Supplements for polycystic ovary syndrome (PCOS)

Executive Summary
Here are the supplements that are advisable for managing Polycystic Ovary Syndrome (PCOS).

Necessary:
Coenzyme Q10 (100 to 300 mg a day);
B-Vitamin Complex;
A multimineral containing chromium and magnesium taken from natural sources;
Omega-3 fish oils (3,000 mg a day); and
Vitamin D (2,000 IU a day);

There are many other excellent supplements depending on the specific type of PCOS pattern. Read the article for more details.

Disclaimer: The information, including but not limited to, text, graphics, images, and other material, contained on this website is for informational and educational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Polycystic Ovary Syndrome (PCOS) is a serious medical disorder that affects women of reproductive age. While it is not life-threatening, its effects are quite devastating on a young woman’s body as well as her mind.

Poly– means many, a cyst is a membraneous sac of abnormal nature, an ovary is an organ in the female reproductive system that produces an egg, and syndrome refers to a group of symptoms that occur together. So PCOS is a condition where small fluid-filled sacs are formed on the ovaries causing certain symptoms.

In this article, I will discuss supplementation strategies for PCOS. I will first cover a bit of science behind the condition. Towards the end, in the section on My Views, I will also talk about a similar condition called Polycystic Ovarian Disease (PCOD). It has similar symptoms but a totally different cause.

Introduction

Here is a brief primer on the female reproductive system as regards the development of PCOS.

In a typical menstrual cycle of a woman, an egg is released by a normal ovary. That process is termed Ovulation. The mechanism and sequence are explained in this article and the accompanying animation by Mayo Clinic: Women’s Health. Exhibit 1 shows what normal ovaries look like in a female reproductive system.

Female hormones circulate in significant amounts in women’s bodies. However, they also need male hormones such as testosterone and androstenedione (sorry for the long names 😀) in small quantities. Those hormones help in the growth and maintenance of the female reproductive organs. So a gland called the adrenal gland as well as the ovaries make such male hormones in roughly equal amounts in women.

Obviously, the testosterone levels normally found in a woman’s body are healthy and desirable. The hormone is needed for many health reasons in a woman such as bone mass, energy, and cognition.

That is why I don’t like testosterone being called a male hormone. The original usage was meant to indicate that male bodies, but not female bodies, have high levels of testosterone. However, increasingly, the phrase male hormone has come to signify masculinity and so is considered undesirable in a woman, which is unfair and incorrect.

It is only when the testosterone levels rise way above the normal levels in a woman’s body that they become a problem, which is what happens in PCOS. For reasons unknown to the science yet, sometimes ovaries start producing far more male hormones.

This excess of male hormones prevents the maturation and release of eggs from a woman’s ovaries. Such ovulation dysfunction causes three possible problems:

1. Irregular periods: Since eggs are not released regularly, the menstrual cycle becomes erratic. Every month, when a woman ovulates normally, the uterine lining is shed. When the ovulation is disrupted, the uterine lining can become thicker over a period of time and when it is shed, there can be heavy bleeding during the woman’s periods. The irregularity can also result in female infertility.
2. Polycystic ovaries: The ovaries become enlarged. They develop many fluid-filled sacs or cysts on their surface. These sacs produce even more male hormones.
3. Excess male hormones: The high levels of male hormones lead to physical signs such as:
   • Acne: On face, back and chest. In teenagers, it is quite common have acne. However, acne due to excess male hormones continues way past teenage and cannot be easily treated with acne medications;
   • Excess facial and body hair: This condition is called Hirsutism and is seen in nearly seventy percent of the PCOS patients. It involves excess hair growth on arms, abdomen and chest; and
   • Thinning scalp hair: some women face male-pattern baldness and hair loss.

To make the diagnosis of PCOS, the doctors need a woman to have at least two of these three features for reasons that will become obvious later.

Exhibit 2 shows what polycystic ovaries look like. Notice the enlarged ovaries with small sacs on their surface. Compare the image with Exhibit 1.

Causes of PCOS

Science does not know the exact cause of PCOS. But we know the factors that play a role in the development of PCOS. Based on each of them, PCOS starts and develops slightly differently. As a result, we will have a separate supplementation strategy for each pattern of PCOS development.

Insulin Resistance

Insulin is a hormone that helps our body use blood glucose for energy. However, various factors including excess and frequent carbohydrate intake make the body cells less sensitive to insulin. This is called insulin resistance. An insulin-resistant body needs more insulin to utilise glucose better.

High levels of blood insulin trigger the ovaries to make more male hormones. Their increased levels suppress ovulation—the process of maturation and release of an egg. Seventy percent of women with PCOS have insulin resistance.

Our supplementation strategy for such PCOS should be to lower insulin resistance.

Chronic Inflammation

Thirty percent of women with PCOS do not have insulin resistance. So how do they develop PCOS? If not excess insulin, what else triggers their ovaries to make excess male hormones? It turns out that many such women have chronic, low-grade inflammation. It pushes the ovaries into making more testosterone.

About ten percent of PCOS patients have this problem. In this type of PCOS, insulin levels are normal. However, the blood levels of inflammatory chemicals such as c-reactive protein (CRP) are elevated.

Interestingly, it turns out that insulin also stimulates the ovaries to make excess male hormones through the process of inflammation. But even when insulin levels are normal, one can get chronic, low-grade inflammation because of incorrect diet and oxidative stress.

Our supplementation strategy for this inflammation-related PCOS should be to reduce inflammation and oxidative stress. Of course, eating anti-inflammatory foods is also helpful.

Genetics

PCOS runs in families. Many genes are implicated in this. In fifty percent of the families that have PCOS, a gene that regulates testosterone production in the ovaries is found to be involved.

It is quite possible that all the PCOS patterns may have an association with one’s genetic makeup. There are genes that:

• Increase male hormones production from ovaries;
• Increase male hormones’ action to cause hirsutism symptoms;
• Worsen ovulation in presence of male hormones;
• Increase insulin resistance;
• Increase chronic inflammation;
• Increase resistance to weight loss.

So genetics may play a role in the development of each type of PCOS. However, we are in the early stages of understanding the genetic causes of PCOS. So there is no supplementation strategy here.

Stopping Oral Contraceptives

When a woman stops taking an oral contraceptive, the ovaries go into overdrive producing excess male hormones for a few months. This can cause PCOS symptoms. Such a condition is called Post-pill PCOS.

This condition is temporary and self-correcting with time. At best, supplements can be used to improve ovulation.

So far we have seen four ways PCOS can develop. All of them involve ovaries malfunctioning to produce excess male hormones and then, the extra male hormones cause ovaries to further malfunction and not ovulate properly.

But there is another way one can get extra male hormones without ovaries making a lot of them. As discussed earlier, they can come from the adrenal gland.

Abnormal Stress Response

In twenty percent of PCOS patients, the levels of a hormone called DHEA-Sulphate or DHEA-S are found to be elevated. It is produced by the adrenal gland and cannot be made by the ovaries. So if its levels are elevated, it cannot be because of overactive ovaries. Something else must be going on.

Also, DHEA-S is a precursor to the production of testosterone. So elevated DHEA-S increases testosterone levels, which can cause PCOS symptoms.

The question is what can elevate the DHEA-S levels high enough and long enough to cause PCOS symptoms? Chronic stress!

When a female body goes through a prolonged period of high stress, it secretes high levels of stress hormones such as cortisol. That in turn raises the levels of the hormone DHEA-S, which is secreted to counterbalance cortisol. Due to the raised DHEA-S, testosterone levels can rise long enough to cause ovarian problems and PCOS symptoms.

Notably, in such PCOS, there is no damage to the ovaries. It is just the elevated levels of testosterone that cause menstrual irregularities. This is not an ovarian disorder, but an adrenal disorder.

Many young women continuously push their bodies in pursuit of slimmer looks. They may undertake extreme diets and heavy exercise routines. They may also be busy juggling fledgling careers, bringing up families, and sacrificing sleep in the process. All of these add to persistent and excessive stress.

Our supplementation strategy for stress-related PCOS should be to reduce the stress response of the body.

Disclaimer

PCOS is not a simple medical condition that can go away on its own unless it is caused by stress or the stoppage of oral contraceptives. It is a serious medical condition that can cause infertility. Please seek a medical practitioner’s treatment for your PCOS.

Supplementation comes under complementary and alternative therapies, which means that it is to be used along with or after trying medical treatment. Consult with your doctor before using any supplement regimen. This article and the reference links are for the purpose of being better informed as you seek guidance from a doctor.

Principles of Supplementation for PCOS

Supplementation in PCOS depends on the type of PCOS:

1. Insulin-Resistant PCOS:
   Insulin resistance needs to be lowered along with obesity, if present.
2. Inflammatory PCOS:
   Body inflammation should be lowered. Obesity is also an inflammatory condition and controlling it will help.
3. Post-Pill PCOS:
   Support healthy ovulation.
4. Adrenal (Stress-Induced) PCOS:
   The stress response of the body should be controlled, along with lifestyle changes to reduce stress.

Supplements for Insulin-Resistant PCOS

1. Chromium: Decreases insulin resistance. Take 200 µg a day of chromium picolinate.
2. Magnesium: Magnesium is required for insulin action in body’s cells. Take 300 mg a day.
3. Vanadium: Reduces insulin resistance. Mimics insulin action.
   Best to take the three minerals above through a good plant-based multimineral supplement. If they are derived from a plant-based source, their bioavailability, or absorption in the body, is much higher than if they are from chemical-based salts.
4. Vitamin D: Helps in reducing insulin resistance. Some researchers believe it also helps in regulating insulin production. Take 2000 IU a day of vitamin D.
5. Aloe vera: Helps control pancreatic function and lower blood glucose, leading to a reduction in blood insulin levels.
6. Gymnema: Reduces insulin resistance, increases insulin secretion, and reduces carbohydrate absorption in the intestines.
7. Ginger: Increases insulin secretion, reduces insulin resistance, and mimics insulin action.
8. Cinnamon: Reduces carbohydrate digestion in the intestines. It reduces stomach emptying rate, without affecting the feeling of satiety. Reduces insulin resistance and mimics insulin action.

Many of the supplements mentioned above perform a similar role in type 2 diabetes, which also is caused by insulin resistance. I have written a separate article on this website where these supplements are discussed in more detail. Read: Supplements for type 2 diabetes.

Supplements for Inflammatory PCOS

Anti-inflammatory supplements reduce overall low-grade inflammation in the body. Anti-oxidants go a step further and protect tissues from damage that can cause inflammation. So antioxidants prevent inflammation, while anti-inflammatories cure inflammation.

1. Omega-3 fish oils: Omega-3 oils reduce inflammation in the body. Take 1,000 mg a day of omega-3 oils or 3,000 mg of fish oil (roughly, one-third of fish oil contents are omega-3 oils). For a comprehensive coverage of this nutrient, read on this website: Omega–3 oils: A complete guide.
2. Curcumin: A 5% extract of turmeric.
3. Garlic: Consider an enterically-coated garlic tablet.
4. Vitamin C: High-dose vitamin C is a water-soluble anti-oxidant. Take 1,500 mg a day.
5. Vitamin E: High-dose vitamin E is a fat-soluble anti-oxidant. Take 400 IU a day.

Many other food items are anti-inflammatory. Supplements of them such as ginger, green tea, and resveratrol (grapes) help control inflammation.

Supplements for Post-Pill PCOS

Since this is a reversible condition, we simply need to support the body’s return to the normal ovulation stage. Supplements that provide nourishment during the ovulation process are helpful.

1. B-Vitamins: Vitamins B₁, B₂, B₃, B₆, B₉ and B₁₂ improve the quality of the egg and the ovulation process.
2. L-Carnitine: L-carnitine improves ovulation. Take 2 g a day orally for 3 months. Acetyl L-carnitine is even more effective than L-carnitine, as it is also an antioxidant. Again, 2 g a day for 3 months.
3. Coenzyme Q10: Helps energy production in egg cells, improving chances of healthy egg release. Take 100 to 300 mg a day. For a detailed coverage of this nutrient, read on this website: Coenzyme Q10: A complete guide.

Supplements for Adrenal PCOS

While there are ways to reduce stress through mindfulness and meditation, supplementation tries to achieve the same through another way: Instead of reducing stress, the supplements try to reduce the body’s response to stress. By controlling the release of stress hormones, the supplements blot out the effects of stress on the body.

Supplements that reduce stress response are called adaptogens. Stress is of two types: acute or immediate, and chronic or long-term. For adrenal PCOS, one would need to control the long-term stress. The supplements that help with long-term stress are:

1. Ashwagandha: A known herb in Ayurveda, the Indian medicinal science.
2. Asian ginseng: Also known as Korean Ginseng or Panax Ginseng. There is another ginseng called American Ginseng, which has similar properties. Both of them help with long-term stress management.
3. Tulsi (Holy basil): Mild reducer of chronic stress. Called the Queen of Herbs in Ayurveda, the Indian medicinal science.
4. Probiotics: Our intestines are considered the ‘second brain’. Probiotics improve the digestive system health and indirectly reduce the stress felt by the body. Take 20 billion CFU—colony forming units—a day. A CFU is typically a viable and helpful gut bacteria.
5. Prebiotics or Fiber: These provide food for healthy gut bacteria. Take 4–8 g of supplemental fiber a day.

Long Term Complications

PCOS comes with many complexities that can cause serious health problems in the long term:

1. Infertility: PCOS hampers ovulation and egg release, which is needed for pregnancy.
2. Obesity: The insulin resistance that accompanies PCOS also leads to obesity. Nearly seventy five percent of PCOS patients are overweight or obese.
3. Metabolic syndrome: Insulin-resistant women develop high blood sugar, high blood pressure, and cholesterol problems. A combination of these issues is called Metabolic syndrome.
4. Diabetes: Insulin resistance leads to type 2 diabetes.
5. Heart disease: Metabolic syndrome increases the risk for heart disease.
6. Stroke: Metabolic syndrome is known to raise the risk of stroke.
7. Endometrial cancer: Every month, when a woman ovulates, the uterine lining is shed. Since PCOS disrupts ovulation, the uterine lining—endometrium—can become thicker over a period of time. This increases the risk for endometrial cancer.
8. Depression: Hormonal changes alter one’s mood making one anxious. The symptoms such as excess facial and body hair can reduce one’s self-image and may lead to depression.
9. Sleep apnea: The woman gets interrupted sleep due to brief but repeated stoppages in breathing while being asleep. PCOS may or may not be causing sleep apnea but the risk of developing one is five times higher in women who have PCOS.

My Views

1. You must make sure the diagnosis of PCOS is properly made. While the condition is called polycystic ovary syndrome, some afflicted women don’t develop cysts on their ovaries. On the other hand, some women have cysts on their ovaries but they do not have PCOS. The cysts in such cases are just follicles—a small group of cells enclosing a cavity in which a microscopic egg is maturing inside. These follicles are a normal part of anatomy. But on an ultrasound (USG) examination, they look exactly the same as a cyst. So one cannot make the diagnosis of ovarian cysts based only on a USG exam. That is why one needs two of the three criteria described above to make a PCOS diagnosis.
2. Another completely different condition with a similar set of symptoms is Polycystic Ovarian Disease (PCOD). While the two display similar symptoms, PCOD is caused by simple hormone imbalance, whereas PCOS is a full-fledged endocrine system disorder. PCOD is far more common, with as many as one-third women of childbearing age suffering from it. PCOS affects about twenty percent of such women. Managing PCOD is simpler and it does not cause infertility. PCOS is a far more serious condition.
3. Having a genetic predisposition does not mean one will develop PCOS for sure. Genes are like light switches. They need to be turned on (the exact term is: genes need to be expressed) for the problem to develop. Many times, certain environmental conditions trigger a gene to turn on or become active. Thus, if one is able to tightly control the prevailing conditions, genetic factors may not always lead to the problem.
4. If you need help with any of the supplements discussed, write to me on madhur.kotharay@gmail.com (Disclaimer: No medical advice from my side, please. But I will be happy to help with supplements part). Kindly mention “Supplements for Polycystic Ovary Syndrome” in the subject of the email.

To Read More

• Cleveland Clinic: Polycystic Ovary Syndrome (PCOS)
• CDC: PCOS (Polycystic Ovary Syndrome) and Diabetes
• WebMD: Natural Anti-Inflammatory Diet
• PCOS Awareness Association: PCOS or PCOD? Most people don’t even know!

First published on: 18th April 2022
Image credit: Stomach pain photo created by diana.grytsku – www.freepik.com
Last updated on: 2nd June 2022