As a syndrome, it is not a black and white disease but rather a cluster of symptoms. The most common criteria for diagnosis is the Rotterdam Criteria which requires at least two of the following three symptoms ⁽¹⁾:

1. Oligo-anovulation (irregular or no ovulation)
2. Clinical or biochemical evidence of hyperandrogenism (having either high androgens in blood tests OR having the symptoms of high androgens which may include acne, excess male pattern hair growth (called hirsutism) and/or hair loss)
3. Polycystic ovaries on ultrasound examination

In my clinical experience, PCOS presents very much like a spectrum condition with some women on the severe side who are overweight, have very few cycles in a year and perhaps have excess hair growth, to some women on the milder side who might have slightly longer but regular ovulatory cycles (around 35 days) and mild androgen symptoms but can control their weight relatively well. There are also so many women in between. I find, with the correct dietary and lifestyle recommendations, as well as tailored herbal and nutritional prescriptions, women move from the severe end of the spectrum down towards the milder and far more manageable end.

Of course, no prescription should ever be the same, however, here are some of the many tools that can be used to improve PCOS symptoms naturally:

Dietary modification

A modified diet is the first step and one of the most important steps to managing PCOS for the rest of your life⁽²⁾. Specific recommendations include:

• Ensuring each meal contains a serve of protein (animal or plant proteins), some healthy fats (avocado, nuts, seeds, olive oil, fatty fish) and predominantly vegetables (aiming for 50-75% of your plate/bowl to be veggies).
• Significantly reducing or avoiding added/refined sugars⁽³⁾: sugar increases insulin-like growth factor-1 (IGF-1) and insulin which in turn drives testosterone production. Excess insulin also leads to fat storage, inability to shift excess weight and fatigue which are common symptoms women with PCOS experience.
• Swap refined carbohydrates with wholegrain and vegetable alternatives⁽³⁾: for the same reasons as above, refined carbohydrates essentially act like sugar in the blood and spike blood sugar and insulin levels. Wholegrains are buffered with fibre and essential nutrients and are much better alternatives to their white counterparts but should still be consumed in moderation.

Avoid processed/packet foods⁽³⁾: these foods are usually laden with sugar, salt and unhealthy fats that do not support healthy metabolic and reproductive outcomes

Minimising inflammatory foods such as⁽⁴⁾:

• Dairy: as it also increases IGF-1 and is particularly problematic for PCOS symptoms such as acne and hirsutism
• Gluten-containing grains: gluten is certainly not an issue for everyone but it can be quite inflammatory for many women and many report feeling more energetic, less bloated, more mentally clear when they avoid it.
• Alcohol

Daily exercise

Exercise makes your muscles more sensitive to insulin resulting in greater insulin uptake and lower fasting insulin levels⁽⁵⁾. I always recommend varied exercise that the person actually enjoys so that it is sustainable. You want to aim for at least 30 minutes per day. Great options include walking, jogging, pilates, yoga, swimming, biking, and some resistance training.

Stress management

Women with PCOS, and particularly adrenal driven PCOS are often very sensitive to the effects of stress. High cortisol can drive insulin production and can worsen PCOS symptoms. It is important to implement daily stress management techniques such as exercise, mediation, yoga, adequate sleep and possibly supplementation with herbs and nutrients that help to support stress levels⁽⁶⁾.

Nutritional supplementation

The following nutrients are some of the many highly beneficial in PCOS management:

• Zinc: particularly useful for symptoms such as acne, hirsutism or thinning hair⁽⁷⁾. Zinc helps to reduce testosterone levels, regulate insulin levels⁽⁸⁾, and is also an important nutrient for healthy ovulation and hormone production (among hundreds of other functions in the body).
• Inositol: helps to improve the sensitivity of cells to insulin and thus reduce fasting insulin levels⁽⁹⁾.
• Magnesium: is important for stress support, insulin sensitivity, sleep quality and so much more!
• Chromium: can be an important nutrient to consider for blood glucose management⁽⁹⁾.

Herbal medicine

• Peony & licorice: this combination works by converting testosterone to oestrogen, thus reducing elevated testosterone levels⁽¹⁰⁾. It is also thought to block androgen receptors resulting in fewer androgen excess symptoms. Peony in particular is an incredible herb for regulating the communication from the brain to the ovaries for healthy and regular menstrual cycles.
• Spearmint tea: studies have found spearmint tea at a dose of two cups per day to be beneficial in reducing androgens and resulting hirsutism⁽¹⁰⁾.
• Berberine-containing herbs: Berberine a phytochemical found in a number of different herbs. Studies have found berberine to be just as effect as metformin in lowering insulin levels, resulting in significant weight loss and BMI reduction⁽¹¹⁾.
• Herbs for blood sugar regular: other herbs to consider include cinnamon and gymnema
• Herbs for stress management: great options include rhodiola, withania and passionflower to name a few.

Weight management

Research suggests that as little as a 2-5% body weight reduction can improve metabolic and reproductive outcomes in PCOS⁽¹²⁾. This is not about appearances or vanity in any way, and when it comes to PCOS- excessive and quick weight loss is definitely not the answer.

I believe that weight loss comes as a result of addressing the underlying drivers of PCOS, which is usually insulin resistance. By implementing the previously mentioned strategies, women find their insulin levels begin to drop and as a result they are able to shift the weight that was more stubborn before. With healthy weight loss comes healthier ovarian function, resulting in more regular ovulation and menstrual cycles.

PCOS is certainly a condition that can be managed with the correct diet and lifestyle alone. However, with professionally advised herbal and nutritional prescriptions on top of these, it can significantly help to manage PCOS and its symptoms. As mentioned before, with PCOS women presenting quite differently, the suitable natural treatment might vary between them depending on the severity of their symptoms and their underlying drivers. By managing PCOS naturally, women tend to gain a much greater understanding and appreciation for their body which is certainly a wonderful bonus.

References:

1. March, W. A., Moore, V. M., Willson, K. J., Phillips, D. I. W., Norman, R. J., & Davies, M. J. (2010). The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction, 25(2), 544–551. https://doi.org/10.1093/humrep/dep399
2. Legro, R. S. (2000). Evaluation and Treatment of Polycystic Ovary Syndrome. Endotext. MDText.com, Inc. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25905194
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8. Marreiro, D. D. N., Geloneze, B., Tambascia, M. A., Lerário, A. C., Halpern, A., & Cozzolino, S. M. F. (2006). Effect of zinc supplementation on serum leptin levels and insulin resistance of obese women. Biological Trace Element Research, 112(2), 109–118. https://doi.org/10.1385/BTER:112:2:109
9. Mansour, A., Hosseini, S., Larijani, B., & Mohajeri-Tehrani, M. R. (2016, September 5). Nutrients as novel therapeutic approaches for metabolic disturbances in polycystic ovary syndrome. EXCLI Journal. Leibniz Research Centre for Working Environment and Human Factors. https://doi.org/10.17179/excli2016-422
10. Grant, P., & Ramasamy, S. (2012, April). An update on plant derived anti-androgens. International Journal of Endocrinology and Metabolism. Kowsar Medical Institute. https://doi.org/10.5812/ijem.364
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