A regular menstrual cycle is a hallmark of good health for women of reproductive age. 

Polycystic Ovarian Syndrome (PCOS) is associated with a long cycle and metabolic disturbances. For the women experiencing PCOS, the subfertility and associated metabolic imbalances can be very frustrating, especially when they are unsure of treatment options. This case is an example of how simple herbal and nutritional treatment can restore a healthy cycle and improve fertility in a few months, whilst also empowering the patient to make healthier lifestyle choices.

Initial Consultation

A 27-year old female presented with a 9-month history of oligomenorrhoea since ceasing the oral contraceptive pill. Her cycles were around 50 days in length, however her most recent menses was 4 months prior. She experienced some hair growth on her upper lip, feeling angry when hungry (i.e.‘hangry’ - potentially indicating poor blood glucose control) and skin breakouts. She was hoping to fall pregnant in the next 12 months and was eager to have a regular cycle to improve her fertility. Testing through her doctor, found elevated insulin-like growth factor-1 (IGF-1) at 1.12 U/mL (range 0.45-1.03) and ultrasound revealed multiple small cysts on both ovaries. Her GP diagnosed her with polycystic ovarian syndrome (PCOS) and prescribed metformin 500mg/d which she had been taking for 2 weeks. Other relevant history and symptoms included:

• A history of hyperthyroidism, for which she had not been medicated for over 1 year;
• Poor sleep – taking hours to fall asleep and waking tired in the morning;
• Variable energy – ranging from 4-8/10;
• Mild anxiety;
• Loose stools once per week;
• Poor memory and concentration;
• Thrush-like symptoms;
• Scalp hair loss.

A physical exam revealed kidney banding on her nails (indicating poor blood glucose control), a strong tongue quiver and lacuna around the thyroid area in her iridology exam. She was a healthy body weight and consumed a mostly healthful diet, avoiding gluten and lactose as she thought these might contribute to her loose stools.

Initial Prescription

The initial prescription was aimed at balancing hormones, encouraging a regular cycle, optimizing blood sugar control, improving sleep latency and supporting gastrointestinal health.

Treatment consisted of:

• A herbal liquid containing paeonia (Paeonia lactiflora), licorice (Glycyrrhiza glabra), chaste tree (Vitex agnus-castus), black cohosh (Cimicifuga racemosa), withania (Withania somnifera) and thuja (Thuja occidentalis) to be taken 7.5mL twice daily;
• A herbal and nutritional tablet containing gymnema (Gymnema sylvestre) 3.2g, chromium 223mcg and co-factors to support balanced blood glucose to be taken 1 tablet 3 times daily with food;
• A herbal tablet containing valerian (Valeriana officinalis) 2.5g and hops (Humulus lupulus) 720mg to be taken 1-2 tablets ½ hour before bed;
• A probiotic containing Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus rhamnosus total 25 billion CFU/cap to be taken 1 capsule daily;
• Continue taking current self-prescribed supplements:
  • magnesium (150mg) twice daily;
  • inositol (1000mg) twice daily;
• Dietary and lifestyle advice included:
  • Avoid all dairy products;
  • Add nuts, seeds and 1 teaspoon of cinnamon to morning chia pudding;
  • Follow a low glycaemic index diet for PCOS;
  • Limit phone use before bed: use a sleep hypnosis app or YouTube to help induce a restful sleep if needed, but avoid social media and games.

2-Week Follow-Up

The patient was pleased as her period had come in the 2 weeks since her initial appointment. Her flow was normal, however she reported spotting 3 days prior to the beginning of menstruation. She was experiencing daily anxiety and was also feeling grumpy ‘similar to when she was hyperthyroid’. She was still feeling ‘hangry’, was getting some foot cramping and was concerned because her hair loss seemed to be getting worse. She was falling to sleep within 45 minutes, however was feeling tired (energy 5/10) and stressed (8/10). She also mentioned feeling nauseous after having the liquid herbs. I changed her prescription to address the anxiety, adding an herbal tablet containing:

• Kava kava (Piper methysticum) 2.8g, zizyphus (Zizyphus spinosa) 3.0g, passionflower (Passiflora incarnata) 1.5g, magnolia (Magnolia officinalis) 1.5g, lemon balm (Melissa officinalis) 750mg, magnesium 50mg and glycine 100mg to be taken 2 tablets twice daily;

The liquid herbal formula was replaced with a tablet containing:

• paeonia (Paeonia lactiflora) 852mg, licorice (Glycyrrhiza glabra) 847mg, black cohosh (Cimicifuga racemosa) 300mg, and thuja (Thuja occidentalis) 250mg to be taken 3 times daily;

And referred back to her GP for further blood tests. I also recommended she take part in gratitude journaling daily, referred her for acupuncture and suggested practising deep breathing exercises to assist with the anxiety.

4-Week Follow-Up

The patient reported feeling better in all areas except for her memory and concentration and energy which was still 5/10. She was falling to sleep easier although forgetting to take her herbs for sleep on occasion. She was no longer experiencing food cravings, reporting just regular hunger now. The previous prescription was continued, with the addition of the following supplements to assist with daytime energy and to improve sleep latency and quality:

• A herbal tablet containing rhodiola (Rhodiola rosea) 3g and schisandra (Schisandra chinensis) 660mg to be taken 2 at breakfast and 2 at lunch;
• A magnesium and B vitamin powder containing 310mg magnesium as a blend of phosphate, citrate and orotate and supportive vitamins and minerals to be taken once daily before bed to replace her self-prescribed magnesium supplement.

6-Week Follow-Up

The patient reported an improvement in her energy levels to 7/10, was sleeping better – often falling asleep immediately, was experiencing better memory and concentration and believed that her hair was falling out less. She felt as though she had ovulated; noticing fertile mucous and a rise in body temperature since suspected ovulation. Her blood results revealed:

• low/normal 10 am cortisol 222 nmol/L (range 100-540);
• elevated anti-thyroglobulin antibody 20.3 IU/mL (range <4.5);
• elevated anti-thyroperoxidase antibody 178.8 IU/mL (range <5.5);
• normal TSH 1.52 mIU/mL (range 0.40 -3.80);
• low/normal vitamin D 52 nmol/L (range 50-150).

Treatment remained the same except for the addition of the following supplements to support thyroid function, reduce inflammation and optimise vitamin D levels:

• Selenium as selenomethionine 150 mcg to be taken once daily;
• Vitamin D3 1000 IU to be taken 2 capsules twice daily with food;
• A herbal and nutritional tablet containing grape seed (Vitis vinifera) 4.8g, ginger (Zingiber officinale) 150mg, bromelains 100mg, ascorbic acid 25mg, and quercetin dihydrate 250mg to be taken 2 tablets twice daily.

9-Week Follow-Up

The patient reported feeling ‘so much better’. Her energy had returned to normal at 8/10, anxiety was only occurring occasionally, her period had come again (this last cycle length: 47 days) with only 1 day of spotting prior to the bleed. Her skin was looking great and her memory and concentration had also improved. She noticed some cramping in her feet that occurred when she ran out of her magnesium supplement. The prescription was changed slightly to provide continued hormonal and thyroid support and to manage the elevated thyroid antibodies and included:

• A herbal tablet containing bacopa (Bacopa monnieri) 3.75g, schisandra (Schisandra chinenis) 660mg, Siberian ginseng (Eleuthrococcus senticosus), 500mg and rosemary (Rosemarinus officinalis) essential oil 10mg to be taken 2 at breakfast time and 1 at lunch [replacing the herbal tablet containing rhodiola (Rhodiola rosea) and schisandra (Schisandra chinensis)];
• A herbal tablet containing chaste tree (Vitex agnus-castus) 500mg to be taken 2 tablets at breakfast time;
• A herbal tablet containing rehmannia (Rehmannia glutinosa) 350mg, bupleurum (Bupluerum falcatum) 700mg, hemidesmus (Hemidesmus indicus) 500mg and feverfew (Tanacetum parthenium) 165mg to be taken 1 tablet 3 times daily;
• All other supplements were continued for the next 10 weeks

20-Week Follow-Up

The patient’s menstrual cycle continued to shorten (her next 2 cycles were 43 and 39 days) and she continued to maintain her energy levels at 8/10. Her skin remained clear which was very important to her as she was getting married. Due to the time pressures of her upcoming wedding and honeymoon she ceased her naturopathic appointments at this point. She was provided with repeats for her supplements to continue with the same treatment for the next 3 months.

This case is an example of how using nutritional and herbal remedies can assist to restore a regular menstrual cycle, improve quality of life, and assist with improving associated metabolic symptoms.