The disease is polycystic ovary syndrome (PCOS) that is characterized by increased androgen levels, ovulatory dysfunction and morphological changes. NIH (National Institutes of Health) defines it as hyperandrogenism and ovulatory dysfunction. Around 5-10% of women of reproductive age are affected.
There are 44 reproductive age women with PCOS
(Anjali et al., 2019). It is an issue where the hormones of a woman are disproportionate. It may lead to their difficulties in getting pregnant and problems with their periods. Unless it is treated, in the long run, it can cause severe health conditions, including Diabetes and Heart disease. Majority of the women with PCOS develop numerous small cysts in their ovaries. This is the reason why it is referred to as polycystic ovary syndrome. The cysts are harmless though cause hormonal imbalances. The symptoms can be managed and averted beneficial long run issues by early diagnosis and treatment. The commonest endocrine disorder in women is Polycystic Ovarian Syndrome (PCOS). Enlarged ovaries with numerous small cysts and hypervascularized androgen secreting stroma are some of the indicators of this condition. Some of the clinical symptoms are irregular menstruation, polycystic ovaries, obesity, infertility, hair, acne and hyperandrogenism
(Shetye et al., 2025). It is believed that PCOS is a condition that is affected by the environment and heredity.
(Patel et al., 2024) It is originally known as Stein-Leventhal syndrome. The ovaries development in this severe disorder where women are afflicted
(Kamble et al., 2020) is of numerous cysts, which are essentially tiny, immature follicles. During a normal menstrual cycle where ovulation takes place, a mature follicle that is also a cystic structure is formed. A mature follicle which is fertile is approximately 18 to 28 mm in diameter. The fundamental distinction between polycystic and the normal ovaries is that though there are numerous, tiny antral follicles that are filled with eggs in the polycystic ovaries, they fail to grow and mature in the right manner- hence ovulation does not take place. Women having polycystic ovaries do not ovulate in a regular manner and hence they do not experience regular menstrual periods
(Adams et al., 2004) (Azziz et al., 2006). The normal treatment of PCOS is now comprised of pharmacological and lifestyle interventions. All of these treatment approaches are associated with lifestyle modifications, including weight loss, regular exercise and dietary changes. Pharmacological treatments include insulin-sensitizing agents (metformin and thiazolidinediones), anti-androgens (spironolactone and flutamide) and combination therapies.
Examples of pharmacological therapies include estrogen and progesterone. Although these treatments are quite effective, they may be expensive and can cause several adverse effects, such as weight gain, gastrointestinal disturbances, irregular menstruation and insulin resistance
(Pachiappan et al., 2017). Modern medicine also uses metformin, eflornithine, letrozole, spironolactone and clomiphene citrate to treat PCOS. Menstrual problems are commonly treated with oral contraceptives. Commonly used pharmaceuticals include anti-androgens, oral contraceptive pills and metformin. Nevertheless, these drugs may produce several unwanted side effects (
Patel and Prajapathi, 2017).
The medical approach to treating disease through medication due to research findings has a lot of side effects, therefore, the natural treatments was preferred to help in restoring the normal cycle of the menstrual cycle through balancing the hormones and also they are known to correct the imbalance of doshas, which was created as a result of ovulation. Also, there are plants with phytoestrogens which can be used in the treatment of disease. The same can be said of the plants that control the insulin levels. and herbs that reduce lipids, which can also be incorporated in the treatment of PCOS (
Temkar and Menon, 2022). Phytochemicals can also be taken in sufficient amounts to control several metabolic problems. Therefore, a possible alternative treatment of PCOS is the utilization of phytochemicals (
Temkar and Menon, 2022). This means that herbs could be used to treat PCOS. Herbal plants are believed to be safer as compared to the manufactured drugs.
The use of herbal treatment has now become common in the treatment of various chronic disorders such as PCOS
(Agrahari et al., 2025). The cause of PCOS is still unclear but it is likely that the cause is a complex process. The range of the abnormalities in polycystic ovary syndrome could not be fairly attributed to one etiologic factor
(Shermin et al., 2019).
This review was conducted at the Department of Clinical Nutrition and Dietetics, School of Biosciences and Technology, Galgotias University, Greater Noida, Uttar Pradesh, India. Relevant literature on polyherbal formulations and nutritional approaches for the management of Polycystic Ovary Syndrome (PCOS/PCOD) was collected from peer-reviewed journals and scientific databases. The literature search, data compilation, critical evaluation and manuscript preparation were carried out over a period of approximately four months. The morphological differences between a normal ovary and a polycystic ovary are illustrated in Fig 1.
History
PCOS syndrome was originally referred to as Stein Leventhal syndrome since despite the original description of poly cystic ovaries in the 19
th century, the syndrome did not receive any recognition or it was not named until 1935. This is due to the fact that Stein Leventhal were the first to associate polycystic ovaries with amenorrhea, obesity and hirsutism.
Patients, In their research, dating back to 1721, young married women who were infertile and somewhat fat had ovaries which were of larger size than normal and which were not identified at the time. These sclerocystic changes in ovaries were originally described by Chereau in 1844 and they had to be recognized by the comprehensive work of Stein and Leventhal. Additional research was carried out by Adams and his co-workers in 1985 where polycystic ovaries exhibited an abnormal follicular number. This syndrome is what they referred to as multifollicular. To them, polycystic ovaries are ovaries that contain over ten peripherally structured cysts with a diameter of between 2 and 8 mm.
Etiology
It is still unclear how PCOS or PCOD is etiologically predetermined; however, there is apparent innate insulin resistance, despite the slimness of women (
Dunaif, 1997) Abnormal control of gonadotropin-releasing hormone (GnRH) may result in follicular arrest, high anti-Mullerian hormone (AMH), low FSH, high luteinizing hormone (LH) and high secretion of testosterone, estradiol and follicular estradiol. dehydroepiandrosterone. The pituitary gland produces an abnormally high level of luteinizing hormone (LH) into the blood disruptions the normal menstrual cycle of a female eventually resulting in the imbalance between progesterone, estrogen, Follicle Stimulating Hormone (FSH) and (LH), resulting in anovulation.
Symptoms and pathology
Symptoms may include irregular menstrual cycle, obesity, change in blood pressure, Body mass index, increase androgen level in blood, high glucose in blood, enlarge breasts and hyper insulinemia. Ultrasound may show poly cysts. PCOS women may have unwanted body or facial hair growth, thinning hair on the scalp, Skin problems like skin darkening and acne. Hyper androgenism and anovulation interact with insulin resistance in the PCOD. Ovarian hyper androgenism is mainly caused by inherent steroidogenic defect of theca cells. Increase level of Lutenising hormone (LH) and insulin amplify the instrinsic abnormality of theca steroidogenesis. Decrease ratio of Follicle stimulating hormone(FSH)/ Lutenising hormone(LH) are also involved
(Legro et al., 1998). Anovulation in PCOD is because of defective folliculogenesis. The follicular defect is due to enhanced early follicular growth and distortion of the subsequent stages towards the selection of dominant follicle (
Jonard and Dewailly, 2004). During folliculogenesis androgen and insulin play a synergestic role with LH.Insulin stimulated tyrosine phosphorylation of Insulin receptor substrate -1(IRS- 1) and increased Glycogen synthetase kinase 3β(GSK-3β) in adipose tissue cause insulin resistance through IRS-serine phosphorylation. Decrease expression of insulin regulated glucose transporter GLUT-4 in PCOD adipocytes is also reported (
Diamanti-Kandarakis and Papavasiliou, 2006). Skeletal muscle appears to be affected by androgen induced insulin resistance (
Goodarzi, 2007). Androgen may interfere with insulin signaling by amplifying phosphorylation of Akt mammalian target ribosomal S6 Kinase and increasing serine 636/639 phosphorylation of IRS-1. Recently Advanced glycan end product (AGE) and their receptors, which are involved in inflammation and metabolic stress are found to be elevated and correlated to PCOD.
Major organs associated with PCOD
The next organs are also important in the pathophysiology of Polycystic Ovary Disease (PCOD).:
• The ovary is a crucial female organ of the reproductive system that is found on both sides of the uterus and charged with the responsibility of secretion of the two main hormones, progesterone and estrogen.
• The pancreas is an organ, which provides the body with insulin.
• The adrenal gland that is situated above the two kidneys in PCOD patients over produces adrenal hormone.
• The secretion of all hormones is controlled by the pituitary gland.
Risk factors of PCOS
Hereditary influence
• Family history of PCOS (mother or sister diagnosed with the condition).
• Genetic alterations affecting insulin and hormone regulation.
Insulin resistance
• Body cells exhibit reduced sensitivity to insulin.
• Elevated insulin levels stimulate excess androgen (male hormone) production.
Excess weight / Overweight
• Accumulation of fat, especially in the abdominal area, worsens insulin resistance.
• Increases the likelihood of hormonal disruptions and irregular menstrual cycles.
Hormonal disruption
• Irregular secretion of luteinizing hormone (LH) from the pituitary gland disrupts menstrual cycles.
• Imbalance among progesterone, estrogen, FSH (Follicle Stimulating Hormone) and LH leading to anovulation.
• Excess testosterone in the ovaries prevents ovulation, causing infertility.
• Formation of cysts-underdeveloped follicles remaining in an unresolved state (Fig 2).
• Physical manifestations: acne, hirsutism androgenic alopecia/baldness.
• Clinical consequences: diabetes, hypertension, dyslipidemia, endometrial/breast cancer, recurrent pregnancy loss.
• Reduced melatonin levels in follicles and moderate sleep disturbances.
Lifestyle factors
• Insufficient physical activity.
• Unhealthy diet (high sugar, processed carbohydrates, junk food).
• Stress and inconsistent sleep routines.
Environmental and hormonal elements
• Exposure to endocrine-disrupting chemicals (
e.g., BPA, phthalates).
• Chronic stress affecting cortisol levels and overall hormonal balance.
Premature puberty
• Early onset of menstruation (menarche before age 11) increases PCOS risk.
Diagnosis of PCOS
Both clinical and Biochemical hyperandrogenism are typically diagnosed in the identification of the onset of menstruation in peripubertal. One of the most controversial aspects is the detection of polycystic ovaries with the use of an ultrasound scan. Peripheral cysts (smaller than 10 mm) 10 or more in a large ovary with a marked enlargement of the central stroma.
Characterize polycystic ovaries (Agarwal and Reddy, 2018)
Hormonal tests
• LH, FSH, LH/FSH ratio
• Total and free testosterone
• Prolactin
• TSH DHEA-S
• hydroxyprogesterone
Metabolic evaluation
• Fasting glucose and insulin
• Lipid profile
Ultrasound
• Transvaginal or pelvic ultrasound to evaluate ovarian morphology
(Ande et al., 2022).
The commonly used pharmacological treatment options for PCOS, along with their therapeutic roles and potential adverse effects, are summarized in Table 1.
Lifestyle modifications in PCOS management
Physical activity
Exercise has been shown to decrease insulin resistance, help in loss of weight and enhance better mental results among PCOS patients. Aerobic as well as resistance training has been linked with the increase in ovulatory frequency and hormonal levels
(Harrison et al., 2019).
Stress management
Stress-related chronic stress may worsen PCOS symptoms because of high cortisol concentration that may enhance insulin resistance and hormonal disregard. Mindfulness, yoga and cognitive behavioral therapy (CBT) have been found to have positive stress-reducing and mental health impacts on women with PCOS
(Ehrmann et al., 2020).
Sleep hygiene
PCOS symptoms have been associated with poor sleep quality, which worsens the symptoms especially insulin resistance and mood disorders. These problems can be mitigated by better practices of sleep hygiene, including regular sleep routines and screen time
(Powers et al., 2021).
Effective medicinal plants for the management of PCOS
Cinnamon (Cinnamomum verum)
Dalchini, also commonly referred to as Dalchini is a spice used centuries as a culinary, fragrance and medication ingredient. Cinnamon is usually used orally in the treatment of polycystic ovary syndrome (PCOS), especially at the luteal phase when progesterone concentration naturally increases to facilitate hormonal regulation and enhance the regularity of the menstrual cycle
(Cowan et al., 2023). Cinnamon has also been demonstrated to contain insulin-sensitizing effects, which is especially significant to women with PCOS that tend to be insulin-resistant and have difficulty in the metabolism of glucose. It increases the insulin receptor activity, promotes the insulin intake at the adipose and muscle tissues and aids in the reduction of blood sugar
(Lakshmi et al., 2023) (Sharma et al., 2023).
Fenugreek (Trigonella foenum-graecum)
Fenugreek (
Trigonella foenum-graecum L.) is a natural medicinal plant with hypocholesterolemic and anti-diabetic effects reported in human and animal research and no toxicological effects reported, making it safe to use
(Moond et al., 2023).
Galactomannans and steroidal saponins are abundant in the fenugreek seeds and enhance the insulin action, blood sugar regulation through the pancreas and peripheral cells and lead to a significant decrease in the levels of testosterone in women with PCOS
(Masroor et al., 2024). This was a prospective, randomized, placebo-controlled and double-blind trial that involved 58 women who had normal ovaries and oligo-anovulatory PCOS. In 8 weeks, the participants were randomly divided into two groups, those who were to be treated with hydroalcoholic fenugreek seed extract mixed with metformin (n = 30) and those who were to be treated with metformin placebo (n = 28) and assessed at baseline and after every four weeks. The use of Furocyst, a seed extract of fenugreek, led to a decrease in ovarian volume and a decrease in the number of ovarian cysts, normalization of menstrual cycles and conception in some subjects. Altogether, the daily supplementation of fenugreek helped most of the women to resume their menstrual cycle and enhance conception (
Hassanzadeh Bashtian et al., 2013).
Chaste tree (Vitex agnus-castus)
Vitex (
Vitex agnus-castus, Lamiaceae) or chaste berry is an effective regulator of the menstrual cycle with a millennia-long history of application in traditional medicine. It can be used as one of the most common herbs to treat PCOS because it acts as a stimulus and controls the pituitary gland, balances LH and FSH and balances the prolactin levels in the hypothalamic-pituitary-ovarian axis. Vitex can be used to reduce estrogen and androgen, increase progesterone, aid ovulation, boost fertility, normalize menstrual cycles and improve acne and skin condition by modulating luteinizing hormone (
Alamoudi and Bakrshoom, 2021).
Turmeric (Curcuma longa)
Curcumin, the key active ingredient of turmeric, has a strong anti-inflammatory and antioxidant effect. Curcumin is an antioxidant, which increases the effects of insulin and by inhibiting the NF- 0B, curcumin lowers the synthesis of pro-inflammatory cytokines which help the ovarian tissue to resist oxidative damage. Curcumin aids towards achieving endocrine and metabolic balance because of its systemic benefits.
Even though curcumin did not directly treat PCOS, it has been extensively researched due to its anti-inflammatory, antioxidant and metabolic activity. Its high antioxidant property can counter the oxidative stress linked to PCOS and its anti-inflammatory effect can help to relieve some of the symptoms related to PCOS
(Sirisidthi et al., 2016).
Reddy et al., (2016) compared the effect of curcumin to that of clomiphene citrate on female Wistar rats with induced PCOS by letrozol. In general, the study revealed that curcumin can assist PCOS rats to restore hormonal and metabolic balance (
Chitra and Dhivya, 2017).
Ashwagandha (Withania somnifera)
Ashwagandha has been an extensively used nutritional supplement because of its varied therapeutic effects (
Budhiraja and Sudhir, 1987). Steroidal lactones or also referred to as withanolides are the important bioactive compounds that are attributed to affect its activity (
Santhi and Aishwarya, 2011). Ashwagandha is also known as a powerful adaptogen that is able to lower insulin resistance, anxiety and cortisol levels and help in thyroid control, normally disturbed in PCOS patients. It has been established to equalize neuroendocrine hormones, which helps in successful stress management, control menstruation, sexual wellness and folliculogenesis through augmentation of follicle-stimulating hormone (FSH). Also, it can assist in the reduction of hyperinsulinemia, dissolution of the existing ovarian cysts and inhibition of the development of new ones. Other studies have also indicated that ashwagandha may result in a growth of size of ovaries, which is also a good contributor to reproductive health. Its clinical effects were mentioned in a case study of a 57-year-old female who had significant scalp hair loss, dryness and burning sensation without any reproductive problems, hirsutism, obesity, acne, or menstrual irregularities. Her BMI was 21.5 kg/m² and her daughter had PCOS. She was given 400mg of standardized ashwagandha root twice a day due to its anti-stress and antioxidant properties. It takes less than one month for her hair fall to almost normal levels. At the same time, the levels of corticosterone, cortisol, 11-deoxycortisol, 17-hydroxycorticosterone and 18-hydroxycorticosterone in the serum were found to fall
(Kalani et al., 2012).
Shatavari (Asparagus racemosus)
Shatavari (
Asparagus racemosus), one of the widely used Ayurvedic herbs that grow in India, Sri Lanka and the Himalayas, is a source of essential fatty acids, polycyclic alkaloids, isoflavones, flavonoids and steroidal saponins (shatavarins). It is conventionally employed to enhance ovulation, control estrogen, develop follicles, prevent free radicals and preserve ovarian and endometrial cells. Satapushpa Shatavari powder (SSP) and Satapushpa-Shatavari Grita (SSG) Matra Vasti (therapeutic enema) are usually used either orally, rectally, or nasally to treat oligomenorrhea, hypomenorrhea and anovulation as causes of PCOS.
According to clinical research among women with PCOS (18-42 years old), SSP and SSG interventions decreased ovarian volume, endometrial thickness, lowered the level of hirsutism and improved the length of the menstrual cycle and the blood flow
(Kumarapeli et al., 2018). A six-month multi-phase Ayurvedic remedy comprising of Shatavari, Shatapushpa, Guduchi and the use of other herbal preparations resulted in 75 per cent conception rates, 85 per cent effective treatment of infertility and most patients exhibiting normal menstrual cycles (
Dayani Siriwardene et al., 2010).
Spearmint (Mentha spicata)
Mentha spicata commonly referred to as spearmint has been well known to lower androgenic effects and therefore it is a good natural intervention in treating PCOS in women. In numerous studies, regular use of spearmint tea has been found to lower the level of inflammation, hirsutism and testosterone
(Balasubramanian et al., 2023). Spearmint is also employed in cosmetic preparations as an aid in the treatment of acne and excessive hair growth especially when applied alongside other substances. Randomized controlled trials (RCT) have also shown that spearmint tea has a significant effect on reducing free and total testosterone levels and hirsutism severity indicating that women with mild hirsutism can use it as a natural alternative
(Akdogan et al., 2007).
Other animal model experiments also corroborate these results. Rats were grouped into Estrous cycles (Group I control) up to Group V (the last) where Group I was orally fed 1 mL of distilled water over 20 days. Letrozole (1 mg/kg, three times per day and 28 days) orally was given to groups II 5 through V to induce PCOS, which was confirmed by a long estrus phase and ovarian cysts in histology sections. Oral dosage of spearmint oil (150 mg/kg or 300 mg/kg) or sesame oil was then administered to treatment groups over 20 days. PCOS rats treated with spearmint oil exhibited a drastically decreased testosterone level (p<0.001) when compared to the PCOS untreated groups.
Licorice (Glycyrrhiza glabra)
Licorice (
Glycyrrhiza glabra) is a natural medicine herb that has many pharmacological effects such as antiulcer, antiviral, antifungal, anticancer, anti-diabetic, anti-oxidant and immunostimulatory. Its primary bioactive compounds, glycyrrhizic acid and flavonoids including liquiritin, isoliquiritin, glabrene and glabridin, have estrogen-like activity and reduce LDL cholesterol and ovarian functioning. Licorice has been demonstrated to block the synthesis of 17b-hydroxysteroid dehydrogenase, an enzyme involved in the production of androgens, lower testosterone levels and enhance the insulin sensitivity, which is especially significant because PCOS raises the level of blood sugar and predisposes to type 2 diabetes (
Kshama and Ray, 2024).
Licorice has the potential to improve oocyte fertilization and embryo development in animal models of PCOS and is commonly employed as an adjuvant treatment to treat the hormonal, metabolic and psychological components of the syndrome
(Aya et al., 2025) (Khanage et al., 2019). Licorice lowers the spironolactone-induced volume loss and has the potential to increase its anti-androgenic properties when used together with spironolactone and thus it particularly works well in women with PCOS
(Andhalkar et al., 2021).
Berberine
Clinicians have suggested the use of berberine as a possible solution to insulin resistance that is usually experienced by patients with polycystic ovary syndrome (PCOS).
Rondanelli et al. (2021) in a study conducted on twelve women with PCOS treated with berberine found that there were significant increases in sex hormone-binding globulin as well as a decrease in the levels of free testosterone and the free androgen index. They were the first to use the Global Acnes grading system and the Cardiff acnes disability index in measuring acne. Berberine seems to reduce acne and increase the quality of life of people with PCOS, which is demonstrated by the significant drop in the disability scores (high to low) and the severity ratings (moderate to mild).
The major medicinal herbs discussed above, along with their active compounds, proposed mechanisms of action and potential benefits in PCOD management, are summarized in Table 2.
Safety, dosage and standardization
Potential side effects
People believe that herbal treatments are safe, however, they can lead to issues when consumed in the correct quantity, too long or in combination with other medications. Excess of certain herbs may be disastrous in polyherbal formulations. Excessive use of liquorice (
Glycyrrhiza glabra) in the long run may lead to high blood pressure, water retention and low potassium. Likewise, cinnamon and cinnamon particularly contains coumarin and may harm the liver in large doses. There are gastrointestinal problems in some individuals following the consumption of fenugreek
(Zeng et al., 2022).
Standardization
One of the most important actions in polyherbal therapy is to make sure that every batch has identical active ingredients. Standardisation establishes and continues physiologically active amounts of herbal medicine ingredients. This is through standardisation. In this way, the formula will be ensured to be effective, powerful and harmless. Unless there is sufficient standardisation, the dose can be incorrect and excessively high, which influences clinical outcomes
(Zarezadeh et al., 2021).
