, placebo-controlled trial. Int J Fertil Steril 2021; 15(1): 44-50.
[http://dx.doi.org/10.22074/ijfs.2020.45677] [PMID: 33497047]
[22]
Shokrpour M, Asemi Z. The effects of magnesium and vitamin E co-supplementation on hormonal status and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome. Biol Trace Elem Res 2019; 191(1): 54-60.
[http://dx.doi.org/10.1007/s12011-018-1602-9] [PMID: 30565017]
[23]
Hager M, Nouri K, Imhof M, Egarter C, Ott J. The impact of a standardized micronutrient supplementation on PCOS-typical parameters: a randomized controlled trial. Arch Gynecol Obstet 2019; 300(2): 455-60.
[http://dx.doi.org/10.1007/s00404-019-05194-w] [PMID: 31101977]
[24]
Izadi A, Ebrahimi S, Shirzai S, et al. Hormonal and metabolic effects of coenzyme q10 and/or vitamin E in patients with polycystic ovary syndrome. J Clin Endocrinol Metab 2018; 104(2): 319-27.
[http://dx.doi.org/10.1210/jc.2018-01221] [PMID: 30202998]
[25]
Morsy AA, Sabri NA, Mourad AM, Mojahed EM, Shawki MA. Randomized controlled open‐label study of the effect of vitamin E supplementation on fertility in clomiphene citrate‐resistant polycystic ovary syndrome. J Obstet Gynaecol Res 2020; 46(11): 2375-82.
[http://dx.doi.org/10.1111/jog.14467] [PMID: 32885585]
[26]
Chen J, Guo Q, Pei Y, et al. Effect of a short-term vitamin E supplementation on oxidative stress in infertile PCOS women under ovulation induction: a retrospective cohort study. BMC Womens Health 2020; 20(1): 69.
[http://dx.doi.org/10.1186/s12905-020-00930-w] [PMID: 32252736]
[27]
Taher MA. Effect of metformin and antioxidant agents on hirsutism in women with polycystic ovary syndrome. Iraqi J Pharm Sci 2017; 15(1)
[http://dx.doi.org/10.31351/vol15iss1pp33-36]
[28]
Okoroh EM, Hooper WC, Atrash HK, Yusuf HR, Boulet SL. Prevalence of polycystic ovary syndrome among the privately insured, United States, 2003-2008. Am J Obstet Gynecol 2012; 207(4): 299.e1-7.
[http://dx.doi.org/10.1016/j.ajog.2012.07.023] [PMID: 22921097]
[29]
Rodin DA, Bano G, Bland JM, Taylor K, Nussey SS. Polycystic ovaries and associated metabolic abnormalities in Indian subcontinent Asian women. Clin Endocrinol (Oxf) 1998; 49(1): 91-9.
[http://dx.doi.org/10.1046/j.1365-2265.1998.00492.x] [PMID: 9797852]
[30]
Zhao Y, Qiao J. Ethnic differences in the phenotypic expression of polycystic ovary syndrome. Steroids 2013; 78(8): 755-60.
[http://dx.doi.org/10.1016/j.steroids.2013.04.006] [PMID: 23624030]
[31]
Wolf W, Wattick R, Kinkade O, Olfert M. Geographical prevalence of polycystic ovary syndrome as determined by region and race/ethnicity. Int J Environ Res Public Health 2018; 15(11): 2589.
[http://dx.doi.org/10.3390/ijerph15112589] [PMID: 30463276]
[32]
Saei Ghare Naz M, Ramezani Tehrani F, Alavi Majd H, et al. The prevalence of polycystic ovary syndrome in adolescents: A systematic review and meta-analysis. Int J Reprod Biomed (Yazd) 2019; 17(8): 533-42.
[http://dx.doi.org/10.18502/ijrm.v17i8.4818] [PMID: 31583370]
[33]
Ng SW, Zaghloul S, Ali HI, Harrison G, Popkin BM. The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States. Obes Rev 2011; 12(1): 1-13.
[http://dx.doi.org/10.1111/j.1467-789X.2010.00750.x] [PMID: 20546144]
[34]
Sulaiman N, Elbadawi S, Hussein A, et al. Prevalence of overweight and obesity in United Arab Emirates Expatriates: the UAE National Diabetes and Lifestyle Study. Diabetol Metab Syndr 2017; 9(1): 88.
[http://dx.doi.org/10.1186/s13098-017-0287-0] [PMID: 29118852]
[35]
Elmenim SOA, Emam AMM. Effect of lifestyle changes on symptoms of polycystic ovarian syndrome in obese girls 2016; 5(3): 1-10.
[36]
Lord JM, Flight IHK, Norman RJ. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ 2003; 327(7421): 951-3.
[http://dx.doi.org/10.1136/bmj.327.7421.951] [PMID: 14576245]
[37]
Ibáñez L, Oberfield SE, Witchel S, et al. An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Horm Res Paediatr 2017; 88(6): 371-95.
[http://dx.doi.org/10.1159/000479371] [PMID: 29156452]
[38]
Saleh HS, Omar E, Froemming GRA, Said RM. Tocotrienol preserves ovarian function in cyclophosphamide therapy. Hum Exp Toxicol 2015; 34(10): 946-52.
[http://dx.doi.org/10.1177/0960327114564793] [PMID: 25585998]
[39]
Riley JCM, Behrman HR. Oxygen radicals and reactive oxygen species in reproduction. Exp Biol Med (Maywood) 1991; 198(3): 781-91.
[http://dx.doi.org/10.3181/00379727-198-43321C] [PMID: 1946472]
[40]
Rosselli M, Keller PJ, Dubey RK. Role of nitric oxide in the biology, physiology and pathophysiology of reproduction. Hum Reprod Update 1998; 4(1): 3-24.
[http://dx.doi.org/10.1093/humupd/4.1.3] [PMID: 9622410]
[41]
Celik F, Kose M, Yilmazer M, Köken GN, Arioz DT, Kanat Pektas M. Plasma L -carnitine levels of obese and non-obese polycystic ovary syndrome patients. J Obstet Gynaecol 2017; 37(4): 476-9.
[http://dx.doi.org/10.1080/01443615.2016.1264375] [PMID: 28141959]
[42]
Mahalingaiah S, Diamanti-Kandarakis E. Targets to treat metabolic syndrome in polycystic ovary syndrome. Expert Opin Ther Targets 2015; 19(11): 1561-74.
[http://dx.doi.org/10.1517/14728222.2015.1101067] [PMID: 26488852]
[43]
Victor VM, Rovira-Llopis S, Bañuls C, et al. Insulin Resistance in PCOS Patients Enhances Oxidative Stress and Leukocyte Adhesion: Role of Myeloperoxidase. PLoS One 2016; 11(3): e0151960.
[http://dx.doi.org/10.1371/journal.pone.0151960] [PMID: 27007571]
[44]
Anatoliotakis N, Deftereos S, Bouras G, et al. Myeloperoxidase: expressing inflammation and oxidative stress in cardiovascular disease. Curr Top Med Chem 2013; 13(2): 115-38.
[http://dx.doi.org/10.2174/1568026611313020004] [PMID: 23470074]
[45]
Sharaf A, Gomaa N. Hormonal properties of vitamin E and its synergism with gonadal hormones. Plant Foods Hum Nutr 1972; 22(1): 91-8.
[http://dx.doi.org/10.1007/BF01099740]
[46]
Mumford SL, Browne RW, Schliep KC, et al. Serum antioxidants are associated with serum reproductive hormones and ovulation among healthy women. J Nutr 2016; 146(1): 98-106.
[http://dx.doi.org/10.3945/jn.115.217620] [PMID: 26581679]
[47]
Takasaki A, Tamura H, Taniguchi K, et al. Luteal blood flow and luteal function. J Ovarian Res 2009; 2(1): 1.
[http://dx.doi.org/10.1186/1757-2215-2-1] [PMID: 19144154]
[48]
Tefagh G, Payab M, Qorbani M, et al. Effect of vitamin E supplementation on cardiometabolic risk factors, inflammatory and oxidative markers and hormonal functions in PCOS (polycystic ovary syndrome): a systematic review and meta‐analysis. Sci Rep 2022; 12(1): 5770.
[http://dx.doi.org/10.1038/s41598-022-09082-3] [PMID: 35388031]
[49]
Saadia Z. Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non- Obese Women Med Arch 2020; 74(4): 289-93.
[http://dx.doi.org/10.5455/medarh.2020.74.289-293]
[50]
Blank SK, McCartney CR, Helm KD, Marshall JC. Neuroendocrine effects of androgens in adult polycystic ovary syndrome and female puberty. Semin Reprod Med 2007; 25: 352-9.
[http://dx.doi.org/10.1055/s-2007-984741]
[51]
Dokras A, Sarwer DB, Allison KC, et al. Weight loss and lowering androgens predict improvements in health-related quality of life in women with PCOS. J Clin Endocrinol Metab 2016; 101(8): 2966-74.
[http://dx.doi.org/10.1210/jc.2016-1896] [PMID: 27253669]
[52]
Müderris İ, Ozturk A, Açmaz G, Boztosun A. Clinical efficacy of low dose flutamide plus Diane-35 in the treatment of idiopathic hirsutism and polycystic ovary syndrome. Ginekol Pol 2013; 84(4): 258-62.
[http://dx.doi.org/10.17772/gp/1573] [PMID: 23700857]
[53]
Letur-Konirsch H, Delanian S. Successful pregnancies after combined pentoxifylline-tocopherol treatment in women with premature ovarian failure who are resistant to hormone replacement therapy. Fertil Steril 2003; 79(2): 439-41.
[http://dx.doi.org/10.1016/S0015-0282(02)04579-X] [PMID: 12568863]
[54]
Bendich A, Bendich LJ. Safety of oral intake of vitamin E. Am J Clin Nutr 1988; 48(3): 612-9.
[http://dx.doi.org/10.1093/ajcn/48.3.612] [PMID: 3046299]
[55]
Begum RF, Mohan S. Insights into vitamin e with combined oral contraceptive on INSR gene in PCOS by integrating in silico and in vivo approaches. Appl Biochem Biotechnol 2023. Epub ahead of print
[PMID: 37610513]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy