REVIEW ARTICLE Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence E. Stener-Victorin,* E. Jedel and L. Mannera ˚s* *Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, Go ¨teborg University, Go ¨ teborg, Sweden.  Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Polycystic ovary syndrome (PCOS), the most common female endo- crinopathy, is associated with hyperandrogenism, ovulatory dys- function and obesity (1). PCOS increases the risk of hyperinsulinaemia, insulin resistance and type 2 diabetes. Type 2 diabetes results primarily from insulin resistance and is correlated with both hyperandrogenaemia and obesity (1). Women with PCOS often develop hypertension and have an increased likelihood of developing cardiovascular risk factors (2). They also appear to have impaired mental health (3, 4). Common features of PCOS can be highly distressing to patients and body image appears to be strongly associated with depression (5), and there are also indica- tions that anorexia nervosa coexists with PCOS (6). Taken together, PCOS-related symptoms lead to higher levels of depression, psycho- logical and psychosexual morbidity, and increased exposure to stressful stimuli. Data on the dietary history of women with PCOS are limited but there are indications that women with PCOS consume: (i) more saturated fat and less dietary fibre than age-matched control women (7) and (ii) larger quantities of specific foods with a high glycaemic index compared to matched controls (8). This review aims to describe the aetiology and pathogenesis of PCOS and to evaluate the use of acupuncture to prevent and reduce symptoms related with PCOS. Polycystic ovary syndrome aetiology The aetiology of PCOS is incompletely understood, despite high prevalence of the syndrome, morbidity from its metabolic, repro- ductive and hyperandrogenic features, and the associated cardio- vascular risk. The most consistent endocrine feature is hyperandrogenaemia from a predominantly ovarian source, which likely plays a key aetiological role (9, 10). Insulin sensitivity is decreased by 30–40% in women with PCOS, predominantly in overweight women, and the compensatory hyperinsulinaemia Journal of Neuroendocrinology Correspondence to: Elisabet Stener-Victorin, Institute of Neuroscience and Physiology, Department of Physiology / Endocrinology, Sahlgrenska Academy, Go ¨teborg University, Box 434, SE-405 30 Go ¨teborg, Sweden (e-mail: 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 hyperandroge- nism, ovulatory dysfunction and obesity. PCOS increases the risk for metabolic disturbances such as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life. Despite extensive research, little is known about the aetiology of PCOS. The syn- drome 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 pharmaco- logical approaches are effective but have adverse effects. Therefore, nonpharmacological treat- ment 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 polycys- tic 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. Key words: acupuncture, insulin resistance, metabolic syndrome, obesity, opioids, ovulation, physical exercise, polycystic ovary syndrome, sympathetic nerve activity. doi: 10.1111/j.1365-2826.2007.01634.x Journal of Neuroendocrinology 20, 290–298 ª 2008 The Authors. Journal Compilation ª 2008 Blackwell Publishing Ltd