Over-the-Counter Medications for PCOS Management
The only evidence-based over-the-counter supplement for PCOS is inositol (specifically myo-inositol), which can improve metabolic outcomes with fewer side effects than prescription medications, though it has limited benefits compared to metformin. 1
Primary OTC Option: Inositol
- Myo-inositol is the main OTC supplement with evidence for PCOS management, particularly as an adjunctive treatment to lifestyle modifications 2
- Inositol appears to have limited benefits for metabolic outcomes but is associated with fewer adverse effects than metformin 1
- It can be considered as an alternative for patients who cannot tolerate metformin or prefer non-prescription options 2
- Do not combine inositol with other insulin-sensitizing agents without medical supervision 2
Critical Limitation of OTC Approach
- No OTC medications are recommended as first-line therapy by ACOG guidelines - lifestyle modification targeting 5-10% weight loss through diet and exercise remains the foundational treatment 2, 3
- The American College of Obstetricians and Gynecologists recommends prescription medications (metformin, oral contraceptives, clomiphene citrate) over supplements for managing PCOS symptoms 2, 3
When OTC Is Insufficient - Prescription Alternatives
For women NOT attempting pregnancy:
- Combined oral contraceptives are first-line prescription treatment, suppressing ovarian androgen secretion and increasing sex hormone binding globulin 3
- Metformin improves insulin sensitivity and reduces risk factors for diabetes and cardiovascular disease 3
- Spironolactone (antiandrogen) is second-line for hirsutism and acne when added to oral contraceptives 4
For women attempting pregnancy:
- Letrozole is first-line for ovulation induction, with superior live birth rates compared to clomiphene citrate 5
- Clomiphene citrate achieves 80% ovulation rate and 50% conception rate among ovulators 2, 3
- Metformin can be used as adjunct to ovulation induction agents 5
Lifestyle Modifications (The True "OTC" Foundation)
- Target 500-750 kcal/day energy deficit with total intake of 1,200-1,500 kcal/day 3
- Perform at least 250 minutes/week of moderate-intensity exercise for weight loss 3, 5
- Even 5% weight loss improves insulin sensitivity, ovulation rates, and metabolic outcomes 2, 3
- Any balanced dietary approach creating an energy deficit is acceptable - no specific diet type is superior 3
Common Pitfalls
- Do not rely solely on supplements when prescription medications are indicated - PCOS requires metabolic screening and often prescription management 3, 5
- Avoid delaying lifestyle intervention, as it must be the foundation regardless of other treatments 5
- Do not neglect metabolic screening (fasting glucose, lipid profile) even in normal-weight PCOS patients 3
- Women with PCOS have higher rates of depression, anxiety, and eating disorders requiring mental health assessment 3