Polycystic Ovary Syndrome (PCOS)

What is PCOS?

PCOS is a reproductive, metabolic and psychological condition that affects roughly 5% to 18% of women.^[1] The cause is complex and includes genetic susceptibility, hormonal changes in the brain and ovaries, excess androgen exposure, insulin resistance and weight-related factors.^[1] The name refers to the many small follicles seen on the ovaries on ultrasound, but not everyone with PCOS has them.^[1]

Common symptoms

PCOS features vary widely and often start in adolescence and change over time.^[1] Common signs include irregular or absent periods, acne, excess facial or body hair, thinning scalp hair, weight gain and trouble getting pregnant.^{[1, 2]}

Sleep apnea, anxiety, depression and other psychological symptoms are also common.^[2] Darkened skin patches around the neck or underarms can also occur.

Causes and risk factors

The exact cause is not known. Genetics play a part, and PCOS tends to run in families.^[1] Insulin resistance and excess weight can raise androgen levels and worsen symptoms.^[1]

How it is diagnosed and treated conventionally

Diagnosis is based on the Rotterdam criteria, which require two of three features: high androgen levels or signs of them, irregular cycles, and polycystic-appearing ovaries on ultrasound. In adolescents, both high androgens and irregular cycles are needed.^[1] Your physician also rules out other causes, such as thyroid disease. A 2023 international guideline adds that anti-Müllerian hormone testing can substitute for ultrasound in adults.^[2]

Treatment combines healthy eating and regular exercise with medical care. Metformin can improve insulin resistance, combined oral contraceptives regulate cycles and lower androgen effects, and anti-androgens are used when needed.^[1] Fertility treatment is a separate path for those who want to conceive.^[2] The guideline stresses lifestyle, emotional well-being and quality of life, and notes that the evidence behind many recommendations is of low to moderate quality.^[2]

Why PCOS calls for a whole-person approach

PCOS involves the ovaries, the pituitary and brain, fat tissue, blood sugar control and mood together, so no single organ explains it.^[1] The 2023 guideline highlights metabolic risk, cardiovascular disease, sleep apnea, a very high rate of psychological features and risks during pregnancy.^[2]

Care that looks at more than one of these is a reasonable addition to the medical plan. The factors below are the most relevant.

Insulin resistance and metabolic health

Insulin resistance is a core feature of PCOS, and metformin is used to improve it.^[1] Nutrition research suggests that some diets and supplements may improve certain metabolic markers, though certainty ranged from very low to high depending on the intervention, and no diet alone showed high-certainty benefit.^[3]

Androgens and the menstrual cycle

Excess androgens drive acne, hair changes and irregular ovulation.^[1] Cycle regularity and androgen levels are outcomes that acupuncture studies have tried to measure.^[4]

Weight, activity and daily habits

Healthy lifestyle is the base of PCOS care.^{[1, 2]} Yoga has been studied as one way to build activity and reduce stress in PCOS.^[5]

Mood, stress and sleep

Psychological symptoms such as anxiety and depression are very common in PCOS, and sleep apnea is more frequent.^[2] These are medical issues that deserve their own assessment and care.

Acupuncture for PCOS

What the research shows

Acupuncture has not been shown to improve fertility in PCOS, and its other possible benefits rest on low-quality evidence. In a large Chinese trial of 1,000 women, active acupuncture did not raise live birth rates compared with control acupuncture, with or without clomiphene, whereas clomiphene did. Bruising and diarrhea were more common with active acupuncture.^[6]

A 2019 Cochrane review of eight trials with 1,546 women found no clear difference in live birth, pregnancy or ovulation between real and sham acupuncture, and rated the evidence as low quality. Intermenstrual days may have decreased with real acupuncture.^[7] A trial of 342 women with insulin resistance found acupuncture did not improve insulin sensitivity more than sham acupuncture and was less effective than metformin, although it caused fewer digestive side effects.^[8]

A 2020 meta-analysis of 22 studies found that acupuncture was associated with recovery of the menstrual cycle and lower LH and testosterone, with low to very low certainty, and no benefit for live birth, pregnancy or ovulation.^[4] A 2025 meta-analysis of 46 articles found that acupuncture and combined therapies may improve hormonal and metabolic measures, but noted risk of bias and heterogeneity.^[9] For mood, a meta-analysis of seven studies suggested acupuncture may ease depressive symptoms in PCOS, but the evidence was low in quality and the authors urged caution.^[10]

How acupuncture may work

Researchers have proposed that acupuncture changes beta-endorphin and gonadotropin-releasing hormone signaling, which could affect ovulation.^[7] This is a hypothesis, and the large sham-controlled trials did not show a fertility benefit.^[6]

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. The large fertility trial used two 30-minute sessions a week, and the insulin trial used three a week for four months, which are research schedules and not recommendations.^{[6, 8]} We reassess after a short course of visits.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant or may be pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for PCOS

The Ayurvedic view

In Ayurveda, PCOS is not a single classical disease. Its features are often discussed in terms of Kapha and Vata imbalance, weak digestive fire (agni) and the accumulation of ama, together with disturbed flow in the channels that govern menstruation. These are traditional frameworks for choosing care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine aimed at balancing Kapha, such as regular meals, less heavy and sugary food, and steady sleep hours
• Yoga, breathing practices and regular movement
• Herbs prescribed individually by a qualified practitioner; in studies, dill seed, black sesame, kanchanara guggulu and rajapravartini vati were the most used^[12]
• Basti, a medicated enema therapy from Panchakarma, which has been the most used complex intervention in studies^[12]

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it should not be used while trying to conceive without guidance from your physician.

What the research shows

The research on Ayurveda for PCOS is limited. A scoping review found 57 studies, but 32 were case studies, and only 13 were randomized trials, most conducted in India and many using complex or compound interventions. It described the findings as promising for symptoms, and called for rigorous safety reporting and studies of Ayurveda as an add-on to medical treatment.^[12]

A review of yoga in PCOS reported benefits for lipids, glucose, hormones, mood and quality of life, although it covered only 16 papers.^[5] These findings concern yoga, not Ayurvedic medicine as a whole.

Herbal medicine for PCOS

Herbs and formulas that have been studied

Chinese herbal medicine, often combined with acupuncture or moxibustion, has been studied in PCOS, mostly in China.^{[13, 14]} Other herbs with PCOS trials include cinnamon and curcumin from turmeric.^{[15, 16]}

What the research shows

The evidence is limited and comes mostly from low-quality trials. A Cochrane review of five trials with 414 women found insufficient evidence for Chinese herbal medicine for PCOS-related subfertility. Evidence was very low quality, and none of the trials reported live birth.^[13] A meta-analysis found Chinese herbal medicine combined with moxibustion was associated with higher pregnancy rates than Western medication, but the authors cautioned that the included studies were of poor methodological quality.^[14]

A meta-analysis of five trials found cinnamon supplementation lowered fasting glucose, insulin and insulin resistance in PCOS, and called for longer, better trials.^[15] For curcumin, animal studies were promising but the clinical trials gave mixed results, so the authors could not conclude that it helps manage PCOS.^[16] An umbrella review rated curcumin's effect on insulin measures as moderate-certainty, with the same review finding no high-certainty benefit of diet alone.^[3]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Cases have been reported of low blood sugar when garlic was taken with an antidiabetic drug, so anyone taking metformin or other glucose-lowering medicine should tell us before any herb is considered.^[17] Case reports also describe bleeding when warfarin was combined with some herbs.^[17]

Herbal and dietary supplements can cause liver injury.^[18] In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[19] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant, trying to conceive or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes PCOS in terms of phlegm-dampness, kidney deficiency and liver qi stagnation. Reviews of Chinese medicine in PCOS look at its effects on insulin, lipid metabolism and ovulation.^[20] Acupuncture research has looked at beta-endorphin and gonadotropin-releasing hormone signaling.^[7]

Ayurveda's Kapha excess and ama can be set alongside excess weight and metabolic disturbance. No study has shown that a dosha or a TCM pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for PCOS is complementary. Keep your physician, gynecologist or endocrinologist, and do not stop or change prescribed medicines, including metformin, birth control pills or fertility drugs, without your prescriber. We do not diagnose PCOS or manage its medical complications, so a diagnosis and regular follow-up with your doctor are important.^[2]

Please bring your diagnosis, recent blood test results, any ultrasound reports, a full list of medicines and supplements, and tell us if you are trying to conceive.

When to seek urgent medical care

PCOS is a long-term condition that needs regular medical follow-up, but some symptoms need prompt attention.

• Very heavy bleeding or bleeding that soaks a pad or tampon every hour
• Sudden, severe pelvic or abdominal pain
• No period for several months, or bleeding after a long gap, without a doctor having evaluated it
• Extreme thirst, frequent urination or unexplained weight loss, which can signal high blood sugar
• Thoughts of harming yourself or ending your life; call or text 988
• A positive pregnancy test with pain or bleeding

For any emergency, call 911 or go to the nearest emergency department.