Often I'm asked what is the best supplements for PCOS. There is no BEST supplement for PCOS in the market. Supplements can be an effective way to fast track healing and support healthy hormones. A balanced hormonal system can create more predictable periods, glowing skin, healthy hair, and reduced and PCOS symptoms.
Before we jump into the supplements, let us recap what PCOS is all about.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a complex condition characterized by elevated androgen levels, menstrual irregularities, and/or small cysts on one or both ovaries.
According to the National Institutes of Health Office of Disease Prevention, PCOS affects approximately 5 million women of childbearing age in the U.S. Costs to the U.S. health care system for the identification and management of PCOS are approximately $4 billion per year.[1]
Research suggests that 5% to 10% of females 18 to 44 years of age are affected by PCOS, making it the most common endocrine abnormality among women of reproductive age in the U.S. [2]
What does it mean on hormonal levels
The pathophysiology of PCOS involves primary defects in the hypothalamic–pituitary axis, insulin secretion and action, and ovarian function. Although the cause of PCOS is unknown, PCOS has been linked to insulin resistance and obesity. The association with insulin function is expected; insulin helps to regulate ovarian function, and the ovaries respond to excess insulin by producing androgens, which can lead to anovulation. [3]
Clinical signs of PCOS include elevated luteinizing hormone (LH) and gonadotropin–releasing hormone (GnRH) levels, whereas follicular-stimulating hormone (FSH) levels are muted or unchanged. As a result of the increase in GnRH, stimulation of the ovarian thecal cells, in turn, produces more androgens. [4]
Clinical Symptoms
Usually PCOS patients present with
Enlarged ovaries with numerous small cysts
Irregular menstrual cycles
Pelvic pain
Hirsutism
Hair loss
Acne
Acanthosis nigricans(characterized by areas of dark, velvety discoloration in body folds and creases)
Skin tags.
Recurrent miscarriage
Infertility
Anovulatory cycles (when ovary can't produce eggs)
The body’s needs nutrients and vitamins are increased when your body undergoes stress such as inflammation, lack of sleep or mood swings. You can “balance this imbalance” by supplementing your bodies with targeted supplements.
Can diet help PCOS?
Definitely. I have always emphasised that supplements and even TCM are only there to restore your imbalance. Your lifestyle, diet and nutrition play a more important role in treating PCOS. My recommendation is a wholesome diet which I will write a separate post in days to come. Supplements are there to just complement some of the nutrients not often found in your diet.
My Take on PCOS Supplements
I have a Biomedical Sciences degree background and I do screen scientific journals on a regular basis to see which supplements have actually gone through rigorous clinical trials to be ready for the market. I seldom recommend supplements that have just gone through one or two animal trials with a significant result and claim to solve PCOS or infertility.
Let's not waste time, I will go in-depth into our top 10 PCOS supplements.
1) Inositol for PCOS
It is noteworthy that improvement of Insulin Resistance(IR) and reduction of circulating insulin are key therapeutic targets in PCOS [5], enhancing fertility and reducing the lifelong risk for type 2 diabetes and early cardiovascular disease. Besides metformin, Myo-Inositol(MI) is now considered as a further insulin-sensitizing supplement which could benefit women with PCOS [6].
Other than Myo-Inositol, another isomer known as D-chiro-inositol (DCI), has been found to improve pathological conditions associated with PCOS. [7] In the ovary, DCI is involved in insulin-mediated androgen synthesis [8], whereas MI mediates glucose uptake and follicle stimulating hormone (FSH) signaling [9]. Several studies have also emphasized the pivotal role of MI in improving oocyte quality [10]
If your doctor recommend metformin for your PCOS treatment plan, you might actually be better off taking Myo-Inositol supplements. In a clinical trial, researchers found that when women with PCOS took Myo-Inositol supplements achieved a natural pregnancy rate of 30% within six months compared to just 18% of women who were prescribed metformin. [11]
I Have Insulin Resistance. Will Myo-Inositol help me?
Some women (i.e. with ovarian cysts) have insulin resistance which means the cells in your body are not very sensitive to insulin. When your cells are resistant to insulin, you tend to have higher than normal levels of insulin circulating in your bloodstream, causing higher than normal levels of testosterone, which in turn can interfere with ovulation and menstruation. By supplementing with Myo-Inositol, insulin sensitivity can be improved.
There are a few Myo-Inositol products on the market, and below are some of more trustworthy ones.
a) Fairhaven Health Myo-Inositol Supplement
Fairhaven Health Myo-Inositol Supplement provides 2 grams of myo-inositol. This is packed in vegetable capsule, meaning it is 100% fully suitable for vegetarians and vegans. It is manufactured in the USA in a GMP-certified facility. The supplement is all natural and contains no wheat, gluten, yeast, soy, dairy, animal products, artificial colors, or artificial preservatives.
What others are saying about this supplement (taken from its website):
NW – January 29, 2019
We have been “trying” to conceive since we got married in 2015. A friend told me about this product and I ordered it without hesitation thinking if anything, maybe my cycles would be regular making it easier to conceive. I did not even take this product for a full month and we just got our BIG POSITIVE last night, and again this morning. I am not sure if it is a coincidence but after trying to get pregnant for years, this was the ONLY thing we changed. I highly recommend it to anyone struggling with conceiving & see how it can work for you!
Kayne McIntosh – November 29, 2018
My husband and I tried for a baby for over 2 years. I took myo-inositol for 3 weeks and was pregnant!! This is the only thing we did different for 2 years so I know this had to play a big part in this pregnancy!! I am now 9 weeks 2 days pregnant with a healthy baby!!
b) Life Extension, Inositol Caps, 1,000 mg, 360 Vegetarian Capsules
Life Extension Inositol Caps is also 100% vegetarian, using vegetable cellulose as capsule.
What others are saying about this supplement: (taken from website)
Posted by Mickey the unwise guy from Bellingham, WA 1 year ago| Verified Purchase
Helps relaxation so that I can sleep better and stops me worrying too much
Posted by Healthy Exerciser from Atascadero, CA on 2 years ago| Verified Purchase
I've been taking inositol for many years, so this sale deal for a year's supply was too good to pass up.
2) Omega-3
When you are talking about omega-3, you are essentially talking about EPA and DHA. According to a study done, omega-3 supplementation results in a decrease in testosterone concentration after 8 weeks trial and also regulate mentrual cycles in recruited women diagnosed with PCOS[12]. Another study found that omega-3 can increase sex hormone binding globulin, which is a protein that binds to testosterone and estrogen to normalize hormonal levels. When SHBG is below optimum levels, testosterone levels increase, which may further contribute to PCOS. [13]
Having PCOS means you are probably DHA deficiency because chronic inflammation (one of the main characteristics of PCOS) is a major risk factor. Omega-3s can help decrease inflammation in the body. Many researchers suggest that inflammation is a possible cause for insulin resistance and PCOS.[14] Omega-3 fatty acids are the very substance that increases the sensitivity to insulin by producing and secreting anti-inflammatory adipokine (such as adiponectin) and reducing inflammation and proinflammatory cytokines [15],
Based on a meta analysis done in 2018, omega-3 fatty acid may be recommended for the treatment of PCOS with insulin resistance as well as high Total Cholesterol(TC) (especially LDL - low density lipoprotein) and Triglycerides(TG). [16] This is because Omega-3 fatty acids can also reduce cholesterol absorption and LDL-C synthesis, improve LDL receptor activity in liver, and increase fractional rate of catabolism of LDL-C [17]. Therefore, omega-3 fatty acid supplementation had a beneficial effect on some cardiometabolic risk factors in women with PCOS [18].
Our bodies have evolved to require omega-6 and omega-3 fatty acids in a ratio of between 4:1 to 1:1 despite the fact that the average Western diet typically results in a ratio of 20:1 or higher. [19]
These are the more credible ones that I have found online. Do comment below if you have recommendations for other inositol supplements, as well as do let us know what do you think of the content, and your PCOS-fertility journey!
[1] American Congress of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 108: Polycystic Ovary Syndrome. Obstet Gynecol. 2009;114(4):936–949.
[2] National Institutes of Health Department of Health and Human Services. Beyond Infertility: Polycystic Ovary Syndrome (PCOS) NIH Pub. No. 08-5863, April 2008
[3] Diamanti-Kandarakis E, Kandarakis H, Legro RS. The role of genes and environment in the etiology of PCOS. Endocrine. 2006;30:19–26
[4] Urbanek M. The genetics of polycystic ovary syndrome. Natl Clin Pract Endocrinol Metab. 2007;3:103–111.
[5] Nestler JE. Insulin regulation of human ovarian androgens. Human Reproduction 1997. 12(Supplement 1) 53–62. (10.1093/humrep/12.suppl_1.53)
[6] Nestler JE, Unfer V. Reflections on inositol(s) for PCOS therapy: steps toward success. Gynecological Endocrinology 2015. 31 501–505. (10.3109/09513590.2015.1054802)
[7] Genazzani A. D., Battaglia C., Malavasi B., Strucchi C., Tortolani F., Gamba O. Metformin administration modulates and restores luteinizing hormone spontaneous episodic secretion and ovarian function in nonobese patients with polycystic ovary syndrome. Fertility and Sterility. 2004;81(1):114–119. doi: 10.1016/j.fertnstert.2003.05.020.
[8] Nestler J. E., Jakubowicz D. J., de Vargas A. F., Brik C., Quintero N., Medina F. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. The Journal of Clinical Endocrinology & Metabolism. 1998;83(6):2001–2005. doi: 10.1210/jc.83.6.2001.
[9] Unfer V., Carlomagno G., Dante G., Facchinetti F. Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological Endocrinology. 2012;28(7):509–515. doi: 10.3109/09513590.2011.650660.
[10] Gerli S., Mignosa M., Di Renzo G. C. Effects of inositol on ovarian function and metabolic factors in women with PCOS: a randomized double blind placebo-controlled trial. European Review for Medical and Pharmacological Sciences. 2003;7(6):151–159
[11] Raffone, Emanuela; Rizzo, Pietro; Benedetto, Vincenzo. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. GYNECOLOGICAL ENDOCRINOLOGY, 2010.
[12] Nadjarzadeh, A., Dehghani Firouzabadi, R., Vaziri, N., Daneshbodi, H., Lotfi, M. H., & Mozaffari-Khosravi, H. (2013). The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: A randomized clinical trial. Iranian journal of reproductive medicine, 11(8), 665–672.
[13] Oner G, Muderris.(2013) Efficacy of omega-3 in the treatment of polycystic ovary syndrome. J Obstet Gynaecol. 2013 Apr;33(3):289-91
[14] Sekhon LH, Gupta S, Kim Y, Agarwal A. Female infertility and antioxidants. Curr Womens Health Rev. 2010;6:84–95. doi: 10.2174/157340410791321381.
[15] Mohammadi E, Rafraf M, Farzadi L, Asghari-Jafarabadi M, Sabour S. Effects of omega-3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome. Asia Pac J Clin Nutr. 2012;21:511–518.
[16] Yang, K., Zeng, L., Bao, T., & Ge, J. (2018). Effectiveness of Omega-3 fatty acid for polycystic ovary syndrome: a systematic review and meta-analysis. Reproductive biology and endocrinology : RB&E, 16(1), 27. doi:10.1186/s12958-018-0346-x
[17] Davidson MH. Mechanisms for the hypotriglyceridemic effect of marine omega-3 fatty acids. Am J Cardiol. 2006;98:27i–33i. doi: 10.1016/j.amjcard.2005.12.024
[18] Cussons AJ, Watts GF, Mori TA, Stuckey BGA. Omega-3 fatty acid supplementation decreases liver fat content in polycystic ovary syndrome: a randomized controlled trial employing proton magnetic resonance spectroscopy. J Clin Endocrinol Metab. 2009;94:3842–3848. doi: 10.1210/jc.2009-0870.
[19] Vieira de Melo, Ingrid Sofia; dos Santos, Aldenir Feitosa; Bueno, Nassib Bezerra. Curcumin or combined curcuminoids are effective in lowering the fasting blood glucose concentrations of individuals with dysglycemia: Systematic review and meta-analysis of randomized controlled trials. PHARMACOLOGICAL RESEARCH, 2018.