Variational quantum circuits are promising tools whose efficacy depends on their optimisation method. For noise-free unitary circuits, the quantum generalisation of natural gradient descent was recently introduced. The method can be shown to be equivalent to imaginary time evolution, and is highly effective due to a metric tensor reconciling the classical parameter space to the devices Hilbert space. Here we generalise quantum natural gradient to consider arbitrary quantum states (both mixed and pure) via completely positive maps; thus our circuits can incorporate both imperfect unitary gates and fundamentally non-unitary operations such as measurements. Whereas the unitary variant relates to classical Fisher information, here we find that quantum Fisher information defines the core metric in the space of density operators. Numerical simulations indicate that our approach can outperform other variational techniques when circuit noise is present. We finally assess the practical feasibility of our implementation and argue that its scalability is only limited by the number and quality of imperfect gates and not by the number of qubits.