Spearmint with Myoinositol for PCOS
The combination of spearmint with myoinositol is not supported by current evidence-based guidelines for PCOS management, and myoinositol alone (4000 mg daily) should be considered as adjunctive therapy primarily for women attempting conception, while combined oral contraceptives remain first-line for those not seeking pregnancy. 1, 2
Evidence for Myoinositol in PCOS
Myoinositol demonstrates meaningful benefits for metabolic and reproductive parameters in PCOS patients:
Myoinositol 4000 mg daily with folic acid improves menstrual regularity in approximately 68% of patients, with significant reductions in LH levels, LH/FSH ratio, fasting insulin, and insulin resistance markers 3
For women attempting pregnancy, myoinositol 4000 mg daily should be initiated alongside lifestyle modification, with clomiphene citrate added if ovulation does not occur within 2-3 months 2
The combination of myoinositol with metformin shows improved menstrual cycle regularity and quality of life compared to metformin alone, though metabolic parameters show similar improvements 4
When combined with oral contraceptives, myoinositol (4 g daily) provides superior reduction in hirsutism scores, insulin resistance, and androgen levels compared to oral contraceptives alone 5
Absence of Evidence for Spearmint
No guideline-level evidence or high-quality research supports the use of spearmint in PCOS management:
Current ACOG guidelines do not mention spearmint as a treatment option for any aspect of PCOS management 6
The evidence-based treatment hierarchy prioritizes lifestyle modification (5-10% weight loss), combined oral contraceptives for non-pregnancy goals, and clomiphene citrate for ovulation induction 1, 7
Recommended Treatment Algorithm
For women NOT attempting pregnancy:
- Start with lifestyle modification targeting 5-10% weight loss through 500-750 kcal/day deficit 7
- Initiate combined oral contraceptives as first-line pharmacologic therapy 1, 7
- Consider adding myoinositol 4000 mg daily if metabolic parameters remain suboptimal despite oral contraceptives 5
For women attempting pregnancy:
- Begin with lifestyle modification plus myoinositol 4000 mg daily with folic acid 2
- Add clomiphene citrate if ovulation does not occur within 2-3 months 2
- Consider metformin if insulin resistance or glucose intolerance is documented 7
For hirsutism management:
- Combine oral contraceptives with antiandrogens (spironolactone, finasteride, or flutamide) as this is more effective than either alone 6, 1
- Adding myoinositol 4000 mg daily to oral contraceptives provides additional benefit for hirsutism reduction over 6 months 8, 5
Critical Clinical Considerations
Important caveats about myoinositol use:
Myoinositol shows no clinical evidence for endometriosis management, as the pathophysiology differs fundamentally from PCOS 2
The combination of myoinositol with metformin does not provide additional metabolic benefits beyond either treatment alone for insulin resistance parameters, though menstrual regularity may improve more 9, 4
Myoinositol is safe with good compliance and can be justified as adjunctive therapy, but should not replace established first-line treatments 3
Mandatory metabolic screening regardless of treatment choice: