Saw Palmetto May Reduce Elevated Androgens and Prolactin in Women with PCOS

By Jillian Stansbury, ND

Saw Palmetto Indications

Serenoa is indicated for benign prostatic hyperplasia, polycystic ovarian syndrome, and hormone imbalances (estrogen or testosterone). It promotes genitourinary health in both sexes, improves libido and sexual vigor, and chronic nonbacterial prostatitis/chronic pelvic pain syndrome.

Mechanism of Action

Serenoa berries contain fatty acids known collectively as liposterols and named individually as lauric, oleic, myristic, and linoleic acids. All of these fatty acids have been shown to inhibit the 5 alpha-reductase enzyme, found in the adrenal glands (and in men, the prostate as well) that converts testosterone into its most active form, dihydrotestosterone.  Women with hirsutism and elevated testosterone may have excessive 5 alpha-reductase enzyme activity. Male pattern baldness, also known as androgenic alopecia in men, and thinning of the hair in women may also be initiated and promoted when 5 alpha-reductase is up regulated. Saw palmetto has been shown to promote hair growth compared to placebo in men with androgenic alopecia, and the herb might benefit women as well.

Elevated androgens is the hallmark of PCOS in women. Serenoa has been shown to reduce the uptake of androgens, including dihydrotestosterone and testosterone, into tissues by 40%.  Prolactin is typically elevated in women with PCOS and a leading cause of amenorrhea and infertility.

In women with PCOS, elevated prolactin can suppress follicle maturation, ovulation, and contribute to ovarian cysts. Animal studies show Saw Palmetto to inhibit prolactin receptors on ovarian cells and reduce the basal activity of K(+) channels and of protein kinase C involved with the transduction of prolactin signals.

Evidence Based Research

There has been a great deal of research regarding Saw Palmetto and its ability to treat diseases of the prostate in men, but very little research in women.  Environmental toxins can disrupt reproductive development and function by both mimicking and inhibiting endogenous steroids contributing to infertility, polycystic ovarian syndrome, hormonal cancers, thyroid disease, and other ailments.

Saw Palmetto may help reduce elevated androgens and prolactin typically seen in women with PCOS.  Animal studies show Saw Palmetto to block prolactin receptors on ovarian cells over-expressing prolactin receptors.

Safety in Pregnancy and Breast Feeding

There is no information on the safety of Saw Palmetto in pregnancy or lactation in the scientific or traditional literature.

General Safety

There has been an anecdotal report of a single incidence of cholestatic hepatitis in a patient using Saw Palmetto, however dosage ranging within normal human dosage (9.14 or 22.86 mg/kg/body weight/day) did not elevate liver enzymes or any other biomarkers of liver toxicity in rats. Another rat study showed no evidence of hepatotoxicity at 150 and 300 mg/kg. A detailed safety assessment on 225 men using 160 mg of Saw Palmetto twice a day found no significant side effects or toxicity compared to placebo. Saw Palmetto may interact with pharmaceuticals via cytochrome p450 effects.

Dosage: 160 to 450 mg twice daily of an extract containing 45-95% fatty acids.

Traditional Uses

Serenoa repens or Saw Palmetto extracts have been used for centuries in the treatment of benign prostatic hyperplasia. Classic herbal books and folkloric traditions report Serenoa to be a genitourinary tonic in both sexes.

Jillian Stansbury, ND, BS, AHG, CMA has practiced in Southwest Washington state for more than 25 years specializing in women’s health, mental health, and chronic disease. Dr. Stansbury is the former chair of the Botanical Medicine Program at the National College of Naturopathic Medicine in Portland, Oregon and remains on the faculty teaching natural products chemistry, botanical influences on cell biology, ethnobotany field course, and other miscellaneous topics in herbal medicine. She writes for numerous professional journals plus teaches around the country at a variety of medical and herbal conferences. She will speak about botanical influences on cell biology and optimizing fertility with pure concentrated botanicals at the 14th Annual International Restorative Medicine Conference, Sept. 15-18 at the Sonesta Resort on Hilton Head Island, S.C.