Polycystic ovarian syndrome (PCOS) is a common hormonal disorder in women of reproductive age and is associated with a number of long and short term health consequences (1).
Women with PCOS can suffer from a number of symptoms, including multiple metabolic aberrations, such as:
- insulin resistance (IR) and hyperinsulinemia
- high incidence of impaired glucose tolerance
- visceral obesity
- inflammation and endothelial dysfunction
- hypertension and dyslipidemia.
Although the condition is relatively common, it is not well understood and thus treating it can be challenging and often a multifaceted therapeutic approach is required.
Treatment for the condition involves four primary aspects:
Although there is no known cure for PCOS, there are a variety of supplements that can be used to manage the symptoms of the condition, alongside taking prescribed medications.
There are also a number of lifestyle changes that may be helpful, including engaging in regular exercise and eating a diet where a significant amount of total carbohydrates are obtained from fruit, vegetables, and whole grains.
10 Natural Supplements That Help PCOS
Vitamin D is a fat-soluble nutrient and is one of the 24 micronutrients that is essential for human survival. Although sunlight provides the main natural source of the nutrient, it is also found in fish and eggs.
Vitamin D is also frequently added to foods as a supplement.
The body produces vitamin D from cholesterol as long as there is an adequate amount of UV light from sun exposure. This only occurs when the UV index is 3 or higher, which only occurs year-round near the equator, between the 37th parallels.
How Does Vitamin D Help PCOS?
In women with PCOS, low levels of vitamin D are associated with insulin resistance, impaired β-cell function, IGT and metabolic syndrome, which suggests a potential role of vitamin D in contributing to the symptoms of PCOS (9, 10).
How do I take vitamin D for PCOS?
The recommended daily allowance for Vitamin D is currently between 400 and 800IU/day, but improvements for PCOS have been seen at doses as low as 40IU per day (11).
In order to determine the best dose, it is advisable to check existing levels of vitamin D by visiting a health care professional. If levels are low, much higher doses may be needed to see a benefit for PCOS.
Vitamin D3 supplementation (cholecalciferol) is preferable to D2 supplementation (ergocalciferol) because D3 is used more effectively in the body. Vitamin D should be taken daily, ideally with a source of fat to improve absorption.
Vitamin B12 (also known as cobalamin) is a water-soluble vitamin required for a number of different functions in the body, such as producing red blood and DNA. It is also heavily involved in the proper functioning of the nervous system.
It is naturally found in animal foods, such as meat, fish, poultry, eggs, and dairy. However, it can also be found in products fortified with vitamin B12, such as certain varieties of bread, cereals, and plant-based milk.
Vitamin B12 deficiency is common, especially in the elderly. This can occur either through not getting enough through the diet or not absorbing it properly from food.
How does vitamin B12 help PCOS?
In PCOS, those with low serum vitamin B12 levels are more likely to have poor insulin sensitivity and higher levels of homocysteine, which is a risk factor for cardiovascular disease (13).
A study found that supplementation of once-daily 250 mg of vitamin B1, 250 mg of vitamin B6 and twice-daily supplementation 1000 μg of vitamin B12 over 12 weeks was able to reduce homocysteine levels in women with PCOS (14).
This is particularly beneficial because one of the common treatments for PCOS, a medication called metformin, is known to increase homocysteine levels.
How do I take vitamin B12 for PCOS?
It is recommended to take 1000 μg of vitamin B12 twice per day to obtain the benefits for PCOS, ideally alongside other B vitamins (14).
Intake can also be boosted by consuming fortified foods mentioned above.
Inositol is a small molecule, which is structurally similar to glucose and that is involved in cellular signaling. Inositol refers to molecules with a similar structure, a collection of nine stereoisomers.
Although the term ‘inositol’ is used commonly with dietary supplements, this tends to refer to a specific stereoisomer called myoinositol.
Inositols are pseudo vitamin compounds that are found in a number of foods but are particularly high in whole grains and citrus fruits.
How does inositol help PCOS?
6-8 weeks of supplementation with 600mg inositol daily has been shown to be effective in reducing androgens, increasing ovulation and improving other health markers, such as blood pressure and triglycerides (15).
Supplementation of inositol in young women with PCOS, where acne is a common side effect, found benefits when 2000mg of inositol was taken daily for six months (16). Acne at baseline was moderate (68%) or severe (32%).
Following supplementation, it was reduced to 34% and 13% respectively with more than half the sample (53%) reporting elimination of acne.
Supplementation of 4,000mg inositol daily for between 12 and 16 weeks in women with PCOS was able to improve tolerance to glucose and glucose handling as well as improve cardiovascular health (17).
How to take inositol for PCOS
To obtain the benefits for PCOS, it is recommended to take between 200 and 4,000mg once daily before breakfast. Higher doses are more likely to be effective.
If using a soft gel rather than powdered formulation, only 30% of the same dose is required.
There are two kinds of omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These omega-3 fats are found in fish, animal products, and phytoplankton (algae).
EPA and DHA are involved in regulating a number of different biological processes such as inflammation, metabolic signaling pathways, and brain function. These fatty acids can be synthesized in the body from alpha-linolenic acid (ALA), which is found in nuts and seeds.
Although ALA can be converted into EPA and DHA, it is not in itself a fish oil fatty acid.
How does omega 3 help PCOS?
A 6-week, prospective, double-blinded, placebo (soybean oil)-controlled study found that 3.5g of omega-3 daily was able to reduce triglycerides in women with PCOS and improved insulin sensitivity (18). Improvements were also seen in terms of reducing blood glucose levels.
Another double-blind randomized controlled clinical trial gave 64 women with PCOS omega- 3 fatty acids capsules (each one contained 180 mg EPA and 120 mg DHA) or placebo daily for 8 weeks (19).
Omega-3 fatty acids had beneficial effects on serum adiponectin levels, insulin resistance and lipid profile in participants.
It was found that levels of triglyceride significantly decreased HDL cholesterol (often known as ‘good cholesterol’) in the omega-3 fatty acids group compared.
Improvements were also seen in terms of increased serum levels of adiponectin as well as decreased glucose and insulin levels.
How to take omega 3 for PCOS
It can be taken throughout the day but it is best taken with meals to avoid the potential for a “fish burp” taste.
Zinc is an essential mineral involved in a number of enzymes. It plays a key role in antioxidant enzymes, brain function, and the immune system, as well as having several other biological functions.
Meat, egg, and legume products are common sources of zinc in the diet.
Zinc is lost through sweat, which means that it is particularly important to ensure that intake is sufficient through both food and supplements.
How does zinc help PCOS?
Both anxiety and depression are common in people with PCOS (20, 21) although the mechanisms are unknown. There have not been studies conducted in those with PCOS but zinc has consistently shown to be helpful in reducing symptoms compared to placebo (22).
A single-center, randomized, double-blind, placebo-controlled trial of zinc supplementation was conducted in patients with major depression.
44 patients aged 18-55 years received either 25mg zinc sulfate per day or a placebo, alongside taking their antidepressant medication. It was found that zinc significantly reduced depression after 12 weeks (22).
Research has also demonstrated zinc to be effective for treatment-resistant patients when compared to placebo (23).
How to take zinc for PCOS
Zinc comes in a number of different forms, including citrate, gluconate, monomethionine and sulfate. Studies have tended to use sulfate and thus taking this form is advisable.
Intake can also be boosted by increasing the intake of legumes, such as beans and lentils.
Chromium is an essential mineral that regulates glucose metabolism and insulin sensitivity. It is found in trace amounts in plant-based foods, particularly grains.
Chromium’s main mechanism is linked to chromodulin, a protein that augments the signaling of insulin receptors. If this protein is impaired, insulin’s ability to work in the body is impaired.
This negatively affects blood glucose levels.
How does chromium help PCOS?
In women with PCOS, 200 mcg (0.2 mg) daily of chromium picolinate has been shown to improve glucose tolerance compared with placebo after 16 weeks (24).
Six patients were randomized to treatment with chromium, and four patients, to treatment with placebo. The number of participants was small because this was a pilot study.
Authors have suggested that further studies should investigate whether higher doses might be even more beneficial.
How to take chromium for PCOS
Although 200mcg (0.2mg) per day of chromium has been shown to improve glucose tolerance in women with PCOS (24), several studies of people without PCOS have shown 1000mcg daily to provide greater benefits (25, 26).
This should come from chromium picolinate and be taken in at least 2 doses throughout the day, ideally with carbohydrate-containing meals.
Cimicifuga Racemosa (Black cohosh)
Cimicifuga Racemosa, also known as black cohosh, is a herb native to North America that has traditionally been used for cognitive and inflammatory conditions.
Its mechanism of action is not well understood but it is thought to act centrally (in the brain) via serotonin, dopamine or opioids.
How does black cohosh help PCOS?
194 women with PCOS who also were struggling with fertility were randomized to receive either clomiphene citrate (a fertility medication) alone or clomiphene citrate with cimicifuga racemose (27).
Significant effects in the combined group were found for the reduced number of days to ovulation, pregnancy rates, and reduced miscarriage.
How to take black cohosh for PCOS
If using an isopropanolic extract, 20-40mg daily in doses of 20mg is recommended to obtain the benefits for PCOS.
Alternatively, if using an aqueous: ethanolic extract then doses range from 64-128mg daily, usually taken in two divided doses.
L-Carnitine is a compound produced by the body from lysine and methionine, which can be acetylated to produce Acetyl-L-Carnitine (ALCAR). Both are similar but ALCAR can cross the blood-brain barrier more efficiently.
L-Carnitine has a number of functions in the body, including playing a role in glucose tolerance, insulin function, and fatty acid metabolism.
How does L-carnitine help PCOS?
In a prospective, randomized, double-blind, placebo-controlled trial, 60 women with PCOS were randomized to receive either 250 mg carnitine supplements or placebo for 12 weeks (28).
The results showed that L-carnitine led to a significant reduction in fasting plasma glucose and serum insulin levels compared to placebo.
How to take L-carnitine for PCOS
To obtain the benefits for PCOS, it is recommended to take 250mg of L-carnitine per day.
There are a number of alternative forms of carnitine supplementation available, including Acetyl-L-Carnitine (ALCAR) and L-Carnitine L-Tartrate (LCLT).
If either of these forms is used, higher doses will be required. The equivalent dose is 315mg for ALCAR and 5000mg for GPLC.
Berberine is an alkaloid extracted from a range of different herbs used in traditional Chinese medicine. It is primarily used to improve blood glucose control, although its exact mechanism of action is not well understood.
Berberine activates an enzyme called Adenosine Monophosphate-Activated Protein Kinase (AMPK) while inhibiting Protein-Tyrosine Phosphatase 1B (PTP1B), which increases insulin sensitivity.
Other potential mechanisms of action include protecting β-cells, regulating hepatic gluconeogenesis, and reducing inflammatory cytokine signaling.
How does berberine help PCOS?
Berberine has been shown to have positive metabolic and hormonal effects in women with PCOS (29).
A clinical study in 89 women with PCOS and insulin resistance randomized participants to receive berberine or a placebo for 12 weeks.
Berberine was effective in reducing both fasting plasma glucose and fasting insulin levels. It also significantly reduced total cholesterol, triglycerides, and low-density lipoprotein cholesterol as well as increasing high-density lipoprotein cholesterol.
How to take berberine for PCOS
To obtain the benefits of berberine for PCOS, it is recommended to take 1500mg of berberine daily, in three doses of 500mg each.
This helps prevent the potential for stomach upset, cramping, and diarrhea, which can occur if too much is taken at once.
Berberine ideally should be taken with a meal, or just after, to take advantage of the blood glucose and lipid increase associated with eating.
Cinnamon is a blend of nutrients and is commonly used as a spice. It contains a number of bioactive agents that can help to regulate glucose metabolism.
These include MethylHydroxyChalcone polymers (MHCPs), tannins, flavonoids, glycosides, terpenoids, and anthraquinones (30).
Some variants of cinnamon also contain coumarin, which is a hepatotoxic and carcinogenic phytochemical. Coumarin does not affect blood sugar but exists alongside the active ingredients that do have this effect.
How does cinnamon help PCOS?
15 PCOS sufferers were randomized to receive 333 mg of cinnamon extract, three times per day, or a placebo daily for 8 weeks. Cinnamon was found to have significant effects on improving insulin sensitivity and glucose tolerance compared to placebo (31).
How to take cinnamon for PCOS
To obtain the benefits for PCOS, it is recommended to take 1000mg cinnamon per day.
It is best to take Ceylon cinnamon to avoid the high level of coumarin, Ceylon cinnamon has the lowest levels of coumarin, with levels below 190 mg/kg, whereas Cassia contains between 700 mg/kg to 12,230 mg/kg (32).
The Bottom Line
There is no known cure for PCOS but there is a range of supplements that can help to reduce the symptoms of PCOS, both for those taking prescribed medications and those who are not.
However, if taking prescription medication for PCOS, it is important to check with a doctor before using any dietary supplements as there could be interactions.
Lifestyle changes may also be helpful to manage the condition, including engaging in regular exercise and eating more foods which are lower on the glycaemic index, such as fruit, vegetables, and whole grains. As for your general health, reducing your stress levels is always a welcome lifestyle change as well.
Keep Reading: 11 Best Supplements for Women’s Health
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