Supplements for PCOS: Exploring Alternative Approaches

The primary medical treatments for PCOS typically involve metformin for metabolic issues and anti-androgens for hormonal imbalances. However, many women prefer incorporating supplements into their management of PCOS, either because they are more tolerable or align with a more integrative approach to health. While inositol is the only supplement recommended by international guidelines, this blog will explore other supplements that have shown potential in managing PCOS symptoms.

Inositol

Inositol is a group of molecules similar to glucose, essential in cellular signaling. It is naturally produced in the body and found in foods like citrus fruits, beans, nuts, and seeds. Most supplements contain myo-inositol, the most abundant form in the body.

Supplementing with inositol can increase insulin sensitivity, improve glucose control, and potentially aid in weight loss. It has been shown to reduce body mass index (BMI), blood pressure, triglycerides, and LDL cholesterol. While inositol may help manage some metabolic aspects of PCOS, its effects on ovulation, hirsutism, and weight are limited. Commonly, 1–4 grams per day are used in studies, but more research is needed to determine optimal doses for PCOS. It is generally well-tolerated with minimal side effects.

In cases of hirsutism or central adiposity, metformin may be more effective, though inositol offers a gentler alternative for those who experience gastrointestinal issues with metformin.

Omega-3 Oils

Omega-3 fatty acids, particularly EPA and DHA, are commonly found in fish oil and algae-based supplements. Research shows that omega-3s can improve waist circumference, insulin resistance, triglycerides, cholesterol levels, and insulin sensitivity in women with PCOS.

For PCOS management, omega-3 supplementation for at least eight weeks is recommended to address metabolic dysfunction. Side effects may include stomach discomfort, fishy breath, or heartburn. A daily intake of 250 mg of combined EPA and DHA is the minimum recommended dose, with higher amounts suggested during pregnancy.

Berberine

Berberine is a plant-based compound traditionally used in Chinese and Ayurvedic medicine. It has shown promise in improving insulin resistance, reducing androgen levels, and improving lipid profiles in women with PCOS. Some studies suggest berberine may be more effective than metformin for managing PCOS symptoms.

However, berberine can cause gastrointestinal issues like diarrhea and constipation and may interfere with other medications due to its effects on certain liver enzymes. It should be avoided during pregnancy and breastfeeding.

N-Acetylcysteine (NAC)

NAC, a form of the amino acid L-cysteine, is known for its antioxidant and anti-inflammatory properties. It has shown potential in improving metabolic parameters and reproductive function in women with PCOS. Doses typically range from 600–1,800 mg daily, divided into two or three doses.

Common side effects include nausea and diarrhea, with some supplements having a sulfuric “rotten-egg” odor. Overall, NAC is considered a safe supplement for PCOS management.

Coenzyme Q10 (CoQ10)

CoQ10 is an essential compound in the body’s energy production and an antioxidant. It has been shown to improve insulin resistance, hormone levels, and lipid profiles in women with PCOS.

The recommended dosage ranges from 100–200 mg per day, ideally taken with fat-containing foods to improve absorption. CoQ10 is well-tolerated and safe, even at high doses.

L-Carnitine

L-carnitine helps transport long-chain fatty acids into cells for energy production. It is found in meat products and can be taken as a supplement. In women with PCOS, L-carnitine may improve ovulation, insulin resistance, BMI, and cholesterol levels.

The typical dosage is between 500–2,000 mg per day, but some users report a “fishy” odor from sweat or breath. Despite these minor side effects, L-carnitine is generally well-tolerated and safe.

Alpha-Lipoic Acid

Alpha-lipoic acid (ALA) is a mitochondrial compound involved in energy metabolism. ALA provides a short but potent reduction of oxidation by increasing antioxidant enzymes, and may decrease blood glucose acutely. It also appears to be beneficial for female fertility processes like oocyte maturation, fertilization, and embryo development in the context of PCOS

The typical dosage is 300-600mg daily. ALA is generally found to be safe and tolerable, though it may cause gastrointestinal upset, headache, rash, and rarely, renal dysfunction.

Conclusion

While supplements like inositol, omega-3 oils, berberine, NAC, CoQ10, and L-carnitine show promise in managing PCOS, their effectiveness varies, and more research is needed to solidify their role. Always consult with a healthcare provider before introducing new supplements, particularly if you are taking other medications or are pregnant.