A case study by Cherelle Almarker, Naturopath – Costal Care Clinical Naturopath

A Cycle Gone Quiet

When G.E. first walked through my door in January 2025, she hadn’t had a consistent period in years. She had ceased the oral contraceptive pill in 2021 and waited 10 months for her cycle to return – it didn’t. That prompted GP investigation, a pelvic ultrasound confirming bilateral polycystic ovaries and a formal diagnosis of polycystic ovarian syndrome (PCOS) in 2022.

Sporadic cycles returned in 2024 – five in total, each light and lasting just three days. By November, they had stopped again. She arrived with three months of amenorrhoea, jawline acne and hirsutism concentrated on the right side of her jaw.

PCOS affects an estimated 10 to 13% of women of reproductive age and is the leading cause of anovulation worldwide.¹

For G.E., the hormonal picture was clear: elevated luteinising hormone (LH), androgen excess and insulin dysregulation working together to suppress ovulation.

What the Pathology Told Me

Her February 2025 pathology confirmed:

• LH 14 IU/L, FSH 5 IU/L: a 2.8:1 LH:FSH ratio, a hallmark of anovulatory PCOS
• Progesterone 1.5 nmol/L: consistent with anovulation
• Total testosterone 1.1 to 1.3 nmol/L, free androgen index (FAI) 4.8%: upper range, consistent with active hyperandrogenism
• Fasting insulin 7 to 11 mU/L: within range, but a 2022 dynamic insulin function test had revealed significant post-load hyperinsulinaemia (one-hour insulin 63 mU/L, reference 9 to 45; 2-hour 99 mU/L, reference 5 to 30)
• Ferritin 12 to 20 μg/L: persistently low

The First Prescription: Enter Chaste Tree

My initial treatment focused squarely on the hypothalamic-pituitary-ovarian (HPO) axis. The hero ingredient from day 1 was Vitex agnus-castus (Chaste Tree), prescribed in the following:

• Luteal phase support formula: 1 tablet twice daily; containing Chaste Tree dried fruit extract, Paeonia lactiflora (Paeonia) dried root extract, Matricaria chamomilla (Chamomile) dried flower extract, pyridoxal 5-phosphate (P5P) monohydrate (active vitamin B6), manganese amino acid chelate, potassium iodide, selenomethionine, and zinc citrate

An observational study in Switzerland found that women with menstrual irregularities (i.e. polymenorrhoea, oligomenorrhoea or amenorrhoea) experienced vastly improved symptoms when treated with Chaste Tree extract over three consecutive menstrual cycles. Of the 53 women who reported an unfulfilled desire to have children at the start of the study, 12 (23%) got pregnant during treatment.²

Alongside Chaste Tree, I prescribed the following:

• Cruciferous-based oestrogen clearance formula to support hepatic hormone metabolism and reduce androgen-driven acne and hirsutism: 4 g serve (1 level teaspoon) daily; containing Brassica oleracea (Broccoli) seed powder, Punica granatum (Pomegranate) dried peel/husk/rind extract, Curcuma longa (Turmeric) dried rhizome extract, Rosmarinus officinalis (Rosemary) dried leaf extract, Camellia sinensis (Green Tea) dried leaf extract, and Agaricus bisporus (White Button Mushroom) extract
• PCOS-specific herbal formula to target LH:FSH balance and ovarian androgen activity: 1 tablet three times daily; containing Glycyrrhiza glabra (Licorice) dried root extract, Paeonia lactiflora (Paeonia) dried root extract, Hypericum perforatum (St John’s Wort) dried flowering tops extract, and Cinnamomum verum (Cinnamon) dried outer stem bark extract
• N-acetylcysteine (NAC) as a glutathione precursor with established insulin-sensitising and antioxidant activity:³ 1 g twice daily

Dietary guidance included daily cruciferous vegetables to support oestrogen metabolism, flaxseed oil and bitter foods for liver hormone clearance.

Follow-up Consultation: 3 Weeks

On 25 January 2025, just 21 days after her first consultation, G.E.’s period returned.

After three months of silence, her body responded. From there, her cycle began to establish a rhythm. She missed one cycle while travelling overseas which was understandable – since physiological and lifestyle stressors commonly disrupt a recalibrating HPO axis – before resuming upon return.

Building the Next Stage

With cycles re-established, my focus shifted. I introduced a formula targeting elevated LH and oestrogen dominance alongside continued Chaste Tree, NAC and insulin-sensitising support through a herbal formula containing Cinnamon and other insulin-modulating ingredients.

By October 2025, pathology showed LH had risen again to 17 IU/L. Progesterone at 6.0 nmol/L suggested weakly ovulatory or anovulatory cycles. Consistent with a phased approach, I introduced Tribulus terrestris (Tribulus) as a short-term ovulatory stimulus. This I prescribed from day 1 to day 20 for three cycles only alongside Chaste Tree, myo-inositol (2 g twice daily) and NAC.

What the Pathology Shows Thirteen Months In

The FAI halving from 4.8% to 2.2% is perhaps the result I am most pleased about — it carries direct clinical significance for G.E.’s acne and hirsutism. The LH reduction from 17 to 8 IU/L tells a clear mechanistic story about HPO axis recalibration. A day-21 progesterone test is currently underway to confirm whether consistent ovulation is now occurring.

My Clinical Pearl

Two lessons stand out from this case.

The first: look beyond fasting markers. G.E.’s fasting glucose and fasting insulin appeared reassuring in isolation. The dynamic insulin function test revealed the metabolic driver hiding underneath.

The second: Chaste Tree works best when you give it time and context. It is not a quick fix, and it is not appropriate for all PCOS phenotypes but in G.E.’s case the match between her pathology and Chaste Tree’s mechanism of action was precise. And the result — a period in three weeks after three months of amenorrhoea — speaks for itself.

Where We Are Headed

G.E.’s body has done the hard work of restarting a system suppressed for years. The journey from amenorrhoea to 11 cycles in 12 months required a phased, individually tailored approach — and Chaste Tree was the thread running through every stage of it. PCOS is frequently framed as something to be managed indefinitely. My experience tells me that, with the right naturopathic support, the body can do far more than manage — it can genuinely restore.

Author Biography

Cherelle Almarker is a naturopath and member of the NHAA (MNHAA) practicing at Coastal Care Clinical Naturopath in Rosebud, Victoria. Her clinical focus includes women’s hormonal health, menopause, reproductive medicine, and the naturopathic management of PCOS, endometriosis and cycle irregularity.

References

1. World Health Organization (WHO). Polycystic ovary syndrome [Internet]. Geneva: WHO; 2023 [cited 2025 Apr 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

2. Eltbogen R, Litschgi M, Gasser UE, Flueeli A, Nebel S, Zahner C. Vitex agnus-castus extract (Ze 440) improves symptoms in women with menstrual cycle irregularities. Reprod Endocrinol. 2016;(28):86-91. DOI: 10.18370/2309-4117.2016.28.86-91

3. Fang YQ, Ding H, Li T, Zhao XJ, Luo D, Liu Y, et al. N-acetylcysteine supplementation improves endocrine-metabolism profiles and ovulation induction efficacy in polycystic ovary syndrome. J Ovarian Res. 2024 Oct;17(1):205. DOI: 10.1186/s13048-024-01528-8