PCOS and Natural Treatment: A Naturopathic Approach

Irregular periods. Acne that arrived in your twenties and never quite left. Being told to "just lose some weight and come back in six months." If any of that sounds familiar, and it’s not landing well with you, you are not alone.

PCOS affects roughly one in eight women, which makes it one of the most common hormone conditions there is, and one of the most commonly missed. It is real, it is manageable, and it is also one of the most nonsensically named conditions in medicine. Let's start there.

First, can we talk about the name?

PCOS stands for polycystic ovary syndrome, and honestly, that name does the condition a disservice.

Those "cysts" are not cysts. They are small, immature follicles, little eggs that started to develop and then stalled, often described on an ultrasound as a "string of pearls." They are not the painful, pathological cysts the word brings to mind. Naming the whole condition after them spotlights the ovaries and hides the bigger story: PCOS is a whole-body endocrine (hormone) and metabolic condition, not just an ovary problem. It’s not only semantics. The name has contributed to delayed diagnosis, fragmented care, and stigma, and has even shaped how the condition gets researched and funded.

This is starting to change. In 2025, an international consensus recommended a new, more accurate name: polyendocrine metabolic ovarian syndrome, or PMOS. "Polyendocrine" and "metabolic" recognise that this involves far more than the ovaries, and "ovarian" keeps the connection to reproductive health. The plan is to bring it in gradually (evolution, not a hard reset), so you'll see PCOS and PMOS side by side for a while. I'll keep using PCOS here, since it's still the term most people are searching for and bringing to their appointments. Here is the link to the consensus article if you are interested.

So what is PCOS, really?

PCOS is a hormone and metabolic condition classified as a syndrome, meaning it’s a collection of signs and symptoms that tend to occur together and not everyone presents in the same way. The diagnosis of this syndrome is not as clear-cut as it is for most diseases due to the ambiguity of the symptom picture, but usually rests on what's called the Rotterdam criteria. To make the diagnosis of PCOS you need two of these three:

• Irregular or absent ovulation, which shows up as cycles that are long, unpredictable, or missing
• Signs of higher androgens (hormones like testosterone), either on a blood test or showing up as acne, unwanted hair growth, or scalp hair thinning
• Polycystic ovaries on ultrasound, meaning those stalled follicles we just talked about

Two of three is the important part. You can have PCOS with perfectly ordinary-looking ovaries. Important to note that a few follicles on an ultrasound on their own do not tick one out of the three criteria, nor do a few areolar nipple hairs. Also, o

ther causes, like thyroid issues and high prolactin, need to be ruled out first.

Underneath the diagnosis there is almost always a metabolic story, and for many people that story is insulin resistance. Insulin ushers sugar out of your blood and into your cells for energy. When your cells go a wee bit "hard of hearing" to that message, your body makes more and more insulin to get the job done, and all that extra insulin can nudge the ovaries to produce more androgens, which disrupts ovulation. It is a feedback loop, which is why treating PCOS means looking at the whole picture. Insulin also has its own early warning signs that rarely get tested, and PCOS is one of the big reasons I care about that test.

What are the symptoms of PCOS?

PCOS looks different from person to person, which is part of why it gets missed. Here's what I see most often in clinic:

• Irregular, infrequent, or absent periods, or cycles that run long (more than 35 days)
• Acne, often along the jawline and chin, that hangs on past the teenage years
• Unwanted hair growth (hirsutism) on the face, chest, or abdomen, or scalp hair thinning in a male-pattern distribution. Yes, a few nipple/areola hairs are totally common and normal
• Weight changes, often around the midsection, and difficulty losing weight despite real effort
• Sugar cravings, energy crashes, and fatigue
• Skin changes like skin tags or darker velvety patches (acanthosis nigricans), which can point to insulin resistance
• Difficulty conceiving, since PCOS is one of the most common reasons for irregular ovulation
• Mood changes, including anxiety and low mood, which are more common with PCOS and deserve real attention

One symptom on its own does not mean PCOS. The part I always come back to is not just what the symptoms are, but why they're happening for you: for some it's insulin resistance, for others it's stress and the adrenal glands, often with inflammation in the mix. Working out which one is yours is what shapes the plan.

How do you test for PCOS?

When someone comes in wondering about PCOS, I want the full story first: your cycle history, symptoms, family history, stress, sleep, and what you're hoping for. Testing is informed by the story, not the other way around. Depending on what I hear, a workup may include:

• Androgen testing: total and free testosterone, DHEA-S, and SHBG, to see whether androgens are genuinely elevated if and only if you are not showing signs of hyperandrogenism (i.e., hirsutism or androgenic acne)
• Fasting insulin and glucose, and HbA1c: because the metabolic side of PCOS is so often the part that gets missed
• LH and FSH, two signalling hormones from the pituitary that can show a particular pattern in PCOS
• A full thyroid panel and prolactin, mostly to rule out the conditions that mimic PCOS
• A pelvic ultrasound, when it will actually change what we do, keeping in mind the ovaries are not the whole story

A very BC-specific note: when I order bloodwork, it is not covered by MSP, so the tests you choose to pay for out of pocket (sometimes people have coverage through extended medical) should genuinely change what we would do for treatment. Otherwise, what’s the point in spending that money?

Can PCOS be cured naturally?

The honest answer: PCOS is not cured, but it is manageable, and naturopathic medicine has plenty of tools to help you feel better, regulate your cycle, and protect your long-term health. What we reach for depends on your goals, whether that is conceiving, getting your cycle back, calming acne or hair changes, or protecting your long-term metabolic health.

Food, without the shame

Let's clear this up first: PCOS is not your fault, and you did not eat your way into it. I practise and preach moderation, not restriction, so there's no need to be scared of food. The goal is steadier blood sugar, which usually means building meals around protein, fibre, and healthy fats so your energy and insulin stay on a more even keel. No food is off-limits unless you’re truly allergic.

Movement, sleep, and stress

Regular movement improves insulin sensitivity, strength training especially, but the best kind is the kind you'll actually keep doing. Sleep and stress matter too: cortisol has a real say in blood sugar and hormones, and for stress-driven presentations, this is often where we get the most traction.

Nutraceuticals, medications, and herbs

It’s important here that care gets individualised, because not everyone needs everything. A few of the tools we may reach for include:

• Myo-inositol has a solid stack of research behind it for improving insulin sensitivity, supporting ovulation, and gently lowering androgens.
• Spearmint (Mentha spicata), licorice (Glycyrrhiza glabra), and white peony (Paeonia lactiflora) are all aimed at decreasing testosterone, with each herb having other added benefits.
• Vitamin D, omega-3s, melatonin, and N-acetylcysteine (NAC) each have a role for some people, depending on whether the picture is more inflammatory, more metabolic, or focused on ovulation.
• Metformin, OCP, letrozole, and spironolactone at times, as medications may have an important role in care depending on the goals of the person.

A real caution: herbs, medications, and supplements are not one-size-fits-all, and some are not appropriate if you're trying to conceive or are pregnant. This is the kind of thing we sort out together, not from a bottle off the shelf. Acupuncture, including facial acupuncture, is another tool I offer that some people find helpful for skin, cycle support, and stress.

When should you see a naturopath for PCOS?

Short answer: as soon as your symptoms are affecting your quality of life, or you want a real plan rather than "come back when you want to get pregnant." It is worth a visit if any of these feel true:

• You've been diagnosed and handed a prescription, but nobody talked through the "why" or the day-to-day
• Your periods are irregular or missing and you want to understand what's going on
• You're managing acne, hair changes, or weight changes that haven't budged
• You're thinking about trying to conceive, now or down the road
• You want someone to look at the whole person, not just one lab value

A naturopathic approach looks at the root cause, not just the symptom. We treat the whole person, because with PCOS your hormones, metabolism, gut, and nervous system are all part of the same conversation. Your first visit with me is a comprehensive, unhurried look at all of it, because you are a whole person with a story, not a diagnosis or an algorithm.

Ready to get some answers?

If PCOS has left you frustrated, dismissed, or just tired of guessing, let's figure out what's actually going on for you. I offer one-on-one care for people across BC, in person in Vancouver or online. If you're ready to get started, book in for an initial visit.

PCOS is complex, but managing it doesn't have to be. The earlier you understand what's driving your symptoms, the more options you have to support your hormones, your metabolism, and your long-term health.

💚 Dr. Erin