Natural Treatments for PMOS

Polyendocrine metabolic ovarian syndrome (PMOS) is the most common endocrine pathology in females worldwide, affecting between 5 and 15 percent 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 PMOS is a complex syndrome with unique diagnostic criteria. This article explores naturopathic and conventional management and support.

PMOS pathophysiology

There are two primary components of PMOS: 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, in response to the increased insulin typical of PMOS, ovaries produce more androgens.

When evaluating a person for PMOS, several lab tests are needed to measure female and male sex hormone levels, thyroid hormones, fasting blood glucose, insulin, hemoglobin A1C (which indicates how your body metabolizes glucose), and cholesterol (as it 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.

PMOS 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 treatments

Hormonal contraceptives are typically first-line treatment for menstrual abnormalities, hirsutism, and acne. Supplemental hormones naturally decrease 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 PMOS.

Spironolactone is the most common drug used for anti-androgenic effects, after hormonal contraceptives. It is known to suppress testosterone levels.

Natural treatments for PMOS

Naturopathic doctors take a combined and individualized approach to manage any health condition, including polyendocrine metabolic ovarian syndrome. When treating PMOS, 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 to improve patients’ quality of life and communicate the many ways to do so. Lifestyle changes, dietary supplements,³Kiani 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,⁴Manouchehri 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 hydrotherapy, and acupuncture are all viable options for PMOS treatment.

Nutrition

Randomized controlled trials have shown that a proper diet can help manage PMOS symptoms and regulate insulin and male hormones.⁵Cowan 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 PMOS 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 with 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 PMOS, 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, which is typically more complicated for PMOS patients.

Exercise

Patients with PMOS should exercise regularly and are not limited to one type of physical activity.⁶Shele 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 crucial to PMOS management. People with PMOS tend to get less quality sleep and may struggle with sleep disorders, such as obstructive sleep apnea.⁷Ee 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 PMOS 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 or a series of sleep studies.

Stress management

Many of us live in a highly driven, busy state, which can push our bodies into a sympathetic “fight or flight” state. This heightens insulin sensitivity and may exacerbate PMOS. Managing PMOS 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.⁷Ee 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 PMOS 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 support the gastrointestinal system, immune system, and overall mental health. Evidence suggests omega–3s improve insulin sensitivity and lipid profile in PMOS patients.

Vitamin D: Vitamin D deficiency is quite common and may exacerbate PMOS. 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 PMOS patients.

CoQ10: CoQ10 is a potent anti-inflammatory and may lessen the risk of conditions associated with PMOS, 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 PMOS 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 PMOS. 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 can suppress luteinizing hormone (LH) levels in PMOS patients. LH has a vital role in ovulation. Ginseng is a potent adaptogen in the fight against stress-related fatigue and hormonal changes.

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 PMOS patients who are trying to conceive.

Hydrotherapy

Hydrotherapy supports liver detoxification and cardiovascular health, both essential for people with PMOS. Contrast showers are a convenient way to practice hydrotherapy at home.

Acupuncture

Traditional Chinese medicine studies on acupuncture show improvement in PMOS symptoms and a direct effect on reproductive hormones that induce ovulation and restore menstrual cycles.⁸Sadeghi 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

• 1
  Rasquin 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 ↩︎
• 2
  Ndefo 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
  Kiani 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 ↩︎
• 4
  Manouchehri 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 ↩︎
• 5
  Cowan 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 ↩︎
• 6
  Shele 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 ↩︎
• 7
  Ee 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 ↩︎
• 8
  Sadeghi 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 ↩︎