10 Natural Remedies for Polyendocrine Metabolic Ovarian Syndrome (PMOS)

Polyendocrine metabolic ovarian syndrome (PMOS) — formerly called polycystic ovary syndrome (PCOS) — is a complex metabolic and hormonal disorder that affects up to 15% of women in the U.S. It’s the most common hormonal disorder in women of reproductive age. It can lead to symptoms like irregular periods, infertility, and weight gain, in addition to acne and abnormal hair growth.

If you have PMOS, your healthcare team will likely recommend medications that affect your insulin and hormone levels. But not everyone likes the idea of taking prescription medications.

The good news is that there are natural treatment options — from supplements to lifestyle strategies — that can help you manage your PMOS symptoms. But no single approach works for everyone, and “natural” doesn’t always mean safe or effective.

1. Inositol

Inositol is a substance that already exists in your body. The most commonly studied forms are myo-inositol and D-chiro-inositol. These are the supplements with the best evidence to support its use in PMOS.

Research shows that inositol improves insulin resistance, menstrual regularity, and ovulation. But the benefits are usually modest. There’s not enough high-quality evidence to recommend one type, dosage, or combination over another. And, as with all supplements, product quality and dosage vary.

The 2023 International Evidence-based Guidelines for PMOS says inositol can be an option for some people, but emphasizes that its potential upsides are limited, and that it shouldn’t take the place of evidence-based PMOS treatments like metformin.

If you take inositol or another complementary product, tell your healthcare team. Ask specifically about interactions, pregnancy safety, product quality, and whether the treatment is addressing your main health goals.

2. Probiotics and synbiotics

Probiotics and synbiotics (a mix of prebiotics and probiotics) provide good bacteria that help regulate gut function. They also help regulate overall inflammation. 

The balance of bacteria in your gut has an effect on body weight, insulin, and glucose regulation. By reducing inflammation, these supplements may help with hormonal balance and fertility in PMOS. But they haven’t been shown to improve fertility or pregnancy outcomes.

If you try probiotics, know that the effects will depend on the product and dosage, and there’s no established product or dosage for treating PMOS. It’s best to consider it a complementary approach rather than a replacement for standard PMOS care.

3. Berberine

Berberine is a compound extracted from plants. Small studies and reviews have examined berberine for insulin resistance, androgen levels, menstrual cycles, and fertility-related outcomes in PMOS. But the evidence isn’t strong enough to recommend berberine as an established PMOS therapy.

Berberine can cause side effects and may interact with prescription medications. Its safety during pregnancy and breastfeeding is uncertain. Talk with a healthcare professional before taking it, especially if you're trying to get pregnant, or could become pregnant.

Some healthcare professionals recommend using berberine with metformin (or other diabetes medications) since it may have an additive effect. This means the medications may help each other work better than if they were used alone. But the research here is still developing. You shouldn’t do this without the guidance of your healthcare team.

4. Chromium

Chromium is a mineral involved in metabolism. Chromium picolinate has been studied for blood sugar and insulin measures, particularly in people with diabetes. But research in PMOS is limited and inconsistent.

Chromium may improve insulin sensitivity and blood sugar in people with diabetes and PMOS, but the clinical benefit is uncertain. Research on weight loss is also uncertain. And, there’s also not enough good quality evidence to say that chromium increases ovulation and fertility.

If you’re considering chromium, ask your care team whether it’s appropriate for you and whether it could interact with your medications or supplements.

5. Herbal remedies and apple cider vinegar

Herbs such as cinnamon and turmeric, curcumin, spearmint, and others have been studied for possible effects on blood sugar, inflammation, androgen levels, or menstrual cycles. The studies are small, vary widely in the products and dosages used, and don’t establish a benefit in treating PMOS. As such, experts don’t routinely recommend them at this time.

Small studies suggest apple cider vinegar may improve some metabolic outcomes, when added to metformin. There was no impact on fertility. Overall, the evidence for apple cider vinegar is limited and isn’t enough to recommend it as part of standard treatment.   

6. Weight loss

PMOS can occur at any body size, but women with PMOS are more likely to carry excess weight. This is likely due to a combination of factors, including genetics, environment, and lifestyle. And research shows that weight loss can help PMOS. According to research, weight loss can help improve insulin resistance and menstruation changes in people with PMOS.

Weight loss, exercise, and a nutritious diet are also key to managing both the symptoms and potential complications of PMOS, such as: 

• High blood pressure

• Stroke

• Heart disease 

• Sleep apnea

• Fatty liver disease

That said, everyone has a different relationship to their body and weight. And weight loss doesn’t have to be a health goal if it doesn’t feel right for you. But the actions commonly associated with weight loss — like balanced eating and increased physical activity — can help with PMOS symptoms.

7. Diet

A nutritious and balanced diet can help some of the hormone changes that happen with PMOS. No one specific diet is proven to be better than another. The key is to eat a complete, balanced diet full of nutritious foods.

Kelley recommends sticking with foods low in glycemic index and high in fiber content. Fiber helps prevent spikes in blood glucose and insulin levels. It also smooths out digestion and increases satiety (feeling full and satisfied).

“Overall, the best diet is the one you can stick to and sustain,” Kelley said. She recommends a diet low in saturated and trans fats, processed foods, and simple sugars. And the diet should be high in fruits, vegetables, and healthy proteins. 

Soy products don’t have any effect on estrogen levels or fertility, so they can be a part of a balanced diet.

8. Physical activity

Experts recommend plenty of physical activity for anyone with PMOS. One benefit is that it can help improve fertility. Exercise can also help regulate blood sugar, support weight management, and improve cholesterol, among other health benefits.

There isn’t one type of exercise or physical activity better than another, so choose what you’re most likely to stick with. Aim for at least 30 minutes of activity each day, most days of the week. But at the end of the day, any movement is better than none.

9. Lifestyle strategies

In addition to diet and exercise, there are other steps you can take on your own. This may include:

• Stress management

• Yoga

• Improved sleep habits

• Mindfulness exercises

• Mental health support, if needed

While poor sleep and stress don’t cause PMOS, addressing them may help your symptoms. Taking care of your emotional well-being is also important. These steps may not seem like much at first. But small, consistent adjustments can really make a difference — especially in combination with physical activity and nutrition.

10. Acupuncture

Some believe acupuncture can help increase ovulation in people with PMOS. But there’s currently no solid evidence showing that acupuncture helps with ovulation and fertility. When compared with metformin, it doesn’t have an advantage in terms of markers like blood glucose or insulin resistance. 

Medications to treat PMOS

You may feel strongly that alternative treatments for PMOS are the best choice for you. But it still helps to know some of the traditional medications used for PMOS so you can have an open conversation with your healthcare team. These treatments include:

• Hormonal contraceptives like birth control pills and other alternatives can help regulate your hormone levels. This can help with your periods, acne, and hair growth.

• Metformin is a diabetes medication used to help manage insulin resistance, which is one of the changes in the body that happens with PMOS.

• Spironolactone can help block some of the effects of increased male sex hormones (like testosterone), another change that can happen in PMOS. This can help with acne and unwanted facial hair growth. 

• Clomiphene (Clomid) and letrozole (Femara) are used to help people ovulate when they’re trying to get pregnant. This can help with the fertility challenges of PMOS.

What questions should you ask a healthcare professional about PMOS natural treatment?

It can be intimidating to discuss natural treatment options for PMOS with your healthcare team. But it’s important, especially with supplements and herbal remedies. 

There are a few reasons for this, so consider asking about:

• Efficacy: Some alternative treatments may work better in combination with more traditional treatment options.

• Side effects: Supplements and herbs can cause side effects. 

• Medication interactions: They may affect how your other medications work.

Natural treatments aren’t necessarily good options for everyone. It’s important to know which might be better for you specifically. It’s important to keep these in mind when discussing your options.

Kelley encourages her patients to pay attention to the different aspects that can affect PMOS. “Lifestyle modifications are the main approach and a core component of treatment … and go a long way,” she said. For example, you can focus on the following adjustments:

• Maintaining a healthy weight 

• Eating a balanced and nutritious diet 

• Exercising and doing other physical activities

• Getting good quality sleep 

• Managing stress 

• Being mindful of your mental health 

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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