Updated March 1, 2016

I recently received this letter from a wonderful woman who follows my blog. It moved me so much that I decided to weave some of her story into this article, because it brings up a lot of good questions that many of you have probably faced if you are struggling with PCOS or wondering if you have it. It can be especially helpful to know what to do about PCOS if you are already trying to live a healthy lifestyle, eat a great diet, and you pay attention to your exposure to environmental toxins. We’ll talk about this in this article.

Dear Dr. Romm,

I know that you can’t possibly give a medical evaluation over email, but I thought I might ask a few questions that might help with any upcoming posts on PCOS. I’ve been following you for a while, and all of your posts about adrenal fatigue, thyroid issues, the thyroid/gut connection, etc., were really ringing bells.

I had a recent diagnosis of PCOS from my endocrinologist. I’ve always had to work at staying slim, but I’ve never had the difficulty I’m experiencing now. My symptoms also include fatigue, postpartum depression & anxiety, weight gain, and acne. I was tested for testosterone and one or two other hormones. I am waiting on the results. In the meanwhile, I was prescribed 1000 mg of Metformin daily, and advised to stop eating a high fat diet (eggs, grass fed ground beef, avocado) but that grain wasn’t something to avoid.

I eat a very healthy diet of whole foods, low in dairy, sugar and grains. I do high-intensity workouts for an hour 4-5 times per week and I trained for and ran a half marathon a few months ago. I’m super-careful about non-toxic household products and make most of my own.

Despite this, I have not lost a single pound. Even after running over 60 miles in one month, I didn’t lose a single pound. I worked with a naturopathic doctor without any results, and after feeling strongly about my research on thyroid/adrenal problems, I sought out an endocrinologist.

I guess my top questions would be as follows:

  • How do I approach this naturally?
  • How in the world do I reconcile a “PCOS Diet” with all the real/whole food eating I’ve been doing?
  • I want to have more children, and I am determined to lose weight before I get pregnant again (for my health, the health of my pregnancy, and the baby). Is that the safest choice?

Thank you, thank you, for the hard work you do on behalf of women and children. I could cry when I think about all of the help you have provided my family – from ear infection prevention to opening my eyes to the role stress plays in my physical health.

Thank you for using your knowledge to help others!

~ MC

What is PCOS, Really?

PCOS (Polycystic Ovary Syndrome) is a hormonal condition that is thought to affect more than 5 million women in the US alone. Nobody really knows what causes PCOS for sure, though there are many theories. Initially, PCOS was thought to be a condition caused by imbalances in the “sex hormones” (estrogen, progesterone, and testosterone) but now we know that the condition is due to insulin resistance (a condition whereby your cells don’t respond to the normal actions of insulin). Thus, PCOS is considered to be a harbinger of metabolic syndrome and Type 2 Diabetes, which makes it important to pay attention to and treat properly.

In fact, 50 to 70% of women with PCOS demonstrate measurable insulin resistance beyond that which would be expected by their body weight or degree of obesity. Insulin stimulates secretion of testosterone by the ovaries, and inhibits hepatic sex-hormone binding globulin (SHBG) production leading to increased circulating testosterone – this accounts for the acne, facial hair, and male-pattern hair loss in many women.

While there appears to be a strong genetic component that increases one’s risk of developing PCOS, this risk is modified by environmental and lifestyle factors such as diet and stress. In other words, your genetic history doesn’t dictate your destiny – but you may have to work a little harder to prevent insulin resistance if you come from a family that is overweight, diabetic, or have close relatives with PCOS.

How Do I Know if I Have PCOS?

PCOS is a clinical diagnosis. This means it is primarily diagnosed based on having some – or all – of the classical symptoms, with other medical conditions having been ruled out.

While testing can confirm PCOS, lack of abnormalities on hormonal testing including the typically checked LH, FSH, and testosterone does not mean that you don’t have this condition. Test results are very variable based on the time of the month tests were done in relationship to your period, your weight, and other factors. And not everyone with PCOS has abnormal hormone tests or multiple cysts on the ovaries when an ultrasound is done.

Symptoms of PCOS can include any of the following: infertility, irregular periods or lapses between periods for months at time (without being pregnant or breastfeeding), acne, weight gain, unwanted facial hair, hair thinning or hair loss, and less commonly, darkening of the skin in the armpits, back of the neck, or groin.

Women with PCOS are also more likely to suffer from depression and anxiety, and to have eating disorders, particularly binge eating. The reasons for this are unclear but likely have to do with blood sugar dysregulation, which may in turn worsen the problem.

Should I Be Concerned About Having PCOS?

PCOS should be taken seriously. Because PCOS is due to insulin resistance and is related to blood sugar problems, untreated, it carries with it all of the potential risks for diabetes, and with it, heart disease and stroke. Although obesity worsens PCOS and increases insulin resistance, not everyone with PCOS has obvious problems with weight or blood sugar, so just because you’re skinny, doesn’t mean you don’t have PCOS.

Women with PCOS are also more likely to experience pregnancy complications, for example, women with PCOS are 20-40% more likely to experience miscarriage, due to both the insulin resistance and hormonal problems it creates. 

So What’s a Girl to Do? First, Look at the Root Causes…

When I think about the escalating rates of PCOS globally, and how they parallel skyrocketing rates for all kinds of inflammatory and hormonal conditions related to insulin resistance, particularly diabetes, my functional medicine brain kicks into gear looking for root causes.

The ones to think about are those that can have an impact on blood sugar and hormonal balance. Because PCOS is so complex, I’ve put the root solutions into a Guide that you can download and print out as a PDF – it’s just below!

One question you might have is how can a healthy woman who eats well and exercises, like our friend MC above, possibly have PCOS? In fact, this is super common and I treat women like MC in my practice often.

First of all, most of us didn’t grow up with moms who ate healthy during their pregnancy with us, and most of us of a certain age grew up on less-than-optimally healthy diets. So when you take genetics and add in a heaping dose of prenatal and childhood exposures that increase our lifetime risks for insulin resistance and inflammation, we’ve got a set up for developing conditions like PCOS.

Add this to our crazy-busy adult lifestyles that create chronic stress, which in turn impacts our food choices, sleep patterns, exercise, and adrenal stress, and you’ve got an even more jacked up blood sugar situation. All roads lead to insulin resistance.

And here’s something that might surprise you! Too much exercise can also send your adrenals into red alert and drive up inflammation, which can also make you insulin resistant. In fact, I’ve treated quite a number of athletic women for PCOS! Sometimes the answer is to exercise less intensely, and to sub in more restorative forms of exercise like yoga, or gentle hikes. That’s one important tip for our pal MC.

The Natural PCOS Prescription

A natural approach to PCOS means taking an approach to your lifestyle with the overall goals of keeping your blood sugar in balance, reducing stress and nourishing your adrenals, reducing your environmental hormone exposures, supporting your body’s natural detox pathways, and reducing inflammation.

One of the main goals of treatment for PCOS for women who are overweight is weight loss. Easier said than done, right? The good news is that the suggestions in this blog will help you to lose weight naturally, and the supplements for reducing insulin resistance will help if you’ve been weight loss resistant – meaning you’ve had trouble losing weight no matter what you’ve tried.

A number of supplements, including vitamins, minerals, and herbs, have been shown in scientific studies to have positive effects in reversing PCOS. The real benefits come from a combination of making the dietary and lifestyle changes it takes to prevent and reverse insulin resistance, along with taking the supplements. I recommend taking at least one from each category, and sticking with these for a minimum 3 months, ideally 6-12 months, while working on your diet and stress.


pcos image1. Balance Your Blood Sugar & Reduce Insulin Resistance

The main medication used to treat PCOS is metformin. The reason for this is completely logical. It helps to get the blood sugar under control and it acts as an anti-inflammatory. You can do this naturally with the dietary recommendations described in the accompanying download. You might also need the help of some additional supplements to reverse insulin resistance.

  • Eat only whole, real, fresh foods
  • Eat regular, blood sugar balanced meals that include good quality protein, health fats, and vegetables
  • Aim for a pound of fresh vegetables daily (yes, really!), and make sure to eat a rainbow of color of veggies from reds to greens to yellows, orange and blue-purple
  • Eat breakfast everyday and make sure breakfast includes protein
  • Don’t go hungry; keep an emergency food stash in your bag, your desk drawer, your glove compartment – wherever you might get hungry
  • Cut out sugar and white flour products, soda, and fruit juice. While you’re at it, do you really need potatoes and rice? Nah…
  • Dumping the dairy out of your diet can be beneficial in reducing insulin resistance and helping with hormonal problems
  • Don’t eat after 7 pm
  • Cut out the wine and other alcoholic drinks. These massively elevate blood sugar!
  • Supplements to Lower Insulin Resistance
    • A combination of 4 gm. of myo-inositol + 400 mcg of folic acid significantly improved ovulation and conception in women with PCOS, at a rate better than 1500 mg/day of metformin.
    • Alpha-lipoic acid, 200-400 mg/day reduces insulin resistance.
    • Chromium picolinate, up to 1000 mcg/day, improves insulin resistance.
    • Cinnamon improves insulin resistance. One small study looking specifically at its use in women with PCOS found that 1.5 gm/day improved menstrual regularity.
    • Vitamin D is essential for reducing insulin resistance; I recommend keeping blood levels between 50 and 80 for optimal health, and taking a daily supplement of 2000 units/day of Vitamin D3 if you’re struggling with PCOS.
    • D-chiro-inositol, at 1200 mg/day, has been shown improve insulin sensitivity and reduce serum testosterone levels in women with PCOS. Myo-inositol (up to 4 g/day) may be substituted, or a combination of the two may be used and may even be superior.
    • Legumes are also rich in inositol, so including garbanzo beans, kidney beans, and non-GMO organic soy in your diet can also increase your intake.
    • Pinitol, similar to d-chiro-inositol, at 600 mg twice daily for three months lowered blood glucose levels by 19%, lowered average glucose levels by 12% and significantly improved insulin resistance.

2. Nourish Your Adrenals

Our bodies read stress as a crisis. When this becomes our chronic state, we pump out too much cortisol on a regular basis, which increases blood sugar and puts a heavy demand on our bodies to produce insulin to manage this. Additionally, when we are under stress, we tend to crave more sugar, carbs, and fats, which further imbalance our blood sugar. Unchecked this eventually leads to insulin resistance, increased inflammation, downstream hormonal problems, and also affects our sleep which just adds to the vicious cycle of stress, fatigue, and sugar cravings. The “Natural Rx Guide” will teach you how to nourish your adrenals. Also see HERE, and HERE, for more information on adrenal health.

  • Practice meditation, even for just 5 minutes at a time, with a quick meditation in the morning, and a refresher to pick your energy back up without caffeine. See my friend Gabrielle Bernstein’s website for great meditation guidance that is easy to follow.
  • Reduce stress in your life to the extent you can and learn how to internally manage your emotions on the stressors you can’t remove
  • Practice getting good sleep
  • Over-exercise contributes to increased cortisol production and hormonal imbalances; dial back on your exercise if PCOS is a problem and you’re highly athletic.
  • Reduce or remove caffeine include coffee, tea, and if you are sensitive, chocolate; green tea is ok as it has great antioxidants but if you’re caffeine sensitive, skip it too.
  • Supplements to Nourish the Adrenals
    • Adaptogens including Ginseng, Schisandra, Ashwagandha, Rhodiola, Rhaponticum, and Maitake mushroom support adrenal function, regulate cortisol, and help to regulate blood sugar and insulin.
    • Maitake mushroom was specifically shown to induce ovulation in women with PCOS at a dose of 50 mg/day of extract.

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3. Balance Your Hormones & Support Natural Hormone Detoxification

Just by improving your blood sugar balance and reducing insulin resistance your hormones will start to find their natural balance. In addition, we want to reduce our environmental hormonal exposure whenever possible by reducing our use of BPA-containing cans, food storage containers and water bottles, cosmetics, body products, household cleaners, and pesticides and herbicides in our foods. Making sure your diet is rich in antioxidant fresh vegetables, especially dark leafy greens like kale and broccoli, and berries like blueberries and raspberries, you’ll boost your own natural detoxification. Making sure you are having a daily bowel movement is essential for eliminating excess environmental estrogens. There are also a number of herbal supplements, listed in the accompanying guide, that can help along the way.

  • Make sure you are having a daily BM; if not, increase fiber up to 30 gm/day by adding in ground flax seed (1-2 TBS/day) or psyllium husk, take a daily probiotic with Lactobacillus and Bifidobacterium strains, and if needed, take magnesium citrate up to 1000 mg/day before bed to get your bowels moving.
  • Reduce stress (see above)
  • Eat only organic meats, and avoid dairy but if you must have it, use organic only
  • Use only environmentally friendly cosmetics, body products, and household cleaners – see the Environmental Working Group for the best options
  • Avoid exposure to excess environmental estrogens by drinking out of glass bottles and storing your food in glass containers instead of plastic; choose foods that are not in soft plastic wrap whenever possible
  • Supplements to Balance Hormones
    • Peony and Licorice Combination (Kan Herbs): reduced testosterone, increased ovulation, improved fertility in women with PCOS. If you cannot find this combination (Kan Herbs carries it and is a reliable company for Chinese herbs), you can use,
    • Vitex (also called Chaste Berry) Extract: regulates ovulation, increases fertility, and improves progesterone in women with PCOS.
    • Black cohosh Extract: Improves ovulation and reduces effects of excess androgens in women with PCOS. Dose: 20 mg daily.
    • NAC is a naturally occurring detox chemical in our bodies, and supplementation has also been shown to improve insulin resistance and reduce testosterone levels as well as hirsutism (unwanted facial hair) in women with PCOS, while improving menstrual regularity. The dose is 600 mg three times/day, for a minimum of 24 weeks.
  • Supplements that Boost Fertility Medication
    • CoQ10 taken with clomiphene significantly increases ovulation and pregnancy rates compared to clomiphene alone. Dose: 60 mg three times/day
    • L-Carnitine taken with clomiphene significantly increases ovulation and pregnancy rates compared to clomiphene alone, and also less to a reduction in miscarriage rates. Cholesterol levels were also improved, suggesting a role in reducing insulin resistance. Dose: 3 gm/day.

I hope this article helps you to find your natural hormonal balance, improve your insulin resistance, and achieve your dream whether that is losing weight, feeling great, or getting pregnant!

To your fantastic health!





Get the first chapter of my new book The Adrenal Thyroid Revolution, FREE right here.

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Borissova A, Tankova T, Kirilov G, et al. The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients, Int J Clin Pract 2003;57:258-261.

Davis A, Christiansen M, Horowitz J, et al. Effect of pinitol treatment on insulin action in subjects with insulin resistance. Diabetes Care 2000;23:1000-1005.

Galletta M, Grasso S, Vaiarelli A, Roseff SJ. Bye-bye chiro-inositol – myo-inositol: true progress in the treatment of polycystic ovary syndrome and ovulation induction.  Eur Rev Med Pharmacol Sci. 2011 Oct;15(10):1212-4.

Lydic M, McNurlan M, Bembo S, Mitchell L, Komaroff E, Gelato M. Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 2006;86:243-246.

Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutr Metab (Lond). 2005;2:35.

Nestler J, Jakubowicz D, Reamer P, Gunn R, Allan G. Ovulatory and metabolic effects of d-chiro-inositol in the polycystic ovary syndrome. N Engl J Med. 1999; 340:1314-1320.

Nordio M, Proietti E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med Pharmacol Sci. 2012;16(5):575-81.

Oner G, Muderris I. Clinical, endocrine and metabolic effects of metformin vs N-acteyl-cytseine in women with polycystic ovary syndrome. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2011;159:127-131.

Raghuramulu N, Raghunath M, Chandra S, et al. Vitamin D improves oral glucose tolerance and insulin secretion in human diabetes. J Clin Biochem Butr 1992;13:45-51.

Romm A. Botanical Medicine for Women’s Health. St. Louis, MO: Churchill Livingstone; 2010.

Thys-Jacobs S, Donovan D, Papadopoulos A, et al. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999;64:430-435


    • It definitely would! I was first diagnosed with PCOS when I was 13 (after thinking I had diabetes) and started taking Metformin then, but I stopped taking it a few years later because it made my blood sugar go nuts and my body just couldn’t handle it and I had THE WORST periods ever. I know this isn’t for everyone, but now I take the lowest dose of birth control available and it has helped me tremendously, with pain and the side effects of having PCOS.

  1. What is SHBC?
    “Flax seeds may help increases SHBG, and lower testosterone levels. I recommend 1
    -2 TBS/day of ground flax seeds.

    • Sex hormone binding globulin. It’s what carries some of your hormones around so they are bound and not able to do their activities — in this case, lower SHBG = higher free testosterone = more PCOS symptoms.

  2. Are any or all of these safe during breastfeeding and pregnancy? I’m currently breastfeeding but also trying to conceive. I’m concerned if I got pregnant while taking any of these if threw would be adverse effects or that insulin resistance would return if I have to stop taking any of these.

    • Yes, this is a plan you could use while BF’ing. Ginseng, however, can be stimulating to baby and high doses of vitex have historically been used to suppress lactation, though lower doses to stimulate it so pay attention to your milk supply or skip the vitex in your personal plan. Good for you for BF”ing! 🙂

  3. You are a gem!!! Thank you so much for this amazing article… No words can describe how grateful I am for the wealth of information you provide us everyday. Thank you!

  4. This follows so much of what I have been finding. I am an electrologist and see many women with these conditions looking to manage more naturally. I would love your permission to share this with them on my page or website or email with your permission. Our electrologist association is looking to provide alternatives to be pills, spirolacton and met forming when possible. We are attempting to bring more awareness, compassion and resources to women and their doctors as well.

  5. It sounds like a the normal tests done to diagnosis PCOS, hormonal testing and ultrasound, aren’t fool proof. How then do you know if you have PCOS? Is it even worth getting the tests done?

      • See, I was wondering this too. Everything looked normal with most of my hormones, but I had “on the higher side of normal” androgens. I had an ultrasound years ago when I first noticed the hair on my face and there were no cysts. Normal periods got pregnant, not obese am in normal weight range. My main things are hair on face and other areas and some hair loss on head. So, does that sound unlikely to be pcos? The endo didn’t seem to think it was l. Thyroid a and everything have tested normal.

    • I was first diagnosed with PCOS when I was 13, I went to the doctor because I have a family history of diabetes and with all the problems I was having, we thought maybe that was it. My doctor found out I had it by testing my hormones and I had multiple sonograms. My doctor said the cysts made my ovaries look like chocolate chip cookies, gross I know.

      • LOL! A good description and I think folks will still like chocolate chip cookies without thinking of your ovaries!!! 🙂

  6. Thank you for this guide! PCOS is so often not treated seriously by medical professionals. I appreciate all the time and effort you’ve put into this so that we women who suffer with PCOS can begin to effectively help ourselves.

  7. Thank you for all of this information – I’m sure it will be helpful.
    I have an information overload and I don’t know where to start!!

  8. Thank you very much for the above article on PCOS. It is a very clear and succint description of this condition and the addition of natural supplements accompanied by explanations on what is their effect/action make this article a great tool on treating PCOS as much naturally as you can. Thanks again for your good work!

  9. I have PCOS, and I’ve read your article on natural rx…it says you can take flaxseed oil, but WebMed states, that woman with PCOS should not take it. Now my doc has told me to take it also, due to the fact that Metformin constipates me. Maybe you could shed some light on this for me. Thanks, God Bless!!

  10. I was wondering if you are supposed to take all of the supplments? Or just the ones that pertain to my specific needs…I am done having children so no need to worry about my fertility. Thanks.

  11. I noticed that many of the supplements you recommend are geared to improving/increasing ovulation. My sister and I both have PCOS. She’s 45 and I’m 43 and were both starting to have menopausal symptoms and are not planning on having more children, so is it still appropriate for us to take the supplements that improve/increase ovulation?

  12. this was the best article I’ve ever read. More info than I have ever gotten from any doctor I’ve seen. Thank you. How can I follow you for more info??

  13. Hi! I have never been diagnosed with PCOS and only have a couple of the trademark symptoms so I don’t think I have this – but still think these tips could apply to somene who is just looking to balance their hormones naturally? I had my tubes tied 3 years ago after the birth of my 3 rd daughter, but then after a nasty health crash last summer (I was on 2 doses of antibiotics for a reaction to something versus and actual infection and had a horrible reaction to it) my hormones went haywire! I am 36 and my doctor thought I am not procuring enough estrogen though my symptoms seem to be of estrogen dominance so she put me on ortho try cyclen. I feel very anxious on this and have been on birth control for 5 months and want to come off and try to balance on my own…..can I just stop or is there a recommended way to ease off of birth control pills? Also, despite not being overweight or the other trademark things for gallbladder problems ( I am 5’3″ and 113 lbs) I lost my gallbladder 8 months post partum from having my second child. How do I eat hormone supporting fats within be able to digest them? Thank you!

  14. I find this information very helpful myself. I do have PCOS but I also have a under active thyroid gland. Actually it was removed due to a struma ( perhaps you know what it is as I cant really find the English word for it )

    Although i find the above information quite useful, I find it very confusing when it comes to food. For a combined condition of hypothyroidism and PCOS what are the common ground foods someone can aim?

    I would highly appreciate it if you can advice on this matter. THANK YOU

    • Hi Keti,
      Where you really want to aim for your diet is a low inflammation, low glycemic diet. Lots of good quality organic protein and veggies, no white flour products or processed foods, not too many grains, and very low-to-no sugar. Check out The Blood Sugar Solution by Dr. Mark Hyman as an example. Warmly,

  15. I love this article so much! I was wondering what your thoughts were on using berberine instead of Metformin for insulin resistance? The research that I’ve done has been exceptional, in my opinion, instead of using the Rx. Although, I’m concerned if I was to get pregnant would I still be able to use it, i know that berberine should not be taken while pregnant, however, I’m wondering how soon it would damage the child in the pregnancy between finding out of pregnancy. Thanks in advance for your thoughts and opinions!

    • Hi Heather,
      I’m a fan of trying if before metformin, though of all the meds on the market, metformin seems to be one of the better, safer, more useful ones so I’m not opposed to it, either, if needed. I start my patients out with a natural approach unless their blood sugars are sky high, or their A1Cs are over 10. Pregnant, neither berberine or metformin are ideal, but I wouldn’t stay on the berberine if you get pregnant. There’s low risk of any harm, though, between conception and realizing you’re pregnant for either. I usually recommend stopping supplements if you think there’s a chance you’ve conceived, but there’s a 7 day window before baby even implants that serves as a protective window. Good luck with pregnancy plans!

  16. Hi Aviva,

    Thanks so much for all of your work. My chiropractor recently suggested that she thought I might have PCOS, but from looking at various lists of symptoms out there, there’s really only one symptom that strikes me as applicable — I have a ton of hair growth on my chin, which is not something that the women in my family have had historically. Other than that, my periods are fairly regular, and although I do suffer from menstrual migraine, there’s nothing particularly abnormal about my cycle other than that. (I’ve never tried to get pregnant, so I’m not sure if that would be an issue…) My weight is average, I don’t have hair loss, and I (very thankfully) don’t suffer from depression or anxiety.

    So, what I’m wondering is this: From the very significant hair growth on my chin, it seems pretty clear that my androgens are high. I wonder if the treatments that you offer would be helpful for anyone hoping to address abnormally high androgens, or whether they’d only be suitable for someone who truly has PCOS?

    Thanks so much for all you do!

  17. What a great article ~ I am sharing (like so many of your other articles)! As well, I would add that rhodiola can be a bit strong for most folks. And, I’d like to add that nettles seed tincture/extract is a great restorative for adrenal function.

  18. i was officially diagnosed with PCOS after my husband and I went through a miscarriage . That was 7 years ago. I was prescribed Metformin and the fertility med Clomid. We were able to have to healthy babies as a result. We are looking to try for one more. My question is that I know having babies can change our hormones and such, but can they totally change you from having the PCOS? I mean is it more likely I would need to go back on the same mess to ovulate and such? The reason I’m asking is that I recently switched insurance and lost my former OBGYN. My new one has told me that Metformin would not be her first choice for me unless their were signs of blood sugar issues. She has prescribed Progesterone which did cause me to have a cycle, but she wouldn’t do anything else without a thorough exam of tubes etc… In the mean time I do want to help even out my hormonal levels from the highs and lows. I enjoyed your article. It definitely has a lot of info. What are your specific recommendations?

  19. Could my PCOS be causing chronic digestive upset and constipation? I’ve been told that I have PCOS and IBS, and trying to find a diet that works for both is exhausting.

    • Check out The Blood Sugar Solution by Dr. Mark Hyman — so many of my patients have found it a do-able dietary approach and it really does help regulate blood sugar and reduce insulin resistance!

  20. Wow! What a great article! Thank you for the in-depth explanation!!! For those who may not be up for the challenge of completely revamping their whole way of eating (obviously, the healthier we eat, the better any natural solution is going to work) Plexus products may be an option. I have struggled with hormone imbalance my entire life, and after 3 months on these products, my hormones are at near perfect levels!!! Plexus is a company with supplements to balance blood sugar by producing insulin sensitivity (a side affect of that is weight loss), and products to heal the gut. The nice thing is that by taking 3 supplements from Plexus, you can do everything in the article above!

    • What plexus products do you take? I currently use to plexus slim but nothing else. I’m looking into ordering the Probiotic as well. I’m wondering what combination has worked for you?

      • I use Plexus: the BioCleanse, the Probiotic and the Slim together. I also take their vitamins and omegas.

        No one believes I have PCOS, but I have had hirsutism since I was 18. Still looking for ways to reduce or eliminate it.

    • There are a number of combo products on the market targeted at PCOS treatment that contain some, if not all of these, to reduce your number of overall separate supplements. Check Vitanica, Designs for Health, Integrative Therapeutics, and Metagenics if you have a naturopath or MD who can order for you; also check Rainbow Light.

  21. Two questions and a thank you-

    1st- great info. I kept thinking how beneficial it would have been when I was going through my infertility journey.

    1. What about essential oils? Do you know of any on the market that could be beneficial in treating PCOS?
    2. I also have chronic yeast infections. I haven’t received any real, long term solutions from my MD. Could these be related?

    • Hi Angela,
      I don’t use Eos for PCOS, however, they can be helpful for yeast infections. The yeast infections could be due to chronically elevated blood sugar, pH issues, or dysbiosis. I’ve got a blog or two on the topic, and will be launching a vaginal ecology program sometime this year, I believe – on line with plenty of free blogs, as well. Warmly, Aviva

    • Hi Angela,
      I just came across this blog, and saw your question. I realize you posted it almost a year ago, but I thought I would share what helped me in this situation. After I was diagnosed with PCOS, my “occassional” yeast infections became constant! And I mean constant. My doctors tried everything. Finally, I went to my health food store. The wonderful owner, who I own my sanity to, pointed me in the direction of Yeast Gard, and some serious probiotics(and I don’t mean the ones on the shelf. Get the refrigerated ones). After 1 week using the Yeast Gard, my yeast infection symptoms were almost completely gone. After taking the bottle of probiotics, I’ve never had a yeast infection since. And that was over 6 years ago. And no, I don’t take the probiotics regularly. I just took them to help my body rebalance. I hope this helps. And if you have already solved your problems, good for you! I know how happy I was when my “issues” were finally over! 🙂

  22. Great advice, but one point of caution: Be sure not to take licorice every day for more than a month. There is a chemical in licorice that can become toxic to the liver. “DGL” is a supplement form of licorice which has had the toxic constituent removed. It’s found with the other digestive aids in the health food store.

    • Hi Crystal,
      I don’t know of DGL being hepatotoxic; the compound removed is generally done so for blood pressure reasons. Can you please share your source of evidence so we can get this clarified. Thanks! Warmly, Aviva

  23. Where can I go to research for a doctor in my city that is knowledgeable about PCOS and can help me to control it? I’ve seen my regular GP and OB/GYN docs and all they tell me is to take birth control and metformin. I was diagnosed with PCOS at the age of 16 when my periods just stopped. At the time, the doctor suggested birth control, but my parents said absolutely not (they only associated the pill with sex). I am now 36 and after 6 years of trying to conceive, my husband and I have reached the decision we would not have children. We tried all types of medication with no positive results. The next step was IVF, but we decided we were done. 🙁 But I still want to get PCOS under control.

  24. Hi! Thank you so much for this article. Would the diet and herbs recommended also work for someone with both endometriosis and pcos? I was recently told that I most likely have both and a uterine fibroid to which the suggested protocol was surgery or birth control. I’m eager to heal this naturally.
    Thank you

  25. I have been trying to conceive on my own for 27yrs, I did IVF each time I was successful pregnancies and miscarried each time. The longest pregnancy was 5 1/2 months and I lost my son an hour after delivery, his poor lungs were not developed. After 10 years I still have not gotten pregnant. I’ve just learned of the natural herbs that I could used, I was told at 17yrs old I was PCOS and now I figured its maybe worst now in my forties. I’m taking false unicorn root, vitex chasten berry, maitake, cinnamon liquid extract, folic acid, coQ10, and vitamin d3 and also berberine. I trying so hard to ovulate. My cycles are still off, very irregular for about 6 months now. What do you suggest at this point?

  26. Hello,
    I wanted to confirm the amount of inositol you recommend: 4 grams? All the supplements I can find are around 500 mg, which would mean taking 8x the recommended dose (on the container). Is this correct? Thank you! This is such a wonderful guide!

  27. Thank you for the great article. I have PCOS. My OB/GYN wants me to decide what form of progesterone to take in order to have a menstrual cycle. Should I conclude from your article that it is unnecessary to take some form of progesterone but instead to take the supplements to balance hormones naturally that you have listed? Is taking some form of progesterone, even a progesterone creme, incorrect? thank you.

  28. Is there any timeframe within which using these methods is shown to improve likelihood of conception?
    My husband and I are trying to get pregnant, and I would like to set my expectations as to how long we should try something before trying something different.

  29. Hi!
    Thanks so much for this plethora of information! Similar to the question above regarding a combination vitamin versus taking all of these separately: in the section, “supplements to lower insulin resistance,” would you recommend taking EACH of those recommended supplements/doses for anyone with a PCOS diagnosis, or does an individual require a personalized plan? I have the same question for “supplements to balance hormones.” Do you recommend taking each of these (Peony/licorice, vitex, black cohosh, and NAC), or is it dependent on an individual’s specific presentation of PCOS and labs?

    Looking forward to adopting your suggestions, but looking for clarification!

    Thank you!

  30. Thank you for posting this. I have struggled with PCOS since puberty and had issues conceiving. I have three children, but was not diagnosed until my second child was born. My doctor put me on metformin and I was able to conceive my youngest. I didn’t want to take met anymore, but haven’t enjoyed dealing with the weight, hirsutism, alopecia, anxiety, depression, blood sugar fluctuations, and everything else coming at me. I found a woman from across the ocean that has put together a wonderful website with meal plans and everything. I am not using the meal plans since we are going vegetarian, but I learned about inositol, spearmint tea, and how exercise effects Cysters. I am happy to have other herbal information, too, and will be incorporating these into my treatment plan. Currently, I am using inositol, spearmint, yoga, I went dairy free (naturally occurring hormones in mammal milk, including human, could interfere with normal hormone production in women with PCOS) and upped my greens. Going gluten free could cut some of the inflammation in the body, too. I have not stopped eating eggs, yet, because I enjoy them so much and they are a good source of morning protein. I also cut most all sugar, replacing it with green leaf stevia. I have lost 15 pounds in 6 weeks and have barely been exercising. My anxiety is way down and I am not feeling effects of depression. I feel, for the first time in many years, hopeful.

    • Hi Stacy,

      This is Megan from Dr. Aviva’s team and I just wanted to say thank you for sharing your experience. You’re doing a phenomenal job, and I know first hand how difficult PCOS can be. Stay tuned for more from Dr. Romm, I have learned so much from her, and ever since she wrote this article, I have seen some amazing changes in my symptoms.

      -Megan, Aviva Romm Nutritionist

    • Hi Leah,

      This is Megan from Dr. Aviva’s team and yes, you are correct, though Dr. Aviva speaks extensively about the importance of folate Vs folic acid. This is a very individual approach and it’s important that each person be checked to ensure their body processes the correct form for their specific system.

      Megan- Dr. Aviva Romm Nutritionist

  31. What about magnesium? I was diagnosed with PCOS a few months ago, and am taking 100 mg Spironolactone per day. I’m pretty athletic and was taking 450 mg of magnesium a day for muscle soreness/cramps. However, I was reading an article that women with PCOS shouldn’t take magnesium. What are your thoughts?

    • Hi Cristina,

      I suggest checking out the article Aviva wrote (and her new podcast) on magnesium!

      Warm wishes,
      Megan- Dr. Aviva Romm Nutritionist

  32. Hi Aviva,

    I am pregnant and have high testosterone, i was wondering wjat you would recomend during pregnancy.

    Thank you!

  33. Wow this is an amazing article. Thank you so much. It’s the first time I’ve come across your blog. I’ve had pcos for 33 years and am now facing menopause and wondering how to deal with that and pcos (not much info out there). I had my thyroid removed in April and really struggling with weight gain and hair loss (oh the joy) which I had managed to get under control for 5 years. Are most of the supplements still valid at this stage of life?
    Love from sunny South Africa 🙂

  34. Hi Aviva,

    I’ve been diagnosed with polycystic ovaries following two ultrasounds, but then my hormone tests turned out just fine.

    I’m at a normal weight and I don’t struggle with weight gain. I’m a vegan, I eat very few processed foods and I make sure I eat protein and fats all the time. Also, I swim 3-4 times a week.

    However, I’ve been struggling with acne in the past 6 months and I haven’t had my period for more than a year.

    So this is very confusing.

    My GP put me on a pill, of course – standard procedure – but I keep wondering if this is the right thing for me. And I’d feel much more comfortable trying a natural remedy.

    Any thoughts on this?

    Thank you!


  35. Hi!
    I was diagnosed with pcos after my period didn’t return after my missed miscarriage. We conceived easily but it ended in a Mmc at 7.5 weeks. After I was given provera to induce my period, I conceived again but that ended in a chemical pregnancy at 5 weeks. I’ve tried two rounds of clomid after that with +ovulation but no pregnancy. I started taking inositol, spearmint tea & magnesium citrate & N-AC. All of my lab work came back normal except my testosterone was 78. This was drawn three months after my miscarriage when I had not yet had a new period. I’m curious as to what it would be now since using the supplements. I’ve noticed a great decrease in any sort of hirsutism and my acne which I never had before my miscarriage is practically gone. My ob wants to send me to a fertility clinic though because I have yet to sustain a pregnancy and didn’t get pregnant with clomid and does not want to try metformin since I am thin. Is that really the next step left for me? I was really hoping to not have to conceive wth ivf/Iui etc. thanks!

    • Hi Beth, No there are other options! You can consult with me, you can work with other wonderful integrative fertility NDs, acupuncturists, etc. There’s hope until you’ve really exhausted more resources than it sounds like you’ve known about! To consult with me, see my website, look under Let Me Help You. So sorry about your miscarriage — that’s often too under acknowledged a loss for women… Aviva

  36. Hi Aviva,
    I have a million thoughts and questions and am considering saving up to consult with you!!
    One question is about vitamin d levels. I have had prescription D (extremely high level) at least 3 times in the past few years and I between taken over the counter d daily. The highest my level has ever tested is 34. You recommend maintaining a much higher level – is there anything you suggest for getting my level higher?



  37. A HUGE THANK YOU!!!!!! My 23 year old daughter was diagnosed with PCOS after giving birth to her son, who is now 1 1/2. She is over 6′ tall and has batteled her weight most of her life. I remember talking to the drs when she was young, questioning her extream growth, both with weight and height, as she was 5’9 by the time she was 12. The drs initially thought that she had a pituitary issue and ultimately recommended us eating a more natural diet. Staying away from processed foods, milk with hormones, etc. Since her diagnosis we have dealt with extream mood swings, in which i have watched her just sob because she cant control how she is feeling. I have searched the web, spoke to others who have this, as well as spoke to Drs. trying to help aleviate some of my daughters issues. This is the first article i have found that really delves into what exactly it is and a natural approach to helping with it. Thank you for all your hard work and we will keep you posted on how my daughter is doing…I think this is the first time in a few years I am excited for her to get her life back.

    • Hi Melissa,

      This is Megan from Dr. Aviva’s team. Your response is music to Dr. Aviva’s ears! I too have PCOS and the steps in this article were life changing for me. Best of luck to your daughter and she most certainly can regain control of her life!

      Megan- Dr. Aviva Romm Nutritionist

  38. Hi aviva,
    I was prescribed metformin and tried multiple times to get used to the way it made me feel but I was constantly sick from it .. Throwing up and diarrhea everyday. I had to stop taking it .. Is there something over the counter or some kind of vitamin that can help?

    • Hi Candance, Metformin is known to cause diarrhea and stomach upset. Some of my patients have had to start at 250 mg/day, work up to 250 twice daily, then up to 500 twice daily and so on to get the right dose, staying at each new dose for 1-2 weeks to acclimate. But of course, the other suggestions and natural blood sugar management can prevent the need for metformin. I don’t know of anything to take with the metformin to reduce the GI side effects, but like I said, they do go away in many people — but not everyone. Best, aviva

  39. Please can you advise on how this needs to be modified for me after having had hysterectomy with both ovaries removed. Many thanks

    • Hi Julia, The underlying issues are still the same if you have insulin resistance and the other symptoms — so no modifications, actually. Best, Aviva

  40. This is probably a dumb question, but do you recommend taking all of those supplements in each category? I’m struggling a lot, and I’m desperate for relief. Just not sure about taking so many supplements everyday?

    • Hello there,

      This is Megan from Dr. Aviva’s team. There is no such thing as a dumb question! If you look through he comments on this blog Aviva offers some good insights into how to work with the protocol she has laid out.

      Warm wishes,
      Megan- Dr. Aviva Romm nutritionist

  41. Hi. I have struggled with PCOS since I was a teenager. I am now 36, and have 2 kids. I have been on and off Metformin for many years and recently it has not been working. My cycles are very irregular and few and far between. I have been reading more about PCOS and how I can manage it more naturally. Your article is very helpful. Thanks! I would like to download the guide, however, I completed the email form but I have still not received anything.

    Thanks for your help, Jen

  42. So when you do become pregnant would you just stop taking all the recommended supplements and to the traditionally recommended supplements during pregnancy? I

    • Hi Abi,

      Aviva says YES! Once you think you have conceived, discontinue those that are not recommended in pregnancy.

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

      • Of all the supplements listed in this article, which ones are safe during pregnancy and breastfeeding? Which ones are not safe? Usually Aviva mentions whether or not things are safe during pregnancy and/or breastfeeding but this article doesn’t mention anything. Thanks!

        • PCOS supplements aren’t usually recommended during pregnancy. During pregnancy focus on a blood sugar balanced diet. 🙂

    • Hi Sara,

      I suggest taking a look at the handout that accompanies this article!! It is so incredibly helpful and gives you a list of all that Aviva recommends.

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  43. Thank you so much for sharing your knowledge about PCOS. The article is informative for women who are in their child bearing years. What about menopausal women? I have all of the symptoms listed above; however, is the treatment similar for menopausal women?

    • Absolutely, because the key issue we need to be concerned about in all cycles of our lives with PCOS is the insulin resistance.

  44. I have been put on metformin twice and everytime they try and put me on it, I am so sick it comes out the attic and the basement. Just so tired of this crap I just wish it would all go away but I am trying to have 1 more child. I am 34 and so overwhelmed with this. I have pre cancerous cells on my cervix that I have to have surgery on to take the bottom portion of my cervix off. I just want 1 more child then they can take everything out after that. I have had two miscarriages already. Just so frustrated and stressed with all this.

    • Hi Christina,
      Whew – that sounds overwhelming for sure! When I do start patients on metformin I start very low and increase slowly; this usually helps with tolerability. Perhaps you can find a really supportive APRN, NP, or CNM in your area who does women’s health to help you manage all the different medical issues? Sounds like having some local support for your health could make a world of difference! And of course, I do consultations in my practice, but that’s in NYC… Wishing you health and ease, Aviva

  45. Thank you so much for this AMAZING article and podcast!!! I have already shared it with so many women. Can you clarify as to whether myoinositol is the same as inositol? Google is giving me mixed results and I want to make sure I purchase the correct thing. I see lots of options for buying “inositol” but very few for “Myoinositol.” Thank you again.

    • They are different but pretty much equivalent in action – so either can be used. Whichever is easier for you to get. 🙂

  46. This was such a helpful read. diagnosed at 16. I am 30 years old and next week I am going for my 6th and final IVF transfer(still no children). I eat healthy,I exercise yet I’m overweight.
    I will certainly try some of your suggestions. But I’m wondering if you have any suggestions to help implantation?
    thank you.

  47. Great Podcast! I greatly enjoyed. I have IIH along with PCOS. Do you believe there is a correlation between the two meaning obesity and hormones? Thanks!

  48. I have been doing a TON a research on this subject because I have struggled with PCOS for years. We need to be educated to be our own advocates There is one thing I tried for 2 years that had no effect on me personally and in my research found out why. Vitex. Only works on women with elevated prolactin levels and low LH levels. I tried different brands, different doses, and I never got a cycle talking it. Some spotting at best but that’s it. Just thought I’d touch on that. Thank you for the informative pod cast!

  49. Aviva, I was wondering if we take one of each category for the minimum time and they dont work should we continue or change it up? I have had pcos for over 10 years now and currently only taking Inositol and spearmint tea for the hirsutism, even though I take those I should add the other supplements like you suggested correct?

    • Hi Roxanne,

      If you scroll through the comments you will see Aviva’s answer to your question!

      Megan- Aviva Romm’s executive assistant and online nutritionist

  50. I was diagnosed at age 22 due to infertility, non existent or extremely heavy cycles, acne, weight gain and emotional issues…I have struggled my whole life with it and the anxiety and depression it causes….I luckily had one successful pregnancy at age 24 with treatments . I’m now 42… Last August in an attempt to get healthier after an accident and bad back injury I started walking and talking coconut oil capsules and tumeric capsules daily…. After just a month my cycle appeared and has been predictively regular and short every month since….I recently had to stop as I’m being scheduled for gallbladder surgery and they suggest it be out of your system at least a month prior…. Well my cycle stopped as well….I waited a month and resumed with just the coconut oil… Three days later.. Tada…. Lol… I’ve also lost 40lbs…. after reading this i’m thinking of adding the D-chiro-inositol to see what happens.. I’ve also been taking vitamin D and b12 for a few years now to help with the emotional aspects as I was deficient in both after working a steady midnight shift for the past 23 years…

  51. hi, i wanted to know if all this supplements mentioned can be taken all together or i just have to pick one? if you do they cause reaction with each other? i am just so worried i’ll over dose myself trying to follow most of it.. Thank you for all this information, i’ve never seen anything like this. Really helpful information.

    • Hi Kate,

      If you scroll through the comments you will see where Aviva address your question. That being said, you know your body and it’s important to do what you feel most comfortable with.

      Warm wishes,
      Megan- Aviva Romm’s executive assistant and online nutritionist

  52. i had a partial hysterectomy about 5 years ago, would these recommendations be the same for me? I still have my ovaries.

    • Hi Kimberly,

      This is Megan from Aviva’s team. Thank you for your comment! If you scroll through the comments you will see Aviva’s response to a similar question.

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  53. Hi,
    I have been doing my research and either want to take fertilaid or myo inositol. Can you tell me more about these things and are they safe to take. I want to try the natural approach before going towards medication.

    • Hi Erika,

      I believe Aviva talks about inositol in the blog and on in her podcast and we can’t really comment on the fertilaid.

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  54. Hello, I was only recently diagnosed with PCOS though I suspect it’s been building for about 3 years. Facial hair growth, gradual weight gain, poor exercise tolerance, anxiety and mild depression were noted long before diagnosis. I always suspected adrenal or thyroid issues but all testing via my MD or ND has always been negative. I put myself on a gluten free diet 5 years ago noting reduced inflammation. I am also sensitive to eggs and I limit my grain consumption very strictly at most rice and GF oats on occassion.
    Upon reading your article I tightened up my diet even more to exclude dairy, essentially I am sticking to veggies, some fruits in moderation, lots of healthy fats and good animal protein sources. I also started on the following supplements: Myoinositol 4g, Lipoic Acid 350mg, NAC 1000mg 2x/day
    That is in addition to the Estro-Adapt/Vitex/EPO/ActiveB’s/B12/Probiotic I already take.
    My question is, everything seemed fine for about a week, then I had a day when it felt like I was running hypoglycaemic all day, very jittery, agitated, tired with lots of yawning etc. I’m wondering if that can be a side-effect. I stopped all my supplements for a day until things returned to normal and today I only took my original supplements and the myo-inositol. So far so good.
    I know you recommend 600mg of NAC 3 times daily but I can’t find capsules in that dosage so I either do 500 or 1000 at a time, also 3x per day is really challenging so I was hoping to only do twice…how big of an issue is this? I have been doing 1000mg morning and night. Also, I take all my supplements together in the morning with my green smoothie. Is it perhaps too much all at once? Any advice would be much appreciated.

  55. Great article. <3
    Is there any way you can create a "Shopping List" from all of your recommendations? That would be so helpful. I see so many names of different items but having not used or seen many of them before, I don't know where to go out what to look for. A checklist of foods, drugs, prescriptions and where they may be found would be a real blessing to me. Thank you <3

    • Hi Carrie,

      You should be able to download the PDF that has a list of all of the supplements and herbs that Aviva recommends.

      Take a peak and let us know if you don’t find it!

      Warm wishes,
      Megan- Aviva’s executive assistant and Functional Health Coach

  56. I love this information! At the age of 14 I was diagnosed with PCOS and Endometriosis. I was very blessed to conceive and have 2 children.. Unfortunately, due to progression of the diseases I had to have a hysterectomy at the young age of 21. There needs to be more awareness and education on these diseases ! So women like myself do not have to endure the life altering surgery I did ! I would love now to have another baby of my own but can’t ! Good job Doctor keep up the good work informing women and ladies NEVER GIVE UP HOPE

  57. Thanks for the article. I’m an old RN with a daughter who may have PCOS. I received this link from Dr. Poppy’s Facebook page. I sent the link to my daughter.

    • Healthy part of the diet – but also high in sugar. So you nailed it – for PCOS low fruit and stick to about 1 cup of berries (fresh or frozen) daily 🙂

  58. Hi aviva i have pcos i was prescribed metformin a while back i was told to take them duri g or after food as they work better when taken that way but when i do take them they make me feel awful.. Sick dizzy etc.. My periods are regular every month give or take 1 or 2 days. Me and my partner have been trying for a baby for over a year now and still had no luck.is there anything you can advise for me
    Thanks in advance
    And thank you for all the support/advice you have given us all

    • Hi Kirsty,

      Thank you for your question and please know that you have been heard! Unfortunately the answers to what you are struggling with will take a bit more than a blog response can offer. Working with a functional medicine doctor, or consulting with Aviva in her practice is the best way to get you on the healing path that is best for you. I also suggest reading and re-reading this blog as Aviva offers so much insight in both the article and the Podcast she did on PCOS.

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  59. Hi Kirsty

    I have just been diagnosed with PCOS as i have irregular periods and blood test results came back with increased testosterone.

    I am scared to take vitex will this be okay to take if my LH and FSH were both low?

    • Hi Eleanor, Vitex is used actually, to support healthy levels of LH and FSH when they are low. But don’t use if it worries you…. you can try the other approaches. 🙂 Aviva

  60. Thank you Aviva for this info! Could you clarify what supplement you are referring to when you mention “NAC”?
    I have had pcos since age 16, a family history of obesity, diabetes, and auto-immune disease. This past summer, my joint pain and psoriasis got so bad I finally consulted with my midwife who sent me to a nutritionist that does “leap” therapy. We identified what foods were causing inflammation, eliminated them, and I believe it healed my gut about 90%. While I did see some improvement in my pcos symptoms, my hirsutism showed almost no improvement after 3 months on the diet (no gluten, almost no dairy, no sugar, etc). So I am very interested to know what supplements can specifically address hirsutism.
    Thank you!

    • Berberine should be fine while breastfeeding; whether to take instead of metformin largely has to do with your A1C level. If over 10 in my practice I recommend continuing the metformin if already on it, along with and intensive diet until we get it down to a lower number (under 9, for example), then the berberine + diet and other supplements.

  61. I was diagnosed with PCOS in 2009. My doctor prescribed metformin, I took it religiously for 3 months. In that 3 months, I couldn’t be more than 5 minutes away from a bathroom at any given time throughout the day. This was very troubling for me as I had step kids to take care of and errands to run. I told my doctor that I was having digestive issues with the meds after only being on it for 1 month and he told me that my body just needed to get use to the medicine. After 3 months, I couldn’t stand it any more and took myself off after calling him and telling him I couldn’t handle it anymore.
    I still have some effects from the PCOS. Facial hair growth, extremely difficult to lose weight, as well as depression and anxiety. However, I do have a regular cycle, which is nice.
    This article will be very helpful in me treating my PCOS as I do prefer the natural method over pharmaceuticals for any ailments that don’t require antibiotics.
    Thank you for this information!

    • Hi Lindsay!
      I am the nurse practitioner in Dr Romm’s practice, and I often hop in to answer comments and questions since Dr Romm doesn’t always have time to get to them all!
      Metformin can be difficult to tolerate for many people! We’re glad that you found the article helpful. You may want to find an integrative medical provider to help you along your journey with PCOS. Many can be found on the Institute for Functional Medicine’s website: https://www.functionalmedicine.org/practitioner_search.aspx?id=117
      Best of luck!

  62. I am in my 50s was on Diannet for many years which helpped with pcos have come off this for couple of years. I am now suffering with thinning hair more on the top. What supplement do you suggest.

    • Hi Anne!
      I am the nurse practitioner in Dr Romm’s practice, and I often hop in to answer comments and questions since Dr Romm doesn’t always have time to get to them all!
      We can’t provide specific medical advice regarding your concern, and we’d encourage you to seek out an integrative practitioner in your area who may be able to help you figure out the root cause of your symptom and guide you appropriately.
      Wishing you the best!

  63. Thank you for this highly helpful and infotmative blog. I also have PCOS and most of your suggestions follow closelynwhat i have previously been given through various PCOS resources and doctors. You have recommended a few different supplements than my current regimen and I find that very helpful. Likewise, the nutritional information you provided was similar except for one significant difference that I would like to ask about. You recommend legumes, lentils and soy as healthier protein and fiber sources. However, I have always been told to consume minimal amounts of legumes and lentils and to stay away from soy completely because they are all pseudoestrogens and will interfere with creating balanced hormones. Can you speak about that? Also, I have super low progesterone production and had to taken a supplement during my last pregnancy. How can I naturally achieve more regular progesterone levels? Thank you!

    • Hi Rachel, They do not contain pseudoestrogens, they contain PHYTOestrogens, a weaker form of plant estrogen than our own natural estrogen and the form that is in our body’s from environmental toxins. The plant form is actually PROTECTIVE and so important to get in a health hormone balancing diet! And yes – vitex (chaste berry) an herbal, has been shown to improve progesterone and can be used into the pregnancy.

  64. Hi Aviva,

    I have PCOS and am trying to get a grip on my ovulation/menstration. I have not menstruated in 3 months (following a miscarriage). I am a thin PCOSer and am very healthy, take all the supplements you have recommended, eat a very healthy diet like you recommend. I just had my blood panel done and my LH to FSH is 3:1. I know my doctors are going to say Metformin and Clomid but I really do not want to take Metformin. Any recommendations how I can jumpstart my period? I am hoping to come see you when I move back to America this summer 🙂

    • In my practice I use vitex for 2 momnths, and if that doesn’t work, a progesterone challenge. Would love to help, but can’t give direct health advice. Thanks for your understanding.

  65. My 16 year old daughter has secondary ammenorhea. She got her period once when she was 14. Her Testoterone level is high. The female doctor says she needs to go on Progesterone to see if she bleeds and then birth control pills if she does. We are trying Vitex right now but I am wondering if that is a good idea or not?

    • Hi Jill, It is important not to go more than 8 months or so at a time without a period – in which case even in my practice I’ll do a progesterone challenge on a patient. High testosterone and no period is a sign of PCOS. I’d make sure she had a proper work up and try the protocol in this article first, before birth control pills. You can even bring this article to the doctor or find an integrative family doc, gynecologist, or nurse practitioner or nurse midwife.

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