NB: polycystic ovary syndrome (PCOS) has officially been renamed polyendocrine metabolic ovarian syndrome (PMOS) to more accurately reflect the condition’s multisystem pathophysiology¹

PMOS is a common condition that presents with metabolic features together with ovulatory dysfunction, menstrual irregularity, infertility, and other symptoms.¹ By identifying and addressing the underlying metabolic and lifestyle contributors, practitioners can help improve reproductive health and fertility outcomes. In this case, a targeted naturopathic approach supported a patient with PMOS-related fertility challenges to conceive after 12 months of unsuccessful attempts.

Initial Presentation

A 28-year-old female attended the clinic concerned that she and her partner had been trying to conceive over the last 12 months and had not yet been successful. Alongside this concern, the patient was experiencing extreme fatigue, weight gain, dark facial hair growth, and desperately wanted to “gain control of her health again.” She had been reluctant to commit to temperature charting as her sleep was broken during the night due to her young daughter waking her. However, ovulation was thought to occur around day 24 of her cycle, based on her use of an ovulation test kit.

The patient had been diagnosed with PMOS at 18 years of age (via pathology testing and an ultrasound) and was prescribed the oral contraceptive pill (OCP) to “regulate menstruation.” She had conceived her first child with relative ease, and her daughter was now 2.5 years old.

Review of her diet revealed consistent intake of three cups of coffee each day alongside high carbohydrate meals and refined sugars. Symptoms of sugar cravings, mid-afternoon fatigue and weight gain made it clear that she was experiencing insulin resistance. She also experienced loose bowel motions immediately after dairy consumption.

Treatment Plan

The initial prescription was aimed at improving insulin sensitivity as an integral part of regulating hormones, due to the impact of high insulin resistance on testosterone and sex hormone-binding globulin (SHBG) levels in PMOS.²

Prescription

The patient’s prescription included:

• Glucose Metabolism Support Tablets, containing Gymnema sylvestre (Gymnema) leaf 3.2 g, standardised to contain gymnemic acids 50 mg, chromium (as chloride and nicotinate) 223 µg, zinc (as gluconate) 15 mg, and cofactors for balancing blood glucose levels: 1 tablet twice daily with meals
• Herbal formula, containing Paeonia lactiflora (Paeonia), Glycyrrhiza glabra (Licorice), Vitex agnus-castus (Chaste tree), and Rosmarinus officinalis (Rosemary): 7.5 mL twice daily. Licorice and Paeonia are thought to increase the conversion of androgens to oestrogens (aromatisation), thereby reducing testosterone levels. This combination is used in traditional Chinese medicine and is suitable for excess production of ovarian androgens. Paeonia and Chaste Tree may help improve progesterone levels. Licorice’s ability to reduce testosterone levels is thought to be due to inhibition of 17β-hydroxysteroid dehydrogenase, which converts androstenedione to testosterone in the ovary and the hair follicle. Chaste Tree is said to be a herb for the luteal phase.³ The antioxidant activity was considered supportive.⁴
• Concentrated Fish Oil Capsules, containing concentrated omega-3 triglycerides – fish 1000 mg, equiv. eicosapentaenoic acid (EPA) 400 mg and equiv. docosahexaenoic acid (DHA) 200 mg: 1 capsule twice daily
• Prenatal + Pregnancy Multivitamin Tablets, containing levomefolate calcium 309.6 mcg equiv. levomefolic acid 250 mcg, iodine (as potassium iodide) 140 mcg, phytomenadione 25 mcg, menaquinone-7 (MK-7) 25 mcg, colecalciferol 12.5 mcg, riboflavin sodium phosphate 10 mg equiv. riboflavin 7.3 mg, pyridoxal 5-phosphate (P5P) monohydrate 7.84 mg equiv. pyridoxine 5 mg, pyridoxine hydrochloride 6.08 mg equiv. pyridoxine 5 mg, mecobalamin (co-methylcobalamin) 250 mcg, choline bitartrate 243.1 mg equiv. choline 100 mg, selenomethionine 93.1 mcg, equiv. selenium 37.5 mcg, zinc amino acid chelate 25 mg equiv. zinc 5 mg, thiamine hydrochloride 12.5 mg equiv. thiamine 11.15 mg, iron (II) glycinate 43.83 mg equiv. iron 12 mg, biotin 150 mcg, inositol 25 mg, nicotinamide 10 mg, calcium pantothenate 7.5 mg equiv. pantothenic acid 6.9 mg, ascorbic acid 75.5 mg, chromium nicotinate 208.3 mcg equiv. chromium 25 mcg, manganese amino acid chelate 12.5 mg equiv. manganese 1.25 mg, molybdenum trioxide 37.47 mcg equiv. molybdenum 25 mcg, lutein 3 mg, zeaxanthin 600 mcg: 2 tablets daily

Dietary and lifestyle advice included:

• Adopt a Mediterranean-style, low glycaemic index (GI) diet. Reduce refined sugar intake. Increase anti-inflammatory food intake.
• Consume a protein-based smoothie for breakfast every morning to improve satiety and reduce cravings throughout the day. This included a vegan protein powder, due to a suspected dairy sensitivity.
• Slowly reduce coffee consumption. Swap coffee for a blend of green tea and spearmint, since trials in women with PMOS suggests that spearmint tea can reduce free testosterone levels while increasing luteinising hormone (LH) and follicle-stimulating hormone (FSH). The antiandrogenic effects of spearmint are suspected to abate hirsutism with sustained daily use, despite a lack of long-term studies to confirm this.^5,6

Pathology tests were requested to investigate thyroid function, vitamin D and iron levels.

Follow-Ups

The patient reported that her sugar cravings and mid-afternoon fatigue were reduced within two weeks.

Pathology test results showed subclinical hypothyroidism (thyroid-stimulating hormone [TSH] levels were 2.7 mIU/L) which – combined with fatigue, dry skin, mental fogginess, and hair fall – suggested that support for thyroid function was needed. As such, the following was added to her prescription:

• Hypothyroid Support Tablets, containing Fucus vesiculosus (Bladderwrack) whole plant 750 mg, containing iodine 150 µg, Bacopa monnieri (Bacopa) herb 1 g, standardised to contain bacosides calculated as bacoside A 10 mg, and Withania somnifera (Withania) root 600 mg: 1 tablet daily

Over the following three cycles, the length of her menstrual cycle reduced from 38-40 days to 32 days and ovulation was recorded around day 15. She reported an increase in energy levels as well as feeling more balanced throughout the day emotionally. A reduction of hirsutism, mental fogginess and hair fall were also noted.

Five months later, having achieved a healthier body weight and notable improvements in her symptoms, she attended the clinic thrilled to share the news that she had conceived.

Clinical Thoughts

This case highlights how PMOS is often about far more than fertility alone. By addressing interconnected metabolic, hormonal and lifestyle factors, improvements were seen not only in reproductive function but also in overall wellbeing. Ultimately, successful conception was one outcome of a broader improvement in health, reinforcing the value of treating the underlying drivers of dysfunction rather than focusing on a single symptom or goal.

References

1. Teede HJ, Khomami MB, Morman R, Laven JSE, Joham AE, Costello MF, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026 May:S0140-6736(26)00717-8. DOI: 10.1016/S0140-6736(26)00717-8

2. Jayagopal V, Kilpatrick ES, Jennings PE, Hepburn DA, Atkin SL. The biological variation of testosterone and sex hormone-binding globulin (SHBG) in polycystic ovarian syndrome: implications for SHBG as a surrogate marker of insulin resistance. J Clin Endocrinol Metab. 2003 Apr;88(4):1528-1533. DOI: 10.1210/jc.2002-020557

3. Trickey R. Women, hormones and the menstrual cycle: herbal and medical solutions from adolescence to menopause. 2nd ed. Crows Nest: Allen & Unwin; 2003.

4. Braun L, Cohen M. Herbs & natural supplements, volume 2: an evidence-based guide. 4th ed. Sydney: Churchill Livingstone; 2015.

5. Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010 Feb;24(2):186-188. DOI: 10.1002/ptr.2900

6. Akdoğan M, Tamer MN, Cüre E, Cüre MC, Köroğlu BK, Delibaş N. Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytother Res. 2007 May;21(5):444-447. DOI: 10.1002/ptr.2074