PCOS and Supplements

Which supplements work best to manage PCOS symptoms?

According to the 2024 article on Dietary Supplements in PCOS, vitamin D, myo-inositol, selenium and probiotics/synbiotic offer benefits for PCOS.

There is a plethora of well-meaning and sometimes contradictory advice around managing PCOS symptoms with supplements. In this article we explore the link between PCOS and Supplements.

For those seeking to manage their PCOS condition with supplements it is important to recognize that:

Supplements often have most value when they address specific nutritional deficiencies in the individual;[1]
Supplements, like medications, include active ingredients often come with the risk of side-effects and some can interfere with medications but are not regulated in the same way as medications are;
In general, evidence on the benefits of specific supplements for a general population may not be applicable to a specific individual with PCOS and, in some cases, may focus inherently on short-term gains rather than sustained improvements in health;
High dose supplements are not necessarily better for you, particularly where the active ingredient isn’t naturally excreted (e.g., in urine) but builds up in the body;[2] and
There is a vast array of different price points for supplements that are not necessarily reflective of the quality of the product contained.

Before taking a new supplement, it is recommended that you consult a healthcare professional, especially if you have health conditions or are taking medication, to ensure the supplement is safe and appropriate for you.

Individuals with PCOS are at increased risk of certain vitamin deficiencies, including:

Vitamin B5 (pantothenic acid): a vitamin that plays a variety of important roles in metabolism, particularly in metabolizing fat[3] as well as brain health.[4] PCOS is associated with B5 deficiency[5] and its supplementation may be beneficial;
Vitamin B6: a vitamin that plays an important role in metabolism across more than 100 processes, immune function and fetal/infant brain development.[6] PCOS is associated with B6 deficiency[7] and it is believed that B6 supplementation may help with androgen excess;[8]
Vitamin B9 (folate): a vitamin crucial for the formation of DNA and other genetic material as well as cell division.[9] PCOS is associated with B9 deficiency[10] and supplementation may assist with core features of PCOS including fertility and metabolism;[11]
Vitamin B12: a vitamin also critical for the formation of DNA and other genetic material as well as keeping blood and nerve cells health.[12] PCOS is associated with B12 deficiency[13] and supplementation may similarly assist with core features of PCOS including fertility and metabolism;[14]
Vitamin C: a vitamin that acts as an anti-oxidant, is required to make collagen (for wound-healing), improves iron absorption and helps with immune system function.[15] PCOS is associated with C deficiency[16][17] and supplementation may help with androgen excess and inflammation;[18] and
Vitamin D: a vitamin with a number of roles across bone/muscle health,[19][20] inflammation control,[21] glucose regulation[22] and cell growth/differentiation/death.[23] 40-60% of individuals with PCOS may have a Vitamin D deficiency[24][25] and supplementation is believed to decrease testosterone levels, improve ovulation and improve menstrual regularity.[26]

Individuals with PCOS are also at risk of certain mineral deficiencies, including:

Chromium: a mineral that is believed to help metabolize carbohydrates, fats and proteins.[27] PCOS is associated with chromium deficiency and supplementation may assist with maintaining a healthy weight, reducing free androgens and reducing fasting insulin;[28]
Magnesium: a mineral that regulates muscle and nerve function, blood pressure and blood sugar levels as well as making protein, bone and DNA.[29] Hyperinsulinemia (high insulin) is common in PCOS and has been linked to magnesium deficiency.[30] Magnesium supplementation has been shown to increase levels of Dehydroepiandrosterone (DHEA),[31] a hormone produced in the adrenal gland that supports the production of other hormones including testosterone and estrogen;[32]
Selenium: a mineral required for healthy thyroid function, to make DNA and for immune function.[33] PCOS is associated with selenium deficiency[34] and its supplementation can assist with Total Antioxidant Capacity (TAC), the body’s ability to handle harmful free radicals;[35] and
Zinc: a mineral required for healthy immune function and to make DNA and proteins.[36] Some studies have found that individuals with PCOS have lower zinc levels[37] and its supplementation may assist with insulin sensitivity, lipid balance and the intensity of dysmenorrhea (menstrual cramps).^[38]

At its core, PCOS is associated with abnormal functioning of the system of hormones that connects the hypothalamus, the pituitary and the ovaries (the HPO-axis).[39] PCOS is associated with hyperandrogenism (HA) or androgen excess (AE), elevated levels of androgens in individuals assigned female at birth.

Elevated androgens disrupt the way that adipose tissue metabolizes glucose. The adipose tissue produces less adiponectin, a hormone that helps with insulin sensitivity and inflammation, and more leptin, a hormone that causes you to feel hungry in efforts to maintain enough fat stores for long-term health. As a result, 65-70% of individuals with PCOS develop insulin resistance (IR).[40] In another study insulin resistance was shown to affect up to 95% of individuals with PCOS who are overweight and up to 75% of individuals who are lean.[41]

IR makes it more difficult to maintain a healthy weight and can lead to weight gain. Obesity, particularly the buildup of fat around the abdomen (central adiposity), interferes with the production of sex hormones, increasing the level of androgens[42] and therefore exacerbating the effects of PCOS.

There are a variety of supplements that may help improve insulin sensitivity and/or androgen levels, including:

Alpha-Lipoic Acid (ALA): a chemical that helps with cell metabolism and has anti-oxidant properties in higher volumes.[43] In individuals with PCOS, ALA (especially in combination with inositol) has been shown to improve insulin sensitivity, hormonal markers and menstrual regularity;[44]
Cinnamon: a herb containing a variety of proanthocyanidins and phenolic compounds that differ considerably between the plant’s bark, roots, fruit and leaves and have, for example, antioxidant, antidiabetic, anti-inflammatory and anticancer properties.[45] In individuals with PCOS, cinnamon has been shown to support weight loss, improve insulin sensitivity, lower blood sugar and improve lipid balance;[46]
Coenzyme Q10 (CoQ10): also known as ubiquinone, a molecule that naturally occurs in every cell membrane and important for cell metabolism.[47] In individuals with PCOS, CoQ10 has been shown to improve insulin sensitivity, hormonal markers and lipid balance;[48]
Green tea (Epigallocatehin-3-Gallate): a plant with a high content of the EGCG polyphenol with anti-inflammatory, antioxidant, antifibrotic, anti-remodelation, and tissue-protective properties.[49] In individuals with PCOS, green tea has been shown to support weight loss, decrease androgen levels and improve insulin sensitivity;[50]
Inositol: a form of sugar that we both make in our kidneys, liver and brain[51] and consume in our diet (through whole grains, nuts and legumes, cantaloupe and some citrus fruits),[52] inositol plays an important role in a variety of biological processes by regulating the way in which cells respond to substances outside the cell such as hormones, neurotransmitters and growth factors.[53][54][55] Inositol supplements are believed to support individuals with PCOS by increasing insulin sensitivity/improving metabolic indicators, reducing androgen levels, promoting ovulation/improving menstrual regularity and improving the number of good quality mature eggs;[56][57][58][59]
Licorice (glycyrrhizin): a plant root that has antiviral, anti-peptic ulcer, antioxidant, and anti-inflammatory properties.[60] In individuals with PCOS, licorice may offer benefits for weight loss support, lipid balance and insulin levels;[61]
N-Acetylcysteine (NAC): derived from plants in the Allium species (especially onion), it is a powerful anti-oxidant.[62] In individuals with PCOS, NAC improves insulin sensitivity and may improve the cervical mucus to aid conception (counteracting the negative effect of clomiphene citrate);[63]
Resveratrol: a form of polyphenol found in plants such as red grapes, peanuts and blueberries,[64] with anti-inflammatory, anti-oxidant, anticancer and cardioprotective properties.[65] In individuals with PCOS, resveratrol has been shown to significantly reduce androgens, luteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEAS);[66] and
Spearmint tea: a plant with a combination of antioxidant flavonoids and Rosmarinic acid with both antioxidant and anti-inflammatory properties.[67] In individuals with PCOS, spearmint tea has been show to reduce androgen levels.[68]

Individuals with PCOS often exhibit chronic low-grade inflammation, resulting in damage to tissues and increasing the risk of a variety of health complications.[69] Chronic low-grade inflammation is the activation of the immune system persistently, rather than activating temporarily in response to a threat as in acute inflammation[70] and is implicated in a variety of health complications including diabetes, cardiovascular disease, autoimmune conditions, cancer, allergies and chronic respiratory disorders.

There are a variety of supplements that can act as anti-oxidants, neutralizing unstable, potentially harmful molecules, including:

Apigenin: a plant flavonoid that is abundant in common fruits and vegetables and has antioxidant and anticancer properties.[71] Apigenin is a phytoprogestin and, in individuals with PCOS, may offer benefits for hormonal profile, lipid balance and inflammation;[72]
Alpha-Lactalbumin: a whey protein that makes up around 1/5 of the proteins in human milk.[73] In individuals with PCOS, Alpha-Lactalbumin (acting as a prebiotic) has been shown to improve gut dysbiosis, insulin sensitivity, obesity and inflammation;[74]
Flaxseed (Alpha-Linolenic Acid (ALA)): an essential fatty acid that is one of the “omega-3 fatty acids” and has anti-oxidant properties.[75] In individuals with PCOS, ALA (in flaxseed oil) is believed to offer benefits to metabolic markers, hormonal markers and gut microbiome;[76]
Kaempferol: a plant flavonoid that is found in many common fruits and vegetables and has anti-oxidant and anti-inflammatory properties.[77] Kaempferol is a phytoprogestin and, in individuals with PCOS, is believed to down-regulate some genes related to the condition;[78] and
Luteolin: a plant flavonoid that is found in many common vegetables and has anti-oxidant, anti-inflammatory, and anti-allergic properties.[79] In individuals with PCOS, it may offer benefits to lipid metabolism and gut microbiome.[80]

In addition, there are a number of supplements based on “superfoods”, combining a range of these properties; these include:

Berberine: an isoquinoline alkaloid, a naturally occurring organic compound derived from plants including Goldenseal and barberry,[81] with properties that lower blood sugar levels[82] and reduce the formation of adipose tissue (body fat).[83] In individuals with PCOS, berberine has been shown to reduce levels of “bad” cholesterol/increase levels of “good” cholesterol^,[84] improve in-vitro fertilization (IVF) outcomes,[85] improve insulin sensitivity, reduce testosterone levels and decrease markers of inflammation;[86]
Chaste berry (Viteagnusin): a shrub that contains monoterpenoids, labdane-type diterpenoids and flavanoids, organic compounds that have shown antimicrobial, anti-inflammatory, anti-cancer, anti-oxidant and other properties.[87][88][89] In individuals with PCOS, chaste berry was shown to improve several hormonal markers (including prolactin)[90][91] and reduce ovarian volume;[92]
Fennel seed: a plant seed that contains with a variety of bioactive substances such as trans-anethole, estragole, fenchone, and quercetin, with anti-fungal, anti-bacterial, anti-hyperlipidemic, anti-cancer and anti-diabetic properties.[93] In individuals with PCOS, studies on the benefits of fennel have not been compelling although it is widely believed to improve metabolic and inflammatory markers;[94][95]
Maitake mushroom (“hen-of-the-woods”): a mushroom that contains a variety of bioactive substances such as polysaccharides, β-D-glucans, ergosterol, lactulose, dextrin, oligofructose, triterpenes, and different phenolic compounds and with anticancer and immune-system boosting properties.[96] In individuals with PCOS, studies have shown that the extract of the mushroom can induce ovulation;[97]
Okra (lady finger): a vegetable that contains a variety of polysaccharides, polyphenols and flavonoids and with antioxidant, neuroprotective, antidiabetic, antihyperlipidemic, and anti-fatigue properties.[98] In individuals with PCOS, okra may offer benefits for hyperglycemia (high blood sugar), support weight loss and follicle quality;[99]
Spirulina: the ultimate “superfood”, spirulina is a source of plant-based proteins, carbohydrates, essential fatty acids, vitamins and minerals;[100][101] it has a significantly higher protein content than many common plant/animal protein sources[102] and its’ main source of protein, phycocyanin, has properties that include: anti-oxidant, anticancer, anti-inflammatory, anti-neurodegenerative, antimicrobial and anti-diabetic.[103] Spirulina is believed to offer specific benefits for individuals with PCOS as it regulates the of certain genes expression (increasing or decreasing the production of specific products of the gene) that are implicated in the condition;[104]
Turmeric (curcumin): its active ingredient, curcumin, is a polyphenol with both antioxidant and anti-inflammatory properties.[105] In individuals with PCOS, curcumin has been shown to help manage weight, reduce blood sugar, reduce insulin levels, improve lipid balance and increase insulin sensitivity;[106]

Some further supplements are being explored for their potential with PCOS but strong evidence has not yet been established, for example:

Chilli peppers (capsaicin): an extract from chillis that has well-established analgesic (pain relief) properties.[107] In individuals with PCOS, capsaicin may support ovarian health based on animal studies;[108] and
Saw palmetto extract: derived from a small palm tree, it has been explored for a range of therapeutic effects including prostate health (in biological men), urinary health and inflammation.[109] Due to its antiandrogen properties, it has been proposed as a potential treatment for PCOS but evidence is currently lacking.[110]

Individuals with PCOS may be at a 5-10x increased risk of obstructive sleep apnea (OSA) than those without the condition.[111] Sleep apnea is disorder where breathing is interrupted during sleep.[112] Sleep apnea affects quality and quantity of sleep, reducing the percentage of time spent in rapid eye movement (REM) sleep and sleep efficiency,[113] the ratio of total sleep time to time in bed.[114] Sleep apnea is linked to increased risks of cardiometabolic disorders including type 2 diabetes, obesity and cardiovascular disease and can increase blood sugar levels.[115] OSA is the most common form of sleep apnea and is caused by the relaxation of the throat muscles blocking the airway.[116]

PCOS is linked to OSA through IR, chronic hyperglycemia (high blood sugar), obesity, low levels of estradiol, low levels of progesterone, alterations to the levels of melatonin and mental health disorders.[117][118]

Melatonin, a hormone or chemical messenger that is produced by the pineal gland, a tiny gland in the brain,[119] and other tissues in response to darkness.[120][121] Melatonin’s primary role is to help with the timing of your circadian rhythm (your 24-hour internal clock) and with sleep.[122] Melatonin levels typically rise roughly two hours before bedtime, creating a quiet awake state that makes it easier to fall asleep.[123] In individuals with PCOS, melatonin supplements may offer benefits through reducing hyperinsulinemia (elevated levels of insulin),[124] reducing the level of androgens[125] and improving the duration and quality of sleep.[126]

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