Top 10 Herbs and Supplements for PCOS: Inositol to Berberine

Dealing with PCOS is no small matter. Symptoms like acne, hirsutism (hair growth in unwanted places like your chin, breasts, or lower belly), weight gain, alopecia (hair loss), irregular or skipped periods, and possibly even fertility problems are challenging — both physically and emotionally. 

After years of consulting with women struggling with PCOS, I can say that there’s really no end to how this condition can impact quality of life, self-esteem, and mental health. If you have PCOS, you’ve likely been dealing with its symptoms for years, sometimes without realizing what’s really going on. 

Unfortunately, most women tell me that they received nothing more than a brochure from their doctor and prescription for the Pill — no further questions asked, no further guidance given. 

I’m here to tell you there’s a lot more we can do for PCOS. In my new book, Hormone Intelligence, I created a complete Advanced Protocol for PCOS, filled with diet and lifestyle changes that can help treat the underlying causes of PCOS. In this article (and podcast!), I’ll share part of that protocol in the form of the top herbs and supplements for PCOS to address the underlying causes. 

Beyond Just Conventional Treatment

Go to a conventional doctor for PCOS, and you’ll have very limited options. The Pill is used as the first-line treatment for treating high testosterone levels and menstrual cycle irregularities in PCOS. But most women are actually put on the Pill much sooner than they receive an actual diagnosis of PCOS, so they often don’t know they have it until they come off the Pill hoping to get pregnant. It’s also common for women to be put on Metformin for blood sugar regulation, or Spironolactone for symptomatic control of hair loss.

I want to be clear: I’m not against these medications. They can be very effective at putting symptoms at bay, but they also carry their own risks and they’re not addressing the underlying causes that are driving PCOS, which are still happening even if some of your symptoms have improved. The Pill, for example, can actually make insulin resistance worse, putting you at higher risk of long term health consequences and creating more problems when you do finally come off of it, and it can cause or exacerbate depression, which is already a common symptom of PCOS. It’s also important to note that even though these pharmaceuticals are widely accepted as treatments for PCOS, the evidence that supports their use is both limited and inconclusive. Our knowledge of PCOS in general is still in its infancy, and most pharmaceuticals are used without much questioning or critical thinking. Of course, we hear WAY more backlash for “unproven” natural approaches to PCOS — but there should also be critical thinking used when it comes to pharmaceuticals.

At the end of the day, my goal isn’t to shun or shame conventional treatment. There’s a place for their use in treating PCOS and ultimately I want women to do what helps them live their most optimal, healthy life  and never feel pressured to go “all natural” when it’s just not cutting it. But I do want to introduce alternative strategies, including herbs and supplements for PCOS, that can offer you more options. What I’ve seen from treating this condition is that a large percentage of the women with a PCOS diagnosis could be controlling their symptoms and even reversing the condition without these drugs and their risks and side effects. 

10 Herbs and Supplements for PCOS

I use the following herbs and supplements for PCOS in my medical practice to not only help treat the root causes, but to help reduce areas of body burden that might be leading to the cosmetic symptoms associated with PCOS. The following have been shown to reduce insulin resistance, reduce testosterone levels (which causes many common PCOS symptoms), improve ovulation, and decrease hirsutism. They’re most effective when used in combination with making the dietary and lifestyle changes, which you read more about here and I discuss in detail in  my new book. 

Inositol (Myo-inositol and D-chiro-inositol)

Inositol is a must for most women with PCOS. It’s actually one of the most well-studied supplements for this condition with some of the best data behind it. D-chiro-inositol has been shown to reduce insulin resistance, testosterone, and AMH levels and improve ovulation. Myo-inositol, when combined with folate, has been shown to improve fertility, egg quality, and pregnancy rates in women with PCOS. It may also be helpful for presenting gestational diabetes; A study in Gynecology Endocrinology showed the prevalence of GDM among pregnant women with PCOS who took myo-inositol group was 17.4% versus 54% in the control group. I recommend using a combination of both myo- and D-chiro inositol. When compared to myo-inositol alone, a combination of the two improved lowered insulin and improved cholesterol and inflammatory markers more effectively in women with PCOS. It’s also helpful for anxiety, which is also common with PCOS.

How to use it: I recommend using a combination product containing myo-inositol and d-chiro-inositol, up to 4 grams per day, for maximum benefit.

Vitamin D 

Vitamin D is linked to blood sugar control and vitamin D deficiency is clearly tied to PCOS and symptom severity. Supplementing with vitamin D can help improve ovarian reserves, AMH levels, ovarian follicle health, and fertility, even if one isn’t vitamin D deficient. Many of us are low in vitamin D, even with adequate sunlight exposure – so I recommend most women take a daily dose.

How to use it: A dose of 2000 IU daily is generally safe for anyone. But with PCOS, I do recommend getting your vitamin D level tested. Then, based on your level, it's possible to supplements with between 2000 IU and 10,000 IU a day. Even if your vitamin D levels are normal, supplementing with 2,000 IU a day can be helpful for PCOS. 

N-acetyl-cysteine (NAC)

Short for N-acetyl-cysteine, NAC is a naturally occurring chemical in our bodies that increases glutathione, one of the most important detoxifiers that’s produced in our bodies. Studies have shown that supplementation can be effective for PCOS. It’s been shown to improve insulin resistance and reduce testosterone levels as well as hirsutism in women with PCOS, while also improving menstrual regularity. In one study, it was found to be comparable to metformin in lowering insulin and androgens and improving menstrual regularity. So if all things are equal, why not try NAC over metformin, or at least as a first step? 

How to use it: NAC is typically taken at a dose of 600 mg three times/day. I recommend taking it for a minimum of 24 weeks (close to 6 months). If you experience symptom improvement, it’s a very safe supplement that can be taken on an ongoing basis if needed.

Berberine

Berberine, an extract from goldenseal and related herbs, is commonly used to improve blood sugar balance and cholesterol. It’s also one I keep in my toolkit for PCOS because of its effectiveness for insulin resistance and hormone balance. In a first of its kind study, 102 women with PCOS taking 400 mg three times daily were evaluated over a 4 month timeframe. Results included significant improvements in menstrual cycle regularity, ovulation, and insulin resistance. 

How to use it: Use 400 mg three times daily for PCOS. Be aware that berberine may alter liver clearance of certain medications, so talk to your doctor if you take prescription medications such as antidepressants, blood thinners, or beta-blockers. 

Omega 3 Fatty Acids

There are about a dozen reasons why omega-3 fatty acids can be helpful in PCOS, starting with their anti-inflammatory and insulin-regulating properties and ending with their ability to lower leptin levels and aid weight loss. Studies have shown that omega-3 fatty acids, taken for 2 to 6 months, can reduce testosterone levels and unwanted hair growth and improve insulin sensitivity, menstrual regularity, and weight loss. 

How to use it: Supplement with at least 850 EPA / 200 DHA 1–2x/day. Make sure you use products from companies that test for heavy metal contamination.

Spearmint

Two very promising studies have confirmed that drinking 2 cups of spearmint tea daily for even just 30 days has anti-androgenic properties and may be useful for lowering testosterone levels and reducing hirsutism with PCOS. While these studies are small and preliminary, I recommend giving it a try — it’s entirely safe and spearmint tea is delicious!

How to use it: Steep 2 tsp. of organic dried spearmint leaf in 1 cup of boiling water (in a covered vessel) for 10 minutes. Strain and enjoy plain or with lemon. You can use a teapot with a built in strainer, or a French press, and you can drink it hot or cold. You can even try it as Sun Tea in this recipe here, swapping out spearmint for peppermint.

Zinc 

Zinc is often thought of as an immune system supplement, but it can also reduce the negative effects of high testosterone. In fact, one study even showed that supplementing with 50 mg a day of zinc decreased hirsutism, unwanted hair growth in women with PCOS.  The same study showed that zinc supplementation can reduce hair loss, thinning hair, and elevated inflammation levels that are often present with PCOS. Zinc aso plays a role in blood sugar balance and mental health, so although you might think of it as a supplement for the common cold, it’s usefulness in PCOS shouldn’t be underestimated! 

How to use it: Take 15–45 mg/day with meals to prevent nausea, which is common with zinc supplementation.

Melatonin

In recent years, we’ve learned that there are many interesting links between our sleep hormone melatonin and our ovarian health. For example, it’s been shown that a reduction in melatonin levels of follicular fluid exists in PCOS patients and that melatonin receptors in the ovaries are involved in adjusting sex hormone secretion at different phases of ovarian follicular maturation. We’re still learning more about these links but studies have shown that in women with PCOS, 2 mg of melatonin daily for 6 months decreased testosterone levels and reduced menstrual irregularities.

How to use it: For ovarian support, take 1–3 mg/day. Allow 2 hours after eating before taking this supplement; do not exceed 3 mg/day when trying to conceive as higher doses can suppress fertility.

Licorice Root 

Licorice root can be consumed daily as a tea and may be effective for PCOS, including for reducing testosterone levels. One small study found that daily licorice intake improved serum testosterone levels in just two cycles and then when licorice was discontinued, testosterone levels elveated to their previous levels.

How to use it: Brew yourself a daily cup of licorice tea or use the traditional Chinese medicine herbal formula Peony and Licorice Root. Discuss use with your doctor if you have high blood pressure. 

Saw Palmetto

Saw palmetto is an herb that’s historically been used for urinary and reproductive health. It’s commonly used in extract form that’s composed of fatty acids and the medicinal part of the plant. It’s shown to be anti-androgenic, meaning that it may be helpful in reducing testosterone levels that lead to hirsutism and acne. Unfortunately, there’s not as much evidence specifically behind its use with PCOS but it’s also considered very safe, so in many cases it’s worth a try.

How to use it: Consider a product that has 160-450 mg of saw palmetto extract containing a 45 to 95% fatty acid ratio. There are standard products on the market that you can find.

Using Herbs and Supplements for PCOS as Part of Your Protocol

As you approach treating PCOS naturally, remember that it’s likely something you’ve had for years, so it’s going to take some time for the body to start recovering. I recommend sticking with your supplement protocol for at least 3 months, but ideally give it 6-12 months. You may begin seeing symptom improvement in a short amount of time, but give yourself about 3-6 months to really assess your progress. Some symptoms like hair loss and fertility challenges may take closer to 12 months. If you don’t see any changes at all in 6 months, it’s important to work in conjunction with a medical care provider skilled in working with women with PCOS. 

Remember: this doesn’t have to be an all or nothing approach, you can combine these strategies with conventional therapies to create a PCOS protocol that really feels right to you.