Supplements & Polycystic Ovarian Syndrome (PCOS)

Written By Ryan Janjuha

Brief Description

PCOS is a common endocrine disorder affecting how a woman’s ovaries work.

There are three main features:

  • Irregular periods: Ovaries do not regularly release eggs.

  • Excess male hormones (androgens): resulting in excess hair growth (hirsutism)

  • Polycystic ovaries: Ovaries become enlarged and contain many follicles that surround the egg.

In the UK, for a diagnosis of PCOS, you will need to demonstrate 2 of the 3 features above(1).

For more info, please see: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/

Some of the main complications of PCOS include insulin resistance, which can contribute to diabetes, cardiovascular disease & stroke; infertility, obesity and mood changes, such as depression (due to risk of hair growth, weight gain and sleep apnoea etc).

This fact file will cover any commonly researched supplements surrounding PCOS and guide you in managing symptoms/complications.

Please consult with your healthcare provider if you have any specific questions about the supplements.

Evidence Base

  • Inositol: This is a supplement which may help to improve insulin sensitivity and blood glucose control (thereby improving risk of diabetes). The most supplemented forms are: myo-inositol (MI) or D-chiro-inositol (DCI).

    It is produced in the body and also found in foods such as: citrus fruits, bran, beans, nuts and seeds(2).

    A systematic review (SR) of 31 studies (2230 women, mean age: 15-36.5; bmi: 21- 32 & diagnosis by Rotterdam, NIH or AEPCOS criteria) examined supplementation of MI or DCI vs placebo over at least 6 weeks, up to 6 months.

    The study concluded that there was not enough evidence to support it use clinically. Supplementation with DCI or MI produced some inconsistent benefits on metabolic and hormonal changes, but these studies were either too small or had many sources of bias(3). These findings build on similar studies published previously(4, 5).

  • L-Carnitine: A 2023 SR of 839 participants, found that supplementation of carnitine (dose range: 250mg-3g/day) for up to 3 months significantly improved ovulation rates, pregnancy rates, reductions in BMI, insulin levels, and markers of insulin resistance (HOMA-IR)(6).  

    Previous SR’s examining carnitine supplementation also reported benefits on BMI, serum LDL, triglycerides (TG) and total cholesterol (TC)(7, 8).

Please see L-Carnitine post for more info.

  • Omega-3: A SR of 574 participants examined omega-3 supplementation and found significant reductions in TC, TG and HOMA-IR levels(9). Another 2023 SR found similar outcomes and in addition was also able to reduce waist circumference and fasting plasma glucose. Supplementation for >8 weeks was more beneficial in improving cholesterol and insulin resistance(10). Supplementation has not been shown to significantly alter hormone levels(11).

Please see Omega-3 for more info

  • N-Acetylcysteine (NAC): NAC is a variant of an amino acid L-Cystiene and is a potent antioxidant. A SR of 11 randomised studies (n=869 women with PCOS, duration 6-24weeks) compared Metformin or placebo with NAC supplementation (dose 1500mg/day).

    NAC supplementation was able to significantly reduce fasting blood glucose (FBG) levels compared to Metformin (p=0.032). After 24 weeks of supplementation, NAC was able to significantly reduce BMI, FBG and fasting insulin when compared with Metformin (p=0.008)(12).

    Another 2023 SR examined NAC supplementation on hormones (18 studies, n=2185 women with PCOS) and demonstrated it was able to significantly reduce total testosterone levels (p=0.034) & increase follicle stimulating hormone (p=0.02)(13).

  • Co-enzyme Q10: A 2023 SR of 9 randomised studies (n=1021) found that supplementation of CQ10 improved HOMA-IR, FBG, as well as improved markers of sex hormones – FSH, testosterone; and cholesterol, TC, triglycerides, LDLs and HDLs(14, 15).

Other less well researched areas:

  • Herbal Tea: 6 randomised studies (n=235 women with PCOS), found that herbal tea consumption led to significant decreases in weight, BMI, and FBG(16). The herbal tea examined were Green tea (see evidence base in link) or marjoram herb.

Not enough research to support improvements in PCOS (+ associated conditions ):

  • Vitamin D(17),

  • Vitamin E(18-20)(due to co-existing supplements in the intervention group),

  • Berberine(21, 22).

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References:

  1. UK N. Polycystic Ovarian Syndrome 2024 [Available from: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/.
  2. Clements RS, Jr., Darnell B. Myo-inositol content of common foods: development of a high-myo-inositol diet. Am J Clin Nutr. 1980;33(9):1954-67.
  3. Fitz V, Graca S, Mahalingaiah S, Liu J, Lai L, Butt A, et al. Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines. J Clin Endocrinol Metab. 2024;109(6):1630-55.
  4. Jethaliya H, Gajjar N, Patel V, Deshpande S, Patel R. Efficacy of Myo-inositol on Anthropometric, Metabolic, and Endocrine Outcomes in PCOS Patients: a Meta-analysis of Randomized Controlled Trial. Reprod Sci. 2022;29(8):2282-98.
  5. Greff D, Juhász AE, Váncsa S, Váradi A, Sipos Z, Szinte J, et al. Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2023;21(1):10.
  6. Gong Y, Jiang T, He H, Wang Y, Wu GL, Shi Y, et al. Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2023;98(5):682-91.
  7. Mohd Shukri MF, Norhayati MN, Badrin S, Abdul Kadir A. Effects of L-carnitine supplementation for women with polycystic ovary syndrome: a systematic review and meta-analysis. PeerJ. 2022;10:e13992.
  8. Liao D, Liu X, Yuan X, Feng P, Ouyang Z, Liu Y, et al. Clinical evidence of the effects of carnitine supplementation on body weight, glycemic control and serum lipids in women with polycystic ovary syndrome: a systematic review and meta-analysis. Gynecol Endocrinol. 2022;38(2):110-5.
  9. Huang Y, Zhang X. Meta-analysis of the efficacy of ω-3 polyunsaturated fatty acids when treating patients with polycystic ovary syndrome. Medicine (Baltimore). 2023;102(39):e35403.
  10. Zhou J, Zuo W, Tan Y, Wang X, Zhu M, Zhang H. Effects of n-3 polyunsaturated fatty acid on metabolic status in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials. J Ovarian Res. 2023;16(1):54.
  11. Yuan J, Wen X, Jia M. Efficacy of omega-3 polyunsaturated fatty acids on hormones, oxidative stress, and inflammatory parameters among polycystic ovary syndrome: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(8):8991-9001.
  12. Liu J, Su H, Jin X, Wang L, Huang J. The effects of N-acetylcysteine supplement on metabolic parameters in women with polycystic ovary syndrome: a systematic review and meta-analysis. Front Nutr. 2023;10:1209614.
  13. Shahveghar Asl Z, Parastouei K, Eskandari E. The effects of N-acetylcysteine on ovulation and sex hormones profile in women with polycystic ovary syndrome: a systematic review and meta-analysis. Br J Nutr. 2023;130(2):202-10.
  14. Hu X, Wang W, Su X, Peng H, Tan Z, Li Y, et al. Comparison of nutritional supplements in improving glycolipid metabolism and endocrine function in polycystic ovary syndrome: a systematic review and network meta-analysis. PeerJ. 2023;11:e16410.
  15. Zhang T, He Q, Xiu H, Zhang Z, Liu Y, Chen Z, et al. Efficacy and Safety of Coenzyme Q10 Supplementation in the Treatment of Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis. Reprod Sci. 2023;30(4):1033-48.
  16. Abbasi E, Hajhashemy Z, Askari G, Saneei P. Association of Herbal Tea and Follicle-Stimulating Hormone, Anthropometric Parameters, and Fasting Blood Glucose Levels Among Polycystic Ovarian Syndrome Women: A Systematic Review and Meta-Analysis of Clinical Trials. Clin Nutr Res. 2024;13(3):201-13.
  17. Kohlhoff G, Kirwan R, Mushtaq S. The effect of vitamin D supplementation on markers of insulin resistance in women with polycystic ovarian syndrome: a systematic review. Eur J Nutr. 2024.
  18. Heidari H, Hajhashemy Z, Saneei P. A meta-analysis of effects of vitamin E supplementation alone and in combination with omega-3 or magnesium on polycystic ovary syndrome. Sci Rep. 2022;12(1):19927.
  19. Yalle-Vásquez S, Osco-Rosales K, Nieto-Gutierrez W, Benites-Zapata V, Pérez-López FR, Alarcon-Ruiz CA. Vitamin E supplementation improves testosterone, glucose- and lipid-related metabolism in women with polycystic ovary syndrome: a meta-analysis of randomized clinical trials. Gynecol Endocrinol. 2022;38(7):548-57.
  20. Tefagh G, Payab M, Qorbani M, Sharifi F, Sharifi Y, Ebrahimnegad Shirvani MS, et al. Effect of vitamin E supplementation on cardiometabolic risk factors, inflammatory and oxidative markers and hormonal functions in PCOS (polycystic ovary syndrome): a systematic review and meta-analysis. Sci Rep. 2022;12(1):5770.
  21. Xie L, Zhang D, Ma H, He H, Xia Q, Shen W, et al. The Effect of Berberine on Reproduction and Metabolism in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Control Trials. Evid Based Complement Alternat Med. 2019;2019:7918631.
  22. Li MF, Zhou XM, Li XL. The Effect of Berberine on Polycystic Ovary Syndrome Patients with Insulin Resistance (PCOS-IR): A Meta-Analysis and Systematic Review. Evid Based Complement Alternat Med. 2018;2018:2532935.
Ryan Janjuha
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