Supplements for PCOS
The international evidence-based guidelines for PCOS do not recommend routine supplementation, as lifestyle interventions (diet and exercise) remain first-line therapy with the strongest evidence for improving metabolic, reproductive, and psychological outcomes. 1
Primary Management: Lifestyle Over Supplements
The 2020 International Evidence-Based Guideline establishes that healthy lifestyle interventions—including balanced diet and regular physical activity—are the foundation of PCOS management, with no specific dietary composition or supplementation showing superior benefit over general population recommendations. 1
Key lifestyle recommendations include:
- Diet: Energy deficit of 500-750 kcal/day for weight loss in those with excess weight, following general healthy eating principles without requiring specific macronutrient ratios. 1
- Physical Activity: Minimum 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous-intensity exercise, including muscle-strengthening activities on 2 non-consecutive days/week. 1
- Weight Loss: Even modest weight loss (≥5 lb) enhances metabolic and reproductive outcomes. 2
Supplements with Emerging Evidence
While not part of guideline recommendations, research suggests certain supplements may provide adjunctive benefits, though evidence remains insufficient for routine clinical integration:
Supplements with Most Promise
Inositol shows the most consistent findings, with improved metabolic profiles and reduced hyperandrogenism in research studies. 3
Omega-3 fatty acids may reduce cardiovascular risk factors in women with PCOS, though the British Dietetic Association only recommends dietary omega-3 rather than supplementation. 1
Vitamin D, B-12, and folate supplementation may address common nutrient deficiencies in PCOS patients, though direct evidence for symptom improvement is limited. 4
Other Investigated Supplements
Research has explored vitamin E, vitamin K, calcium, zinc, selenium, chromium picolinate, alpha-lipoic acid, melatonin, probiotics, and cinnamon, but findings remain inconsistent and insufficient for clinical recommendations. 4, 3
Pharmacological Options When Lifestyle Insufficient
When lifestyle modifications alone are inadequate:
Metformin (1.5-2 g daily, typically 1000 mg twice daily) decreases LDL cholesterol and triglycerides, improves insulin sensitivity, and enhances reproductive outcomes. 2, 5
GLP-1 receptor agonists including liraglutide (1.8 mg daily) and semaglutide show superior anthropometric outcomes compared to placebo. 1, 5
Orlistat (120 mg three times daily) combined with combined oral contraceptive pills improves anthropometric but not metabolic outcomes. 1, 5
Critical Clinical Considerations
Avoid premature supplementation recommendations without first optimizing lifestyle interventions, as no specific diet composition has proven superior for PCOS management. 1
Monitor for nutrient deficiencies in women with PCOS, who tend to have lower levels of common vitamins and minerals, potentially associated with psychological and physiological sequelae. 4
Provide contraception counseling when initiating metformin or other treatments that improve ovulation, as pregnancy risk increases. 2, 5
Assess renal function before metformin initiation, as it is contraindicated with impaired renal function. 2, 5
Evidence Limitations
The supplement literature in PCOS suffers from significant heterogeneity in study populations (varying age and BMI ranges), inconsistent intervention delivery and duration, and lack of standardized comparators. 3 Most supplement studies are small, and robust clinical trials are needed before integration into routine practice. 4, 3
The most prudent approach remains optimizing evidence-based lifestyle interventions before considering supplementation, as these have the strongest evidence for improving morbidity, mortality, and quality of life outcomes in PCOS. 1