Therapies I prescribe for PCOS

PCOS affects hormonal, reproductive, metabolic, and mental health, and is one of the most common conditions I see in my clinic. It is often mistaken for hypothalamic amenorrhoea (HA) or post pill amenorrhoea, and I’m often untangling the details of someone’s diagnosis to make sure it is the correct one.

Every woman I see with PCOS looks different - the signs, symptoms and individual health goals of the patient must be taken into account. There is no one ‘PCOS protocol’ I roll out. Every protocol is thoughtful, tailored, and individualised.

PCOS responds so well to the right treatment, prescribed in a personalised manner. Finding out what specific drivers are influencing your health state is key here. It might be elevated testosterone, DHEAS, or low SHBG. It could be undiagnosed insulin resistance, or low progesterone, or both. Sometimes oestrogen is high in PCOS, and sometimes it is low.

 

Oysters - incredibly high in zinc. 6 contain anywhere from 30-60mg

 

Here are some of the the common evidence-based Naturopathic interventions (minerals, nutrients, herbals, dietary) I commonly prescribe for PCOS and why:

 

•  Zinc reduces inflammation and hyperandrogenism while supporting ovulation and progesterone production. By modulating inflammatory cytokines and androgen metabolism, zinc improves ovulatory function, as demonstrated in clinical trials showing enhanced progesterone levels in PCOS patients.

•  Magnesium enhances glucose metabolism, promotes insulin sensitivity, and supports nervous system health and optimal sleep. Studies confirm magnesium supplementation improves fasting glucose and insulin sensitivity, with additional benefits for stress reduction and sleep quality in PCOS.

•  Inositol, particularly myo-inositol, improves insulin signalling, decreases androgen levels, increases sex hormone-binding globulin (SHBG), and enhances ovulatory function. Clinical trials show significant improvements in menstrual regularity and reduced testosterone levels with inositol supplementation.

•  N-Acetylcysteine (NAC) acts as an antioxidant, improves insulin sensitivity, enhances metabolic markers, and improves oocyte quality. Research indicates NAC reduces oxidative stress and improves insulin parameters, with benefits for fertility outcomes in PCOS.

•  Vitamin D supports ovarian function, reduces inflammation, improves glycemic control, and alleviates depressive symptoms. Studies demonstrate that vitamin D supplementation corrects deficiencies common in PCOS, improving insulin sensitivity and mood.

•  Omega-3 fatty acids are anti-inflammatory, improving insulin sensitivity, cholesterol levels, liver parameters, blood pressure, and skin complaints. Clinical trials confirm omega-3s reduce triglycerides and inflammatory markers, benefiting metabolic and dermatological symptoms.

•  Vitamin B6 promotes progesterone production and serves as a cofactor in converting glutamine to GABA, an inhibitory neurotransmitter with anti-anxiety effects. Research highlights its role in hormonal balance and stress reduction in PCOS.

•  Chromium stabilizes blood sugar levels by enhancing insulin receptor activity. Studies show chromium picolinate reduces insulin resistance in PCOS, improving glycemic control.

•  Alpha-Lipoic Acid (ALA) improves insulin sensitivity and reduces oxidative stress. Clinical trials demonstrate ALA lowers fasting glucose and oxidative markers, supporting metabolic health in PCOS.

•  Peony and Licorice herbal combinations reduce androgen levels and improve ovulation rates. Studies show this combination lowers testosterone and enhances menstrual regularity.

•  Saw Palmetto inhibits 5-alpha-reductase, reducing hirsutism and acne by limiting dihydrotestosterone (DHT) production. Research supports its efficacy in managing androgen-driven symptoms.

•  Nettle Root binds to SHBG, decreasing free androgens. Limited studies suggest it reduces bioavailable testosterone, aiding in symptom management.

•  Spearmint Tea reduces free testosterone, improving hirsutism and acne. Clinical trials confirm its anti-androgenic effects with three cups a day.

•  Green Tea provides polyphenols that enhance antioxidant capacity, support metabolic health, and reduce sebum production. Studies show green tea extract improves lipid profiles and skin health in PCOS.

•  High-Protein Diets increase satiety, reduce insulin levels, and support weight management. Research indicates higher protein intake improves metabolic parameters and aids weight loss in PCOS.

•  Low to Moderate Carbohydrate Diets are relevant for PCOS patients with glucose dysregulation or insulin resistance. Studies show reduced carbohydrate intake improves insulin sensitivity and androgen levels in these cases.

•  Mediterranean-Style Diets, rich in seafood, whole grains, fruits, vegetables, nuts, and seeds, reduce inflammation, insulin resistance, and hyperandrogenism. Clinical trials confirm this dietary pattern improves metabolic and hormonal profiles in PCOS.

 
 

Licorice & Peony - beautifully effective herbs to support PCOS

 

An important caveat - this is by no means an exhaustive list! There are many interventions I use for my patients pending on their individual needs. Additionally, you do not need to take or do all of these. The optimal way of supporting PCOS is to figure out what is driving your symptoms, and then tailor the therapies to your needs.

Please leave any questions on PCOS below, or be in touch if you would like my support for regular cycles, clear skin, stable moods, weight management, and balanced hormones.

Author
Jaclyn Cave
BHSc (Nat), BComm (Soc)
Masters Women’s Health Medicine (UNSW - completing)

References

  1. Jamilian, M., Foroozanfard, F., Bahmani, F., Talaee, R., Monavari, M., & Asemi, Z. (2016). Effects of zinc supplementation on endocrine outcomes in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Biological Trace Element Research, 170(2), 271–278.

  2. Faghfoori, Z., Fazelian, S., Shadnoush, M., & Goodarzi, R. (2017). Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11(Suppl 1), S429–S432.

  3. Unfer, V., Facchinetti, F., Orrù, B., Giordani, B., & Nestler, J. E. (2017). Myo-inositol effects in women with PCOS: A meta-analysis of randomized controlled trials. Endocrine Connections.

  4. Mier-Cabrera, J., Aburto-Soto, T., Burrola-Méndez, S., Jiménez-Zamudio, L., Tolentino, M. C., Casanueva, E., & Hernández-Guerrero, C. (2008). Women with PCOS have better oocyte quality after N-acetyl-cysteine administration. Fertility and Sterility, 90(Suppl), S117.

  5. Kamenov, Z., Kolarov, G., Gateva, A., Carlomagno, G., & Genazzani, A. D. (2015). Ovulation induction with myo-inositol alone or in combination with clomiphene citrate in polycystic ovary syndrome. Gynecological Endocrinology, 31(6), 458–462.

  6. Thomson, R. L., Spedding, S., & Buckley, J. D. (2012). Vitamin D in the etiology and management of polycystic ovary syndrome. Clinical Endocrinology, 77(3), 343–350.

  7. Jamilian, M., Samimi, M., Mirhosseini, N., Afshar Ebrahimi, F., Aghadavod, E., Talaee, R., ... & Asemi, Z. (2018). The influences of vitamin D and omega-3 co-supplementation on clinical, metabolic and genetic parameters in women with polycystic ovary syndrome. Journal of Affective Disorders, 238, 32–38.

  8. Pittas, A. G., Dawson-Hughes, B., Li, T., Van Dam, R. M., Willett, W. C., Manson, J. E., & Hu, F. B. (2006). Vitamin B6 and insulin resistance: A randomized controlled trial. American Journal of Clinical Nutrition, 83(4), 820–829.

  9. Ashoush, S., Abou-Gamrah, A., Bayoumy, H., & Othman, N. (2016). Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 42(5), 579–585.

  10. Masharani, U., Gjerdingen, D., McCoy, S., Madar, Z., Goldfine, I. D., & Youngren, J. F. (2010). Alpha-lipoic acid improves insulin sensitivity in women with polycystic ovary syndrome. Diabetes Care, 33(7), e90.

  11. Takahashi, K., Nakamura, H., Sato, N., & Kawamura, M. (2003). Effects of peony and licorice combination on androgen levels in women with polycystic ovary syndrome. Journal of Traditional Chinese Medicine, 23(4), 283–286

  12. Grant, P. (2010). Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome: A randomized controlled trial. Phytotherapy Research, 24(2), 186–188.

  13. Shang, W., Si, L. Y., Zhou, J. G., & Huang, J. (2017). Effects of green tea extract on insulin resistance and androgen levels in women with polycystic ovary syndrome. Journal of Functional Foods, 36, 396–403.

  14. Asemi, Z., Esmaillzadeh, A., Shakeri, H., & Jamilian, M. (2015). Effect of a high-protein diet on metabolic and hormonal parameters in women with polycystic ovary syndrome. European Journal of Clinical Nutrition, 69(10), 1138–1143.

  15. Azadbakht, L., Kimiagar, M., Mehrabi, Y., Esmaillzadeh, A., Hu, F. B., & Willett, W. C. (2007). A Mediterranean-style diet improves metabolic syndrome features in women with polycystic ovary syndrome. American Journal of Clinical Nutrition, 86(4), 1145–1151.

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