Advice from Dr. Lynsey Johnson, DNP, APRN, FNP-C
Note: Polycystic Ovary Syndrome (PCOS) has officially been renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS) to better reflect the condition’s metabolic and endocrine nature. Throughout this article, you’ll see both names used to help women find the information they need during this transition. Read why the name changed here.
When you have Polyendocrine Metabolic Ovarian Syndrome (PMOS), it’s natural to wonder which vitamins and supplements might help manage your symptoms. Social media is filled with recommendations, but not every supplement is beneficial, and some can even be harmful.
As a healthcare provider, I often remind patients that vitamins and supplements should never replace evidence-based medical treatment. Instead, they may serve as adjunctive therapy, meaning they are used alongside your personalized treatment plan when appropriate.
Before You Start Any Supplement
Starting any vitamin or supplement should first be discussed with a qualified medical provider, such as a physician (MD or DO), nurse practitioner (NP), or physician assistant (PA).
Patients should also have appropriate blood work performed to determine whether they actually have a deficiency before beginning supplementation.
This is especially important because it is possible to overdose on fat-soluble vitamins (Vitamins A, D, E, &K), and in some cases the symptoms of too much can resemble the symptoms of too little.
Unlike water-soluble vitamins (such as B vitamins), fat-soluble vitamins are stored in body fat and are not easily eliminated from the body.
Supplements That May Be Harmful for Women with PMOS
While many supplements are marketed toward hormone balance, some may actually worsen PMOS symptoms.
- DHEA supplements increase androgen levels, which may worsen PMOS
- Vitex agnus-castus (Chaste Tree Berry) may increase DHEA levels, which can further increase androgen production
- Whey protein may increase androgen levels by stimulating insulin-like growth factor-1 (IGF-1)
- Taking Vitamins A, D, E, or K without confirming a deficiency through laboratory testing is not recommended. Vitamin A deserves special attention because high doses may cause birth defects during pregnancy.
Vitamins and Supplements Commonly Recommended as Adjunctive Therapy
It is important to remember that these supplements are adjunctive therapies.
They do not cure PMOS, but they may provide additional support when used appropriately alongside your individualized medical treatment plan.
For more information on how we work with our patients to create these personalized treatment plans, click here.
Myo-Inositol with D-Chiro-Inositol (40:1 Ratio)
Multiple high-quality studies have shown that myo-inositol combined with D-chiro-inositol in a 40:1 ratio may help improve:
- Insulin sensitivity
- Menstrual cycle regulation
- Testosterone levels
- Modest metabolic markers
Myo-inositol improves insulin sensitivity in a manner similar to metformin. However, its metabolic impact is relatively small by comparison.
Patients should not expect significant weight loss from myo-inositol alone.
It may be an appropriate option for patients who:
- Have sensitive stomachs and cannot tolerate metformin
- Are less focused on weight loss as a treatment goal
Vitamin D
Vitamin D deficiency is common among women with PMOS.
However, deficiency should always be confirmed through blood work before supplementation begins, and blood levels should be retested after treatment to ensure Vitamin D has been adequately replaced without overcorrecting.
Vitamin D is a fat-soluble vitamin, meaning it can accumulate in body fat and reach toxic levels.
Patients should never take more than 600 IU daily without laboratory confirmation of deficiency.
Excessive Vitamin D supplementation can cause hypercalcemia, a dangerous buildup of calcium in the bloodstream.
Symptoms of hypercalcemia include:
- Nausea and vomiting
- Frequent urination
- Excessive thirst
- Persistent muscle weakness
- Fatigue
- Confusion
Blood Vitamin D levels around 150 ng/mL are generally considered toxic.
Omega-3 Fatty Acids
Omega-3 fatty acids may provide modest improvements in:
- Lipid (cholesterol) profiles
- Inflammatory markers
Because fish oil also acts as a blood thinner and may interact with certain medications, dosage recommendations from your medical provider should always be followed.
Berberine
Berberine works similarly to metformin and myo-inositol.
However, supplement quality and manufacturing standards are inconsistent, making formulation and potency difficult to standardize between products.
Iron
Iron deficiency anemia may occur in women experiencing heavy or prolonged menstrual bleeding related to irregular menstrual cycles.
Iron levels should always be tested before supplementation begins and rechecked afterward to ensure successful replacement.
Common oral iron supplements include:
- Ferrous sulfate
- Ferrous glycinate (often gentler on the stomach)
Some patients require intravenous (IV) iron infusions when oral replacement is insufficient.
Common Side Effects
- Constipation
- Upset stomach
Signs of Iron Overload
- Chronic fatigue
- Joint pain
- Generalized weakness
- Abdominal pain
- Unexplained weight loss
Probiotics
Probiotics may help reduce systemic inflammation through modulation of the gut microbiota. Some strains of probiotics may even stimulate GLP-1 receptors in the gut.
The probiotic strains included in studies have varied and include:
- Lactobacillus acidophilus
- Lactobacillus casei
- Bifidobacterium breve
- Lactobacillus rhamnosus
- Lactobacillus fermentum
- Streptococcus thermophilus
- Lactobacillus bulgaricus
- Bifidobacterium longum
When selecting a probiotic, look for a multi-strain formulation with a high number of colony-forming units (CFUs), typically with a potency of at least 10 billion to 50 billion CFUs.
Look for products that combine multiple Lactobacillus and Bifidobacterium species.
Prebiotics
Prebiotics are essentially the food that feeds probiotics. They are also known as fiber.
Good sources of prebiotic fiber include:
- Apples
- Asparagus
- Bananas
- Oats
- Garlic
- Onions
- Green leafy vegetables
- Inulin
- Chicory fiber
- Fructooligosaccharides (FOS)
Fiber provides several important benefits. It can help lower cholesterol, decrease inflammation, help you feel full longer, and regulate bowel movements.
It also serves as food for probiotics, which is why prebiotics and probiotics work best together.
Magnesium
Studies examining the effects of magnesium on PMOS / PCOS have been largely inconclusive. However, magnesium can produce a relaxed state and may help with sleep and anxiety.
You should not take more than 300 mg per day without consulting your medical provider.
Signs of Mild Magnesium Overdose
Early signs may include:
- Nausea
- Vomiting
- Stomach cramps
- Facial flushing
- Watery diarrhea
Signs of Moderate Magnesium Toxicity
Moderate toxicity may cause:
- Lethargy
- Severe muscle weakness
- Loss of deep tendon reflexes
- A sharp drop in blood pressure (hypotension)
Signs of Severe Magnesium Overdose
Severe magnesium toxicity is a medical emergency and may cause:
- Difficulty breathing due to respiratory muscle paralysis
- Irregular heartbeat or complete heart block
- Confusion
- Coma
- Cardiac arrest
Different Types of Magnesium
Magnesium Glycinate: Widely considered the best choice for PMOS / PCOS. It is highly bioavailable, gentle on the stomach, and effectively crosses the blood-brain barrier to aid sleep and anxiety.
Magnesium Citrate: May be useful if you experience chronic constipation alongside PMOS / PCOS, but it can cause loose stools if overused.
Magnesium Oxide: Commonly used in clinical trials, but it has a much lower absorption rate and is more likely to cause mild diarrhea.
Vitamins and Supplements Do Not Cure PMOS / PCOS
It is important to understand that vitamins and supplements do not cure PMOS / PCOS and, when taken without appropriate medical supervision, can cause harm.
Most vitamins and supplements do not treat PMOS / PCOS itself. Instead, they are considered adjunctive therapy.
Adjunctive therapy is an additional treatment given alongside a primary treatment to maximize its effectiveness or assist in recovery.
There is currently no cure for PMOS / PCOS. It is a chronic hormonal condition that requires ongoing medical management throughout your lifetime.
Your PMOS Treatment Needs May Change Throughout Your Life
Your PMOS / PCOS phenotype can change over your lifetime, which means your care plan may need personalized, ongoing adjustments as your body and health needs change.
The combination of medications that works for one patient will not necessarily work for another.
Patients should use FDA-approved medications found in the International Evidence-Based Guidelines for the Assessment and Management of PCOS under the guidance of their medical provider.
Individualized care is important because PMOS / PCOS does not look exactly the same in every patient—and neither should treatment.
Find Out Which Vitamins & Supplements You Need
If you’re wondering whether you have a vitamin or micronutrient deficiency or whether the supplements you’re currently taking are appropriate for you, testing can help provide answers.
If you’re interested in a Vitamin/Micronutrient Deficiency Assessment, schedule a visit with one of our trusted medical providers today. We’ll help identify potential deficiencies and ensure you’re taking supplements safely as part of your personalized PMOS / PCOS care plan.
