When I started investigating the possibility of managing my PCOS without the use of hormonal birth control, I was honestly most concerned about the growth of dark hair in places I did not want to have dark hair (known as hirsutism).

What is hirsutism?

Hirsutism in women with PCOS (and other women) is driven by excess androgen hormones, specifically free testosterone. Most of the testosterone in a well-functioning female body will be bound up by sex hormone binding globulin (SHBG) and albumin, and thus can’t contribute to more masculine characteristics. In the presence of excess insulin, the ovaries excrete higher levels of testosterone while SHBG levels decrease, resulting in more unbound testosterone. This free testosterone can then act on androgen receptors in the body, letting dark hairs sprout where you don’t want them. These hairs are referred to as “terminal hairs” and are coarse and pigmented, in contrast to vellus hairs, often referred to as peach fuzz, which are softer, shorter, and not pigmented.

PCOS, HERBs, and hirsutism

Upon googling some variation on “PCOS holistic treatment excessive hair growth,” various blog posts on herbs rose to the top of my results. While they all offered a variety of options, spearmint immediately stood out to me because 1) I had heard about the herb before (unlike other options like saw palmetto) and 2) I love the taste (unlike options like licorice). I also noticed that most, if not all, herbal tea blends designed specifically for PCOS included spearmint.

So I added spearmint tea to my regimen, and still consume it to this day. I steep one tea bag with about 16 ounces of water overnight, cold brew style, and drink the whole glass first thing in the morning. We all wake up a little bit dehydrated, so this habit helps with that issue as well. I also prefer cold spearmint tea, over hot, but perhaps that’s a weird preference. Report back if you try it!

While I drink spearmint tea every single day, I will admit that I never really looked into the research on it; I just assumed there had to be solid evidence since it was so commonly suggested.

What does the literature say?

There are numerous studies on the use of spearmint in rats in which PCOS conditions were induced. That’s not really compelling evidence to me that spearmint will work in humans, so I won’t discuss those studies here.

The first (of two) studies to try using spearmint tea to treat excess androgens occurred in Turkey and recruited 21 women who experienced hirsutism, 12 of whom had also been diagnosed with PCOS (Akdogan et al. 2007). Twice daily for five days, the women consumed spearmint tea. The tea was prepared with 1 tsp (5 grams) of dried leaves with 1 cup of boiling water which steeped for 5 to 10 minutes. Levels of relevant hormones were tested both before and after the 5-day intervention period. They found about a 40% reduction in free testosterone, although no change in total testosterone was found. This suggests a possible increase in sex hormone binding globulin, although this hormone was not measured. They also found a 27% increase in luteinizing hormone (LH), a 17.5% increase in follicle stimulating hormone (FSH), and a 36.4% increase in estradiol (the most common form of estrogen). Note that most women with PCOS usually have an elevated LH to FSH ratio (Saadia 2020), so while spearmint tea may reduce free testosterone, it may exacerbate existing imbalances between LH and FSH. The relative levels of these hormones are critical for ovulation.

A second study sought to replicate the original study, and also explicitly considered the impact on hirsutism (Grant 2010). This study recruited 42 women with PCOS, half of whom were assigned to the treatment group to consume spearmint tea, twice per day, for 30 days; the other half consumed chamomile tea, which has no impact on androgens. Like the original study, this study measured hormone levels before and after the intervention period. Unlike the previous study, they also specifically measured and compared changes in hirsutism, as measured by the Ferriman-Galway ratings of hirsutism. While they found similar impacts on hormones at the conclusion of the study (29% reduction in free testosterone, 23% reduction in total testosterone, 38% increase in LH, 19% increase in FSH), they found no statistically significant difference in their objective measure of hirsutism. Interestingly, the women in the treatment group assessed their own hirsutism as improved, while the control group did not. This suggests that objective measures of hair growth may not be able to capture all of the nuances of hair growth that women can observe on their own bodies.

It should be noted that the average growth cycle for facial hair is about four months (Matheson and Bain 2019), so neither study lasted long enough to possibly capture all of the impacts of the intervention on hirsutism.

A need for further research

To me, the results of these studies suggest the need for follow-up studies to assess:

• The longer term impact of consumption of spearmint tea on hirsutism using a study of proper length to actually capture these impacts.

• The impact of spearmint tea on timing of ovulation given the impacts found on levels of LH and FSH, two hormones whose levels, in relation to the other, are critical for ovulation.

• The impact of spearmint tea on sex hormone binding globulin, given the conflicting results found in the previous studies in terms of total testosterone and the observed impact of insulin resistance on SHBG.

While there are many studies considering the use of herbs and spices on blood sugar regulation, as discussed here, I suspect that women’s complaints of hirsutism are taken less seriously. Hirsutism is probably seen as less harmful and less significantly impactful on a woman’s life. And while perhaps this may be true in physical terms, it can be hugely impactful on a woman’s mental health and her perceptions of herself.

I still grapple with body image issues related to my own struggles with hirsutism, and I don’t know how many thousands of dollars and hundreds of hours I have spent in my lifetime trying to keep it under control with laser hair removal, waxing, shaving, and plucking.

While I have found managing my blood sugar to be more impactful on my hirsutism, given the documented impacts of spearmint tea on free testosterone, spearmint tea might be something to consider as you work on adjusting your diet. It should be noted that there are possible impacts on liver and kidney function (Read the full discussion here); always consult a trusted medical professional before starting any supplements.

And keep pushing for more studies and better options to combat a substantial women’s health issue.

References

Akdogan M, Tamer MN, Cure E, Cure MC, Koroglu BK, Delibas N. 2007. Effect of Spearmint (Mentha spicata Labiatae) Teas on Androgen Levels in Women with Hirsutism. Phytotherapy Research 21:444-447.

Grant, P. 2010. Spearmint Herbal Tea Has Significant Anti-Androgen Effects in Polycystic Ovary Sundrome: A Randomized Control Trial. Phytotherapy Research 24(2):186-188.

Matheson, E and Bain, J. 2019. Hirsutism in Women. American Family Physician 100(3):168-175.

Saadia, Z. 2020. Follicle Stimulating Hormone (LH:FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non-Obese Women. Medical Archives 74(4):289-293.

Disclaimer: This post is not intended to diagnose or treat any medical issues. It is intended for informational purposes only. I am not a medical practitioner. Always consult a trusted healthcare provider with any questions you may have about a medical condition or treatment and before starting any new health care regimen.