Incredible Combination of Lifestyle Modification and Herbal Remedies for Polycystic Ovarian Syndrome Management

A relatively frequent endocrine-metabolic illness called polycystic ovarian syndrome (PCOS) is characterized by polycystic ovaries, persistent anovulation, and hyperandrogenism, which cause symptoms such as irregular menstruation, infertility, and hirsutism. PCOS is linked to obesity, insulin resistance, and increased amounts of androgens, or male hormones. The sedentary lifestyle, dietary fluctuations, inactivity, and stress are other contributing variables. According to estimates from India in 2021, around 22.5% of women, or one in five Indian women, suffer from PCOS. Evidence-based medical care for PCOS places a strong focus on a multidisciplinary approach, as standard pharmacological treatment frequently targets a single symptom, may be contraindicated, has adverse effects, and is ineffective in certain circumstances. However, long-term treatments have drawbacks and are likely to be ineffective, making complementary and alternative therapies a worthwhile choice. Yoga science is a thorough treatment plan for a healthy body and mind that may eradicate PCOS's primary causes, stress and obesity. Some common herbal remedies, including Foeniculum vulgare, Tinospora cordifolia, Asparagus racemosus, Ocimum tenuiflorum, Areca catechu, and Lepidium meyenii, have been highly regarded sources that have the benefits of lowering PCOS as well as having hypoglycemic and antiobesity effects. In light of existing literature, women with PCOS experienced symptomatic relief, improvement in hormonal balance, and the quality of life by utilizing yoga practices as well as herbal remedies. In conclusion, combining lifestyle modifications with herbal remedies can be used in the management of PCOS as a holistic approach. Therefore, this review opens a new window for researchers all across the world to validate such findings.


Introduction
About 6-8% of women worldwide are afected by polycystic ovarian syndrome (PCOS), which was frst identifed in 1935 by Stein and Leventhal and is linked to polycystic ovarian morphology, chronic oligoanovulation, psychological problems, and metabolic abnormalities, particularly compensatory hyperinsulinemia and insulin resistance [1]. According to estimates from the World Health Organization (WHO), PCOS impacted 116 million women (3.4%) globally in 2012. Estimates of PCOS prevalence vary widely around the globe, from 2.2% to as high as 26% [2]. Experts estimate that 10% of women in India have PCOS, although there is currently no accurate published statistical information on the prevalence of PCOS in India [3]. In India nowadays, PCOS afects roughly 22.5% of women or one in every fve Indian women [4].
Many doctors struggle to recognize this widespread condition since there are no clear diagnostic criteria [1]. Ovarian follicles normally contain egg cells, which are released during ovulation, whereas polycystic ovarian syndrome is characterized by aberrant hormone levels that hinder follicles from developing and maturing in order to produce egg cells, as depicted in Figure 1. However, reproductive abnormalities are more likely in women with PCOS [5]. Tis condition, also known as the Stein-Leventhal syndrome, is a signifcant contributor to infertility in women. Numerous theories explain the hormonal imbalance, which has no clear origin. Polycystic ovaries, hyperandrogenism, and several metabolic abnormalities (including insulin resistance and hyperinsulinemia) [6] are its defning traits. Te current standard of treatment for PCOS in women includes everything from medication therapies to lifestyle changes. Diet, weight reduction, and exercise are all linked to lifestyle modifcations. Modern medicines including metformin, thiazolidinediones, and estrogen-progestin combinations as well as antiandrogens such as spironolactone and futamide (oral contraceptives) are generally used to treat PCOS [7]. Despite being successful, such therapy is expensive and may have a number of adverse efects, including gastrointestinal issues, weight gain, irregular menstruation, and elevated insulin resistance [8]. Since ancient times, medicinal plants have drawn special attention. Today, a number of studies have been conducted, leading to the discovery of valuable and advantageous medicinal plants [9]. In order to better understand the side efects of these therapies and how to identify them, a lot of research has been done on herbal remedies, including case studies, randomized controlled trials, and animal experiments. Insulin resistance is frequently present in PCOS patients, who exhibit testosterone levels that are roughly double those of typical women [10]. Several herbs including jeera powder (cumin seed powder), green tea, chia seeds, anise, fenugreek seeds, black seed oil, fennel seeds, fax seed, evening primrose oil, cinnamon powder, and turmeric have been highly regarded for their benefts in lowering PCOS as well as their antiobesity and hypoglycemic efects [11]. Integrated-pathy, i.e., yoga and traditional herbal remedies can show a better efect for treating polycystic ovarian syndrome, as they have since ancient times.
Tis review is focused on the most current information and research related to PCOS, its pathobiology, and the individual signifcance of herbs and lifestyle changes through yoga practices with various clinical evidence as well as the possibility of the combinational efcacy of herbal treatment and yoga therapy for better efectiveness.

Pathobiology of Polycystic Ovary Syndrome
2.1. Symptoms. Some women begin to experience symptoms right before the beginning of their menstruation. Others do not realize they have PCOS until they have gained a lot of weight or had trouble becoming pregnant. Although not all women with PCOS have the exact same symptoms, hormonal imbalance is a common characteristic of PCOS suferers. For instance, if anyone has high amounts of the male hormone androgen, they will likely battle with irregular periods, facial hair, hormonal acne, and scalp hair loss [12]. Some of the most common PCOS symptoms are incorporated in Figure 2.

Causes.
Although the specifc etiology of PCOS is unknown, it appears to be linked to genetics, family history, hormones that are elevated during the process of our growth in the womb before birth, and lifestyle or environmental factors [13]. Te main factors responsible for the development of PCOS are mentioned in Figure 3.
Since PCOS has not yet been linked to a single gene, the connection is probably complicated and likely involves several genes. A direct female relative with PCOS, such as a mother, aunt, sister, or daughter, is 50% more likely to have it in PCOS-positive women [14]. Families with PCOS are also frequently afected by type 2 diabetes [15]. Te symptoms and indications of PCOS are brought on by an imbalance of the androgens (male-type hormones like testosterone) and hormones insulin in the body [16]. One of insulin's functions in the body is to prevent excessive blood glucose (also known as sugar or energy) increases after meals [15]. It accomplishes this by "unlocking" the body's cells and enabling glucose to enter the cells from the circulation. Te amount of glucose in the blood is reduced as a result. Insulin resistance afects 85% of all women with PCOS [17]. When a person has insulin resistance, the cells in their body cease reacting to insulin as they should and instead inhibit glucose absorption [18]. Tis indicates that your body is not successfully using the insulin that is available to maintain stable blood sugar levels. Te body responds by creating extra insulin since the insulin is not functioning properly. Increased insulin levels lead to an increase in the ovaries' synthesis of androgens like testosterone [19]. Being overweight, whether due to food, physical inactivity, or both, is a lifestyle factor that contributes to insulin resistance. However, women of various weight ranges can develop insulin resistance because of hereditary reasons [16]. Approximately 95% of overweight and 75% of lean women with PCOS exhibit insulin resistance, according to the evidence [20]. It is critical to comprehend what insulin resistance is because it contributes signifcantly to PCOS symptoms. However, it is also critical to be aware that it may decrease.
Regular yoga sessions and a balanced diet are crucial for maintaining and lowering insulin resistance and can signifcantly lessen PCOS symptoms. Androgens, sometimes referred to as "man hormones," are typically found in both women and men, but in considerably lower concentrations in the latter [21]. Androgens are produced at trace levels in the bodily tissues of all females, including the adrenal glands and the ovaries [22]. Women with PCOS have symptoms including increased body hair growth, scalp hair loss, and acne as a result of elevated androgen levels [23]. Tey also lead to signs like abnormal ovulation and menstrual cycles. PCOS can afect both thin and overweight women. However, obesity and being overweight are more likely among PCOS-positive women [24]. Te symptoms of PCOS and insulin resistance are both made worse by excess weight, which is also believed to play a signifcant role in the onset of PCOS [25].

Histopathological Features.
Women with PCOS experience having the following changes to their ovarian tissues [26]: an abundance of multiple, sclerotic, enlarged, and cystic follicles; whole ovarian hypertrophy; a thickened capsule >100 μm; more subcapsular follicle cysts; a lack of corpora lutea or albicantia; hyperplasia and fbrosis of the ovarian stroma; and early lutein. Te microscopic image of a female ovarian tissue that has PCOS such as the presence of many cysts and degenerated follicles [27], is shown in Figure 4.

Complications.
Te short-and long-term impacts of PCOS on women's health are because of a higher incidence of early difculties including worsened fertility and obstetric outcomes and an increased rate of late issues as well as elevated cardiovascular, metabolic, and cancer risks [28], as shown in Figure 5. Due to the varied character of the condition, the ambiguous nature of the pathogenetic pathways, and the existence of confounding variables, such as obesity, it is exceedingly difcult to precisely identify the degree of these difculties. Furthermore, PCOS phenotypes in women vary over the course of a woman's life. As a result, alterations in ovarian function and metabolic control may alter how the illness manifests itself and may contribute to the morbidity of the condition during the late reproductive years and menopause [29].
2.5. Pathophysiology. PCOS is primarily characterized by infertility, hyperandrogenism, lack of ovulation [30], increased levels of LH [31], increased insulin resistance, decreased sex hormone-binding globulin (SHBG) [32,33], and hirsutism [34], which can be seen and diagnosed by ultrasonography and laboratory tests. Te exact cause of PCOS has not yet been identifed. Serum concentrations of androgens such as androstenedione, testosterone, and dehydroepiandrosterone are likely elevated in PCOS-aficted women due to disruptions in the secretion rate and metabolism of androgens and estrogen [34,35]. Additionally, it is extremely possible that some issues may arise, such as hyperinsulinemia and environmental insulin resistance. Diferent degrees of these problems cause obesity. Te defective signaling pathway of the insulin receptor can lead to insulin resistance. As a result, the cell's ability to use insulin is compromised, which results in an additional rise in insulin release to make up for its defciency. Adiponectin levels fall in PCOS patients with insulin resistance, which amplifes the infuence of gonadotropins on ovarian function [35]. Te frequency of GnRH increases as a result of insulin resistance and the excessive rise in insulin levels that follows, which raises LH/FSH levels. Figure 6 provides a brief summary of these hormonal alterations in the theca cells and granulosa cells (GCs), which result in an increase in androgen production and a decrease in estradiol synthesis, impede follicle growth, hamper ovulation, and ultimately contribute to the development of PCOS [36].
PCOS is a hormonal condition that afects a lot of women who are fertile. Menstrual cycles in women with PCOS may be irregular or protracted, and androgen levels may be excessive. It is possible for the ovaries to grow many tiny fuid-flled sacs (follicles) but not consistently discharge eggs [37].   some other validated websites. Reviewers examined 820 abstracts for pertinent search criteria after eliminating duplicates. Additionally, 470 references were disregarded based on title and article screening, and 350 publications were retrieved based on the pathobiology of polycystic ovarian syndrome, potential treatments including herbal and yoga science, and clinical evidence. Furthermore, 201 references overall did not meet the requirements for inclusion in the full-text review since 25 articles were excluded from the data extraction procedure. In the full-text reviews, only 124 references were reviewed. Figure 7 depicts the abovementioned search process.

Polycystic Ovary Syndrome Rectified by Lifestyle Modification
A desk job, a diet high in fried foods, processed meats, hot dogs, and sausages, as well as the consumption of too much sugar and carbonated beverages, all contribute to PCOS by causing insulin and hormonal imbalances that stimulate androgen receptors found outside the ovary. Patients with PCOS can increase their insulin sensitivity and reduce the weight by making lifestyle changes including daily yoga practices, eating a balanced diet, and limiting their intake of dairy and fast food [38]. Terefore, the primary line of treatment for PCOS patients should be lifestyle change.
Unfortunately, all of these therapies only work temporarily, so maintaining this regimen throughout the course of a person's life is necessary for long-term weight loss. Te outcomes are found to be unsustainable in 90 to 95% of the situations. Bariatric surgery is the sole option for treating those who are very obese and want to lose weight consistently [39]. Te National Institutes of Health's most recent recommendations state that individuals who need bariatric surgery must also have additional major medical issues in addition to a body mass index of 40 or less [40]. In light of the additional symptoms of hormonal and endocrine problems that afect women with PCOS, bariatric surgery has been shown to signifcantly reduce PCOS symptoms and may even result in a cure [41]. Although we cannot entirely avoid stress in our daily lives, we can certainly increase our ability to handle it. Practicing yoga regularly might help you reduce stress. Even unintended weight gain in women can be caused by stress. Te body stores fat as a result of cortisol. Te synthesis of the stress hormone cortisol is reduced when one enters a tranquil mood. Trough breathing exercises that completely calm the body, yoga-like Shavasana (Corpse pose) reduces any stress [42]. Te consequences of hormone imbalance may be countered by relaxation, which can also deal with unpleasant feelings, irritation, and frequent mood swings [43]. Te simplest approach to staying in shape is to perform Surya namaskar which helps in weight loss, improves the lipid profle, promotes lush hair and glowing skin, achieves a lower waist-to-hip ratio, strengthens muscles and joints, brings down blood sugar levels, and regulates the menstrual cycle [44]. Efective stress management, a decreased propensity for stress eating, and enhanced bodily awareness-particularly in relation to hunger, satiety mindfulness, and mindful eating-are some of the ways yoga may aid in the weight reduction process [45].

Evidence-Based Complementary and Alternative Medicine
In turn, more muscle mass aids in the fght against insulin resistance, which is one of the cornerstones of PCOS control [46]. A vigorous yoga practice raises the heart rate, resulting in cardiovascular exercise and weight reduction. Asanas and pranayama encourage hormonal balance and profound relaxation, assisting in regulating the adrenal and cortisol levels in anxious PCOS minds and bodies [47]. We may achieve a disease-free body and a healthy mind by incorporating yoga and meditation early in life. Pranayamas (breathing exercises) are potent methods that help keep the mind calm [42]. Asanas (yoga postures) such as Badhakonasana (butterfy pose) and Suptabadhakonasana (reclined bound angle) were developed for PCOS to help open up the pelvic region and encourage relaxation which in turn helps to reduce stress and relieve discomfort related to menstruation [42]. A soothing sitting yoga position known as Bharadvajasana (Bharadvajasana twists) helps to cure PCOS symptoms by stretching the spinal column [45]. By reviving the spine, muscles, and neurological system, regular practice of this yoga posture helps to correct menstrual difculties, regulate blood pressure, and promote calm all around [48]. Another fundamental yoga posture is Chakki Chalanasana, or the "mill churning pose," which massages the uterus, reproductive organs, liver, kidneys, and pancreas in addition to altering the functioning of the endocrine gland to enable optimal hormone release [49]. Both yoga and a balanced diet can aid in weight loss. Along with this, practice certain calming meditations that have a profound impact on the body's physiology and aid in systemic detoxifcation and stress reduction [42].
In teenage females with PCOS, yoga was found to be more benefcial than traditional physical activity in improving glucose, insulin, and lipid levels, including insulin resistance values, irrespective of anthropometric changes [17]. In teenage PCOS, a comprehensive yoga program lasting 12 weeks was shown to be substantially superior to physical activity in lowering LH, AMH, and testosterone, the mFG score for hirsutism, as well as decreasing menstruation frequency with no discernible changes in body weight, prolactin, and FSH [50]. Regularly practicing mindful yoga is a benefcial supplementary therapy option for women with PCOS, especially for reducing serum androgen levels, a defning characteristic of PCOS [51]. Even if there is a break in practice, this improvement may endure even in the absence of weight reduction. Yoga has been recommended as a therapeutic option for PCOS women due to its efects on hirsutism, abdominal circumference, and hip circumference [52]. By lowering perceived stress and state anxiety and enhancing sleep, yoga treatment signifcantly afects DUB results [53].
PCOS considerably lessens the feelings of anxiety than a physical exercise regimen [54]. For adult women with PCOS, yoga treatment is useful in maintaining a steady body mass index (BMI) and testosterone level [55]. As a result, Kayakalpa yoga, which involves recycling the seminal return mechanism, is comparable to the pituitary gland's feedback  process in synchronizing the hormonal efects of the practice for women with PCOS and infertility [56]. Tis yogic practice thereby raises and normalizes FSH and LH levels. As a result, when doing Kayakalpa yoga, life force energy is raised [57]. It causes all endocrine glands and the nerve plexus to work, which is benefcial for releasing hormones, maintaining their normal levels, and curing infertility [42]. Regular yoga practice can be utilized as an alternative therapy for promoting health and preventing obesity in teenagers who are overweight [55]. When PCOS patients with autonomic dysfunction practice yoga, their heart rate variability (HRV) signifcantly improves [56]. Women with PCOS were shown to have signifcantly diferent levels of depression before and after receiving yoga practices. Tere is a signifcant diference in the level of depression among PCOS-afected women between the pre-and postyoga practicing conditions [17].

How Do Herbal Remedies Cure Polycystic Ovary Syndrome?
According to a survey by the PCOS Society, two out of every ten Indian women have PCOS [66]. Six of the 10 women with PCOS who receive a diagnosis are teenagers [67]. According to research from the AIIMS Department of Endocrinology and Metabolism, 20-25% of reproductiveage women had PCOS [68]. Even though 60% of PCOS patients are obese, 35-50% also have fatty livers, 60% to 70% of people have high levels of testosterone, 40% to 60% have glucose intolerance, and 70% have insulin resistance [69].
Although the pathogenesis of PCOS is unclear, some women with the condition have insulin levels that are higher than usual. When insulin levels are too high, the ovaries may create more androgens like testosterone [69]. Women with PCOS frequently battle obesity because of insulin resistance, which might make it more difcult to lose weight [70]. Currently, PCOS is treated with a number of allopathic drugs such as nafarelin, troglitazone, clomiphene, metformin, and spironolactone at the primary level of treatment [71]. However, long-term use of these drugs might result in serious consequences such as menstruation irregularities, nausea, vomiting, gastrointestinal disturbances, weight gain, insulin resistance, and other contraindications [72]. Because of all these complications, people are now moving towards natural treatment including herbal remedies, yoga therapies, lifestyle modifcations, and naturopathy which are much more efective than existing allopathic drugs. Herbal treatments have an important role in prevention, treatment, and rehabilitation [73]. However, polyhedral formulations may also be developed on the basis of the aforementioned variables to decrease the cost, duration, and side efects of current treatments.
In general, a plant, its part, or its extract utilized for favor, fragrance, or medical purposes is referred to as herb in commerce. Traditional herbal remedies are compounds that are naturally occurring and have undergone little to no   industrial processing before being utilized to cure a variety of ailments. In addition, herbal treatments are receiving a lot of attention in discussions about global health [1]. Similarly, herbal medications can be a very useful therapeutic option for PCOS also, due to their generally milder efects on the body and fewer side efects than other medicines [74]. It has reached a whirling point and is fghting to be renowned as a science-a particular feld with its own uniqueness. It has become imperative to demonstrate how herbal rehabilitation can compete with other medical specialties in terms of the depth of its research and its applicability. Te advantage of herbal therapy over normal therapy is that, it is less risky, has fewer complications, and has a potentiating efect due to the existence of many active chemicals in medicinal plants [75]. Herbs may be used for longer periods of time with fewer adverse efects, which is crucial because PCOS requires longterm therapy [76]. Tey may show promising efects in addressing the causes of PCOS, relieving symptoms, and promoting the body's ability to repair itself by enhancing the immune system. Te efciency of selected herbal medications can be increased by combining them with a PCOSfriendly diet and yoga practises [77]. Te use of medicinal plants for both sustenance and the treatment of various ailments is quite signifcant. Indian and other traditional medicinal systems include several active components from a variety of plant species used to treat PCOS, as mentioned in Table 2.
Evidence-based medical care for polycystic ovary syndrome (PCOS) places a strong focus on a multidisciplinary approach, as standard pharmacological treatment frequently targets a single symptom, may be contraindicated, has adverse efects, and is inefective in certain circumstances. Te old Persian and Chinese medical systems saw the introduction of herbal medicine as a supplemental form of treatment [88]. Te treatment of gynecological and reproductive issues in PCOS patients has traditionally included the use of medicinal plants. Tere were several clinical evidence validated as to the degree to which PCOS and associated symptoms are reduced by Satapushpa Shatavari powder treatment coincides with a commensurate reduction in ovarian volume [89]. In order to control oligomenorrhoea, dry cupping combined with fennel seed infusion is a safe and efcient therapeutic strategy [90]. Cinnamon supplementation improved antioxidant status, serum lipid profle, and menstrual cyclicity in PCOS-afected women, which may be helpful for reducing PCOS risk factors [91]. Green tea use by overweight and obese women with PCOS leads to weight loss, a decrease in fasting insulin, and an increase in free testosterone [92]. Furocyst was effective in reducing PCOS symptoms [93]. In PCOS-aficted women, cinnamon dramatically decreased fasting insulin and insulin resistance [94]. Te natural remedy spearmint may be efective in treating PCOS-related hirsutism [95]. In women with polycystic ovarian syndrome, eating raw red onions seems to be an efcient way to decrease cholesterol [96]. Nigella sativa is also a complementary medicine that may help PCOS-afected women with their irregular menstrual cycles [97]. Table 3 provides a summary of several herbs and their clinically proven formulations to cure PCOS.

How Do Yoga Practices and Herbal Remedies Work Together on Polycystic Ovarian Syndrome Management?
Stress and obesity disrupt the healthy hypothalamic-pituitary-ovarian axis, which causes insulin resistance and a stage of hyperandrogenism that leads to the development of somatic symptoms of PCOS like hirsutism, anovulation, irregular menstruation, subfertility, acne, and psychic symptoms like anxiety, depression, insomnia, and loss of concentration [101]. Losing 5 to 10% of one's body weight can signifcantly improve PCOS's endocrine profle [102].
Pathophysiological problems, such as hyperandrogenism, insulin resistance, and chronic infammation in PCOS females, are developed as a result of genetic variation, epigenetic modifcations, and a disrupted lifestyle [103]. A single genetic diagnostic technique fails due to the involvement of several proteins, molecules, and signaling pathways at the molecular level in disease development [104]. Four phenotypic variations of PCOS are used to classify PCOS patients into three groups: classic, ovulatory, and nonhyperandrogenic kinds [105]. Tis genetic method for elucidating the pathophysiology of PCOS was recently discovered. Genetic research can be used to pinpoint the underlying factors that led to the emergence of PCOS. Te primary line of treatment for overweight women with PCOS is lifestyle management, which may control menstruation, lessen hyperandrogenism, treat hyperinsulinemia, and enhance quality of life. With or without dietary and activity improvements, ovulation can return [106]. A decreased prevalence of anovulatory infertility has been associated with regular 30-to 60-minute yoga sessions [107]. Moderate aerobic exercise has a benefcial efect on a variety of cardio-metabolic risk factors in women with PCOS when they do it for more than or comparable to three months [108]. A healthy diet and 30 minutes of moderate-tovigorous yoga practise performed at least four days a week can help women with PCOS lose weight [109]. However, high attrition in randomized controlled trials (RCTs) limits the robustness of the evidence for lifestyle, and clinical adoption is also hampered by the paucity of data for efective daily yoga and appropriate food therapy [110]. In addition, overweight women-especially those with established obesity-frequently exhibit physical and psychological difculties. Despite the possible good endocrine consequences of PCOS, many women also employ supplementary therapies, such as herbal treatments. Numerous clinical studies have shown that regular yoga practise helps to reduce stress and obesity, which are the main causes of PCOS [111]. Based on a variety of clinical indications, herbal medicines can also 12 Phyllanthaceae Phyllanthus emblica L.

Seeds
Polyunsaturated fatty acids Regulation of blood glucose levels [74] Evidence-Based Complementary and Alternative Medicine 11  [86] 12 Evidence-Based Complementary and Alternative Medicine Evidence-Based Complementary and Alternative Medicine Naeimi et al. 2020 [97] help to restore hormonal balance, considerably reduce infammation, enhance insulin sensitivity, and promote proper reproductive system function [112]. Yoga is a lifestyle choice that extends much beyond regular yoga practice for the majority of serious practitioners. It creates such a powerful bond between the body, mind, and soul that it frequently permeates all other facets of day-to-day existence [113]. In actuality, the main goal of yoga's development was to link emotional calmness and mental balance to physical wellness. Yoga aims to promote a way of life that places as much emphasis on harmony, gratitude, tranquilly, and positive thinking as it does on physical health. Yoga is highly efective as a unique type of holistic therapy because of this system of priorities [114]. Given that yoga promotes the integration of the mind and body for general wellness, we could even claim that it is a comprehensive integrative healthcare system unto itself. Breath work, meditation, and physical poses are all combined with the entire being in mind [115]. It only makes sense, then, that yoga may be a great alternative therapy to herbal medication. Let us take a look at how these two allencompassing strategies might be combined for even more advantage.

Herbal Medicine and Yoga Go Hand in Hand.
Yoga and herbal treatments appear to be two completely distinct holistic therapies when we examine their historical roots. Yoga did, after all, start in India about 3000 BC. However, it is quite probable that these two methods of thinking were impacted by one another. While each one has own unique cultural roots, they both adhere to the fundamental idea that mental and physical balance is essential for optimum health and wellness. Integrating these two age-old traditions may help practitioners provide more powerful outcomes for their patients [116]. A regular yoga practice that incorporates herbal treatments might assist you in developing a deeper awareness of your body.
If a person has been practicing yoga for some time, they presumably already recognize the link. Yoga's core tenet is the promotion of both physical and mental well-being via the appropriate movement of energy throughout the body. Restful postures are utilized in yoga and are frequently focused on the body's meridians while being maintained for many minutes [117]. Additionally, some emotions like fear, rage, and enthusiasm are connected to herbal remedies. Excessive emotions are supposed to throw of the body's equilibrium. To regulate the autonomic nervous system and encourage energy fow, herbal medicine practitioners and practitioners of traditional medicine treat the organ and the emotions related to the organ [110]. In yoga, we continue to utilise both the body and the mind to encourage harmony and balance.

How Can Integrated-Pathy Be Useful in the Management of PCOS?
Meditation is a crucial strategy for achieving emotional balance and mental quiet that is used in both yoga and herbal medicines [118]. As a result, when yoga and herbal remedies are used together, they can be quite efective in managing PCOS. Tere are several clinical studies which may support the use of herbal medicine in combination with a healthy lifestyle to treat PCOS. Connecting the mind and body is the main focus of both disciplines.
Modern culture frequently thinks that conventional medicine is superior to holistic modalities like yoga and herbal medicines. However, these integrative and holistic approaches can improve PCOS more profoundly and for a longer period of time. Changes in behavior and lifestyle, in particular, can signifcantly enhance the quality of life for those with chronic diseases. Te symptoms of this condition can be slowed down or even reversed by making lifestyle changes, such as practicing yoga and using conventional herbal medicines. Additionally, holistic treatments might be particularly helpful when mainstream medicine is unable to identify a problem. Tis is so that systemic imbalances, both mentally and physically, may be addressed through these therapies. In our culture, taking a pill is a normal approach for managing PCOS, although this typically only ofers transient relief. Combining these comprehensive strategies may result in a more efective strategy for long-lasting improvement and enhanced mental and physical wellness.
As this review discussed, women with PCOS require individualised treatment employing yoga practices and herbal remedies. Tere are several number of clinical evidence which supports yoga practices and herbal remedies individually efective in the PCOS management. By mixing yoga and herbal treatments into daily life, as briefy shown in Figure 8, it might be possible to treat PCOS and other female health disorders safely and efectively. Hence, the integratedpathy of yoga and herbs in PCOS may ofer signifcant advantages to women.

Adverse Effects of Allopathic Drugs Used in Polycystic Ovarian Syndrome
Te negative consequences of modern medicine on the treatment of PCOS have been reported in a number of cases.
A few examples of such cases include liver toxicity with Flutamide, and a higher relative risk diference for venous thromboembolism with oral contraceptives. In a case study, one hirsute adolescent with signifcant hepatotoxicity induced by Flutamide demonstrated a relationship between the length of the medication and liver damage [119]. In another case, a 14-year-old girl had a dermatological consultation and was given futamide (500 mg, orally) for the treatment of facial hirsutism which leads to fulminant hepatic failure [120]. In another clinical evidence, 626 infertile women with PCOS received metformin and clomiphene alone or in combination up to 6 months. Women were withdrawn from the trial with some adverse efects due to the metformin and Clomiphene. Te side efects of clomiphene on the gastrointestinal tract include abdominal pain and discomfort in 53% of women, diarrhoea (23%), nausea (39%), hot fushes (28%), headaches (44%), fatulence (18%), and mood swings (15%). For metformin, side efects include abdominal pain and discomfort (59%), diarrhoea (65%), nausea (62%), vomiting (30%), fatulence (18%), headaches (42%), and mood swings (17%). As a result of serious adverse Evidence-Based Complementary and Alternative Medicine event due to the administration of metformin includes one death [121].

Conclusion and Future Perspectives
Polycystic ovary syndrome (PCOS) is the most frequent endocrinopathy in women, and most people are unaware that it has become a worldwide epidemic. Women with PCOS often do not receive proper treatment, as few understand its complexity. Conventional medical therapies are limited in quantity and efcacy, with signifcant associated risks. Prevention is the ultimate solution, requiring drastic changes and the elimination of endocrine disruptors and ever-present toxic foods. Minor lifestyle changes along with herbal treatment and yoga therapies can improve the symptoms in PCOS patients. Yoga and lifestyle modifcation should be considered for frst line interventions for PCOS with or without medical interventions, especially in young patients. By adopting a holistic approach that addresses both lifestyle factors and herbal support, women with PCOS can take proactive steps towards hormonal balance, symptom relief, and overall well-being with no side efects and at a cost that is cost-efective. Te integrated approach of lifestyle modifcation and herbal remedies may hold promise for managing PCOS and improving the quality of life for women afected by this condition. In order to determine the efectiveness of herbal remedies combined with yoga practices for PCOS, more preclinical and clinical research is required. Clinical trials and long-term studies can provide more robust evidence regarding the specifc benefts of diferent herbs and their mechanisms of action.

Data Availability
Te data supporting this review are from previously reported studies and datasets, which have been cited.

Ethical Approval
None of the authors of this article have conducted any experiments using humans or animals.

Conflicts of Interest
Te authors declare that there are no conficts of interest.