Acupuncture for Lean-Type Polycystic Ovary Syndrome (PCOS): A Case Report

Polycystic Ovary Syndrome (PCOS) is a reproductive endocrine disorder characterized by hyperandrogenism, menstrual irregularities, and polycystic ovarian morphology. Globally, it affects 10–13% of reproductive-aged women [1], imposing significant health and economic burdens [2,3]. While obesity and insulin resistance are well-established risk factors, lean PCOS (BMI < 23 kg/m²) exhibits distinct genetic and therapeutic profiles [4–6]. Limited research exists on non-pharmacological interventions for this subtype. We present a case in which acupuncture significantly improved symptoms in a lean PCOS patient intolerant to hormonal therapies.

A 29-year-old woman experienced prolonged menstrual cycles (35-90 days) and reduced menstrual flow since 2017. Her amenorrhea began in February 2020. She was diagnosed with PCOS in April 2020 and treated with oral contraceptives which contained drospirenone and ethinylestradiol. In February 2021, she switched to dydrogesterone tablets under medical guidance. However, she discontinued treatment in March 2022 due to severe side effects, including mood depression, increased tearfulness, irritability, sleep disturbances, and cold extremities. 

After discontinuing medication, she experienced four consecutive missed menstrual cycles. She resumed treatment with drospirenone and ethinylestradiol in July 2022 and switched to ethinylestradiol and cyproterone acetate in March 2023, as prescribed. While on medication, she experienced withdrawal bleeding each month. 

Prior to acupuncture, her last menstrual period occurred on September 28, 2024. Laboratory tests revealed elevated testosterone levels (97.13 ng/dL on July 9, 2024; 95.17 ng/dL on September 30, 2024) and androgenetic alopecia. Transvaginal ultrasound demonstrated polycystic ovarian morphology (>12 follicles per ovary, largest 12×11 mm).These manifestations were consistent with the diagnostic criteria for PCOS [1]. Due to the intolerable side effects of hormonal medications, she decided to discontinue pharmacotherapy and initiate acupuncture treatment.

• The patient initiated acupuncture treatment on October 9, 2024, with the following protocol 

Group A: Baihui (GV20/DU20), Shenting (GV24/DU24), Benshen (GB13), Tianshu (ST25), Guanyuan (CV4), Dahe (CV12), Guilai (ST29), Zigong (EX-CA1), Zusanli (ST36), Sanyinjiao (SP6), Taixi (KI3), Taichong (LR3) (Figure 1a-c).

Group B: Geshu (BL17), Yishu (EX-B3), Ganshu (BL18), Pishu (BL20), Shenshu (BL23), Qihaishu (BL24), Guanyuanshu (BL26) (Figure 1d).

For the head and upper back acupoints, horizontal or oblique insertion (approximately 12.5 mm) was performed using the twisting method. For abdominal and lower limb acupoints, as well as BL23, BL24, and BL26, perpendicular insertion (approximately 20 - 25mm) was used with the lifting and thrusting technique to achieve deqi. Needles were retained for 20 minutes post-deqi. Sessions occurred twice weekly (eight sessions per course), with no concurrent medications. 

Figure 1: Acupoint localization for acupuncture treatment of lean polycystic ovary syndrome (PCOS).

• Clinical outcome 

After seven acupuncture sessions, the patient experienced spontaneous menstruation on October 31, 2024, lasting until November 7. The menstrual flow was bright red and mildly reduced compared with her previous cycles. This was her first spontaneous menstrual cycle since discontinuing hormonal medications, which she had been taking since 2020. Follow-up testing on November 2, 2024, revealed a testosterone (T) level of 71.36 ng/dL (reference range: 10 - 75 ng/dL), indicating a 26.7% reduction (Figure 2). She also showed improvement in androgenetic alopecia, with fine vellus hairs emerging along the frontal hairline. The patient reported significant improvements in mood and emotional stability, near-complete resolution of cold extremities, and marked reduction in premenstrual lower backache. 

The patient completed three courses of acupuncture treatment by December 28, 2024, and paused further sessions. Follow-up assessments revealed that she menstruated on December 26, 2024, and a positive urine HCG test was obtained on January 24, 2025. The β-HCG level detected on February 11, 2025, was 11,627 mIU/ml. During the acupuncture sessions, minor subcutaneous bleeding occurred at a few acupoints, resulting in bruising and pain. These symptoms resolved spontaneously within one week, and no other adverse events were reported.

 Figure 2: The changes in testosterone levels before and after acupuncture treatment.

According to traditional acupuncture theory, the Chong Mai (Conception Vessel) and Ren Mai (Thoroughfare Vessel) are closely associated with normal menstrual and fertility functions in women. Acupuncture has been used for over 1700 years in China to treat menstrual disorders and infertility by stimulating acupoints along these meridians. Modern studies confirm that insulin resistance is a key risk factor for PCOS, regardless of body weight. Acupuncture has been shown to enhance insulin sensitivity in normal-weight women with PCOS, comparable to metformin but with fewer adverse effects [7,8]. Moreover, acupuncture can stabilize the Hypothalamic-Pituitary-Ovarian (HPO) axis, likely through neuropeptide-mediated regulation of neuropeptide-mediated regulation of gonadotropin-releasing hormone (GnRH) secretion and subsequent gonadotropin release [9,10]. These mechanisms may contribute to the significant therapeutic efficacy observed in this case.

This case demonstrates that acupuncture can reduce androgen levels, improve hyperandrogenic symptoms, restore menstrual cycles, and alleviate adverse effects associated with hormonal medications. These findings suggest that acupuncture may be a promising treatment option for normal-weight women with PCOS. Future research should include high-quality randomized controlled trials (RCTs) to confirm these therapeutic effects.

The authors would like to thank the patient. The acupuncture protocol detailed in this study is a development of Professor Fang Yi-gong's “Tiaojing Cuyun acupuncture therapy”. We gratefully acknowledge Professor Fang's seminal contributions to this field.

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

The authors received no financial support for the research, authorship and/or publication of this article.

The patient provided written consent for the publication of this case report.

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