Have you recently been diagnosed with polycystic ovary syndrome (PCOS)? If so, you might be wondering what your options are for getting some of the symptoms under control. Understanding the syndrome and how it manifests in you is your first step to choosing the best course of action for treatment.
The great news for you is that PCOS is very treatable, and a few key lifestyle changes and PCOS supplements will help start you off on the right foot. Some of the most effective supplements for PCOS include probiotics, herbal blends to balance hormones, and inositol.
Let’s take a closer look at what PCOS is and the collection of symptoms it could cause, what causes it, and a natural treatment and supplement plan.
What Is PCOS?
PCOS (also called polycystic ovarian syndrome) is a hormonal condition that affects between 5% to 15% of women of reproductive age. It’s a syndrome, not a disease, which means diagnosis is characterized by a collection of symptoms, making it sometimes difficult to diagnose .
In the case of PCOS, if you have two or more of these symptoms, you may have the syndrome or at least might benefit from the prescribed lifestyle changes I’ll go over below.
- Hirsutism: male-pattern hair growth, such as on the jaw and neck, breast and belly
- Thinning scalp hair, whether male-pattern or female pattern baldness
- Hormonal acne around the jawline, chest and back
- Middle-body weight gain and difficulty losing weight
- Anovulation (a lack of ovulation)/missed periods/inconsistent cycles
- Fertility challenges
- Multiple small cysts on the ovaries
- Insulin resistance (which can lead to type 2 diabetes)
- Elevated levels of androgens (male hormones)
Again, just having two symptoms on this list can lead to a PCOS diagnosis, but many women report having more than two.
The Question of Weight
Many clinicians will lean heavily on weight loss as one of the ways to help patients alleviate symptoms of PCOS, but that approach somewhat misses the forest for the trees. Some of the lifestyle changes we recommend could result in weight loss, but the metrics we’re looking for have less to do with the number on the scale and more to do with your labs, your skin and gut health, and your stress levels.
I’ll get more into treatments down below. But for now, suffice it to say that the relationships between weight and PCOS is confusing and still not quite understood in the research. It’s a bit of a chicken and egg: does PCOS cause weight gain and difficulty losing weight, or do women who trend toward overweight and obesity run a higher risk of developing PCOS?
We know that about 80% of patients with PCOS are obese, but about 20% of PCOS patients are of a normal weight . It’s also true that many women are overweight and obese with no signs of PCOS or the health risks that can sometimes accompany the diagnosis. Furthermore, dieting can be stressful, and a goal in treating PCOS is to manage and reduce stress, so be wary of clinicians who prescribe weight loss as a first line of defense against PCOS.
More important than focusing on weight, managing insulin resistance and inflammation is fundamental for rebalancing sex hormones and getting PCOS symptoms in check.
That’s because so much of your functional health relies on your metabolic health, gut health, and hormones. When these systems are out of balance, as is the case in women with PCOS, additional health risks pop up that can lead to poor outcomes. Patients with PCOS have increased risk for type 2 diabetes, cardiovascular disease, stroke, endometrial cancer, and mental health challenges like depression and anxiety .
The origins and causes of PCOS aren’t fully understood, but we know that certain lifestyle factors can play a role. On the other hand, two women could walk into my clinic who follow the same diet, lifestyle, and have the same stress levels, and one woman will have PCOS symptoms while the other will have totally normal hormonal levels and no symptoms. This phenomenon points to a genetic or hereditary component, and research bears that out .
Despite having a genetic component, you are not powerless in helping yourself rebalance your hormones, should you be diagnosed or have genetic risk factors for PCOS. We know that a diet high in sugars and refined carbohydrates, a lack of exercise, poor gut health, and chronic stress all contribute to PCOS.
PCOS can develop as a result of metabolic syndrome, insulin resistance, and chronic, low-grade inflammation . These conditions lead to hormonal imbalances and an excess of androgens, or male hormones, which cause the acne, hair growth, and hair loss associated with PCOS .
PCOS and Gut Health
Poor gut health is at the root of many of the health concerns we see at our clinic, and PCOS is no exception. There are documented links between PCOS and gut dysbiosis (an imbalance in gut microorganisms [6, 7]. Furthermore, lower levels of biodiversity in the gut bacteria of women with PCOS have also been shown [6, 8, 9]. One study even found a correlation between higher androgens/male-pattern hair growth and lower gut microbial diversity .
Leaky gut syndrome also seems to be more prevalent in PCOS patients . Leaky gut is the result of inflammation caused by harmful bacteria in the gut that create microscopic holes in the small intestine, allowing some gut contents to leak into the bloodstream. Leaks like this negatively affect insulin receptor function and can disrupt the endocrine system .
A Functional Approach to Treating PCOS
The standard medical advice for treating PCOS is essentially to balance hormones and suppress the symptoms with prescription medications like hormonal contraceptives (birth control pills or the Nuvaring), and take spironolactone or eflornithine to curb hair growth and acne, and metformin for insulin resistance. Unfortunately, much like many prescription meds, these drugs come with potential side effects, and they generally only serve to mask the symptoms, rather than treating the underlying cause.
A more holistic, functional medicine approach to PCOS takes lifestyle, diet, stressors, sleep quality, exercise, and gut health into account to build a protocol . The goal is to restore wellness rather than plaster over the problem. Your protocol will be tailored to you, but will likely include things like:
- Following an anti-inflammatory diet (like the paleo or Mediterranean diet):
- Lots of vegetables and fruit
- Healthy, unprocessed meat and fish
- Whole food starches like sweet potatoes, winter squash, and quinoa
- Healthy fats like coconut oil, extra virgin olive oil, avocado oil, MCT oil, and omega 3 fatty acids from fish, flax, nuts, or a fish oil supplement (vegans can take DHA from algae)
- Minimal sugar, alcohol, and processed food, especially processed carbohydrates
- Improving sleep hygiene for a better night’s sleep (7-8 hours per night)
- Getting daily moderate exercise like swimming, walking, a light jog, biking, or skating
- Using stress management techniques that work for you, such as mindfulness meditation, listening to relaxing music, spending time outside, or laughing with a friend
- Choosing supplements to rebalance your hormones and improve your gut health
*A quick note on behavior change: it takes time. Changing everything at once is a challenge to even the most “disciplined” among us, and managing stress is a big part of taking charge of your PCOS symptoms.
Please don’t attempt to revamp your entire kitchen, sleep schedule, and exercise routine all in one go. It will almost certainly lead to additional and unnecessary stress. We’d love to help you get started on your health journey, so please consider booking a consultation before starting this process on your own.
The Best PCOS Supplements
To bolster some of the lifestyle changes I’ve enumerated above, I’ve used research to compile a comprehensive list of the best supplements to help support a full recovery, restoring fertility and hormone balance, regulating menstrual cycles, improving skin and hair, and reducing the risk for other serious illnesses.
The seven best supplements for PCOS, based on research, are:
- Herbal blends to balance hormones
- Fish oil
- Mineral supplements
- Spearmint tea
When it comes to taking dietary supplements, less is often more effective. Taking handfuls of supplements every day can get expensive and often unnecessary. It’s better to hone in on the most effective PCOS supplements.
Probiotics help restore balance to the gut microbiota by repopulating your gut with healthy bacteria. By increasing biodiversity in your gut flora, you can heal a leaky gut and stop the inflammatory cycle at its source.
Research supports using probiotics for hormonal balance and reducing inflammation in PCOS patients. A 2020 meta-analysis of 13 randomized controlled trials found that probiotic supplements improved hormonal and inflammatory markers for women with PCOS .
Research supports modest gains in metabolic health with probiotics. Two systematic reviews and meta-analyses found that probiotics somewhat improved insulin sensitivity but not fasting blood glucose or body weight in PCOS patients [12, 13]. This is consistent with other studies of probiotics, which show small improvements for weight loss and blood sugar levels [14, 15, 16, 17].
While probiotics are an effective tool for restoring gut health, balancing hormones, and reducing inflammation, they work best taken in combination with dietary and lifestyle improvements.
2. Herbal Blends to Balance Hormones
A number of herbs have been studied and found to be effective for PCOS and other female hormonal imbalances that involve progesterone and estrogens.
Based on a 2014 systematic review of eight clinical trials, chasteberry (also known as chaste tree or vitex) and black cohosh showed evidence for restoring a healthy menstrual cycle in women with PCOS . Both of these herbs are also effective for a range of female hormonal imbalances [18, 19, 20, 21].
Other clinically studied and effective herbs include:
- White peony (also known as Chinese peony) 
- Cinnamon [18, 24] although one systematic review suggests that may have mild adverse effects and doesn’t restore menstruation .
- Licorice 
- Fenugreek [23, 25]
A combination supplement that combines some of these herbs is the simplest and most cost-effective way to include herbal supports in your daily routine.
Resveratrol is an antioxidant found in the seeds and skins of grapes and berries. It’s the reason many health experts posit that drinking a glass of red wine with dinner could be good for your health.
Clinical trials suggest that resveratrol can effectively:
- Reduce inflammatory markers (800 mg/day) 
- Improve hormone balance (800 mg/day) 
- Significantly reduce testosterone, DHEA, and fasting insulin, and significantly improve insulin resistance 
Inositol is a type of sugar sometimes called vitamin B8. There are two forms of inositol, both of which have been studied for the treatment of PCOS: myo-inositol and d-chiro inositol. While myo-inositol showed the best effect on metabolism, D-chiro-inositol reduced androgen levels better .
A 2019 systematic review and meta-analysis found that myo-inositol was equally effective as metformin at improving fasting insulin, insulin resistance, and testosterone . Since metformin can have adverse side effects like nausea, researchers suggest using myo-inositol as the first choice of treatment PCOS patients .
5. Fish Oil
Fish oil contains vitamin D and omega 3 fatty acids, both of which may be helpful for women with PCOS do to their metabolic and anti-inflammatory effects.
Research shows that Vitamin D lowers fasting blood sugar, reduces insulin resistance, and reduces testosterone in women with PCOS and vitamin D deficiency. Unfortunately, the research doesn’t show that it consistently regulates the menstrual cycle [33, 34, 35].
A large body of research suggests that omega 3 supplements can help improve inflammatory and antioxidant markers, insulin resistance, total cholesterol, and testosterone in women with PCOS [36, 37, 38].
For vegans, flaxseed oil, ground flaxseed, or DHA-rich algae supplements are good sources of omega 3 fats and can be taken with vitamin D drops.
6. Mineral Supplements
Results are mixed when it comes to studies on mineral supplements, but early research does suggest potential benefits.
There may be a connection between lower levels of zinc and the hair loss and body hair issues that women with PCOS face. One study observed that PCOS patients had lower levels of circulating zinc, while a second study showed that adding zinc could help address the hair issues [39, 40]. Zinc may also help lower fasting blood sugar, insulin resistance, and triglycerides in PCOS patients . Zinc provided less conclusive improvements around inflammatory markers and oxidative stress [40, 41].
A placebo-controlled trial of PCOS patients found that, after 12 weeks of supplementing with magnesium oxide and zinc, PCOS patients showed significant reductions in markers of inflammation and oxidative stress . We also know that magnesium works as an effective sleep and relaxation aid, which could potentially offer additional benefit to PCOS patients .
Selenium follows a similar story to zinc, in that it seems that PCOS patients have lower levels of it, but adding it in as a supplement can help [43, 44]. Studies suggest that selenium can balance hormone levels, improve inflammatory markers, reduce hair loss, alleviate acne and unwanted hair growth, and balance cholesterol levels [45, 46, 47].
However, not all selenium research points to PCOS improvements. Researchers in a 2018 systematic review concluded that the data doesn’t yet support adding selenium into a PCOS treatment protocol. One clinical trial found that selenium adversely affected insulin resistance in women with PCOS, which is the exact opposite of what we want when choosing supplements for PCOS .
7. Spearmint Tea
More research is needed on drinking spearmint tea, but at least one study showed that two cups per day for 30 days helped reduce androgen levels in women with PCOS when compared with placebo . If you like spearmint tea, this one seems easy to add into your routine.
Choosing the Right Supplements for You
It’s really important not to add all of these supplements into your daily routine at the same time. Doing that will make it a lot harder to understand which things are actually helping you. I usually recommend starting with probiotics and an herbal supplement for hormonal balance.
Adding a multivitamin without iron or copper is also a good idea to make sure you’re getting a baseline of micronutrients on a daily basis. This combination of supplements and attention to diet and lifestyle is very helpful for the majority of patients.
If you find that, after 30 days of supplement use, along with some of the lifestyle changes I suggested, you’re still looking for more noticeable improvements, consider adding in one of the other supplements on the list. Try 30 days of supplementation for each one, and then reassess your symptoms. It might help to take “before” pictures if you’re dealing with the acne and hair growth/loss, as slow improvements can be hard to track without a baseline to refer back to.
The Bottom Line on Supplements for PCOS
It’s possible to address the root cause of your PCOS symptoms with a natural protocol that includes lifestyle changes and supplementation. While supplements can play an important role, the most important changes you can make will be efforts toward lowering insulin resistance and inflammation to help curb your PCOS symptoms.
If you’re feeling overwhelmed by the breadth of information here, please reach out to our functional medicine center to help you prioritize your goals and get started with confidence and support.