Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, and is classified by metabolic and hormonal traits.
The most common signs and symptoms of PCOS are ovarian dysfunction; lack of or irregular ovulation which causes irregular periods, and hyperandrogenism; elevated male hormones that contribute to acne and excess hair growth and/or hair loss.
PCOS affects between 4 – 20% of women of reproductive age, and it is one of the leading causes of female subfertility. Please note that I did not use the word infertility here, for good reason! If you have PCOS, this does not mean that you are infertile. You may be ‘less fertile’ due to less frequent ovulation occurring, but this is simply not the same thing as infertility.
PCOS is currently classified as a life-long condition, meaning there is no ‘cure’ as such, but can be an extremely well managed condition through dietary, lifestyle and environmental factors, as well as the correct and necessary supplementation, which I will discuss throughout this blog.
For information on PCOS can look like, its signs and symptoms, and how it is diagnosed, I suggest first reading How To Tell If You Have PCOS, then returning to this blog to learn more about which treatment options may be relevant for you.
nositol is a sugar alcohol that was once considered part of the B vitamin complex (vitamin B8), but since discovering that it is produced by our bodies, is now classified as a pseudovitamin. Most of the inositol our body needs comes from our diet, however therapeutic doses of inositol in PCOS have beneficial effects. Myo-inositol functions as second messenger that regulates the activity of insulin, follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH), and has been shown to improve metabolic and hormonal profiles in women with PCOS.
A number of clinical trials have shown that myo-inositol can:
– Improve insulin sensitivity
– Improve glucose tolerance
– Have positive effects on lipid levels
– Restore ovarian activity
– Improve ovulation rate
– Regulate menstruation
– Improve fertility
– Decrease androgen levels
– Decrease acne
– Improve hirsutism
Dosing; 2g, twice daily.
Magnesium is a wonderful nutrient that plays a role in a large amount of chemical reactions in the body – over 300 in fact! It is key for energy production and glucose metabolism, and I very commonly use magnesium for my clients to support a healthy stress response and promote restful sleep.
Low serum and body magnesium levels have been found in women with PCOS. Given that poor magnesium stores has been proposed as a contributing mechanism to insulin resistance, and magnesium stores deplete under elevated levels of stress, magnesium is a very important key nutrient for this syndrome!
Supplementation with magnesium has been shown to improve glucose parameters, insulin sensitivity and serum lipid levels.
Dosing; 300 – 900mg daily in split doses.
Zinc is involved in insulin signalling pathways, insulin synthesis and storage. Zinc supplementation was found to have beneficial effects on metabolic profiles in women with PCOS, including blood lipids, insulin sensitivity, glucose homeostasis, and androgen parameters.
Zinc inhibits the enzyme 5 alpha-reductase, which reduces the conversion of testosterone to dihydrotestosterone (DHT). This effect of androgen metabolism is what makes zinc such an effective and useful mineral for PCOS symptoms related to elevated androgens, such as acne, hirsutism, and alopecia.
Dosing; 30 – 50mg daily after food.
Chromium is a key micronutrient involved in glucose, protein and lipid metabolism. Its deficiency can causes hyperglycaemia, hyperlipidaemia and insulin resistance.
Chromium can improve PCOS symptoms by improving insulin sensitivity and decreasing insulin resistance. In clinical trials, chromium supplementation in PCOS patients has been shown to:
– Decrease fasting insulin
– Decrease BMI
– Lower free testosterone
– Reduce oxidative stress markers (CRP)
– Reduce clinical signs of androgen excess
– acne, hirsutism
– Improve ovulation and menstrual cycle regularity
Dosing; 800 – 1,000mcg daily.
Alpha lipoic acid (ALA)
Alpha lipoic acid is an antioxidant that is used to improve glycaemic control and insulin sensitivity in PCOS. Research shows that ALA supplementation can decrease insulin, glucose, and triglyceride levels.
Oxidative stress is increased in PCOS women because of an increased production of free radicals associated with impaired plasma total antioxidant capacity (TAC). In PCOS women who have elevated inflammatory markers and/or insulin resistance, ALA is an ideal choice.
Dosing; 400 – 600mg twice daily.
N-Acetyl Cysteine (NAC)
NAC exerts positive effects in PCOS by its role as a potent antioxidant and an insulin lowering compound. Recent clinical trials using NAC for PCOS women showed significantly increased ovulation and pregnancy rates, increased endometrial thickness, and decreased androgen markers.
– Improves insulin sensitivity
– Reduces fasting blood glucose
– Improves ovulation and menstrual regularity
– Modulates androgen levels
– decreases free and total testosterone, increases SHBG
– Reduces LH levels
– Improves metabolic parameters
– total and LDL cholesterol, and triglycerides
Dosing; 600mg 2 – 3 times daily.
Vitamin D deficiency is very common in Australia, and is especially common in women with PCOS. Being vitamin D deficient is associated with insulin resistance, a higher body weight, and elevated androgen levels.
Vitamin D is essential for immune, metabolic, and reproductive health and has been shown to reduce inflammation and oxidative stress, improve glycaemic control, insulin sensitivity, and optimise serum lipids in women with PCOS.
Dosing will depend on the individuals’ serum levels. For PCOS I recommend aiming for a Vitamin D status of > 100.
Essential Fatty Acids (EFAs)
EFAs have shown beneficial effects on improving insulin sensitivity, cholesterol levels, liver parameters, and blood pressure in women with PCOS.
The anti-inflammatory effects of fish oil protect against insulin resistance by reducing levels of inflammatory cytokines, and therefore inflammation induced insulin resistance. Importantly, omega-3s from fish oil has been found to significantly improve mental health parameters – the depression and anxiety scores – in PCOS women.
Omega-3 supplementation can:
– Improve insulin resistance
– Decrease blood lipids
– Lower inflammatory markers (CRP)
– Improve mental health parameters
– Improve insulin metabolism
– Decrease testosterone- Decrease hirsutism
The water-soluble B-vitamin B6 plays an essential role in carbohydrate and lipid metabolism. Reduced B6 availability affects insulin levels and negatively impacts lipid parameters.
Additionally, B6 is an essential cofactor in the conversion of glutamine to the inhibitory neurotransmitter GABA, which promotes relaxation, immunity, and has anti-anxiety effects.
Dosing; 50 – 100mg daily.
If you are looking for individualised support for PCOS or another hormonal condition, please get in touch by booking in a Base Chat or Simplify Session here.
Jaclyn is a qualified Naturopath with a focus on hormonal complaints, reproductive and fertility care, skin, and adrenal health.
Jaclyn CaveBHSc (Nat), BComm (Soc)
Learn more about Jaclyn here.
Book a session with Jaclyn here.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941370/ Hechtman, Leah (2020). Advanced Clinical Naturopathic Medicine. Elsevier Health, UK.Trickey, Ruth (2011). Women, Hormones, and the Menstrual Cycle. Allen & Unwin, Australia.