- 1 How to Treat PCOS Naturally with Diet, Herbs, Supplements
- 2 Can you treat PCOS Naturally?
- 3 PCOS References & Resources:
How to Treat PCOS Naturally with Diet, Herbs, Supplements
This article will teach you everything you need to know about treating your polycystic ovarian syndrome (PCOS), and how to design an effective and healing PCOS diet plan.
19-year old Casey has long been a subject of taunts and humiliation by her classmates, Even her friends and younger siblings never missed a chance to call her out by annoying names like ‘hairy chipmunk’ and ‘baby rhino’.
But just a couple of years ago, everything was perfect. Casey was a smart, attractive and vibrant teen who was very popular in school and among her friends. Being the head of cheerleading squad and captain of basketball team, she earned several certificates and medals. However, she began to lose her confidence after her 17th birthday, when she experienced abnormal growth of facial hair on chin, upper lip and neck. Intrigued by the thickness and darkness of facial hair, Casey decided to shave off the annoying hair. But it wasn’t the only problem, in fact it was just the beginning of a trail of issues.
Over the course of next two years, she ended up gaining 22 pounds (surprisingly with no change in appetite or activity status), she noted scalp hair thinning and the facial hair growth worsened. The high stress levels has also made her acne worse and to top it all, her menstrual cycles are all over the place.
But here are a few questions:
- Are all these issues related?
- Can one treatment approach or management strategy help sort these problems?
- Can Casey regain her confidence and youthful attraction before losing it all?
- Is there a natural solution or therapeutic approach?
- Most importantly, if left unaddressed, can these issues get worse over time?
These are some very important questions and it is high time, Casey should start looking for the answers.
Hormonal or endocrinological aberrations can greatly compromise the quality of life of an individual by altering the biological as well as metabolic functioning of the body. It has been observed that minor changes in the secretion, metabolism or degradation of different hormones can exert a wide range of systemic effects. Unfortunately, most cases of hormonal dysregulations are missed due to vague presentation. For example, in this case, the widespread symptoms of Casey are suggestive of PCOS.
According to a new study reported in the peer reviewed journal Clinical Epidemiology (1), more than 15 to 20% females in the reproductive age group are currently living with PCOS (polycystic ovary syndrome).
What is PCOS?
A polycystic ovary syndrome is an endocrine disorder that is characterized by moderate enlargement of ovarian sacs. These sacs (also referred to as cysts due to fluid accumulation) are usually diagnosed via imaging studies. It is imperative to keep in mind that conditions like polycystic ovary can lead to female infertility in poorly addressed cases.
Based on latest estimates, the annual economic burden of PCOS and associated complications is fairly high and costs more than $4 billion each year in United States alone.
Causes of PCOS
The exact cause of polycystic ovary syndrome is not known but the scientists and researchers believe that following factors can play a vital role in the pathogenesis of polycystic ovary syndrome.
PCOS & Insulin Resistance
Insulin is an essential hormone which is produced by the beta cells of pancreas in response to dietary intake of carbs and proteins. Once produced, insulin is released in the blood to control serum glucose concentration after meals.
Unfortunately, in insulin-resistant individuals (such as type 2 diabetes), the tissues are resistant to the action of insulin. In simple words, despite normal serum insulin concentration, the blood sugar concentration remains high as a result of defective receptor interaction. The high blood sugar levels signals the release of more insulin and thus this vicious cycle continues. One side-effect of disproportional release of insulin is hyper-stimulation of androgens, which alters the normal biochemical balance of reproductive hormones and leads to PCOS.
Research indicates that long standing aberrations in the glucose metabolism (due to typ1 diabetes, gestational diabetes or type 2 diabetes) can lead to PCOS (1).
The body has a natural inclination to fight against an invading foreign agent or particle by the activation of immune system. For example, as soon as your defense system detects a foreign presence, it stimulates the release of white blood cells that elicits an acute inflammatory response. In situations when an individual is exposed to persistent stress or low level inflammation, body releases stress high levels of stress hormone that automatically facilitates the release of other stress hormones as well (such as androgens) that further promotes the production of cysts in the ovary.
A positive history of PCOS in the family (especially in the index relatives) can significantly increases your risk of developing PCOS.
Symptoms of PCOS
Females dread polycystic ovary syndrome, because it is not only associated with alterations in the reproductive and sexual functions, but also because it can aggravate the risk of several metabolic and cosmetic ailments.
The signs and symptoms of polycystic ovary syndrome vary depending upon the degree of hormonal/ metabolic dysfunction, age of the female and other co-morbid issues such as obesity or known hormonal aberrations. For example, it has been observed that PCOS is usually silent in lean females. However, most females who are suffering from polycystic ovary syndrome are obese (or over-weight). It is imperative to mention that core body weight is strongly associated with the severity of symptoms and response to different therapies.
Following are some signs and symptoms which are fairly specific to PCOS:
- Irregularity in periods: Irregular menstrual cycles is one of the characteristic feature of polycystic ovary syndrome. The menstrual cycles are less frequent (will less than 8 cycles per year) and are usually short and painful. The average length of one menstrual cycle is 35-37 days in PCOS (2). Some females report scanty menstrual flow while others experience heavy bleeding.
- Serum Androgen levels: Abnormally high levels of androgens are reported in the patients of PCOS (that is helpful in making the clinical diagnosis). Additionally, a lot of females actually manifest the signs and symptoms of high androgen levels; such as increase in the growth of facial hair (also known as hirsutism), acne over skin and onset of male pattern baldness.
- Polycystic ovaries: The enlargement of fluid filled sacs on ultrasound examination is the hallmark of PCOS and is considered the confirmatory test before initiating the treatment.
- Opportunistic infections: Frequent yeast infections are observed in patients with poly cystic ovary. This happens because of oxidative stress in the body which suppresses immune system and aggravates the risk of opportunistic infections.
Other symptoms include; varying degree of insulin resistance, weight gain, metabolic syndrome, hypertension, abnormal changes in the serum lipid concentration, mood changes and abnormalities in the sleep cycle.
How to manage & treat PCOS?
The goal of management in polycystic ovary syndrome is to:
- Identify the core cause
- Control the symptoms
- Restore hormonal rhythm
- Detoxify the body to flush out toxins
So are there any medical/ pharmacological options available?
Indeed there are:
- Medications for the regulation of menstrual cycle include birth control pills (which contains progestin and estrogen), vaginal rings containing estrogen, progesterone therapy, progestin containing intrauterine devices, metformin (anti-diabetic medicine).
- Medications which promote ovulation include clomiphene (anti-estrogen medicine), metformin (for weight loss), injections of FSH (follicle stimulating hormones) and LH (luteinizing hormone) and letrozole.
- Medications which decreases hair growth include spironolactone which blocks androgen release (it is to be noted that use of spironolactone is associated with birth defects so pregnant women are not recommended to take spironolactone during pregnancy). In addition Eflornithine can be used to control the facial hair growth)
However, the classic question is: Should you even consider pharmacological regimens for the management of PCOS symptoms?
PCOS & Metformin
For example according to a new study reported in the Journal of Clinical Endocrinology & Metabolism (4), investigators suggested that drugs like metformin are only helpful at improving the response to insulin and blood glycemic management. Likewise, other medications and pharmacological regimens that are advised for symptomatic relief, only helps in masking the symptoms of PCOS without improving/ resolving or preventing the core issue i.e. polycystic ovary syndrome.
According to another study reported in British Medical Journal (5), scientists suggested that disturbing symptoms recur in patients after stopping the pharmacological regimen. In other words, the effects of therapy are only transient.
If you are looking to maintain long term health and wellness; you only have two options:
- Resort to a bunch of commercial pharmacological agents for years (to mask your symptoms). In addition, pop more pills to combat the adverse effects/ side effects of your prescription medications but be prepared – the symptoms will return as soon as you quit your regimen
- Look for a solution based approach. Identify what is causing your hormonal imbalance and resort to natural and herbal solutions for hazard-free treatment approach.
Can you treat PCOS Naturally?
Although several treatment modalities (including both medical and hormonal) have been devised; yet natural methods are always considered superior to medical regimens. This is mainly because, natural treatments offer maximal benefits, minimize the risk of side effects from conventional medications and improve the quality of life.
The primary aim of choosing natural methods is to treat the underlying cause which is causing the symptoms. According to a new research study 10 of every 12 females can improve their chances of conception by losing at least 5% of their body weight (6).
This is mainly because weight loss is associated with:
- Improvement in insulin sensitivity
- Restoration of normal insulin balance
- A substantial decrease in the production of testosterone
- Reactionary increase in the serum levels of SHBG (sex hormone binding globulin)
All these effects can directly help in restoration of normal estrogen balance and ovarian function but most importantly, the restoration of natural hormonal balance sort other symptoms at the same time; such as male pattern baldness, facial hair growth and menstrual irregularities.
Following methods can be adapted to treat and manage the symptoms of polycystic ovary syndrome.
Lifestyle modification is actually helpful in managing mild cases of PCOS without requiring further medical intervention. For example; some helpful strategies include:
- Intake of low calorie diet can help in effective weight loss (that is needed to maintain normal androgen concentration in the body) It is observed that women who have high levels of luteinizing hormone (LH) in the first half of their menstrual cycle are at higher risk of having miscarriage. According to a study the risk of miscarriage drops from 75% to 18% with 5 to 10% decrease in the total body weight and diet regulation.
- While maintaining a balanced diet, limiting the spiky rise in blood sugar levels is the basic key. It is recommended that a female must limit her sugar intake in order to maintain her blood glucose concentrations within recommended limits. Dietary modification prevent rapid spikes in insulin release and resulting abnormal metabolism.
- Healthcare providers advise moderate exercise and physical activities to maintain optimal insulin sensitivity.
Learning more about Insulin resistance syndrome:
It is a condition characterized by the inadequate management of blood sugar levels due to abnormal insulin response. Once released from the pancreas, insulin facilitates the entry of glucose in the peripheral tissues via intricate tissue receptor interaction; however, sometimes tissue receptors are less responsive to insulin, leading to Insulin Resistance Syndrome- hallmark feature of PCOS.
This improper management causes weight gain and obesity since the body is unable to fully utilize the dietary carbohydrates and store it as fats. Here are some tips through which this insulin resistance syndrome condition can be overcome effectively.
- Limit the intake of carbohydrates.
- Increase the intake of proteins
- Add phytoestrogens
- Use organic foods
- Limit the intake of saturated fats
- Avoid excessive use of dairy products
- Increase your daily intake of water
- Limit alcohol and caffeine
- Avoid use of sugar products
Supplements for PCOS
Most cases of polycystic ovary syndrome responds fairly well to different supplements. This is mainly because:
- These supplements help in curbing the deficiency of essential vitamins and nutrients. This is especially true for females who use oral contraceptives for birth control.
- Natural herbs help in restoring hormonal balance to optimize health benefits.
Healthcare providers recommend high quality dietary supplements based on serum profiling and physician recommendations. For example, certain areas are endemically deficient in certain micronutrients (such as Selenium deficiency is common in some provinces of China). Consumption of multivitamin supplements helps a great deal in improving hormonal balance and overall fertility. According to a new study reported in Nutrition in Clinical Practice (7), investigators suggested that PCOS women are bound to take a controlled calorie diet which may aggravate the risk of nutritional deficiencies. It is highly recommended to consider an over-the-counter supplement which contains:
- Chromium: Normal serum levels are highly recommended for the maintenance of normal blood glucose concentration. In addition, chromium also helps in reducing the cravings and promoting healthy weight los
- Zinc: it helps in controlling appetite, thyroid hormone response and blood sugar levels. Females with significantly low levels of zinc are more prone to develop polycystic ovary syndrome according to a new study (8).
- Iodine: Iodine is essential for maintaining normal thyroid levels in the body. Deficiency of iodine stimulates the excessive release of androgens; thereby increasing the risk of PCOS.
- Magnesium: Magnesium deficiency in the body can worsen insulin resistance and may aggravate PCOS. Research indicates that magnesium supplementation helps in restoring normal glucose metabolism. A dose of 500-2500 mg is prescribed for the management of magnesium deficiency in PCO patients
- Co-enzyme Q10: It is required for control of normal carbohydrate metabolism. Abnormal insulin response can favor the formation of reactive oxygen species. Use of co-enzyme Q and other antioxidants can help in tissue remodeling and early return to normal function.
- B vitamins & Inositol: B-Vitamin complex is essential for the regulation of fat burning process in the body and in treatment of hormonal imbalance. The most important B-vitamin is Inositol that is found abundantely in fruits and vegetables, raisins, nuts and beans. The most common types of inositol that is most beneficial in polycystic ovary syndrome is D-chiro-inositol and Myo-inositol. When consumed in recommended doses, it decreases the levels of testosterone in the blood and helps in promoting ovulation.
- Diindolylmetahne (DIM): it helps in the conversion of estrogen to healthier derivatives. This conversion takes place in the liver
- Amino acids: Different amino acids such as N-acetyl cysteine and L-arginine are known to increase ovarian activity and improves insulin function. N-acetyl Cysteine helps in decreasing the oxidative stress and inhibiting the release of excess insulin and testosterone.
- Acetyl-L-carnitine: Although not many studies are conducted to analyze the efficacy of Acetyl-N-Carnitine in polycystic ovary syndrome cases, but some preliminary researches showed that it helps in lowering down the concentrations of se hormone binding globulin (SHBG); thereby helping the symptoms of hirsutism and menstrual irregularities.
- Omega 3: it helps in regulating menstrual cycles without interfering with sex hormone binding globulin (SHBG), omega 3 also decreases the testosterone levels in the body.
- Vitamin E: Vitamin E is an anti-oxidant which helps in decreasing the formation and levels of free radicals in the body. It also decreases the oxidative stress, hence supports the body’s immune system.
- Vitamin D3: A decline in serum concentrations of vitamin D3 can cause insulin resistance, menstrual and ovulation issues in the body.
- Calcium d-glucarate: it helps in clearing the tissues from the environmental toxins. By promoting the detoxification process it helps in preventing the recycling of hormones and helps in restoring natural biochemical balance.
- Taurine: It possess antioxidant properties to alleviate oxidative stress in the tissues. Taurine is effectively used to treat insulin sensitivity caused by hyperglycemia induced insulin resistance
- Lipoic acid: a dose of 900 mg of lipoic acid is recommended to be taken with biotin (Vitamin B1) for optimal restoration of insulin sensitivity in the system
Herbs for PCOS:
Using different herbs is also effective in treating the condition of polycystic ovary. Natural herbs and active compounds help in the regulation of blood glucose concentrations and promotion of weight loss. If you are looking to naturally treat polycystic ovaries without going through costly and annoying hormonal and pharmacological therapies; you should consider these natural solutions:
- Chaste tree: This herb stimulates the pituitary gland to control the release of luteinizing hormone. Research and clinical data indicates that controlled doses are helpful in the management of infertility.
- Rhodiola, rehmannia, Siberian ginseng are some adrenal tonics which also help in maintaining the adrenal system.
- Peony: This herb is essential for decreasing the serum levels of testosterone in the body while also increasing prolactin and estrogen activity.
- Licorice: This herb is used in combination with peony to maintain optimal hormonal levels
- Maca: This herb which stimulates the hypothalamus to activate pituitary gland for hormonal regulation. Research and clinical study indicates that naturally occurring herbs like maca are effective at stimulating the hypothalamus to activate pituitary gland for hormonal regulation. It is imperative to mention that maca root consumption does not affect the hormonal balance and rate of secretion of other endocrine glands
- Gymnema: It is effective in reducing carbohydrate levels in the body
- Tribulus: It regulates and promotes the process of ovulation.
- Blue cohosh: For years, black cohosh has been in use for the treatment of pelvic inflammatory disease and uterine activity.
- Saw palmetto: Use of Saw Palmetto can manage/ treat hirsutism by decreasing the rate of secretion of testosterone
- Milk thistle, schizandra, rosemary: They help in the removal of excessive estrogen from the body.
- Indole-3 carbinol (I3C): It helps in assisting the clearance and metabolism of estrogen from body.
- Progesterone cream: A dose of 20 mg of progesterone cream is prescribed for last week of the cycle. A significant decline in facial hair growth can be observed.
- Royal jelly: it helps in reducing the inflammation to alleviate and neutralize oxidative stress. It also has a negative effect on the testosterone release in females.
- Coptis: the active ingredient of Coptis chinensis is Berberine is known to treat metabolic conditions in the body especially insulin insensitivity.
- Dong quai: it helps in supporting the reproductive system by improving the blood flow to reproductive organs.
- Fenugreek: it helps in treating insulin resistance in patients of polycystic ovary syndrome
- Red raspberry leaves: it helps in correcting the hormonal imbalances in the body especially by maintaining the normal concentration of estrogen to achieve conception successfully.
- Cinnamon: It helps in regulating the menstrual pattern and cycle in females. Cinnamon is also known to be effective in treating insulin resistance.
- Wild yam: wild yam is used in treatment of fertility issues. It contains diosgenin which has the similar properties like that of a progestin. In this way the body’s ability to conceive a child can be increased.
- Red palm oil: red palm has properties to treat insulin resistance syndrome by lowering down the release of insulin from pancreatic cells.
- Shatavari: it helps in promoting the formation of ovarian cycles and helps in combating the problem of insulin sensitivity in females.
Alternative options for PCOS Treatment:
Besides herbal and nutritional remedies, there are a number of other options as well that can improve the symptoms of PCOS, For example, data indicates that periodic lymphatic drainage can alleviate the disturbing feeling of congestion in PCOS patients.
Other options are:
- Castor oil and linseed packs for relieving pain
- Natural progesterone creams
- Acupuncture for relieving pain by improving the blood flow across the genitals. In addition, according to a study reported in Evidence-based Complementary and Alternative Medicine (13), investigators suggested that acupuncture can help in restoring fertility in females by correcting hormonal rhythm and endocrine balance.
- Aromatherapy is helpful in supporting the reproductive system and hormonal balancing. Aromatherapy with essential oils helps supporting the reproductive system and hormonal balancing. Some of the essential oils that are commonly used in treatment of PCO include geranium, lavender and rose.
Besides regular exercise also plays a vital role in managing the symptoms by improving the fitness levels and promoting weight loss.
Recommended Foods for a PCOS Diet:
- Healthy fats: Intake of healthy fats is required for hormonal metabolism and regulation. The intake of right amount of fats promote weight loss and enhance vitality. Fats which are recommended in PCOS include coconut oil, butter, egg yolks and olive oil
- Consume complex carbs: Limit the intake of simple sugars/ carbs that are known to deteriorate insulin balance. Prefer complex carbohydrates but make sure to maintain a gluten free diet. Replace sugar with sugar free sweeteners such as stevia. For example try It is a form of complex carbohydrate which burns very slowly though out the day and does not increases the fat content in the body. Eating quinoa in controlled amounts help in maintaining the body weight; it is also called as super grain and can be included as flour
- Dairy intake: the three best dairy products which must be added in diet for treating polycystic ovary include clarified butter, raw butter and colostrum. Limit the intake of milk products as well as wheat as they aggravate the symptoms and condition of PCO.
Foods to avoid on a PCOS Diet
- Sugary foods: Sugary drinks elevate the blood glucose concentration and promotes fat deposition that can further make insulin resistance worse. Females who are living with PCOS should avoid cakes, cookies, syrups, sodas and other forms of simple carbs.
- Foods made from white flour: white flour is composed of simple carbohydrates which must be avoided by the PCOS females. Research indicates that white flour promotes fat storage in the body. Foods such as cereals, cookies, cupcakes and muffins must be avoided.
- Sodium containing foods: Limit intake of sodium rich foods such as canned vegetables, smoked meat, canned soups and salted nuts. Instead of using these food products replace them with fresh herbs, citrus fruits, vinegar and dishes seasoned with coarsely crushed black pepper.
- Avoid fatty foods: Patients suffering from PCO avoid the intake of saturated fat foods. Instead try lean meat, white meat and fat free dressings. Use steam food and meat instead of fried fatty food.
- “Consumption of milk has been linked to certain cases of male infertility. Excess estrogen and pesticide exposure has been linked to PCOS and Endometriosis. Studies have found higher concentrations of pesticides in cheese than in non-organically grown fruit and vegetables. The first line of naturopathic treatment I recommend for PCOS and Endometriosis is to minimize intake of animal products. Animal products have a high content of hormones, pesticides and herbicides which are known endocrine disruptor’s. They play havoc with your hormones and this can lead to anovulation.”
- gluten, wheat, etc.“The medical literature has readily established a strong association between gluten sensitivity and hormonal issues, especially with progesterone. At its worst, gluten sensitivity can actually be an autoimmune disease called Celiac disease, a condition that is treated with absolute abstention from gluten (i.e.- can’t eat it EVER). Those who do not have celiac disease but are gluten sensitive do not have to be as careful, but should typically avoid gluten when possible. If you read many PCOS blogs, you may notice a huge amount of information about inflammation, fighting inflammation, how PCOS is caused by inflammation, how inflammation makes everything in your body go wrong. Well, no surprises here then. If you are gluten sensitive, every time you eat gluten, you cause inflammation in your body, which could contribute to lots of other disorders, heart disease, arthritis, diabetes. You get the picture. But the specific mechanism that links gluten and your hormones are in your adrenal glands. These little glands that sit above your kidneys and are responsible for your metabolism, keeping stress in check, and producing another hormone which is required to make progesterone, testosterone, and estrogen. Too much stress, the adrenals go in to overdrive and produce more cortisol to keep us going, and as a result, the sex hormones take a back seat. When we’re constantly inflamed, the adrenals read this as stress. Instead of making the good sex hormones, our adrenals are simply working to keep us alive pumping tons of cortisol (you’ve seen this commercial, the one claiming that cortisol causes belly fat—yep, it’s true). And to add insult to injury, the gluten not only messes with the hormone production in our bodies, it wreaks total havoc on our gut. Odds are good that in addition to being gluten intolerant, you’re also bit lactose intolerance, and any additional source of estrogen (dairy and soy) affects you way more than your non-gluten sensitive friends.”
According to a study reported in peer reviewed the FASEB Journal (14), a diet rich in pulses and low calorie grains can control the symptoms of PCOS. The study conducted on 25 females concluded:
“A pulse-based diet reduced body fat, and improved reproductive measures and serum lipid profiles. Thus, early diagnosis and dietary/exercise interventions are important in alleviating both the personal health and economic costs associated with PCOS”
In short, if you are suspecting polycystic ovaries, it is definitely recommended to seek medical help for accurate diagnosis of your health concerns but it is even more important to look for natural solutions to sort out your ailments. Herbal and nutritional supplements are effective in most cases of mild ovarian dysfunction and optimal regulation may ensure early return to hormonal symphony.
PCOS References & Resources:
- Sirmans, S. M., & Pate, K. A. (2014). Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology, 6, 1.
- Zhang, J., Li, T., Zhou, L., Tang, L., Xu, L., Wu, T., & Lim, D. C. (2010). Chinese herbal medicine for subfertile women with polycystic ovarian syndrome. The Cochrane Library.
- Jeanes, Y. M., Barr, S., Smith, K., & Hart, K. H. (2009). Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians. Journal of human nutrition and dietetics, 22(6), 551-558.
- Moghetti, P., Castello, R., Negri, C., Tosi, F., Perrone, F., Caputo, M., … & Muggeo, M. (2000). Metformin Effects on Clinical Features, Endocrine and Metabolic Profiles, and Insulin Sensitivity in Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled 6-Month Trial, followed by Open, Long-Term Clinical Evaluation 1. The Journal of Clinical Endocrinology & Metabolism, 85(1), 139-146.
- Lord, J. M., Flight, I. H., & Norman, R. J. (2003). Metformin in polycystic ovary syndrome: systematic review and meta-analysis. Bmj, 327(7421), 951.
- Meletis, C. D., & Zabriskie, N. (2006). Natural Approaches for Treating Polycystic Ovary Syndrome. Alternative & Complementary Therapies, 12(4), 157-164.
- Liepa, G. U., Sengupta, A., & Karsies, D. (2008). Polycystic Ovary Syndrome (PCOS) and Other Androgen Excess–Related Conditions: Can Changes in Dietary Intake Make a Difference?. Nutrition in Clinical Practice, 23(1), 63-71.
- Arentz, S., Smith, C. A., Abbott, J. A., & Bensoussan, A. (2014). A survey of the use of complementary medicine by a self-selected community group of Australian women with polycystic ovary syndrome. BMC complementary and alternative medicine, 14(1), 472.
- Lai, L., Flower, A., Moore, M., Prescott, P., & Lewith, G. (2014). Polycystic Ovary syndrome: A Randomised feasibility and pilot study using Chinese Herbal medicine to explore Impact on Dysfunction (ORCHID)—Study protocol. European Journal of Integrative Medicine, 6(3), 392-399.
- Weiss, D. A., Harris, C. R., & Smith, J. F. (2011). The use of complementary and alternative fertility treatments. Current Opinion in Obstetrics and Gynecology, 23(3), 195-199.
- Clark, N. A., Will, M., Moravek, M. B., & Fisseha, S. (2013). A systematic review of the evidence for complementary and alternative medicine in infertility. International Journal of Gynecology & Obstetrics, 122(3), 202-206.
- Vosnakis, C., Georgopoulos, N. A., Rousso, D., Mavromatidis, G., Katsikis, I., Roupas, N. D., … & Panidis, D. (2013). Diet, physical exercise and Orlistat administration increase serum Anti-Müllerian Hormone (AMH) levels in women with polycystic ovary syndrome (PCOS). Gynecological Endocrinology, 29(3), 242-245.
- Wu, X., Ng, E. H. Y., Stener-Victorin, E., & Legro, R. S. (2014). Effects and Mechanisms of Complementary and Alternative Medicine during the Reproductive Process. Evidence-based complementary and alternative medicine: eCAM, 2014.
- McBreairty, L., Zello, G., Rooke, J., Serrao, S., Pierson, R., Chizen, D., & Chilibeck, P. (2014). A pulse-based diet and exercise training in women with polycystic ovarian syndrome (PCOS): effects on body composition, blood lipids and reproductive measures (117.5). The FASEB Journal, 28(1 Supplement), 117-5.