Wellness Goals · Women's health condition
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS), also called polyendocrine metabolic ovarian syndrome (PMOS) · also called PCOS, PMOS, polycystic ovarian syndrome, síndrome de ovario poliquístico, SOP
Polycystic ovary syndrome (PCOS), now also called polyendocrine metabolic ovarian syndrome (PMOS), is a hormone condition that can affect periods, hair growth, fertility, skin and mood. This guide explains the common features, how PCOS is evaluated, what established care looks like, and what inositol and other supplement research shows. Evidence for natural options is mostly low or very low, and PCOS needs a clinician for diagnosis and long-term check-ups.
General information, not medical advice. Last substantive update · Not medically reviewed. A named clinician has not signed off on this page. How this page is made
About Polycystic Ovary Syndrome (PCOS)
PCOS (also called PMOS) is a common hormone condition that can cause irregular periods, extra hair growth, acne, weight changes and difficulty getting pregnant. A clinician diagnoses it with symptoms, blood tests and, in adults, an ultrasound or AMH test. Established care combines lifestyle support, talking therapy and medicines chosen with a clinician. For supplements such as inositol, the evidence is limited or low in certainty, and none has been shown to replace established care.
What PCOS is (also called PMOS)
The NHS describes polyendocrine metabolic ovarian syndrome (PMOS), which used to be called polycystic ovary syndrome (PCOS), as a hormone condition that can affect hair growth, periods, fertility and mood. It can affect anyone who has ovaries, usually starts around puberty and continues until menopause. Symptoms can be mild, severe, or absent.
NICHD says women with PCOS usually have at least two of three features: absent ovulation (leading to irregular or no periods), high androgen hormones or signs of them such as extra face and body hair, and growths in one or both ovaries. It notes PCOS is the most common cause of infertility from absent ovulation, and that some women have no ovarian growths.
Common features and causes
The NHS lists irregular periods or long gaps, excess hair growth or hair loss, weight gain or difficulty losing weight, difficulty getting pregnant, depression or anxiety, oily skin and acne, tiredness, and dark patches of skin on the neck or armpits (acanthosis nigricans). Many of these are common and have other causes, so having them does not mean you have PCOS.
The cause is unknown. The NHS says it may involve hormones such as insulin and testosterone not working properly, and that you may be more likely to have it if a close relative has it or you are from an Asian background.
How PCOS is evaluated
The NHS says a GP may arrange tests with a gynaecologist or endocrinologist: blood tests for hormone levels and insulin resistance, and an ultrasound of the ovaries, which is done only for people over 18.
The 2023 international guideline simplified the diagnostic approach and allows anti-Mullerian hormone (AMH) as an alternative to ultrasound in adults only. In adolescents, diagnosis needs both irregular cycles (judged by time since the first period) and signs of high androgens, after other disorders are excluded; ultrasound and AMH should not be used then.
What established care looks like
The NHS says there is no cure but treatments and lifestyle changes can help. Lifestyle advice includes a healthy balanced diet, regular exercise, losing weight if overweight, and talking therapy if mood is affected. Medicines chosen with a clinician may include hormonal contraception or an intrauterine system for irregular periods, medicines to improve fertility or reduce hair growth, a type 2 diabetes medicine for tiredness and weight, and skin creams or tablets for acne. A procedure called laparoscopic ovarian drilling may be suggested for fertility problems if other treatments have not worked.
The 2023 guideline keeps the emphasis on healthy lifestyle, emotional wellbeing and avoiding weight stigma, and notes the evidence is of low to moderate quality.
Longer-term health
The NHS says PCOS can sometimes increase the risk of type 2 diabetes, high blood pressure, cardiovascular disease, non-alcoholic fatty liver disease and womb cancer, and that regular check-ups help reduce the risk. The guideline also stresses sleep apnea, a very high rate of psychological features and a high-risk status in pregnancy.
What natural approaches and supplement research show
Lifestyle programmes, exercise and DASH-style eating have low-certainty benefit for weight, insulin and androgen measures. Inositol evidence is limited and inconclusive. NAC, vitamin D, omega-3, probiotics and berberine show signals in small trials, but the certainty is low or very low. Spearmint tea was tested in one small trial, and acupuncture was no better than sham in a Cochrane review. Yoga and mindfulness programmes may help weight, hormones and quality of life.
None of these has been shown to replace established care, and safety data were thin in the abstracts read. See the Benefits and Evidence tabs for the details.
At a glance
Traditional uses history, not proof
Studied for research
- Lifestyle programmes, low certainty
- Regular exercise, low certainty
- Eating patterns such as DASH, low certainty
- Inositol, insufficient evidence
- N-acetylcysteine, low certainty
- Vitamin D, low certainty
- Omega-3, very low certainty
- Probiotics and synbiotics, low certainty
- Berberine as an add-on, low certainty
- Spearmint tea, very low certainty
- Acupuncture, insufficient evidence
- Yoga and mindfulness, low certainty
Main compounds
- Inositol
- N-acetylcysteine
- Vitamin D
- Omega-3 fatty acids
- Berberine
- Spearmint tea
- Probiotics
Common forms
- Eating patterns
- Exercise programmes
- Oral supplements
- Herbal tea
- Acupuncture
- Yoga and mindfulness classes
Research links: 2023 international guideline for PCOS (J Clin Endocrinol Metab) · NHS: Polyendocrine metabolic ovarian syndrome (PMOS) · NICHD: About PCOS · Inositol for PCOS, systematic review 2024 · Lifestyle changes in women with PCOS, Cochrane 2019 · Acupuncture for PCOS, Cochrane 2025 · Research Library · Genes & Biomarkers Library
What it is and its history
- Accepted scientific name
- Polycystic ovary syndrome (PCOS), now also called polyendocrine metabolic ovarian syndrome (PMOS)
- Common names
- Polycystic ovary syndrome (PCOS) (English); Polyendocrine metabolic ovarian syndrome (PMOS) (English); Síndrome de ovario poliquístico (SOP) (Spanish)
- Family or group
- Hormone (endocrine) and metabolic condition affecting the ovaries. NICHD says women with PCOS usually have at least two of three features: absent ovulation, high androgen hormones or their signs, and growths (follicles) in one or both ovaries.
Traditional use and history history, not clinical proof
| Tradition or era | Documented use | Source |
|---|---|---|
| Modern guidance | The 2018 international guideline was updated in 2023, which simplified diagnosis and added AMH as an alternative to ultrasound in adults. The NHS now uses the name PMOS. No older history was read for this page. | p37580314 |
Traditional use shows how it was used. It does not show that it works or is safe today.
What is inside, and how it may work
What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.
Main compounds
| Compound | Family | Where it is concentrated | Activity studied | Level of evidence |
|---|---|---|---|---|
| Inositol (myo- and D-chiro-) | sugar-alcohol supplement | Involved in insulin signalling; studied for insulin resistance and ovulation. 1 13 | Human data | |
| N-acetylcysteine (NAC) | amino-acid supplement | Antioxidant; studied for hormones and glucose. 12 10 | Human data | |
| Vitamin D | vitamin | Studied for ovulation, pregnancy and androgen levels. 16 | Human data | |
| Omega-3 fatty acids | fatty acids | Studied for blood fats, insulin resistance and testosterone. 5 | Human data | |
| Berberine | plant alkaloid | Studied as an add-on for ovulation and pregnancy. 4 | Human data | |
| Spearmint tea | herbal tea | Studied for androgen hormones and hirsutism. 3 | Human data | |
| Probiotics and synbiotics | live microbes and fibre | Studied for insulin, testosterone and weight. 14 | Human data |
Mechanisms, receptors and pathways
| Target or pathway | Gene or receptor | What was found | Level |
|---|---|---|---|
| Insulin and androgen hormones | The NHS says the cause is unknown but may involve hormones such as insulin and testosterone not working properly; you may be more likely to have it if a close relative has it or you are from an Asian background. 18 | Agency summary | |
| Ovulation | NICHD says PCOS is the most common cause of anovulatory infertility, where the ovary does not release an egg each month, and that research suggests there may be two or more genetic subtypes. 19 | Agency summary | |
| Insulin resistance | The 2024 inositol review states insulin resistance is common in PCOS, which is why insulin-sensitising approaches are studied. 1 | Review |
Isolated compounds versus whole extracts
The studies read tested single supplements (inositol, NAC, vitamin D, omega-3, berberine), one herbal tea, and whole eating patterns and exercise programmes. Results for one product should not be assumed for another.
8 low certainty2 very low certainty2 not enough evidence
What was looked at
The 12 benefits and uses checked for Polycystic Ovary Syndrome (PCOS), each with how strong the evidence is. Tap one to open it.
- Lifestyle programmes (diet, exercise and behaviour change)Low certainty
- Regular exerciseLow certainty
- Eating patterns (DASH, low-calorie, low-carb)Low certainty
- Inositol (myo-inositol and D-chiro-inositol)Not enough evidence
- N-acetylcysteine (NAC)Low certainty
- Vitamin DLow certainty
- Omega-3 fatty acidsVery low certainty
- Probiotics and synbioticsLow certainty
- Berberine (as an add-on)Low certainty
- Spearmint teaVery low certainty
- AcupunctureNot enough evidence
- Yoga and mindfulness-based programmesLow certainty
Lab markers tracked in the studies
Androgen hormones (testosterone, free androgen index)Insulin resistance (HOMA-IR, fasting insulin)Ovulation and pregnancy rate
What is Polycystic Ovary Syndrome (PCOS) good for?
The natural and lifestyle approaches that have been studied for PCOS, and how strong the human evidence is for each. These describe what studies found, not advice to use them. They do not replace the care described in the About tab.
Benefits, one by one
Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.
Lifestyle programmes (diet, exercise and behaviour change)
Low certaintyA Cochrane review of 15 small trials (498 women) found that diet, exercise and behavioural programmes may lower weight, BMI and the free androgen index, on low-quality evidence. No trial measured live birth or whether periods became regular. The 2023 international guideline keeps healthy lifestyle at the centre of PCOS care.
3 studiesThe trials used different programmes. No amounts or targets are advis…
Studies, doses and limits
What the trials found
Cochrane review of 15 randomised trials (498 women with PCOS; 10 on activity, 5 on combined diet, exercise and behaviour programmes, 1 on behaviour alone) and the 2023 guideline.
Results
Free androgen index fell (6 trials, 204 women); weight fell by about 1.7 kg (9 trials, 353 women); BMI fell slightly (12 trials, 434 women). Effect on glucose tolerance was uncertain. Live birth, miscarriage and menstrual regularity were not reported.
Effect sizes as reported
Free androgen index MD -1.11; weight MD -1.68 kg; BMI MD -0.34 kg/m2 (all low-quality evidence).
Why this rating
Low, the compiler's rating and the review's own: effects are small, trials were at high or unclear risk of bias, and results for the free androgen index varied a lot.
Form and dose studied
The trials used different programmes. No amounts or targets are advised here.
Who was studied
Women with PCOS, mostly overweight; the review gives no age breakdown in the abstract.
Limits
Small trials, mixed programmes, no fertility outcomes. The guideline also asks clinicians to avoid weight stigma.
Why researchers looked
Insulin resistance and weight gain tend to worsen PCOS, so changing eating and activity is the first thing studied and advised.
Proposed mechanism Hypothesis
Proposed: weight and activity changes improve how the body handles insulin, which can lower androgen hormones. Not tested directly in the review read.
A proposed mechanism does not show that the effect happens in people.
Strict dieting or heavy exercise plans are best set up with a clinician or dietitian, especially for teenagers and anyone with a history of disordered eating.
Regular exercise
Low certaintyA review of 18 trials found exercise lowered fasting insulin, insulin resistance (HOMA-IR) and cholesterol, and improved fitness, waist size and body fat in women with PCOS. The gains were largest in overweight women and in supervised aerobic programmes, but the evidence is low to very low quality.
2 studiesSupervised, aerobic and shorter programmes did best in subgroup analy…
Studies, doses and limits
What the trials found
Systematic review of 27 papers from 18 randomised or quasi-randomised trials in women with PCOS.
Results
Versus usual care: fasting insulin lower, HOMA-IR lower, total and LDL cholesterol and triglycerides lower, fitness (VO2 max), waist circumference and body fat improved. No change in blood pressure, fasting glucose or HDL cholesterol. Exercise with diet looked no different from diet alone, on limited data.
Effect sizes as reported
Fasting insulin MD -2.44 uIU/mL; HOMA-IR -0.57; waist -2.62 cm; VO2 max +3.84 ml/kg/min.
Why this rating
Low, the compiler's rating: the authors grade insulin results very low quality and lipid results low quality, and many results changed when single trials were removed.
Form and dose studied
Supervised, aerobic and shorter programmes did best in subgroup analysis. No amounts are advised here.
Who was studied
Women with PCOS; greatest improvement in those who were overweight or obese.
Limits
Modest effects with wide intervals; it was not possible to compare exercise with diet.
Why researchers looked
Exercise improves insulin sensitivity in other groups and insulin resistance is common in PCOS.
Proposed mechanism Hypothesis
Muscle uses blood sugar more efficiently after exercise. The review did not test this directly.
A proposed mechanism does not show that the effect happens in people.
Anyone with heart, joint or other health problems should check with a clinician before starting a new activity plan.
Eating patterns (DASH, low-calorie, low-carb)
Low certaintyA network meta-analysis of 19 trials (727 women) compared 10 diets. A DASH-style eating pattern ranked best for insulin resistance and fasting glucose, a low-calorie diet for BMI and a low-carb diet for cholesterol. These are rankings between diets, not proof that any one diet treats PCOS.
2 studiesStudies compared whole eating patterns. No amounts are advised here.
Studies, doses and limits
What the trials found
Systematic review and network meta-analysis of 19 randomised trials (727 women with PCOS), 10 diet types plus metformin.
Results
DASH ranked first for HOMA-IR, fasting glucose, fasting insulin and triglycerides; low-calorie for BMI; low-calorie with metformin for weight; low-carb for cholesterol; metformin for LDL cholesterol and total testosterone.
Effect sizes as reported
Ranking scores only (for example 92% for DASH on HOMA-IR); no effect sizes in the abstract.
Why this rating
Low, the compiler's rating: each diet was tested in very few trials, and rankings do not show how big the benefit is.
Form and dose studied
Studies compared whole eating patterns. No amounts are advised here.
Who was studied
Women with PCOS in 19 trials.
Limits
Rankings are not effect sizes and follow-up was short. The authors say there is limited evidence to prefer one diet.
Why researchers looked
The NHS advises a healthy balanced diet, and researchers have asked which pattern helps most.
Proposed mechanism Not established
Not established; the review ranked outcomes rather than explaining a mechanism.
A proposed mechanism does not show that the effect happens in people.
Cutting whole food groups can leave nutrition gaps; a dietitian can help.
Inositol (myo-inositol and D-chiro-inositol)
Not enough evidenceInositol is the best known supplement for PCOS. A review of 30 trials (2,230 women) done for the 2023 guideline found some metabolic benefits and possible help with ovulation from D-chiro-inositol, but called the evidence limited and inconclusive. A Cochrane review found low to very low quality evidence for fertility.
3 studiesThe trials used different forms and combinations; the abstracts give …
Studies, doses and limits
What the trials found
Systematic review of 30 trials (2,230 women, 19 pooled) and a Cochrane review of 13 trials (1,472 subfertile women).
Results
Some metabolic measures improved; D-chiro-inositol may help ovulation; other outcomes showed no effect. Compared with metformin, inositol caused fewer stomach side effects (typically mild) but metformin may do better on waist-hip ratio and hirsutism. For fertility, live birth and pregnancy results were uncertain (live birth OR 2.42, CI 0.75 to 7.83).
Effect sizes as reported
Narrative in the 2024 review; Cochrane: clinical pregnancy OR 1.27 (CI 0.87 to 1.85).
Why this rating
Insufficient, the reviews' own conclusion: "limited and inconclusive" (2024) and low to very low quality (Cochrane).
Form and dose studied
The trials used different forms and combinations; the abstracts give no standard product. No amounts are advised here.
Who was studied
Women with PCOS, including subfertile women before IVF.
Limits
Small, varied trials; only 3 comparisons could be pooled; key fertility outcomes were poorly reported.
Why researchers looked
Inositol is involved in insulin signalling, and insulin resistance is common in PCOS.
Proposed mechanism Hypothesis
Proposed: inositol acts as a second messenger for insulin, so extra supply might improve insulin sensitivity. Not confirmed in the reviews read.
A proposed mechanism does not show that the effect happens in people.
Mild stomach upset was the side effect noted. Ask a clinician or pharmacist before adding inositol, especially when trying to conceive.
N-acetylcysteine (NAC)
Low certaintyNAC is an amino-acid supplement. Two meta-analyses of small trials found it lowered total testosterone, raised FSH, and lowered fasting glucose and cholesterol compared with placebo, with no clear difference from metformin on most measures. The evidence is low in certainty.
2 studiesThe trials used different NAC products and lengths. No amounts are ad…
Studies, doses and limits
What the trials found
Meta-analysis of 18 studies (2,185 women) on hormones and ovulation, and meta-analysis of 11 randomised trials (869 women) on metabolic measures.
Results
Total testosterone lower and FSH higher; no clear change in follicle number, progesterone, LH or SHBG. Versus placebo, fasting glucose and total cholesterol were lower. Versus metformin, most measures were not clearly different.
Effect sizes as reported
Total testosterone SMD -0.25 (CI -0.39 to -0.10); fasting glucose vs placebo SMD -0.54 (CI -1.03 to -0.05).
Why this rating
Low, the compiler's rating: small trials, high variation between them, and the abstracts report no side-effect data.
Form and dose studied
The trials used different NAC products and lengths. No amounts are advised here.
Who was studied
Women with PCOS in randomised trials.
Limits
High heterogeneity; mixed comparators; the abstracts say little about safety.
Why researchers looked
NAC is an antioxidant studied for insulin resistance and for ovulation.
Proposed mechanism Hypothesis
Proposed: antioxidant and insulin-sensitising effects. Not tested directly in the reviews read.
A proposed mechanism does not show that the effect happens in people.
Side effects were not described in the abstracts read. Ask a clinician or pharmacist first, particularly when pregnant or trying to conceive.
Vitamin D
Low certaintyA meta-analysis of 20 trials (1,961 women with PCOS) found vitamin D was linked with higher ovulation and pregnancy rates, fewer early miscarriages and lower androgen levels. The authors say the trials were of limited quality, so this is a promising but unconfirmed signal.
1 studiesThe trials used different forms and amounts of vitamin D. No amounts …
Studies, doses and limits
What the trials found
Systematic review and meta-analysis of 20 randomised trials (1,961 women), including women using fertility treatments.
Results
Pregnancy RR 1.44; ovulation RR 1.42; early miscarriage RR 0.44; androgen level lower. No clear change in biochemical pregnancy, fertilisation, gestational diabetes or AMH.
Effect sizes as reported
Pregnancy RR 1.44 (1.28 to 1.62); early miscarriage RR 0.44 (0.30 to 0.66).
Why this rating
Low, the compiler's rating: the review itself cites limited study quality, and pooled trials were mixed.
Form and dose studied
The trials used different forms and amounts of vitamin D. No amounts are advised here.
Who was studied
Women with PCOS, including those undergoing fertility treatment.
Limits
Quality of the included studies was limited; the abstract gives no vitamin D blood levels or doses.
Why researchers looked
Low vitamin D is common in women with PCOS and vitamin D affects ovarian and insulin function.
Proposed mechanism Hypothesis
Proposed: vitamin D receptors in the ovary and effects on insulin. Not tested in the review.
A proposed mechanism does not show that the effect happens in people.
The abstract gives no safety data or amounts for vitamin D, so ask a clinician or pharmacist first, especially during pregnancy.
Omega-3 fatty acids
Very low certaintyA meta-analysis of 7 studies (574 women) found omega-3 lowered cholesterol, triglycerides, insulin resistance and testosterone in PCOS, but not BMI, fasting glucose, or the hirsutism score. Results varied widely, so the certainty is very low.
1 studiesStudies used different omega-3 products. No amounts are advised here.
Studies, doses and limits
What the trials found
Meta-analysis of 7 controlled studies (574 women with PCOS).
Results
Lower total cholesterol, triglycerides, HOMA-IR and testosterone (P < .05). No clear effect on BMI, fasting glucose, LDL, HDL or hirsutism score.
Effect sizes as reported
Significance only (P < .05); sizes not given in the abstract.
Why this rating
Very low, the compiler's rating: only 7 studies, marked heterogeneity and no effect sizes in the abstract.
Form and dose studied
Studies used different omega-3 products. No amounts are advised here.
Who was studied
Women with PCOS in controlled trials.
Limits
Marked heterogeneity; more research and longer follow-up needed, say the authors.
Why researchers looked
Omega-3 fats affect inflammation and blood fats, and blood fats are often raised in PCOS.
Proposed mechanism Hypothesis
Proposed: anti-inflammatory and lipid-lowering action. Not tested directly here.
A proposed mechanism does not show that the effect happens in people.
The abstract gives no safety or interaction data for omega-3 products; ask a pharmacist, especially if you take other medicines.
Probiotics and synbiotics
Low certaintyA 2026 meta-analysis of 11 trials (780 women) found probiotic or synbiotic supplements were linked with lower fasting insulin, testosterone, triglycerides, LDL cholesterol, BMI and weight, with no clear effect on blood sugar, HOMA-IR or most other hormones. The size of the effects is small.
1 studiesDifferent probiotic strains, combinations and one prebiotic were pool…
Studies, doses and limits
What the trials found
Systematic review and meta-analysis of 11 randomised trials (780 women with PCOS).
Results
Fasting insulin MD -1.41; total testosterone MD -0.19; triglycerides, LDL, BMI and weight lower; HDL higher. No clear change in fasting glucose, HOMA-IR, FSH, LH, SHBG or CRP.
Effect sizes as reported
Total testosterone MD -0.19 (CI -0.25 to -0.12); BMI MD -0.49 (CI -0.88 to -0.10).
Why this rating
Low, the compiler's rating: the review reports high GRADE certainty for several outcomes, but trials were few and small, products and strains differed, and several results sit close to no effect.
Form and dose studied
Different probiotic strains, combinations and one prebiotic were pooled; the abstract names none. No amounts are advised here.
Who was studied
Women with PCOS in randomised trials.
Limits
Pooled products are not interchangeable; short trials; abstract read only.
Why researchers looked
Gut bacteria may influence insulin, inflammation and hormones, so probiotics have been tried.
Proposed mechanism Hypothesis
Proposed: changes in gut bacteria alter inflammation and hormone handling. Not shown in the review.
A proposed mechanism does not show that the effect happens in people.
The abstract gives no safety data for probiotics; ask a clinician or pharmacist first, particularly if you have a weakened immune system or are pregnant.
Berberine (as an add-on)
Low certaintyA meta-analysis of 10 trials (713 women) found berberine added to conventional treatment was linked with higher ovulation and clinical pregnancy rates and lower LH and testosterone, compared with conventional treatment alone. It was always an add-on, so this does not show berberine alone works.
1 studiesBerberine was added to conventional medicine in the trials. No amount…
Studies, doses and limits
What the trials found
Meta-analysis of 10 randomised trials (713 women with PCOS and reduced fertility).
Results
Ovulation RR 1.41, clinical pregnancy RR 1.96, endometrial thickness +1.62 mm, LH and total testosterone lower; FSH not changed.
Effect sizes as reported
Clinical pregnancy RR 1.96 (1.59 to 2.41); ovulation RR 1.41 (1.26 to 1.60).
Why this rating
Low, the compiler's rating: no information on trial quality in the abstract, add-on design only, and the authors call for more trials.
Form and dose studied
Berberine was added to conventional medicine in the trials. No amounts are advised here.
Who was studied
Women with PCOS and reduced fertility.
Limits
Add-on design; trial quality not described in the abstract.
Why researchers looked
Berberine is a plant compound studied for blood sugar and insulin resistance.
Proposed mechanism Hypothesis
Proposed: improves insulin sensitivity. Not tested in the review.
A proposed mechanism does not show that the effect happens in people.
The abstract gives no safety data on berberine, including in pregnancy or alongside other medicines, so ask a clinician or pharmacist first.
Spearmint tea
Very low certaintyOne small trial of 42 women found a month of spearmint tea lowered testosterone hormones and improved how women rated their own excess hair, but the clinician-rated hair score did not change. It is a single short trial.
1 studiesSpearmint tea was taken twice a day for a month in the trial; no amou…
Studies, doses and limits
What the trials found
Randomised trial of spearmint tea twice a day for 30 days vs placebo herbal tea (42 volunteers, 41 completed, two centres).
Results
Free and total testosterone fell (p < 0.05); LH and FSH rose; self-rated hirsutism improved; the objective Ferriman-Gallwey score did not differ (p = 0.12).
Effect sizes as reported
Hormone changes significant; objective hair score not significant.
Why this rating
Very low, the compiler's rating: one tiny, one-month trial where the main clinical measure did not change.
Form and dose studied
Spearmint tea was taken twice a day for a month in the trial; no amounts are advised here.
Who was studied
Women with PCOS and hirsutism.
Limits
Very small, short, one trial; author notes 30 days may be too short.
Why researchers looked
Spearmint tea has anti-androgen effects in earlier small studies.
Proposed mechanism Human data
Proposed: lowers androgen hormones. Hormone changes were seen in the trial.
A proposed mechanism does not show that the effect happens in people.
No safety data in the abstract. Ask a clinician if pregnant or taking hormone medicines.
Acupuncture
Not enough evidenceA 2025 Cochrane review of 9 trials (1,606 women) found no clear difference between acupuncture and sham (fake) acupuncture for live birth, ovulation, pregnancy, miscarriage or regular periods. Adverse events were probably more common with acupuncture.
1 studiesAcupuncture and electroacupuncture sessions as reported in the trials.
Studies, doses and limits
What the trials found
Cochrane systematic review of 9 randomised trials (1,606 women with PCOS and irregular ovulation).
Results
Versus sham: live birth RR 0.97 (CI 0.76 to 1.23) in one trial of 1,000 women; ovulation, clinical pregnancy and miscarriage also showed little or no difference. Adverse events RR 1.16 (CI 1.02 to 1.31), including bleeding, fatigue, dizziness, nausea and bruising.
Effect sizes as reported
Live birth RR 0.97; adverse events RR 1.16.
Why this rating
Insufficient, the compiler's rating: low-certainty finding of no difference from sham, very uncertain against other comparators.
Form and dose studied
Acupuncture and electroacupuncture sessions as reported in the trials.
Who was studied
Women with PCOS who rarely or never ovulate.
Limits
Few trials, important outcomes missing, mixed comparators.
Why researchers looked
Acupuncture is thought to affect brain-ovary hormone signals and is used for PCOS and fertility.
Proposed mechanism Hypothesis
Proposed: raises beta-endorphin, which may affect hormone release. Not confirmed.
A proposed mechanism does not show that the effect happens in people.
Adverse events were more common; see a trained, regulated practitioner and tell your clinician.
Yoga and mindfulness-based programmes
Low certaintyA 2026 review of 10 trials (356 women) found mindfulness-based programmes, including yoga, lowered BMI, weight, waist size, testosterone and hirsutism, and improved PCOS-specific quality of life, though general depression and anxiety scores did not clearly change. A separate review of 9 yoga trials was positive but could not pool results.
2 studiesGroup or home programmes of yoga postures, breathing and meditation. …
Studies, doses and limits
What the trials found
Meta-analysis of 10 randomised trials (356 women) and a systematic review of 9 randomised yoga trials.
Results
Lower BMI, weight, abdominal circumference, total testosterone and hirsutism; preliminary improvement in insulin resistance (2 studies); PCOS-specific quality of life better. Mood scores not clearly different. The yoga review reported benefits across body, hormone, menstrual and mood measures but could not pool them.
Effect sizes as reported
Significant but sizes not given in the abstracts.
Why this rating
Low, the compiler's rating for the mindfulness meta-analysis; the yoga review alone would be very low.
Form and dose studied
Group or home programmes of yoga postures, breathing and meditation. No amounts are advised here.
Who was studied
Women with PCOS in small trials.
Limits
Few small trials, very different programmes, no standard protocol.
Why researchers looked
Stress and mood problems are common in PCOS and yoga may help body weight and hormones.
Proposed mechanism Hypothesis
Proposed: lowering stress hormones and improving insulin handling. Not tested in the reviews.
A proposed mechanism does not show that the effect happens in people.
The abstracts give no safety data; check with a clinician if you have joint, heart or pregnancy concerns, and see the Yoga page for safety.
Connections to the rest of health
How Polycystic Ovary Syndrome (PCOS) connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.
Explore every connection: goals, body systems, organs, symptoms, genes
A. Wellness goals
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Womens Wellness | Low certainty | Lifestyle programmes (diet, exercise and behaviour change): A Cochrane review of 15 small trials (498 women) found that diet, exercise and behavioural programmes may lower weight, BMI and the free androgen index, on low-quality evidence. No trial measured live birth or whether periods became regular. The 2023 international guideline keeps healthy lifestyle at the centre of PCOS care. Regular exercise: A review of 18 trials found exercise lowered fasting insulin, insulin resistance (HOMA-IR) and cholesterol, and improved fitness, waist size and body fat in women with PCOS. The gains were largest in overweight women and in supervised aerobic programmes, but the evidence is low to very low quality. | 9 15 18 7 6 1 13 12 10 16 5 14 4 17 8 2 | |
| Womens Wellness | Very low certainty | Spearmint tea: One small trial of 42 women found a month of spearmint tea lowered testosterone hormones and improved how women rated their own excess hair, but the clinician-rated hair score did not change. It is a single short trial. | 3 |
B. Body systems
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Metabolism Weight | Biological association | Low certainty | Studied for: Lifestyle programmes (diet, exercise and behaviour change) Studied for: Regular exercise | 9 15 18 7 6 5 14 |
| Reproductive System | Biological association | Not enough evidence | Studied for: Inositol (myo-inositol and D-chiro-inositol) Studied for: N-acetylcysteine (NAC) | 1 13 18 12 10 16 4 3 17 |
| Stress Mood | Biological association | Low certainty | Studied for: Yoga and mindfulness-based programmes | 8 2 |
I. Biomarkers
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Androgen hormones (testosterone, free androgen index) | Biological association | Low certainty | Measured in trials: fell with lifestyle programmes and with NAC in pooled trials. A lab change is not the same as a health benefit. | 9 12 |
| Insulin resistance (HOMA-IR, fasting insulin) | Biological association | Low certainty | Measured in trials: fell with exercise in pooled trials; DASH-style eating ranked best in a network analysis. A lab change is not the same as a health benefit. | 7 6 |
| Ovulation and pregnancy rate | Biological association | Low certainty | Measured in trials: higher with vitamin D and berberine add-on in pooled trials; no clear difference with acupuncture versus sham. A lab change is not the same as a health benefit. | 16 4 17 |
L. Active compounds
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Inositol (myo- and D-chiro-) | Biological association | Human | Involved in insulin signalling; studied for insulin resistance and ovulation. | 1 13 |
| N-acetylcysteine (NAC) | Biological association | Human | Antioxidant; studied for hormones and glucose. | 12 10 |
| Vitamin D | Biological association | Human | Studied for ovulation, pregnancy and androgen levels. | 16 |
| Omega-3 fatty acids | Biological association | Human | Studied for blood fats, insulin resistance and testosterone. | 5 |
| Berberine | Biological association | Human | Studied as an add-on for ovulation and pregnancy. | 4 |
| Spearmint tea | Biological association | Human | Studied for androgen hormones and hirsutism. | 3 |
| Probiotics and synbiotics | Biological association | Human | Studied for insulin, testosterone and weight. | 14 |
Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 31, 2026).
Evidence at a glance: what the research found for 12 outcomes
Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.
The evidence
The research centre for Polycystic Ovary Syndrome (PCOS). Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.
Evidence by outcome
Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).
How we rate evidence
High certainty
Several well-run trials or reviews agree; further research is unlikely to change the picture much.
Moderate certainty
Good trials point the same way, but some doubt remains.
Low certainty
Small, short or inconsistent trials. The finding could change with better research.
Very low certainty
Very little or very weak human data. Treat as a possibility only.
Mixed findings
Trials or reviews disagree with each other.
Not enough evidence
Not enough human research to say either way.
Evidence against
Good research found no benefit, or found harm.
We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, re-read the abstract of every review, trial and guideline cited, and downloaded and read the NHS and NICHD pages. Full texts of studies were not read. Certainty ratings are the compiler's own reading, except where a source gives its own grade (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.
Study library: every study we checked 19
| Study | Design | People | Product, dose, length | Result |
|---|---|---|---|---|
| Fitz 2024 Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines. J Clin Endocrinol Metab · PMID 38163998 · DOI |
Systematic review meta analysis |
2230 30 trials (2,230 women with PCOS), 19 pooled |
Myo-inositol or D-chiro-inositol, alone or with other therapies · vs Placebo, no treatment, or metformin |
Some metabolic measures improved with inositol and D-chiro-inositol may help ovulation, but inositol may have no effect on other outcomes. Metformin may improve waist-hip ratio and hirsutism more than inositol, with likely no difference for reproductive outcomes. Myo-inositol likely causes fewer stomach and gut side effects than metformin, typically mild and short-lived. Conclusion: evidence is limited and inconclusive. Narrative summary; no numbers in the abstract Methods, limits and fundingOutcomes: Hormonal, metabolic, lipid, psychological, body, reproductive outcomes and side effects Limitations: Only 3 comparisons could be pooled; the authors call the evidence limited and inconclusive. Abstract read only. Funding and conflicts: Done to inform the 2023 guideline; funding not stated in the abstract. Read: abstract |
| Gautam 2026 Yoga as a complementary intervention for polycystic ovary Syndrome management: a systematic review. Front Reprod Health · PMID 42318079 · DOI |
Systematic review |
9 randomised trials of yoga in women with PCOS (4 from one research group counted as one) | Yoga (postures and breathing), plus meditation or mindfulness · vs Control or other care |
Yoga was linked with better body measures, insulin and glucose, lipids, hirsutism, some hormones, menstrual and mood outcomes. Meditation and mindfulness helped mainly body image, stress, anxiety, depression and quality of life. No pooled analysis was possible because trials differed so much. No pooled numbers Methods, limits and fundingOutcomes: Weight, insulin, hormones, periods, mood Limitations: Very few trials, small, very different in method, so the findings may not apply broadly. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract |
| Grant 2010 Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res · PMID 19585478 · DOI |
Randomised controlled trial |
42 42 volunteers with PCOS at two centres; 41 finished |
Spearmint herbal tea twice a day for 30 days · vs Placebo herbal tea |
Free and total testosterone fell in the spearmint group and LH and FSH rose. Self-rated hirsutism scores improved, but the clinician-rated Ferriman-Gallwey score did not differ between groups (p = 0.12). The author says the 30 days may have been too short. Hormone changes significant (p < 0.05); objective hirsutism score not significant Methods, limits and fundingOutcomes: Androgen hormones, Ferriman-Gallwey hirsutism score, quality-of-life questionnaire Limitations: Very small, one month long, and the objective hair-growth measure did not change. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract |
| Ha 2024 Berberine as adjuvant therapy for treating reduced fertility potential in women with polycystic ovary syndrome: A meta-analysis of randomized controlled trials. Explore (NY) · PMID 39236662 · DOI |
Systematic review meta analysis |
713 10 randomised trials, 713 women with PCOS and reduced fertility |
Berberine added to Western (conventional) medicine · vs Conventional treatment alone |
Berberine as an add-on was linked with higher ovulation (RR 1.41) and clinical pregnancy (RR 1.96), thicker endometrium, and lower LH and total testosterone. FSH did not differ. Clinical pregnancy RR 1.96 (1.59 to 2.41); ovulation RR 1.41 (1.26 to 1.60) Methods, limits and fundingOutcomes: Ovulation, pregnancy, endometrial thickness, LH, testosterone Limitations: Berberine was always an add-on to conventional treatment, quality of the trials was not described in the abstract, and further trials are needed. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract |
| Huang 2023 Meta-analysis of the efficacy of ω-3 polyunsaturated fatty acids when treating patients with polycystic ovary syndrome. Medicine (Baltimore) · PMID 37773824 · DOI |
Systematic review meta analysis |
574 7 controlled studies, 574 women with PCOS |
Omega-3 fatty acids (ω-3 PUFAs) · vs Control |
Omega-3 lowered total cholesterol, triglycerides, HOMA-IR and testosterone. No clear effect on BMI, fasting glucose, LDL or HDL cholesterol, or the hirsutism score. Results varied widely between studies. Significant (P < .05) for cholesterol, triglycerides, HOMA-IR and testosterone; sizes not given in the abstract Methods, limits and fundingOutcomes: Cholesterol, triglycerides, insulin resistance, testosterone, hirsutism score Limitations: Marked heterogeneity and only 7 studies; the authors call for more research. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract |
| Juhász 2024 Ranking the dietary interventions by their effectiveness in the management of polycystic ovary syndrome: a systematic review and network meta-analysis. Reprod Health · PMID 38388374 · DOI |
Systematic review network meta analysis |
727 19 randomised trials, 727 women with PCOS |
10 dietary approaches (including DASH, low-calorie, low-carb diets) · vs Standard diet, other diets, or metformin |
The DASH-style diet ranked best for insulin resistance (HOMA-IR), fasting glucose, fasting insulin and triglycerides. A low-calorie diet ranked best for BMI. The low-carb diet ranked best for cholesterol. Metformin ranked best for LDL cholesterol and total testosterone. The authors conclude diets differ in their effects on metabolic measures. Ranking values (SUCRA) only, e.g. DASH 92.33% for HOMA-IR; no effect sizes in the abstract Methods, limits and fundingOutcomes: Body measures, hormones, glucose, insulin, lipids Limitations: Rankings are not effect sizes; many diets were tested in very few trials. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Registration: PROSPERO CRD42021282984 Read: abstract |
| Kite 2019 Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev · PMID 30755271 · DOI |
Systematic review meta analysis |
27 papers from 18 randomised or quasi-randomised trials in women with PCOS | Exercise, or exercise combined with diet · vs Usual care, diet alone, or each other |
Versus usual care, exercise lowered fasting insulin and HOMA-IR (very low-quality evidence), total and LDL cholesterol and triglycerides (low-quality evidence), and improved fitness (VO2 max), waist circumference and body fat. No effect on blood pressure, fasting glucose or HDL cholesterol. Gains were largest in overweight or obese participants and in supervised, aerobic, shorter programmes. Exercise plus diet was not clearly different from diet alone on limited data. Fasting insulin MD -2.44 uIU/mL (CI -4.24 to -0.64); HOMA-IR -0.57 (CI -0.99 to -0.14); waist -2.62 cm (CI -4.13 to -1.11) Methods, limits and fundingOutcomes: Insulin, HOMA-IR, cholesterol, fitness, waist, body fat, BMI Limitations: Many effects were modest with wide intervals, and several were sensitive to removing single trials. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Registration: PROSPERO CRD42017062576 Read: abstract |
| Li 2026 Efficacy of mindfulness-based interventions on psychological distress, hyperandrogenism, and metabolic profile in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Appl Psychol Health Well Being · PMID 42538604 · DOI |
Systematic review meta analysis |
356 10 randomised trials, 356 women with PCOS |
Mindfulness-based interventions (including yoga and mindfulness meditation) · vs Control |
Lower BMI, weight and abdominal circumference, preliminary improvement in insulin resistance (2 studies), lower total testosterone and less hirsutism. General depression and anxiety scores did not differ, but PCOS-specific quality of life improved. Significant but sizes not given in the abstract Methods, limits and fundingOutcomes: Body measures, insulin resistance, hormones, hirsutism, quality of life, mood Limitations: Only 10 small trials of mixed programmes; insulin resistance rests on two studies. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract |
| Lim 2019 Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev · PMID 30921477 · DOI |
Systematic review meta analysis |
498 15 randomised trials, 498 women with PCOS |
Lifestyle treatment (exercise, diet, behavioural, or combined) · vs Minimal or no treatment |
No trial measured live birth, miscarriage or menstrual regularity. Lifestyle treatment may lower the free androgen index (6 trials, 204 women), weight (9 trials, 353 women) and BMI (12 trials, 434 women), all on low-quality evidence. The authors were uncertain about glucose tolerance. Free androgen index MD -1.11 (95% CI -1.96 to -0.26); weight MD -1.68 kg (CI -2.66 to -0.70); BMI MD -0.34 kg/m2 (CI -0.68 to -0.01) Methods, limits and fundingOutcomes: Live birth, miscarriage, pregnancy, free androgen index, weight, BMI, glucose tolerance Limitations: Most studies were low quality with high or unclear risk of bias, and the free androgen index result was highly inconsistent (I2 71%). Abstract read only. Funding and conflicts: Cochrane review; the abstract gives no funding detail. Read: abstract |
| Liu 2023 The effects of N-acetylcysteine supplement on metabolic parameters in women with polycystic ovary syndrome: a systematic review and meta-analysis. Front Nutr · PMID 37841396 · DOI |
Systematic review meta analysis |
869 11 randomised trials, 869 women with PCOS |
N-acetylcysteine (NAC) supplement · vs Metformin or placebo |
Against metformin, NAC changed BMI, weight, insulin and lipids by amounts whose intervals included no difference, and lowered fasting glucose slightly (SMD -0.23, CI -0.43 to -0.04). Against placebo it lowered fasting glucose (SMD -0.54, CI -1.03 to -0.05) and total cholesterol (SMD -0.74, CI -1.37 to -0.12). The authors call it a possible alternative. Fasting glucose vs placebo SMD -0.54 (CI -1.03 to -0.05) Methods, limits and fundingOutcomes: Weight, glucose, insulin, cholesterol Limitations: Small trials and wide intervals; most outcomes showed no clear difference. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Registration: PROSPERO CRD42022339171 Read: abstract |
| Peña 2025 International evidence-based recommendations for polycystic ovary syndrome in adolescents. BMC Med · PMID 40069730 · DOI |
Clinical guideline |
Adolescents with PCOS or "at risk" of PCOS (adolescent-specific part of the 2023 guideline) | Diagnosis and care of PCOS in adolescents |
In adolescents, diagnosis needs both irregular cycles (judged by years since the first period) and signs of high androgen hormones, after other disorders are excluded. Ultrasound of the ovaries or AMH should not be used for diagnosis in adolescence. Adolescents with only one feature can be considered "at risk" and followed up. Lifelong health planning includes healthy lifestyle, screening for depression and metabolic features, and shared decision-making, while explaining weight-related risks without weight stigma. Evidence in adolescents is limited and recommendations rest on low to moderate certainty. Not a pooled estimate Methods, limits and fundingOutcomes: Adolescent-specific recommendations Limitations: Evidence in adolescents is limited; abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract |
| Shahveghar Asl 2023 The effects of N-acetylcysteine on ovulation and sex hormones profile in women with polycystic ovary syndrome: a systematic review and meta-analysis. Br J Nutr · PMID 36597797 · DOI |
Systematic review meta analysis |
2185 18 studies, 2,185 women with PCOS |
N-acetylcysteine (NAC) supplement · vs Placebo or other treatments |
NAC lowered total testosterone and raised FSH. There was no clear effect on follicle number, endometrial thickness, progesterone, LH or sex hormone-binding globulin. The authors say NAC might help reproductive function. Total testosterone SMD -0.25 (CI -0.39 to -0.10); FSH SMD 0.39 (CI 0.07 to 0.71) Methods, limits and fundingOutcomes: Ovulation-related measures and sex hormones Limitations: Moderate to high heterogeneity (I2 54% and 71%); trials mixed placebo and drug comparators. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract |
| Showell 2018 Inositol for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev · PMID 30570133 · DOI |
Systematic review meta analysis |
1472 13 randomised trials, 1,472 subfertile women with PCOS (mostly before IVF) |
Myo-inositol · vs Standard treatment, placebo, metformin, clomiphene or others |
The authors were uncertain whether myo-inositol improves live birth (OR 2.42, CI 0.75 to 7.83; 2 trials, 84 women) or clinical pregnancy (OR 1.27, CI 0.87 to 1.85; 4 trials, 535 women). A lower miscarriage result depended mainly on one trial, and the effect vanished when it was removed. Evidence was low to very low quality. Live birth OR 2.42 (CI 0.75 to 7.83); clinical pregnancy OR 1.27 (CI 0.87 to 1.85) Methods, limits and fundingOutcomes: Live birth, miscarriage, multiple pregnancy, clinical pregnancy Limitations: Poor reporting of methods, inconsistency, and no reporting of key outcomes such as adverse events. Abstract read only. Funding and conflicts: Cochrane review; the abstract gives no funding detail. Read: abstract |
| Sun 2026 Efficacy of probiotic and synbiotic supplementation on metabolic and endocrine parameters in polycystic ovary syndrome: a meta-analysis of randomized controlled trials. BMC Endocr Disord · PMID 42420973 · DOI |
Systematic review meta analysis |
780 11 randomised trials, 780 women with PCOS |
Probiotic or synbiotic supplements (one trial of a prebiotic) · vs Placebo or control |
Fasting insulin, total testosterone, triglycerides, LDL cholesterol, BMI and weight were lower and HDL cholesterol higher. No clear effect on fasting glucose, HOMA-IR, FSH, LH, SHBG, total cholesterol or CRP. The authors rate the certainty as high for testosterone, lipids, BMI and weight. Total testosterone MD -0.19 (CI -0.25 to -0.12); fasting insulin MD -1.41 (CI -2.76 to -0.05); BMI MD -0.49 (CI -0.88 to -0.10) Methods, limits and fundingOutcomes: Insulin resistance, hormones, lipids, body measures, inflammation Limitations: Different strains and products were pooled; several results had intervals close to no effect; the authors rate certainty higher than small, short trials usually support (the compiler view). Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Registration: PROSPERO CRD420251125178 Read: abstract |
| Teede 2023 Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab · PMID 37580314 · DOI |
Clinical guideline |
People with polycystic ovary syndrome; international guideline, 39 organisations in 71 countries | Assessment and management of PCOS (all approaches) |
The 2023 update has 77 evidence-based and 54 consensus recommendations and 123 practice points. Key updates: a simpler diagnostic approach that allows anti-Mullerian hormone (AMH) as an alternative to ultrasound in adults only; wider recognition of metabolic risk, cardiovascular disease, sleep apnea, a very high rate of psychological features and high risk of adverse pregnancy outcomes; and a continued emphasis on healthy lifestyle, emotional wellbeing and avoiding weight stigma. The evidence has improved but remains of low to moderate quality. 254 recommendations and practice points in total Methods, limits and fundingOutcomes: Recommendations for diagnosis and care Limitations: The authors say recommendations are strengthened but the evidence is generally low to moderate quality, and much more research is needed. The abstract is a summary of a much longer guideline. Funding and conflicts: Mainly funded by the Australian Government (NHMRC) with society partners; some authors declare industry grants, consulting or advisory roles with fertility and diagnostics companies (stated in the abstract). Read: abstract |
| Yang 2023 Effects of vitamin D supplementation on ovulation and pregnancy in women with polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) · PMID 37593349 · DOI |
Systematic review meta analysis |
1961 20 randomised trials, 1,961 women with PCOS |
Vitamin D supplementation · vs Control (placebo or none) |
Pregnancy rate (RR 1.44), ovulation rate (RR 1.42), mature oocyte rate and androgen levels favoured vitamin D, and early miscarriage was lower (RR 0.44). Fertilisation rate, biochemical pregnancy, gestational diabetes and AMH showed no clear difference. Pregnancy RR 1.44 (1.28 to 1.62); ovulation RR 1.42 (1.14 to 1.78); early miscarriage RR 0.44 (0.30 to 0.66) Methods, limits and fundingOutcomes: Pregnancy, ovulation, miscarriage, hormones Limitations: The authors cite limited quality of the included studies and call for better trials. Abstract read only. Funding and conflicts: No funding or conflict statement in the record read. Registration: PROSPERO CRD42021250284 Read: abstract |
| Zhang 2025 Acupuncture for polycystic ovary syndrome. Cochrane Database Syst Rev · PMID 41147529 · DOI |
Systematic review |
1606 9 randomised trials, 1,606 women with PCOS and irregular or absent ovulation |
Acupuncture (including electroacupuncture) · vs Sham acupuncture, relaxation, exercise, or conventional drugs |
Against sham acupuncture there was little or no difference in live birth (RR 0.97, 1 trial of 1,000 women), ovulation, clinical pregnancy or miscarriage, all low-certainty. Adverse events were probably more common with acupuncture (RR 1.16, CI 1.02 to 1.31). Reported events included vaginal bleeding, weight gain, fatigue, dizziness, nausea and bruising. Evidence against other comparators was very uncertain. Live birth RR 0.97 (0.76 to 1.23); adverse events RR 1.16 (1.02 to 1.31) Methods, limits and fundingOutcomes: Live birth, ovulation, pregnancy, miscarriage, periods, adverse events Limitations: Few trials, mostly small; important outcomes missing. Abstract read only. Funding and conflicts: The review authors declare no funding support or conflicts. Read: abstract |
| s-nhs-pmos NHS: Polyendocrine metabolic ovarian syndrome (PMOS) (page last reviewed 30 June 2026) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-nichd-pcos NICHD (US NIH): About Polycystic Ovary Syndrome (PCOS) (last reviewed 2 July 2026) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text |
What we do not know yet
- No large, long placebo-controlled trial of a single supplement for diagnosed PCOS with live birth as the outcome was read.
- Primary trials behind the vitamin D, omega-3, probiotic and berberine reviews were not read.
- Safety and pregnancy data for the supplements were not in the abstracts read.
- Interaction studies between supplements and PCOS medicines were not read.
- Long-term follow-up beyond a few months was not read for any natural approach.
- MedlinePlus and NCCIH pages on PCOS could not be loaded, so they were not used.
How new research is added
New studies are found by a saved PubMed search and placed in a review queue before the page changes.
Lab markers
What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".
Other 3
Androgen hormones (testosterone, free androgen index)
Fell with lifestyle programmes and with NAC in pooled trials in trials
Blood measures of male-type hormones, which are raised in many women with PCOS and linked to extra hair growth, acne and irregular periods.
Low certaintyResults and what it means
Why it was measured
High androgens are one of the main features of PCOS and a common trial outcome.
Statistical vs. clinical meaning
A lab value, not a symptom: a lower testosterone does not always mean fewer symptoms.
Insulin resistance (HOMA-IR, fasting insulin)
Fell with exercise in pooled trials; DASH-style eating ranked best in a network analysis in trials
A calculated score from fasting blood sugar and insulin that shows how well the body responds to insulin.
Low certaintyResults and what it means
Why it was measured
Insulin resistance is common in PCOS and is linked to metabolic risk.
Statistical vs. clinical meaning
A useful measure of metabolic health, but a score on paper, not how a woman feels.
Ovulation and pregnancy rate
Higher with vitamin D and berberine add-on in pooled trials; no clear difference with acupuncture versus sham in trials
The share of women who ovulate or become pregnant in a trial.
Low certaintyResults and what it means
Why it was measured
Fertility is a main concern for many women with PCOS.
Statistical vs. clinical meaning
Directly relevant outcome, but the supplement trials are small and of limited quality.
| Study | Result | People | Product |
|---|---|---|---|
| 16 | Vitamin D: pregnancy RR 1.44 (1.28 to 1.62); ovulation RR 1.42 (1.14 to 1.78). | 1,961 women in 20 trials | Vitamin D |
| 4 | Berberine add-on: ovulation RR 1.41; clinical pregnancy RR 1.96. | 713 women in 10 trials | Berberine added to conventional treatment |
| 17 | Acupuncture vs sham: live birth RR 0.97 (0.76 to 1.23). | 1,000 women in 1 trial | Acupuncture |
Safety
What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.
Main points to know 6
- See a doctor if you think you have PCOS or symptoms affect daily life. The NHS says to see a GP if you think you might have PMOS (PCOS) or if symptoms are affecting your everyday life, work and relationships. Many symptoms, such as irregular periods, extra hair, acne and tiredness, can have other causes, so they are worth getting checked rather than self-treating. A clinician can arrange blood tests and, in adults, an ultrasound. Health agency guidance 18 15
- PCOS can raise longer-term health risks, so regular check-ups matter. The NHS lists type 2 diabetes, high blood pressure, cardiovascular disease, non-alcoholic fatty liver disease and womb (uterus) cancer as conditions PCOS can sometimes make more likely. It says regular check-ups reduce the chance of developing them. The 2023 guideline also stresses metabolic risk, sleep apnea and high rates of psychological features. Health agency guidance 18 15
- Low mood and anxiety are common and treatable. The NHS lists depression and anxiety among PMOS symptoms and suggests talking therapy if symptoms are causing them. The guideline reports a very high prevalence of psychological features, and the adolescent recommendations include screening for depression. Tell a clinician if mood is low or you cannot cope. Health agency guidance and guideline 18 15 11
- Do not stop prescribed treatment for a supplement. No study read compared a supplement with established care. Inositol, NAC and other products are described as limited or uncertain, and the guideline names inositol evidence as inconclusive. Decisions about medicines for periods, hair growth, acne, blood sugar or fertility belong with a clinician. Guideline and review 1 15
- Fertility and pregnancy need clinician guidance. The NHS says PMOS can make it harder to get pregnant, usually because the ovaries do not release an egg every month, and that treatments exist. The 2023 guideline notes a high risk of adverse outcomes during pregnancy. Ask a clinician or pharmacist before using any supplement or herb when trying to conceive or pregnant. Health agency guidance and guideline 18 15
- Acupuncture caused more side effects than sham. The Cochrane review found adverse events were probably more common with acupuncture than sham (RR 1.16), including bleeding, weight gain, fatigue, dizziness, nausea and bruising, with no clear benefit for pregnancy or ovulation. Systematic review of randomised trials 17
Side effects 3
| Effect | How often | Severity and recovery | Evidence |
|---|---|---|---|
| Stomach and gut upset with inositol | Described as typically mild and self-limited, and likely less than with metformin; no rate in the abstract. | Mild | Systematic review 1 |
| Bleeding, fatigue, dizziness, nausea and bruising with acupuncture | Adverse events RR 1.16 (CI 1.02 to 1.31) vs sham acupuncture, 3 trials, 1,230 women; moderate certainty. | Not graded in the abstract | Cochrane review of randomised trials 17 |
| Safety of vitamin D, omega-3, NAC, probiotics, berberine and spearmint tea | Not reported in the abstracts read. | Unknown | Absence of evidence 16 5 12 14 4 3 |
Medicines and supplements 2
| With | Why it matters | Importance | Evidence | What to do |
|---|---|---|---|---|
| Prescription medicines for PCOS (hormonal contraception, metformin, anti-hair-growth, acne, blood-sugar or fertility medicines) prescription | No study found. | No interaction study of the natural options with these medicines was read. Absence of a study is not proof of safety. | Absence of evidence Not enough evidence 18 1 | Tell your doctor or pharmacist about every supplement, tea or herb you use, especially berberine, inositol, NAC and vitamin D, which were studied alongside or against conventional treatment. |
| Other supplements and herbal products general | No study found. | The sources read did not test combinations of supplements. Several PCOS products are sold together. | Absence of evidence Not enough evidence 17 | Avoid stacking several supplements without a clinician or pharmacist reviewing the list. |
Who should check first 4
| Situation | Advice | Evidence |
|---|---|---|
| Pregnancy, trying to conceive or breastfeeding | Ask a clinician or pharmacist before any supplement, herb or tea. The guideline notes higher risk of adverse pregnancy outcomes in PCOS, and none of the supplement reviews read gave pregnancy safety data. | Guideline 15 |
| Teenagers | The adolescent recommendations say diagnosis differs from adults: ultrasound and AMH should not be used for diagnosis in adolescence, and adolescents with only one feature are followed as "at risk". Care should be directed by a clinician. The NHS says ultrasound is only done for adults over 18. | Guideline 11 18 |
| History of disordered eating | Weight-focused advice can be harmful; the guideline asks for care to avoid weight stigma. Talk to a clinician before a diet or exercise plan. | Guideline 15 11 |
| Diabetes, prediabetes or high blood pressure | Supplements that affect blood sugar (inositol, berberine, NAC) were not tested alongside diabetes medicines in the abstracts read. Ask a clinician. | Absence of evidence 1 4 10 |
Overdose, product quality and regulators
| Body | Action | Date |
|---|---|---|
| NHS (England) (United Kingdom) | Describes PMOS (formerly PCOS) as a hormone condition affecting periods, hair growth, fertility, skin and mood. Lists blood tests and an ultrasound (adults over 18), treatments including hormonal contraception, medicines for hair growth, acne, fertility and weight, and lifestyle advice. Says there is no cure. source | 2026-06-30 |
| NICHD, US National Institutes of Health (United States) | Says women with PCOS usually have at least two of three features: absent ovulation, high androgen hormones or their signs, and ovarian growths; notes it is the most common cause of anovulatory infertility. source | 2026-07-02 |
| 2023 International Evidence-based PCOS Guideline (Monash University-led, approved by Australia NHMRC) (International) | Simplified diagnosis, AMH as an alternative to ultrasound in adults only, wider recognition of metabolic, sleep apnea and psychological features; evidence of low to moderate quality; inositol evidence called limited and inconclusive in the linked review. source | 2023 |
When to get medical help
- Thoughts of harming yourself, or feeling unable to keep yourself safe: contact your local emergency number or a crisis line in your country now, or go to the nearest emergency department.
- Low mood, hopelessness or anxiety that is affecting daily life: see a clinician. The guideline reports a very high rate of psychological features in PCOS and the NHS suggests talking therapy.
- Loud snoring, gasping or breathing pauses at night, or heavy daytime sleepiness: tell a clinician, because the guideline names sleep apnea as a broader feature of PCOS.
Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.
General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.
Frequently asked questions
What is PCOS?
The NHS describes polyendocrine metabolic ovarian syndrome (PMOS), formerly PCOS, as a hormone condition that can affect hair growth, periods, fertility and mood. NICHD says women with PCOS usually have at least two of three features: absent ovulation, high androgen hormones or signs of them, and ovarian growths.
Is PCOS the same as PMOS?
What are the common features of PCOS?
The NHS lists irregular periods or long gaps, extra hair growth or hair loss, weight gain or difficulty losing weight, difficulty getting pregnant, depression or anxiety, oily skin and acne, tiredness, and dark patches of skin on the neck or armpits. Many have other causes, so having them does not mean you have PCOS.
How is PCOS evaluated?
A clinician may arrange blood tests for hormone levels and insulin resistance and, if you are over 18, an ultrasound of the ovaries. The 2023 guideline allows AMH as an alternative to ultrasound in adults only; in adolescents diagnosis rests on irregular cycles and signs of high androgens after other causes are excluded.
Can PCOS be cured?
The NHS says there is no cure, but treatments and lifestyle changes can help symptoms.
Does inositol work for PCOS?
Do diet and exercise help PCOS?
Do any natural supplements for PCOS have good evidence?
Can I get pregnant with PCOS?
Does PCOS affect long-term health?
The NHS says it can increase the risk of type 2 diabetes, high blood pressure, cardiovascular disease, fatty liver disease and womb cancer, and advises regular check-ups.
Is PCOS linked to depression or anxiety?
Does PCOS go away after menopause?
The NHS says some symptoms stop or may change after menopause.
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Editorial transparency
- Written by
- AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
- Medical review
- None. This page has not been reviewed by a physician or pharmacist.
- First published
- 2026-10-31
- Last substantive update
- 2026-10-31
- How we research
- We searched PubMed, re-read the abstract of every review, trial and guideline cited, and downloaded and read the NHS and NICHD pages. Full texts of studies were not read. Certainty ratings are the compiler's own reading, except where a source gives its own grade (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.
- How we rate evidence
- See "How we rate evidence" in the Evidence tab.
- Independence
- No product is promoted on this page. No affiliate links are shown.
Sources 19
Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.
- Fitz V, Graca S, Mahalingaiah S et al.. Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines.. J Clin Endocrinol Metab. 2024. PMID 38163998. DOI 10.1210/clinem/dgad762. (abstract)
- Gautam R, Maan P, Arora A et al.. Yoga as a complementary intervention for polycystic ovary Syndrome management: a systematic review.. Front Reprod Health. 2026. PMID 42318079. DOI 10.3389/frph.2026.1753608. (abstract)
- Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial.. Phytother Res. 2010. PMID 19585478. DOI 10.1002/ptr.2900. (abstract)
- Ha S, Song X. Berberine as adjuvant therapy for treating reduced fertility potential in women with polycystic ovary syndrome: A meta-analysis of randomized controlled trials.. Explore (NY). 2024. PMID 39236662. DOI 10.1016/j.explore.2024.103040. (abstract)
- Huang Y, Zhang X. Meta-analysis of the efficacy of ω-3 polyunsaturated fatty acids when treating patients with polycystic ovary syndrome.. Medicine (Baltimore). 2023. PMID 37773824. DOI 10.1097/MD.0000000000035403. (abstract)
- Juhász AE, Stubnya MP, Teutsch B et al.. Ranking the dietary interventions by their effectiveness in the management of polycystic ovary syndrome: a systematic review and network meta-analysis.. Reprod Health. 2024. PMID 38388374. DOI 10.1186/s12978-024-01758-5. (abstract)
- Kite C, Lahart IM, Afzal I et al.. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis.. Syst Rev. 2019. PMID 30755271. DOI 10.1186/s13643-019-0962-3. (abstract)
- Li D, Zheng J, Wang G. Efficacy of mindfulness-based interventions on psychological distress, hyperandrogenism, and metabolic profile in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials.. Appl Psychol Health Well Being. 2026. PMID 42538604. DOI 10.1111/aphw.70195. (abstract)
- Lim SS, Hutchison SK, Van Ryswyk E et al.. Lifestyle changes in women with polycystic ovary syndrome.. Cochrane Database Syst Rev. 2019. PMID 30921477. DOI 10.1002/14651858.CD007506.pub4. (abstract)
- Liu J, Su H, Jin X et al.. The effects of N-acetylcysteine supplement on metabolic parameters in women with polycystic ovary syndrome: a systematic review and meta-analysis.. Front Nutr. 2023. PMID 37841396. DOI 10.3389/fnut.2023.1209614. (abstract)
- Peña AS, Witchel SF, Boivin J et al.. International evidence-based recommendations for polycystic ovary syndrome in adolescents.. BMC Med. 2025. PMID 40069730. DOI 10.1186/s12916-025-03901-w. (abstract)
- Shahveghar Asl Z, Parastouei K, Eskandari E. The effects of N-acetylcysteine on ovulation and sex hormones profile in women with polycystic ovary syndrome: a systematic review and meta-analysis.. Br J Nutr. 2023. PMID 36597797. DOI 10.1017/S0007114522003270. (abstract)
- Showell MG, Mackenzie-Proctor R, Jordan V et al.. Inositol for subfertile women with polycystic ovary syndrome.. Cochrane Database Syst Rev. 2018. PMID 30570133. DOI 10.1002/14651858.CD012378.pub2. (abstract)
- Sun Z, Zhang R, Tian X et al.. Efficacy of probiotic and synbiotic supplementation on metabolic and endocrine parameters in polycystic ovary syndrome: a meta-analysis of randomized controlled trials.. BMC Endocr Disord. 2026. PMID 42420973. DOI 10.1186/s12902-026-02398-5. (abstract)
- Teede HJ, Tay CT, Laven JJE et al.. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.. J Clin Endocrinol Metab. 2023. PMID 37580314. DOI 10.1210/clinem/dgad463. (abstract)
- Yang M, Shen X, Lu D et al.. Effects of vitamin D supplementation on ovulation and pregnancy in women with polycystic ovary syndrome: a systematic review and meta-analysis.. Front Endocrinol (Lausanne). 2023. PMID 37593349. DOI 10.3389/fendo.2023.1148556. (abstract)
- Zhang GS, Lim ECN, Cheng NCL et al.. Acupuncture for polycystic ovary syndrome.. Cochrane Database Syst Rev. 2025. PMID 41147529. DOI 10.1002/14651858.CD007689.pub5. (abstract)
- . NHS: Polyendocrine metabolic ovarian syndrome (PMOS) (page last reviewed 30 June 2026). . . (full-text)
- . NICHD (US NIH): About Polycystic Ovary Syndrome (PCOS) (last reviewed 2 July 2026). . . (full-text)
