Polycystic ovary syndrome (PCOS) is the most common endocrine pathology in females worldwide, affecting between 5 to 15% of women.1Rasquin L, Anastasopoulou C, Mayrin J. Polycystic Ovarian Disease. In StatPearls – NCBI bookshelf. NIH National Library of Medicine. November 15, 2022. Accessed August 25, 2023. https://www.ncbi.nlm.nih.gov/books/NBK459251. PCOS is a complex syndrome with unique diagnostic criteria. This article explores naturopathic and conventional approaches to management and support.
Cause and Pathophysiology of Polycystic Ovary Syndrome
There are two primary components of PCOS: reproductive and metabolic.2Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P T. 2013;38(6):336-355. The cause of polycystic ovary syndrome is unknown; however, there are links to insulin resistance and obesity. Insulin regulates ovarian function and, responding to increased insulin typical with PCOS, ovaries react by producing more androgens.
When evaluating a person for PCOS, several lab tests are needed to determine various female and male sex hormone levels, thyroid hormones, fasting blood glucose levels, insulin levels, hemoglobin A1C (which indicates how your body metabolizes glucose, and cholesterol levels (as these may increase with metabolic syndrome). A transvaginal/transabdominal ultrasound is also important to detect polycystic ovaries while ruling out other conditions. Polycystic ovary syndrome is a diagnosis of exclusion, and proper diagnosis requires checking for conditions with similar symptoms, such as thyroid disease, hyperprolactinemia, and nonclassic congenital adrenal hyperplasia.
PCOS Symptoms
- Enlarged ovaries with numerous small cysts
- Irregular menstrual cycles
- Pelvic pain
- Hirsutism (excess facial or body hair on chest, stomach, and back)
- Alopecia
- Acne or oily skin
- Acanthosis nigricans (dark or thick skin patches on the back of the neck, in the armpits, under breasts)
- Skin tags (small pieces of excess skin on the neck or in the armpits)
- Weight gain or difficulty losing weight
- Infertility
- Fatigue
Conventional Treatment
Hormonal contraceptives are typically first-line treatment for menstrual abnormalities, hirsutism, and acne.3(8) Supplemental hormones naturally cause a decrease in androgen levels, which are commonly regarded as male sex hormones: free and total testosterone.
Metformin has been shown to improve menstrual cycles and glucose metabolism, help facilitate weight loss, and decrease cardiovascular risk markers in non-obese people with PCOS.
Spironolactone is the most common drug used for anti-androgenic effects, after hormonal contraceptives. It is known to suppress testosterone levels.
Natural Treatments for PCOS
Naturopathic doctors take a combined and individualized approach to manage any health condition, including polycystic ovary syndrome. When treating PCOS, priorities include evaluating and addressing aspects of hormonal health, insulin resistance, and metabolic syndrome. Naturopathic philosophy involves targeting the root cause in addition to managing symptoms. The goal is improving patients’ quality of life and communicating the many ways to do so. Lifestyle changes, dietary supplements,4Kiani AK, Donato K, Dhuli K, Stuppia L, Bertelli M. Dietary supplements for polycystic ovary syndrome. J Prev Med Hyg. 2022;63(2 Suppl 3):E206-E213. Published 2022 Oct 17. https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2762 herbal medicine,5Manouchehri A, Abbaszadeh S, Ahmadi M, Nejad FK, Bahmani M, Dastyar N. Polycystic ovaries and herbal remedies: A systematic review. JBRA Assist Reprod. 2023;27(1):85-91. Published 2023 Mar 30. https://doi.org/10.5935/1518-0557.20220024 homeopathy, hydrotherapy, and acupuncture are all viable options for PCOS treatment.
Nutrition
Randomized controlled trials have shown that a proper diet can help manage PCOS symptoms and regulate insulin and male hormones.6Cowan S, Lim S, Alycia C, et al. Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. BMC Endocr Disord. 2023;23(1):14. Published 2023 Jan 16. https://doi.org/10.1186/s12902-022-01208-y The best approach to nutrition for PCOS management is a high-protein, low-glycemic diet balanced with a variety of vegetables and some fruits. Choosing carbohydrates with a lower glycemic index can regulate blood sugar levels, which correlates to improved insulin resistance and regulated reproductive hormones, such as testosterone and sex hormone-binding globulin. Increased protein intake is the ideal dietary change for people with PCOS, as it is even more effective than carbohydrate changes. High-protein meals may reduce insulin and DHEA, which the body uses to make reproductive hormones. High-protein diets have also shown efficacy for weight loss, typically a more complicated process for PCOS patients.
Exercise
Patients with PCOS should exercise regularly and are not limited to one type of physical activity.7Shele G, Genkil J, Speelman D. A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome. J Funct Morphol Kinesiol. 2020;5(2):35. Published 2020 May 31. https://doi.org/10.3390/jfmk5020035 Studies show vigorous aerobic exercise can improve insulin sensitivity, while strength training can improve androgen levels. Lower-intensity activities such as yoga, Pilates, and walking have many of the same benefits. If chronic fatigue is a concern, a combination of lower-intensity exercises may be best. Remember to hydrate. A good rule of thumb is to drink 8 ounces of water every 45 minutes of exercise.
Sleep
Supporting sleep is a crucial part of PCOS management. People with PCOS tend to get less quality sleep and may struggle with sleep disorders, such as obstructive sleep apnea.8Ee C, Pirotta S, Mousa A, Moran L, Lim S. Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success. BMC Endocr Disord. 2021;21(1):234. Published 2021 Nov 23. https://doi.org/10.1186/s12902-021-00890-8 Overweight PCOS patients are more likely to suffer from obstructive sleep apnea. Sleep disturbances and deprivation activate the sympathetic nervous system, further contributing to insulin resistance. To address sleeplessness and difficulty sleeping, a doctor may suggest polysomnography, one or a series of sleep studies.
Stress Management
Many of us live in a highly driven and busy state, further propelling our bodies into a sympathetic “fight or flight” state. This heightens insulin sensitivity and may exacerbate PCOS. Managing PCOS in and of itself can be challenging, affecting stress levels and mental health. Effective stress management techniques include cognitive behavioral therapy, journaling, meditation, yoga, and nature walks.9Ee C, Pirotta S, Mousa A, Moran L, Lim S. Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success. BMC Endocr Disord. 2021;21(1):234. Published 2021 Nov 23. https://doi.org/10.1186/s12902-021-00890-8
Supplements
Inositol: Myoinositol and D-chiro-inositol are the best forms of inositol most used in PCOS treatment. Myoinositol has been shown to improve insulin resistance and various fertility-related physiological processes, such as egg maturation and early embryo development. As myoinositol improves insulin resistance, it also lowers testosterone levels. D-chiro-inositol also supports insulin resistance and egg quality.
Omega-3 Fatty Acids: Anti-inflammatory omega-3s benefit the gastrointestinal system, immune system, and overall mental health. Evidence suggests omega-3s improve insulin sensitivity and lipid profile in PCOS patients.
Vitamin D: Vitamin D deficiency is quite common and may exacerbate PCOS. Vitamin D supports insulin resistance and fat metabolism and may reduce inflammation. Vitamin D is vital for mental health.
Magnesium: Magnesium has an essential function in glucose metabolism. Many people are deficient, and supplementation can improve symptoms for PCOS patients.
CoQ10: CoQ10 is a potent anti-inflammatory and may lessen the risk of conditions associated with PCOS, such as type 2 diabetes and cardiovascular disease.
Botanical Medicine
Chamomile: Chamomile is a nervine herb with anti-inflammatory properties. Nervines promote more restful sleep, which is essential for PCOS patients struggling with fatigue and sleep disturbances.
Chaste Tree: Also known as Vitex, chaste tree may regulate estrogen and progesterone ratios, which tend to be affected by PCOS. Studies show chaste tree can help regulate progesterone levels and normalize menstrual cycles.
Cinnamon: Cinnamon is a powerful antioxidant that can reduce blood sugar and lipid levels and regulate menstrual cycles.
Ginseng: Panax Ginseng has been able to suppress luteinizing hormone levels (LH) in PCOS patients. LH has a vital role in ovulation. Ginseng is also a potent adaptogen in the fight against fatigue and hormonal changes due to stress.
Licorice Root: Licorice root stimulates insulin secretion, lowering blood sugar levels.
Rhodiola Rosea: Rhodiola is a potent adaptogen that supports chronic stress, mental health, and hormone balance.
Maca: Maca is another powerful adaptogen herb that supports menstrual regularity and ovulation induction. This herb is recommended for PCOS patients who are trying to conceive.
Hydrotherapy
Hydrotherapy supports liver detoxification and cardiovascular health, both essential for people with PCOS. Contrast showers are a convenient way to practice hydrotherapy at home.
Acupuncture
Traditional Chinese Medicine studies on acupuncture show improvement in PCOS symptoms and a direct effect on reproductive hormones that induce ovulation and restore menstrual cycles.10Sadeghi HM, Adeli I, Calina D, et al. Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. Int J Mol Sci. 2022;23(2):583. Published 2022 Jan 6. https://doi.org/10.3390/ijms23020583 Many naturopathic doctors are licensed acupuncturists.
Footnotes
- 1Rasquin L, Anastasopoulou C, Mayrin J. Polycystic Ovarian Disease. In StatPearls – NCBI bookshelf. NIH National Library of Medicine. November 15, 2022. Accessed August 25, 2023. https://www.ncbi.nlm.nih.gov/books/NBK459251.
- 2Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P T. 2013;38(6):336-355.
- 3(8)
- 4Kiani AK, Donato K, Dhuli K, Stuppia L, Bertelli M. Dietary supplements for polycystic ovary syndrome. J Prev Med Hyg. 2022;63(2 Suppl 3):E206-E213. Published 2022 Oct 17. https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2762
- 5Manouchehri A, Abbaszadeh S, Ahmadi M, Nejad FK, Bahmani M, Dastyar N. Polycystic ovaries and herbal remedies: A systematic review. JBRA Assist Reprod. 2023;27(1):85-91. Published 2023 Mar 30. https://doi.org/10.5935/1518-0557.20220024
- 6Cowan S, Lim S, Alycia C, et al. Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. BMC Endocr Disord. 2023;23(1):14. Published 2023 Jan 16. https://doi.org/10.1186/s12902-022-01208-y
- 7Shele G, Genkil J, Speelman D. A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome. J Funct Morphol Kinesiol. 2020;5(2):35. Published 2020 May 31. https://doi.org/10.3390/jfmk5020035
- 8Ee C, Pirotta S, Mousa A, Moran L, Lim S. Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success. BMC Endocr Disord. 2021;21(1):234. Published 2021 Nov 23. https://doi.org/10.1186/s12902-021-00890-8
- 9Ee C, Pirotta S, Mousa A, Moran L, Lim S. Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success. BMC Endocr Disord. 2021;21(1):234. Published 2021 Nov 23. https://doi.org/10.1186/s12902-021-00890-8
- 10Sadeghi HM, Adeli I, Calina D, et al. Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. Int J Mol Sci. 2022;23(2):583. Published 2022 Jan 6. https://doi.org/10.3390/ijms23020583
