Study: N-Acetylcystein for the treatment of polycystic ovarian syndrome?

Veröffentlicht: 27. März 2023, 23:01 Uhr

Von: Natur.wiki Autoren-Team

Reference

Thakker D, Raval A, Patel I, Walia R. N-Acetylcystein for polycystic ovarian syndrome: a systematic review and meta-analysis of randomized controlled clinical studies. Obstetrics Gynecol Int . 2015; 2015: 817849.

study design

A systematic review and meta-analysis were carried out to rate the risks and advantages of N-acetyl cysteine (NAC) supplementation in women with polycystic ovarian syndrome (PCOS) compared to placebo or diabetes medication metformin. The meta-analysis comprised 8 randomized controlled clinical studies with 910 women (average age between 20 and 33 years) with a PCOS diagnosis confirmed by the Rotterdam criteria.

target parameter

primary endpoints were the live birth rate and the clinical pregnancy rate, measured by the fetal heart rate. The secondary result parameters included ovarian hyperstimulation syndrome, miscarriages and multiple pregnancy rates. Further assessed measures were the resumption of menstrual regulator and the spontaneous ovulation as well as improvements in the body mass index (BMI); Testosterone, sober insulin and glucose mirror; Glucose-to-insulin ratio; and homeostatic evaluation model of insulin resistance.

important knowledge

The living birth rate was three times higher for women who received a NAC supplement than with placebo (odds ratio [or]: 3.00; 95% confidence interval [ci]: 1.05-8.60; p = 0.04). In women in the NAC group, the probability of getting pregnant was 3.5 times higher than in women in the placebo group (OR: 3.58; 95 %-KI: 2.05–6.25; p <0.0001). Women with a resistance to clomifencitrate (CC), a common medication for the treatment of PCOS, showed a 5-time advantage in the pregnancy rate if they had NAC income (OR: 4.83; 95 % KI: 2.30–10.13; p <0.0001) and a 9-time ovulation rate compared to placebo (OR: 8.40; 95 % KI: 4.50-15.67; Women who were not CC resistant still reported that they had a three times greater chance of ovulation when using NAC. In the NAC group, a reduction in the BMI, the overall test easteron and the sober glucose mirror was also reported. No differences were found in the miscarriage rates, the regularity of menstruation, hirring or the severity of the acne. Compared to metformin, the likelihood that they became pregnant (OR: 0.40; 95 %-KI: 0.23–0.71), 60 %lower and the ovulation rate was 87 %lower (OR: 0.13; 95 %KI: 0.08–0.22; 95 %-KI: 0.08–0,22). p <0.001).

practice implications

PCOS affects approximately 5 % to 15 % of women and is the main cause of infertility due to chronic annovulation. Conventional approaches to the treatment of ovulatory dysfunction typically include CC, followed by more invasive interventions as required. Ovulatory success is only achieved in 15 % to 40 % of the women treated with CC. In addition, improved ovulation rates do not correlate directly with the outcome of pregnancy.

The polycystic ovarian syndrome affects approximately 5 % to 15 % of women and is the main cause of infertility due to chronic establishment.

metformin, another frequently used intervention for women with PCOS, reduces insulin resistance, which is said to play an important role in the underlying pathophysiology of PCOS. It was found that increasing insulin sensitization directly influences the metabolic parameters and improves the ovulation rate. In the meta -analysis available here, Metformin NAC was clearly superior to both when the icing and increasing the successful pregnancy rates are being triggered.

NAC, which is widely known for its mucolytic properties and is used as a therapeutic intervention in cystic fibrosis, is another treatment that has shown an improvement in both the metabolic and hormonal parameters of PCOS. The addition is often compared to metformin, since it has shown a similar benefit in the treatment of PCOS.

The first clinical study to investigate the effect of NAC on metabolic parameters was published in 1998. It identified a correlation between increased plasma concentrations of the vascular cell adhesion molecule 1 (VCAM-1) and reduced glutathione mirrors for untreated, non-insulin-dependent diabetes patients. The theory was drawn up that oxidative stress contributes to the high regulation of VCAM-1 expression. In view of this, it was found that the supplementation with NAC reduces its expression and therefore offers protection against diabetes -related endothelial damage.

women with PCOS typically have a highly regulated expression of VCAM-1, which is positively correlated with increased testosterone levels. Interventions such as NAC that lower the VCAM 1 levels can consequently reduce the occurrence of a PCOS worsening.

Fulghesu et al. directly the effect of NAC on PCOS. The study was the first of its kind and found improvements in insulin sensitivity and androgen levels with NAC supplementation. Reductions of the triglyceride, total cholesterol and low-density-lipoprotein cholesterol level were also observed. Above all, this study emphasized the fact that NAC was well tolerated and produced little to no side effects.

Since 2002, several studies have examined the effect that has a NAC supplement on pathophysiology and symptoms of the disease. This current meta-analysis combines data from these studies and suggests that NAC supplementation is worth considering for patients with PCOS. On the other hand, it also indicates that metformin could be superior treatment. Should both take patients? Maybe not.

A study from 2014 made the reason to ensure that the simultaneous administration of NAC and Metformin nailed some of the advantages found if one of the two is given alone. The serum levels of luteinizing hormone, testosterone, cholesterol and triglycerides did not fall off in the test group, which both received, whose parameters improved if either NAC or metformin was administered alone. Based on these results, the authors suggest that the combination of NAC and metformin for patients who undergo ovulation stimulation through intracytoplasmic sperm injection may not make sense.

The quintessence for the moment is that NAC seems to be beneficial for PCOS patients, but metformin may be superior. We may want to hesitate to recommend these therapies at the same time until more research illustrates how the two work together.

note of the publisher: Megan Chmelik wrote this article under the direction of Jacob Schor, ND, Fabno, a co -editor of this magazine.

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