This protocol was developed for practitioners using Fullscript in Canada and the templates cannot be applied to accounts operating outside of Canada

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through D-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study
D
Non-RDBPC human or In-vivo animal trials
 

Introduction

Whole person care is a person-centered approach to medicine. It goes beyond treating symptoms or isolated conditions, focusing on the interconnectedness of bodily systems and addressing a wide range of factors. These include biological makeup, behavioral habits, environmental factors, and a patient’s personal beliefs, values, and goals. By tailoring care to align with these unique aspects, healthcare providers can create highly personalized treatment plans that address not only physical health but also emotional and mental well-being.

This template, developed in partnership with OvationLab, aims to provide healthcare providers with practical suggestions for supplements and lifestyle strategies, helping them design personalized, whole-person care plans for patients seeking support in managing polycystic ovarian syndrome (PCOS).

PCOS is a complex endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology that affects up to 13% of reproductive-aged women worldwide. It is a chronic condition associated with metabolic, reproductive, and inflammatory comorbidities, such as insulin resistance, obesity, nonalcoholic fatty liver disease (NAFLD), and fertility issues. (Tay 2023)(Teede 2023) Risk factors are multifactorial, including genetic predisposition, obesity, diabetes, and certain early-life factors (e.g., maternal obesity, smoking during pregnancy). (Boldis 2023)(Memon 2024) Despite the prevalence of PCOS, diagnosis is often delayed, and dissatisfaction with current diagnostic and treatment approaches is common, reinforcing the need for a personalized approach to care. (Gibson-Helm 2017)

Evidence-based supplements included in this protocol are selected for their potential to support key PCOS-related domains, including hormonal balance, blood sugar regulation, inflammation, fertility, and weight management. These botanical and nutritional therapies serve as adjunctive tools to help patients meet clinical and laboratory targets.

Lifestyle modifications play a central role in long-term PCOS management. Incorporating an anti-inflammatory diet, regular exercise, sleep hygiene practices, stress reduction techniques, and strategies for mitigating environmental exposures are foundational to addressing the underlying drivers and comorbidities of PCOS. By integrating these lifestyle strategies into a comprehensive treatment plan, providers can empower patients with practical, actionable tools to support their overall well-being.

Ingredients

Androgen/Hormonal Support: Chasteberry (Vitex agnus-castus)

Dosing: 20–40 mg daily for at least three months (Roemheld-Hamm 2005)

Supporting evidence:

  • Chasteberry influences the hypothalamic-pituitary-ovarian (HPO) axis, which can be imbalanced in women with PCOS. Evidence shows that Vitex can help lower prolactin and androgen levels to improve ovulation and menstrual cycle regularity. (Shahnazi 2016)(Hossein-Rashidi 2017) 

Additional ingredient to consider for androgen/hormonal support: 

Saw palmetto (Serenoa repens) | 100–320 mg daily: Saw palmetto acts as an inhibitor of the 5-alpha-reductase enzyme, with evidence supporting its potential to reduce androgen levels and female-pattern hair loss (which affects 20–30% of women with PCOS). (Tu 2019)(Evron 2020)

 

Blood Sugar Support: Inositol 

Dosing: 2 g twice daily for three months (in a 40:1 myo-inositol to D-chiro-inositol ratio) (Nordio 2019)

Supporting evidence:

  • A systematic review and meta-analysis of 26 randomized controlled trials (RCTs) found that administering inositol to women with PCOS (n=1,691) significantly increased the likelihood of achieving regular menstrual cycles compared to placebo (similar to metformin). Inositol also improved metabolic and reproductive parameters, including free and total testosterone, androstenedione, glucose, insulin, and sex hormone-binding globulin (SHBG). (Greff 2023)

Additional ingredients to consider for blood sugar support: 

  • Berberine | 500 mg twice daily for three months: Berberine exhibits antidiabetic effects that can improve the cardiometabolic profile in patients with PCOS, including reductions in fasting glucose, fasting insulin, insulin resistance, total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol. These improvements are associated with increased ovulatory menstrual regularity and enhanced in-vitro fertilization (IVF) pregnancy and live birth rates, comparable to results seen with metformin. (Li 2015)(Mishra 2022)(Ionescu 2023)
  • Chromium picolinate | 200 mcg daily for eight weeks: Chromium picolinate reduces insulin resistance, body mass index (BMI), and free testosterone, in addition to reducing systemic inflammation (as measured by high-sensitivity C-reactive protein (CRP) and malondialdehyde) and increasing total plasma antioxidant capacity. Clinically, these effects have been shown to translate to improvements in hirsutism and acne. (Jamilian 2016)(Fazelian 2017)(Alesi 2021)
  • Vitamin D | 50,000 IU per week for 8–24 weeks (Alesi 2021): Vitamin D plays a role in blood sugar management by influencing insulin secretion by pancreatic beta cells and peripheral insulin sensitivity. In patients with type 2 diabetes (n=28), supplementation has been associated with a 0.5% reduction in hemoglobin A1c (HbA1c). (Yousefi Rad 2014) In women with PCOS (n=483), a meta-analysis of 11 studies found that vitamin D improved insulin resistance (measured by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)), hyperandrogenism, and lipid metabolism (measured by total and LDL cholesterol). (Miao 2020)

 

Inflammation Support: Omega-3 Fatty Acids

Dosing: 2 g daily for at least six months (Colombo 2023)

Supporting evidence:

  • Omega-3 polyunsaturated fatty acids (PUFAs), known for their ability to reduce triglyceride levels, support cardiovascular health, and reduce inflammation, may offer benefits in preventing and reversing the metabolic complications commonly seen in PCOS. (Albardan 2024) A meta-analysis of nine RCTs of women with PCOS (n=591) concluded that omega-3 supplementation supported reductions in HOMA-IR, total cholesterol, triglycerides, and LDL cholesterol. (Yang 2018)

 

Additional ingredient to consider for inflammation support: 

Alpha-lipoic acid (ALA) | 600–1,200 mg for at least six months: ALA possesses antioxidant and insulin-sensitizing properties. In one trial, 57 women with PCOS and oligoamenorrhea were treated with ALA and myo-inositol for 24 months. This combination was associated with improvements in the insulin response in a three-hour oral glucose tolerance test, BMI, and menstrual cycle regularity. (Fruzzetti 2020) Other clinical trials have found improvements in hormonal profiles, such as reduced levels of testosterone and luteinizing hormone (LH), associated with supplementation. (Guarano 2023)

Fertility Support: N-Acetylcysteine (NAC)

Dosing: 1,200–1,800 mg daily for 8–24 weeks (Thakker 2015)

Supporting evidence:

  • Meta-analyses support using NAC to benefit reproductive and metabolic outcomes in PCOS. Positive reproductive outcomes include improved rates of conception and live births, spontaneous ovulation, and hormonal profiles (e.g., reduced total testosterone, increased follicle-stimulating hormone (FSH)). (Thakker 2015)(Shahveghar Asl 2023) NAC has also been associated with improved glucose regulation in patients with metabolic syndrome. (Panahi 2022)

 

Microbiome Support: Probiotics

Dosing: The literature does not consistently provide specific daily dosages, but interventions are generally for 12 weeks. Commonly administered strains include Lactobacillus acidophilus, L. casei, L. rhamnosus, Bifidobacterium bifidum, B. longum, B. breve, and Streptococcus thermophilus.

Supporting evidence:

  • The effects of multi-strain probiotics and synbiotics (a combination of prebiotics and probiotics) on metabolic, inflammatory, and hormonal parameters may lead to improved fertility in women with PCOS. Probiotics and synbiotics have been linked to decreased weight, improved insulin and lipid levels, reduced inflammatory markers, more favorable hormonal indices (e.g., free androgen index, SHBG), and better hirsutism scores. (Cozzolino 2020)(Colombo 2023)(Hu 2023)(Han 2024)

 

Weight Management Support: Green tea extract

Dosing: 500–1,000 mg of extract or 2 cups of tea daily for 1–3 months (Shen 2021)

Supporting evidence:

  • The catechin in green tea, epigallocatechin gallate (EGCG), has shown promise in supporting women with PCOS by improving metabolic markers such as body weight, fasting glucose, and insulin levels. Its antioxidant and anti-inflammatory properties may help reduce oxidative stress and inflammation linked to PCOS. (Ohishi 2016)(Mohammadi 2019)

 

Lifestyle Recommendations

Nutrition

Recommend that patients adopt general healthy dietary patterns (such as those aligned with the Mediterranean diet) as a first-line strategy to reduce chronic inflammation and support weight management, glycemic control, and cardiometabolic health. (Ajorlouie 2025) 

  • Encourage adherence to general macronutrient targets. Protein intake should be 20–30% of total energy, carbohydrates 45–65%, and fats around 20%.
  • Guide patients toward choosing low-glycemic index foods to help prevent/manage insulin resistance.
  • Counsel to minimize the intake of simple sugars, refined carbohydrates, saturated/trans fats, and salt.
  • Advise patients to consume at least 400 mg of omega-3 fatty acids daily from dietary sources such as fatty fish, flaxseeds, or walnuts.
  • Recommend cooking foods using low-temperature methods and avoiding high-heat techniques such as frying or grilling to reduce exposure to advanced glycation end products (AGEs). (Mouanness 2022)(Colombo 2023)(Manta 2023)

Recommend that patients consume a wide variety of fruits, vegetables, legumes, nuts, and seeds to support optimal intake of these key micronutrients:

Individualize dietary counseling to the patient’s weight loss or weight management goals, focusing on sustainable, behavior-based strategies. (Teede 2023)

  • Instruct patients to avoid excessive caloric intake.
  • Address food cravings by identifying potential triggers and recommending structured meal timing.
  • Encourage the practice of mindful eating to help patients develop a more intentional and supportive relationship with food.

Encourage utilizing specific functional foods and herbs as food-based strategies to support metabolic, hormonal, and inflammatory pathways.

  • Cinnamon: When consumed at a dose of approximately 1.5 g (~1 tsp) per day, cinnamon demonstrated beneficial effects on insulin resistance, fasting glucose, and fasting insulin levels, showing improvements in HOMA-IR over 8–24 weeks. Additionally, intake has been associated with favorable lipid changes and improvements in menstrual regularity and ovulatory function in women with PCOS. (Heydarpour 2020)(Maleki 2021)(Xiaomei 2024)
  • Spearmint tea: According to one study, drinking 2 cups daily for 30 days led to significant reductions in both total and free testosterone levels and subjective improvements in hirsutism in women with PCOS (n=41). (Grant 2010)
  • Flaxseed: Daily intake of 30 g of milled or powdered flaxseed has been associated with improvements in body weight, insulin sensitivity, lipid profiles, and inflammatory markers, as well as favorable shifts in reproductive hormones, including increased FSH and a reduced LH/FSH ratio. (Haidari 2020)(Najdgholami 2025)

Movement

The benefits of regular exercise include improved cardiorespiratory fitness, reduced central obesity, increased insulin sensitivity, and amelioration of psychological distress. (Piercy 2018)

  • Advise patients to reduce sedentary behaviors and physical inactivity by engaging in light movement throughout the day.
  • Recommend an exercise plan that includes aerobic and resistance training and focuses on the comprehensive health benefits of exercise.
  • For cardiometabolic health, recommend at least 150–300 minutes per week of moderate-intensity aerobic exercise or 75–150 minutes per week of vigorous-intensity activity. For patients with weight loss goals, advise increasing aerobic activity to >250 minutes per week of moderate intensity or >150 minutes per week of vigorous intensity.
  • Counsel on the importance of muscle-strengthening training on at least two non-consecutive days per week. (Teede 2023)

Stress

Be aware of the high prevalence of moderate-to-severe anxiety and depression among patients with PCOS, and implement proactive strategies to screen for mental health disorders and minimize healthcare-related stress.

  • Regularly screen for anxiety and depression using validated screening tools, such as the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7).
  • When indicated, refer patients to evidence-based psychological interventions, like cognitive behavioral therapy (CBT), or discuss the initiation of pharmacologic treatment.
  • Reduce internalized weight-stigmatizing beliefs and adopt a weight-inclusive approach in your clinical practice, emphasizing health behaviors over weight outcomes. 
  • Support patients in developing stress management skills by incorporating behavioral strategies such as goal-setting, self-monitoring, and problem-solving that align with their values. (Teede 2023)

Environmental

Exposure to endocrine-disrupting chemicals (EDCs), including bisphenols and phthalates, is increasingly associated with the development and progression of PCOS through disruption of hormonal regulation and epigenetic modifications. (Srnovršnik 2023)  

  • Educate patients on common sources of EDCs, including plastics, pesticides, personal care products, and household cleaners. 
  • Recommend practical strategies to reduce exposure, such as using glass or stainless steel food storage, avoiding microwaving food in plastic containers, choosing fragrance-free or Environmental Working Group-verified personal care products, and buying organic produce when possible.

Sleep

Sleep disturbances, such as obstructive sleep apnea (OSA), are more prevalent in women with PCOS, independent of BMI, and can worsen metabolic and mental health outcomes. 

  • Offer behavioral strategies to support healthy sleep duration and quality, such as avoiding caffeine and alcohol, adhering to routine sleep and wake times, and practicing stress management techniques as part of an evening routine. 
  • Routinely assess for symptoms of OSA and, if present, use validated screening tools like the Berlin questionnaire or refer to sleep specialists for further evaluation and management. (Fernandez 2018)(Teede 2023)

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

View protocol on Fullscript
References
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