What is PCOS?

Polycystic ovary syndrome (PCOS) is a metabolic and hormonal disorder that can disrupt menstrual cycles and lead to symptoms such as irregular periods, high androgens, excess hair growth, acne, and polycystic ovaries (multiple small cysts on the ovaries), weight gain and others symptoms. PCOS is also related to autoimmune disorders.

Among the known causes are hormone imbalance, insulin resistance, inflammation, lifestyle factors, and genetics or a combination of either. The exact cause can vary from person to person, and researchers are still working to fully understand the underlying mechanisms of the disorder.

A proper and thorough blood test should be done to identify causes and underlying deficiencies to identify the root cause specific to you before starting any interventions such as diet modifications, medicine, and/or supplementation.

This article covers the research backed vitamins and supplements for naturally reducing the symptoms of PCOS in the body. Optimal food sources and times to take the supplements are also inlcuded.

What Supplements Are Used for PCOS?

When picking the right supplements for you it’s important to consider that currently in the United States and Europe the Food and Drug Administration (FDA) and European Medicines Agency (EMA) do not do pre-market approval for safety or efficacy - it’s up to the manufacturers of supplements to ensure safety. The FDA and EMA have a stricter approval process for pharmaceutical drugs.

When evaluating supplements, look for certifications from independent organizations, such as NSF International or US Pharmacopeia (USP), which indicate that the supplement meets quality and purity standards. Vitamin manufacturers can send their products to the USP which performs tests to ensure the ingredients match the claim on the label. They also perform testing of the manufacturing facility. Learn more here.

Inositol for PCOS

Myoinositol (MI) and D-chiro-inositol (DCI) produce an insulin sensitizing action in PCOS patients. 50-60% of PCOS patients have insulin resistance, eventually leading to excess glucose levels, and can lead to diabetes. Metformin, a diabetes medication, has been used for years to manage this condition. Inositol has shot up in popularity as an alternative.

Both Myonositol and D-chiro-Inositol are a type of sugar alcohol that play a complex role in the body’s metabolism, reproductive, and insulin pathways.

The body produces inositol from the carbohydrates in food. It’s in foods mostly from fresh fruits, beans, grains, and nuts. The typical US diet has anywhere from 225 to 1500 mg of Inositol.

So, what does Inositol do for PCOS?

Out of 47 clinical trials studied, several showed positive effects of Inositol on improved ovarian function and fertility, decreased hyperandrogenism including acne and hirsutism, positively affected metabolic aspects, and modulated various hormonal parameters.

In 2023, it was shown to be just as effective as Metformin in regulating the menstrual cycle. Secondary outcomes showed decreased body mass index, free testosterone, total testosterone, androstenedione, glucose levels, and area under the curve insulin levels.

A 2016 study has also shown a supplementation with a combination of myo- and d-chiro-inositol being effective and safe for improving glycemic control in patients with type 2 diabetes.

A meta-analysis on the effects of inositol for PCOS mostly show the effectiveness at a ratio of 40:1 between Myo and D-chiro Inositol, with at least 2,000mg of myo-inositol.

Best effectiveness is seen at a 40:1 ratio between Myo and D-chiro Inositol, with at least 2000 mg of myo-inositol. Supplementation of Inositols go much higher in dosage and have proven effective for multiple mental health, fertility improvement with little side effects. Usually up to 6 months of regular supplementation is recommended for optimal results.

Food Sources: Fresh Melons, Citrus Fruits (oranges, limes), Cantaloupe, Cabbage, Nuts, Meat (especially liver), Whole Grain Bread and Bran, Beans

Optimal Time to Take Supplement: on an empty stomach and at least 30 minutes before food

Vitamin D for PCOS

Vitamin D, also known as the sunshine vitamin, is both a nutrient we eat and a hormone our bodies make. It’s a fat soluble vitamin that is important for absorbing and retaining calcium and phosphorus (necessary for building bone).

There are 2 types available in supplementation form, Vitamin D2 and D3. D2 is produced in plants and fungi and D3 in animals, including humans.

Vitamin D3 can be formed when a chemical reaction occurs in human skin through sun exposure. The amount of the vitamin absorbed can vary widely. Darker skin tones due to having higher amounts of the pigment melanin (which acts as a type of natural sunscreen), are slower at synthesizing Vitamin D.

Vitamin D deficiency is much more prevalent in PCOS patients. A 2020 meta analysis of 11 studies on 483 participants showed an improvement in total testosterone, insulin resistance, beta cell function, total cholesterol, and low-density lipo-protein-cholesterol.

Food Sources: Cod liver oil, Salmon, Orange juice fortified with vitamin D, Egg yolk, Beef liver, Dairy and plant milks fortified with vitamin D

Optimal Time to Take Supplement: Vitamin D is fat soluble which means you should eat it with fats like avocado or generally alongside a meal for improved absorption.

Vitamin B Complex for PCOS

Vitamin B6, folate, and vitamin B12 play a role in converting food into energy, create new blood cells, maintain healthy skin, brain cells and other body tissues. They also play a role in sleep, fatigue, anemia, and other mental health symptoms. This is done by producing serotonin and dopamine, the neurotransmitters that help us regulate mood and focus.

We don’t make B vitamins on our own so we get it from food. If there’s a deficiency, supplements might be helpful.

The B Complex vitamins have significant roles in homocysteine (Hcy) regulation. PCOS patients sometimes show elevated Hcy. These three B-vitamins play a role in breaking down the amino acid homocysteine. In order to reduce elevated levels of serum Hcy, folic acid supplementation for 3 months has shown effective results in studies.

Birth control and long term use of metformin are known to deplete B vitamin levels. So supplementing in this area can be helpful.

B vitamins also have a critical role in mood regulation and help with PMS symptoms.

Food Sources: Leafy Greens, Oranges, Meat (especially liver), Seafood, Poultry, Eggs, Dairy Products, Legumes, Seeds

Optimal Time to Take Supplement: Take them with or without foods, best results if taken in the morning and/or an empty stomach

Vitamin B Complex for PCOS

The two major classes of polyunsaturated fatty acids (PUFAs) are the omega-3 and omega-6 fatty acids. Omega-3s play important roles in the body by making up parts of the phospholipid layers of cell membranes.

Higher consumption of fish and higher dietary or plasma levels of omega-3s are associated with a lower risk of heart failure, coronary disease, and fatal coronary heart disease. A 2018 study shows the benefit of Omega-3s in improving insulin resistance, total cholesterol, triglyceride, and general inflammation in women with PCOS.

Food Sources: Plant oils (such as flaxseed, soybean, and canola oils), Chia Seeds, English Walnuts, Flaxseed, Salmon

Optimal Time to Take Supplement: With a meal

Zinc for PCOS

Zinc is a trace mineral, meaning that the body only needs small amounts. It’s a major player in the creation of DNA, growth of cells, building proteins, healing damaged tissue, and supporting a healthy immune system.

Many different foods contain zinc, but that of animal-origin (organs and flesh of mammals, fish, eggs and dairy products) are the richest source of well absorbable zinc.

Zinc plays a pivotal role in the reproductive system processes such as ovulation, fertilization, normal pregnancy, fetal development, and parturition. When balanced it maintains homeostasis of testosterone and male fertility parameters.

Studies have shown that circulating zinc availability in women with PCOS is lower than average.

60 women with PCOS took part in a recent study where they took zinc (50 mg) and magnesium (250mg) twice daily. The women were told to not make any lifestyle changes. At the end of the 12 weeks it was noticed that there was a reduction of hs-CRP and protein carbonyl, as well as an increase in plasma total antioxidant capacity. Improvements in inflammation were noticed.

A 2020 meta analysis of 36 studies has also shown positive correlation between zinc (as zinc sulfate) and various markers of insulin resistance, including insulin and lipid concentrations, total cholesterol and triglycerides.

The main inhibitor of zinc bioavailability is an anti-nutrient called phytates which are present in many plant foods. Cereals (ie. white rice) and legumes (ie. beans) contain the most phytates. Soaking, boiling, autoclaving, germination, and fermentation can be removed or deactivated by soaking, sprouting, or boiling the food before eating. You can do an overnight soak to reduce the anti-nutrients.

When choosing a supplement, find a highly absorbable form of Zinc. These may include Zinc Picolinate, Zinc Glycinate, Zinc Sulfate, and Zinc Citrate. Otherwise a zinc rich diet is recommended.

Please note that supplementation of zinc in high doses (11 mg/day for men and 8 mg/day for women) can impair copper absorption. This is why these two are sold together as a complex to account for any depletion in the long run.

Food Sources: Poultry, Whole grains, Legumes, Pumpkin Seeds, Crab, Shrimp, Mushrooms, Tofu

Optimal Time to Take Supplement: At least 1 hour before or 2 hours after meals

Berberine for PCOS

Berberine is a naturally occurring compound in many plants including goldenseal, Oregon grape, tree turmeric, barberry, and others. Studies related to berberine have shown significant decreases in both weight and BMI in people who took berberine. Generally insulin resistance, hyperandrogenism, and inflammation have shown to be improved.

There is also research that points to Berberine reducing the secretion of the hormone leptin which stimulates hunger. As a result weight gain is strongly modulated.

And finally, while there are some early indications that berberine could improve reproductive function, more robust studies on berberine alone is needed to make a determination.

According to the NIH, positive effects on weight were seen primarily on people who took berberine in doses of more than 1 gram per day and for more than 8 weeks.

Despite all the research, Berberine supplementation must be accompanied by interventions like lifestyle changes.

There are side effects like nausea, abdominal pain, bloating, constipation, or diarrhea. And, it's not safe for women that are pregnant or breastfeeding. Check if it mixes well with any of your current medications here.

If insulin resistance is the main driver of your PCOS symptoms, berberine may be an option for you.

Food Sources: European Barberry, Oregon Grape, Phellodendron, Goldenseal, Chinese Golden Thread, and Tree Turmeric

Optimal Time to Take Supplement: before meals

Curcumin for PCOS

Curcumin is an active bright yellow polyphenol chemical compound found in Turmeric spice along with other ginger-like plants of the same family.

Inflammation can be one of the main drivers of our PCOS symptoms. Curcumin is known to be an antioxidant and anti-inflammatory agent which plays a big role in preventing oxidative stress which is increased by external pollutants, UV, heavy metals, and certain drugs, alcohol, cigarette smoke, chemical solvents and more. When stressors are high they can trigger premature aging and chronic conditions like PCOS.

Curcumin’s antimicrobial, anti-cancer, and antioxidant potential has been well studied. It improves the oxidative stress and chronic inflammation, hyperglycemia, hyperlipidemia, hyperandrogenemia, manifestations of PCOS when taken between 6-12 weeks.

Natural curcumin has weak solubility, limited bioavailability and undergoes rapid degradation. Piperine, which is found in black pepper, increases its solubility.

Food Sources: Turmeric or Turmeric Root, Curry Powder

Optimal Time to Take Supplement: during a meal with fats for optimal absorption

Chromium for PCOS

Chromium is an essential trace mineral. It plays a role in enhancing the effects of insulin through carbohydrate, lipid, and protein metabolism pathways. A deficiency happens when you are overall poor nutrition.

A study done of 40 women with PCOS showed lowered levels of inflammation, better regulation of glucose and cholesterol levels. Similar studies have emphasized related outcomes for PCOS patients.

Another double-blind randomized control trial with 85 women with PCOS found that with 6 months of supplementation with chromium picolinate reduced insulin levels, increased fasting glucose-insulin ratio, and higher chances of ovulation, and regular menstruation.

Food Sources: Grape juice, Whole Wheat Products, Brewer’s Yeast, Orange Juice, Beef, Shellfish, Tomato Juice, Apples, Green Beans, Broccoli

Optimal Time to Take Supplement: take it in the morning so it doesn’t disturb sleep

Chromium for PCOS

Magnesium helps keep blood pressure normal, bones strong, and heart rhythm steady. It also plays a role in improving mood, anxiety, sleep, exercise performance (muscle function), blood sugar and cortisol regulation and more. It functions as an electrolyte and antioxidant.

According to the NIH, people with insulin resistance and/or type 2 diabetes are at risk of magnesium deficiency. Both conditions are associated with PCOS.

Evaluating studies involving 363 patients, magnesium alone cannot improve PCOS symptoms. However, when it’s combined with other supplements such as Vitamin E, Zinc, Calcium, Vitamin D glucose and lipid metabolism can be significantly improved. Its effects on androgen regulation is inconclusive and needs further research.

Food Sources: Green Leafy Vegetables, Pumpkin Seeds, Chia Seeds, Whole Grains, Quinoa, Cashews, Bananas, Salmon

Optimal Time to Take Supplement: any time of day, with or without food, as long as you take them consistently!

Coenzyme Q10 for PCOS

CoQ 10, aka Ubiquinone, is naturally part of every cell of the body and plays a vital role in converting energy properly. Highest levels are present in the heart. According to the NIH it’s been shown that it may reduce the risk of heart damage.

The amount of CoQ10 in the body increases until the age of 20 years and then it decreases throughout life. Deficiencies typically happen due to genetic disorders.

CoQ 10 has been shown to modulate insulin as well as provide improvements in glycemic control and lipid metabolism.

Other results include:

• CoQ10, vitamin E co supplementation can lead to decreased serum total testosterone levels, significant improvement in sex hormone–binding globulin (SHBG) levels
• Improvement in egg quality, higher fertilization rate, and more oocytes retrieved.

A recent randomized trial shows the safety and efficacy of supplementing with CoQ10 for PCOS. A 12 week supplementation is recommended for best results.

Food Sources: Soybean products (tofu), Organ meats (kidney, liver), Meats (chicken, beef, pork), fatty fish (sardines, salmon, trout, mackerel), spinach, broccoli, soybeans, lentils, peanuts, whole grains

Optimal Time to Take Supplement: in the morning or afternoon to start the day alert and focused