Supported by multiple clinical trials and systematic reviews
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic condition affecting 8–13% of reproductive-aged women and people assigned female at birth. It is characterized by a triad of ovulatory dysfunction, hyperandrogenism, and polycystic ovarian morphology and is strongly linked to insulin resistance, weight gain/obesity, dyslipidemia, and elevated cardiometabolic risk. Symptoms can include irregular or absent menses, infertility, acne, hirsutism, alopecia, weight gain or difficulty losing weight, and mood disturbances such as anxiety and depression. Long-term risks include type 2 diabetes, nonalcoholic fatty liver disease, endometrial hyperplasia/cancer (from chronic anovulation), and sleep apnea. Presentation varies by phenotype and across the life course; adolescents require careful diagnostic interpretation due to pubertal overlap with PCOS features. Western medicine uses standardized criteria to diagnose PCOS after excluding other causes (e.g., thyroid disease, hyperprolactinemia, nonclassic congenital adrenal hyperplasia, androgen-secreting tumors). Management is goal-directed: restoring menstrual regularity and ovulation, addressing hyperandrogenic symptoms, optimizing metabolic health, preventing endometrial pathology, and supporting mental well-being. Lifestyle modification is first-line for nearly all, as modest weight loss (5–10%) and regular physical activity improve ovulation, insulin sensitivity, lipids, and quality of life. Pharmacologic therapies include combined oral contraceptives to regulate cycles and lower androgens when pregnancy is not desired; metformin to improve insulin resistance and metabolic outcomes (and sometimes cycle frequency); and antiandrogens such as spironolactone for hirsutism/acne (with reliable contraception). For those seeking pregnancy, letrozole is the preferred first-line ovulation induction agent and is superior to clomiphene for live birth. Dermatologic measures (eflornithine cream, laser/IPL hair reduction) can
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
Rotterdam criteria: 2 of 3—(1) oligo-/anovulation, (2) clinical and/or biochemical hyperandrogenism, (3) polycystic ovarian morphology on ultrasound—after exclusion of mimicking disorders (e.g., thyroid dysfunction, hyperprolactinemia, nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, Cushing syndrome). Use age-appropriate thresholds and caution in adolescents. Baseline metabolic screening: BMI/waist, blood pressure, fasting lipids, and glycemia (75-g OGTT or HbA1c per risk), plus mental health and sleep apnea screening. Consider 17-hydroxyprogesterone, TSH, prolactin, and androgen panel based on presentation.
Treatments
- Lifestyle modification (nutrition, physical activity, sleep, stress); 5–10% weight loss can significantly improve cycles, ovulation, and metabolic markers
- Combined oral contraceptives (COCs) for menstrual regulation and androgen suppression when contraception is acceptable
- Metformin for insulin resistance, impaired glucose tolerance, and menstrual irregularity (especially with metabolic risk)
- Antiandrogens for hirsutism/acne (e.g., spironolactone) with reliable contraception
- Ovulation induction: letrozole first-line; clomiphene second-line; gonadotropins or IVF if needed
- Inositol supplementation (myo-inositol ± D-chiro-inositol) as an adjunct for metabolic and ovulatory parameters
- Dermatologic therapies: eflornithine cream; laser or intense pulsed light for hirsutism
- Weight-loss pharmacotherapy for obesity (e.g., GLP-1 receptor agonists) per general obesity guidelines
- Bariatric/metabolic surgery for severe obesity with comorbidities; typically improves cycles and metabolic measures
- Psychological support; screen and treat anxiety/depression; address disordered eating; behavioral therapy
Medications
- Combined oral contraceptives (ethinyl estradiol + progestin variants)
- Metformin (immediate or extended-release)
- Letrozole (ovulation induction)
- Clomiphene citrate (ovulation induction)
- Spironolactone (hirsutism; teratogenic—requires contraception)
- Eflornithine topical (facial hirsutism)
- GLP-1 receptor agonists (e.g., liraglutide, semaglutide) for obesity/insulin resistance per indications
- Occasionally gonadotropins for ovulation induction under specialist care
Limitations
PCOS is heterogeneous; no single therapy addresses all domains. COCs regulate bleeding and reduce androgens but do not directly treat insulin resistance and may modestly worsen lipids or blood pressure in some. Metformin has GI side effects and is less effective than letrozole for fertility outcomes. Antiandrogens are teratogenic and require effective contraception. GLP-1 receptor agonists are costly and require injections; long-term reproductive data in PCOS are still accruing. Inositol quality and dosing vary across supplements; evidence suggests benefit but remains less definitive than for core pharmacotherapies. Lifestyle change is effective but challenging to sustain; social and psychological factors often need dedicated support.
Sources
- International evidence-based guideline for the assessment and management of PCOS (2023): Monash University/ESHRE/ASRM collaboration
- Legro RS et al. Letrozole vs Clomiphene for Infertility in the Polycystic Ovary Syndrome. N Engl J Med. 2014;371:119–129
- Teede H et al. Recommendations from the 2023 International PCOS Guideline. Hum Reprod Open. 2023
- Skubleny D et al. The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: Systematic Review and Meta-analysis. Obes Surg. 2016
- Pundir J et al. Myo-inositol for women with PCOS undergoing fertility treatment: systematic review and meta-analysis. BJOG. 2018
Eastern & Traditional Medicine
Traditional Chinese Medicine (TCM)
PCOS is commonly conceptualized as kidney deficiency with phlegm-damp accumulation, liver qi stagnation, and blood stasis disrupting the chong/ren meridians. Treatment aims to tonify kidney, resolve phlegm-damp, move liver qi, and invigorate blood to restore ovulation and cycle regularity.
Techniques
- Individualized herbal formulas (e.g., pattern-based combinations; examples used clinically include Cang Fu Dao Tan Tang for phlegm-damp, Gui Zhi Fu Ling Wan for blood stasis; formulation varies by diagnosis)
- Acupuncture/electroacupuncture protocols targeting pelvic blood flow and neuroendocrine modulation (e.g., CV3, CV4, SP6, ST29, ST36, LR3; individualized)
- Moxibustion and lifestyle/dietary guidance to reduce dampness (emphasizing whole, warm foods; limiting cold/raw, greasy, sugary foods)
Ayurveda
Often framed as Kapha predominance with meda dhatu aggravation, avarana of vata affecting artava (menses/ovulation), and agni (metabolic) imbalance. Treatment focuses on restoring agni, reducing kapha/meda (weight and insulin resistance), and normalizing artava through herbs, diet, daily routines, and mind-body practices.
Techniques
- Herbal agents used traditionally: Shatavari (Asparagus racemosus) for reproductive support; Triphala for digestion/weight; cinnamon for insulin sensitization; formulations individualized by practitioner
- Dietary guidance emphasizing kapha-pacifying, low-glycemic, fiber-rich foods and regular meal timing
- Panchakarma and detoxification in selected cases
- Yoga asana, pranayama, and meditation to reduce stress and improve metabolic function
Yoga and mind–body therapies
Targets hypothalamic–pituitary–ovarian axis regulation, stress reactivity, insulin resistance, and body composition through physical postures, breathing, and meditation. Useful adjunct across PCOS phenotypes, including normal-weight individuals.
Techniques
- Structured yoga programs (e.g., 3–5 sessions/week) combining asana (sun salutations, backbends, hip openers), pranayama (alternate nostril, diaphragmatic breathing), and mindfulness/relaxation
- Mindfulness-based stress reduction or CBT for anxiety/depression common in PCOS
Herbal and dietary adjuncts (naturopathic/herbalism)
Select botanicals and teas are used traditionally to reduce androgens, improve insulin sensitivity, support ovulatory function, and manage hirsutism. Quality control and individualized dosing are important; use as adjuncts to lifestyle and medical care.
Techniques
- Spearmint tea (Mentha spicata) twice daily for anti-androgen effects and hirsutism symptom relief
- Cinnamon (Cinnamomum spp.) standardized extract or culinary doses for insulin sensitization and cycle regularization
- Inositols (myo-inositol ± D-chiro-inositol, often 40:1 ratio) as a nutraceutical bridging paradigms to support ovulation and metabolic health
Sources
- Wu XK et al. (PCOSAct) Effect of Acupuncture vs Sham on Live Birth Among Women With PCOS Undergoing Ovulation Induction: JAMA. 2017 (overall negative; subgroup/secondary signals reported)
- Lim CE et al. Acupuncture for PCOS: Systematic reviews report mixed/low-certainty evidence. Obstet Gynecol Surv. 2013
- Smith CA et al. Acupuncture for subfertility: Cochrane Review. 2016
- Nidhi R et al. Effects of a yoga program in adolescent girls with PCOS: Int J Yoga. 2012
- Patel K et al. Yoga for PCOS: Systematic review/meta-analysis suggests improvements in insulin resistance and anxiety; 2020
- Small RCTs of cinnamon showing improved menstrual cyclicity and insulin sensitivity in PCOS (e.g., Jamilian M, Asemi Z., 2018)
- Patel K et al. Yoga for PCOS: Systematic review/meta-analysis, 2020
- Nidhi R et al. Int J Yoga. 2012 (adolescents with PCOS)
- Akdogan M et al. Spearmint tea reduces hirsutism markers: Phytother Res. 2007; small RCTs
- Grant P. Spearmint herbal tea as an antiandrogen in women with hirsutism. Phytother Res. 2010; small RCT
- Pundir J et al. BJOG. 2018 (inositol meta-analysis)
- Small RCTs of cinnamon in PCOS showing improved glycemic and menstrual outcomes (e.g., 2014–2018 trials)
Integrative Perspective
Insulin resistance is a central therapeutic target in both paradigms. A practical integrative plan often combines: (1) lifestyle first (Mediterranean or low–glycemic index dietary pattern, adequate protein/fiber, resistance + aerobic training, sleep optimization, and stress reduction via yoga/mindfulness); (2) metformin and/or GLP-1 receptor agonist when indicated for glycemic/weight goals; (3) inositol (e.g., myo-inositol 2 g twice daily ± D-chiro-inositol in a 40:1 ratio) as an adjunct for ovulatory and metabolic benefits; and (4) selective herbal/dietary aids such as cinnamon for insulin sensitivity or spearmint tea to modestly reduce hirsutism—recognizing effects are generally small-to-moderate and slower than pharmaceuticals. For cycle control and androgen symptoms when not seeking pregnancy, COCs remain core; spironolactone can be added for hirsutism with reliable contraception. For fertility, prioritize letrozole; consider adjunctive acupuncture during induction recognizing mixed evidence. Coordinate care with qualified TCM/Ayurveda practitioners if using individualized herbal formulas and monitor for interactions (e.g., antiandrogens are teratogenic; discontinue if pregnancy is possible; some herbs may have estrogenic effects or affect liver enzymes). Standardize supplement quality, start low, and reassess every 8–12 weeks with objective markers (cycle tracking, ovulation tests, weight/waist, fasting glucose/HbA1c/lipids, Ferriman–Gallwey score). Shared decision-making, mental health support, and long-term cardiometabolic risk reduction are essential.
Sources
- International evidence-based guideline for the assessment and management of PCOS (2023) – Monash/ESHRE/ASRM
- Legro RS et al. N Engl J Med. 2014;371:119–129 (letrozole superior to clomiphene)
- Skubleny D et al. Obes Surg. 2016 (bariatric surgery and PCOS)
- Pundir J et al. BJOG. 2018 (inositol meta-analysis)
- Wu XK et al. JAMA. 2017 (PCOSAct acupuncture trial)
- Lim CE et al. Obstet Gynecol Surv. 2013 (acupuncture review)
- Patel K et al. 2020 (yoga for PCOS systematic review)
- Akdogan M et al. Phytother Res. 2007; Grant P. 2010 (spearmint tea RCTs)
- Small RCTs 2014–2018 of cinnamon in PCOS indicating improved glycemic/menstrual parameters
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.