Herbal Medicine for PCOS: Which Plants Can Help You Heal?
Did you know that a lot of pharmaceutical drugs are actually derived from plants and herbs?
The problem is that they strip the plant of it's synergistic compounds and often isolate a single active compound.
This results in a powerful medication, however it can also lead to many side effects, as this isn't how the plants in nature have been designed to work.
Along with nutrition, regular exercise, stress management and the avoidance of environmental toxins, I often recommend the addition of herbal supplements to my clients with PCOS, as they can be extremely effective.
Polycystic Ovarian Syndrome (PCOS) is a complex condition and the most common endocrine (hormonal) disorder affecting women of reproductive age.
The conventional treatment tends to include hormonal birth control pills (to 'regulate' the menstrual cycle), meformin (if insulin resistance is present) and anti-androgen medications such as spironolactone (to 'manage' symptoms such as acne and hirsutism).
Although these drugs can be effective at managing symptoms, they don't actually support the body or address the underlying cause of the imbalances. Herbal medicine on the other hand, can actually help to improve the metabolic and hormonal dysfunction, with minimal side effects (possibly even some side-benefits!).
The main drivers of PCOS are...
Insulin resistance: present in approximately 70% of women with this condition.
Inflammation: likely present in all PCOS women, to some degree
Adrenal stress: it is estimated that 20-30% of women with PCOS have adrenal androgen excess.
These can lead to the common PCOS symptoms such as acne, hair loss, hirsutism, irregular or absent menstrual cycles and weight gain.
I recommend you figure out the root causes of your personal PCOS as this will help you determine what diet, lifestyle and supplements will work best for you!
Here are the most effective herbs for Polycystic Ovarian Syndrome (PCOS)...
(I'm not a qualified herbalist but use herbal supplements with clients regularly with great success. Please speak to your healthcare practitioner before supplementing with any of these herbs)
Best for: Insulin resistant & Inflammatory PCOS
This herb is known as an insulin sensitising agent and some studies have shown it to be as effective (if not more) than the drug metformin (1) It has also been shown to have anti-inflammatory effects, reduce cholesterol levels, increase sex hormone binding globulin (SHBG) and significantly lower androgens in women with PCOS (2)
Berberine is often used in antimicrobial protocols to aid in the eradication of pathogens in the gut, such as bacteria, yeast and parasites. There is a strong connection between poor gut health and PCOS, therefore improving the microbiome, may also improve hormonal balance.
Typical dosage is 500mg 3 x day, however this is not to be used long term because of the antimicrobial effects in the gut. I don't recommend taking it longer than 8 weeks if you aren't under the supervision of a practitioner. Berberine can lower blood glucose levels so do not take this if you experience hypoglycemia or are already taking a medication like metformin.
Best for: Insulin resistant PCOS
This classic kitchen staple doesn't just make food taste great, it also has amazing health benefits for women with PCOS. Cinnamon improves insulin sensitivity and allows glucose to be transported from the blood and into the cells much more efficiently. (3)
It may also reduce insulin levels by slowing the movement of food from the stomach into the small intestine (a part of digestion called “gastric emptying”) which also slows the breakdown of carbohydrates (4)
The effective dose is typically 1–6 grams or around 0.5–2 teaspoons of cinnamon per day. Make sure that you purchase Ceylon aka 'true cinnamon', not cassia. If you regularly experience hypoglycaemia (low blood glucose), I wouldn't recommend this.
Best for: Insulin resistant & Post Pill PCOS
Testosterone can be converted into the super potent androgen Dihydrotestosterone (DHT) by the 5-alpha reductase enzyme. Many women with PCOS have signs of elevated androgens, such as acne, hair loss and hirsutism, but blood levels can be within normal range. Our body can metabolise (break down) hormones via different pathways, which can make them more or less problematic. Saw Palmetto can help to slow down the 5-alpha reductase enzyme (5) (6)
It may also help to lower prolactin levels, which can often be elevated in women with PCOS. High prolactin can suppress follicle maturation, ovulation, and contribute to the development of ovarian 'cysts'.
I tend to use saw palmetto in combination with other nutrients such as zinc and inositol, for a synergistic effect. It is recommend to assess 5-alpha reductase activity before supplementing, using functional lab testing such as the DUTCH test. A general dosage is around 200-500mg per day.
Best for: All Types of PCOS
It is not exactly understood how spearmint can help to improve PCOS symptoms such as acne and hirstusim, however several studies have shown that it helps to reduce free testosterone levels (up to 30%!)
One study had women with PCOS drink 2 cups of spearmint tea per day, during the follicular phase of their menstrual cycles. After treatment with spearmint teas, there was a significant decrease in free testosterone and increase in luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol. However, there were no significant decreases in total testosterone or dehydroepiandrostenedione sulphate (DHEA-S) levels (7)
I am often asked whether peppermint tea provides similar results. Although it will likely have some similar benefits, I do find that spearmint is more effective for PCOS and peppermint tends to work better for gastrointestinal complaints. I recommend drinking 2 cups of organic spearmint tea per day during the first half of your cycle (up until ovulation), for the best results.
Best for: Insulin resistant, Post-Pill & Inflammatory PCOS
Green tea has many health benefits and is very rich in antioxidants. Some degree of inflammation is likely present in all women with PCOS, therefore antioxidants from diet and herbs can help to repair free radical damage.
There are many studies that show the metabolic benefits of green tea, and one study in particular found that the consumption of green tea by overweight and obese women suffering from PCOS lead to weight loss, a decrease in fasting insulin, and a decrease in the level of free testosterone (8)
Green tea does contain caffeine, therefore those with anxiety or elevated cortisol levels may not tolerate it well. That being said, individuals who are sensitive to the caffeine in coffee, may actually tolerate green tea better, as it also contains a calming amino acid known as l-theanine. This can give you a stable, energy boost, without causing that 'wired' or jittery feeling. Try consuming 1 or 2 cups, before mid-day.
Liquorice & Peony
Best for: Insulin resistant, Inflammatory & Adrenal PCOS
The combination of liquorice and peony is very effective for women with PCOS. A few studies have shown that this combo reduces testosterone and improves cycle regularity.
Liquorice works to lower testosterone in women and can block androgen receptors, whereas peony inhibits testosterone production and promotes the aromatase enzyme which converts testosterone to oestrogen. Peony also helps to reduce LH levels (which can be elevated in women with PCOS), and increase sex hormone binding globulin (SHBG), which acts as a sponge in the bloodstream and 'soaks up' excess hormones (9) (10)
The dosage of these herbs depends on the formulation. This combination is not widely available in supplemental form in the UK, however a qualified herbalist may help to formulate a PCOS supportive blend for you, containing these effective herbs. These herbs are quite powerful, so I don't recommend supplementing without supervision from a practitioner. Liquorice can raise blood pressure!
Vitex (Chaste Tree Berry)
Best for: Any Type Without High LH levels
Polycystic Ovarian Syndrome (PCOS) is a condition of ovulatory dysfunction, which often leads to very low progesterone levels during the luteal phase of the menstrual cycle. Vitex actually helps to boost progesterone levels, by increasing luteinising hormone (LH). It can also help to lower prolactin levels, which are often elevated in women with PCOS. If you have elevated Luteinising Hormone (L.H) on blood work (which can be common in women with PCOS), taking vitex may increase it too much and this can actually worsen PCOS symptoms for those women (11)
Vitex can help to restore ovulation and menstrual regularity for women with hypothalamic amenorrhea (H.A), which can be misdiagnosed as PCOS. I also like to recommend it to those who are struggling to regain their cycle after 3 months of stopping hormonal birth control. It often works best for women without PCOS who suffer with PMS, due to low progesterone, in my opinion.
Vitex is a slow acting herb, therefore it should be taken for a minimum of 3 months to see any real changes to your hormones. I recommend you take it cyclically, by discontinuing it during your menstrual bleed each month if you are regularly cycling, if not, take a few days off each month. Typical dosing is 20-40 mg/day, though up to 240 mg of products containing the herb has been shown to be safe and effective. Most results will occur within 6 months, therefore I don't like to recommend taking Vitex long term, as the effects on the pituitary gland then start to diminish.
Best for: All PCOS Types
Stress is a huge driver of all health conditions, especially hormonal imbalances like PCOS. Ashwagandha is an adaptogenic herb, meaning that it helps your body to 'adapt' to stress by up or down regulating energy and hormone levels, depending on what your body needs (12) High cortisol can elevate blood glucose levels, promote insulin resistance, create inflammation and stimulate the production of androgens (such as DHEA-S) from the adrenal glands.