PCOS Supplement Recommendations: What Actually Helps, What’s Overhyped, and What to Prioritize

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions in women—and also one of the most confusing to manage. If you’ve ever searched “PCOS supplements,” you’ve probably been met with endless, conflicting advice: inositol, berberine, fertility teas, hormone powders, magnesium, peptides, apple cider vinegar, pink salt, and more. Chances are you’ve been flooded with supplement recommendations on social media, in Facebook groups, or from well-meaning friends as well.

It can feel overwhelming and expensive very quickly.

As a dietitian specializing in PCOS, hormone health, and metabolic nutrition, I want to cut through the noise and clarify what the research actually supports. Supplements can be helpful—but they are not magic pills, and they are not interchangeable.

As a dietitian specializing in PCOS, metabolic health, and hormone balance, I want to clarify what the research actually supports, what supplements may help specific symptoms, what’s optional, and what’s simply marketing.

This guide breaks down evidence-based PCOS supplements, common supplements you’ll see recommended online, what supplements may help specific symptoms, budgeting priorities, what’s optional, what’s simply marketing, and how to choose wisely—without chasing trends.

This guide breaks down:

• Evidence-based PCOS supplements

• What each supplement does

• Who it’s best for (and who should be cautious)

• Exact dosing used in research and clinical practice

• Which supplements to prioritize if your budget is limited

Throughout this guide, I’ll also link to deeper PCOS resources where nutrition and lifestyle strategies come first—because supplements only work when the foundation is solid.

Before We Begin: Supplements Are Supportive, Not Standalone PCOS Treatment

Supplements work best when paired with:

• Balanced, blood-sugar-supportive meals (see my PCOS Plate Blueprint)

• Adequate protein and fiber intake

• Stress and nervous system regulation (covered in Nervous System Nutrition for PCOS)

• Regular movement

• Adequate sleep and circadian rhythm support

If you’re skipping meals, under-eating, or chronically stressed, supplements will not override those signals. (I explain this further in PCOS Calorie Deficits & Weight Loss and PCOS Fatigue & Low Energy.)

Always inform your healthcare provider before starting supplements, especially if you’re pregnant, breastfeeding, trying to conceive, or taking medications like metformin, fertility drugs, thyroid meds, or GLP-1s.

Foundational, Evidence-Based Supplements for PCOS

These address the core drivers of PCOS: insulin resistance, inflammation, ovulatory dysfunction, and cardiometabolic risk.

1. Myo-Inositol (The #1 PCOS Supplement to Prioritize)

What it is: Myo-inositol is a vitamin-like compound involved in insulin signaling and ovarian function.

What it does in PCOS:

• Improves insulin sensitivity

• Lowers fasting insulin levels

• Supports ovulation and menstrual regularity

• Improves ovarian hormone signaling

• May improve egg quality and fertility outcomes

• Supports mood and anxiety regulation

In PCOS, impaired insulin signaling disrupts ovarian communication. Myo-inositol helps restore that signaling.

Who it’s best for:

• Insulin-resistant PCOS (including lean PCOS)

• Irregular cycles or anovulation

• Fertility support

• PCOS with anxiety or mood symptoms

Recommended Dose:

• 4 grams per day

• Can be taken once daily or divided into two 2-gram doses

Many protocols use a 40:1 ratio of myo-inositol to D-chiro-inositol, which reflects physiological ovarian ratios.

I break this down fully in Inositol for PCOS.

Bottom line: If you can only afford one supplement for PCOS, this is it.

2. N-Acetyl Cysteine (NAC)

What it is: NAC is a precursor to glutathione, the body’s primary antioxidant.

What it does in PCOS:

• Improves insulin sensitivity

• Reduces oxidative stress

• Supports ovulation

• Improves egg quality

• May enhance response to fertility medications

NAC is especially helpful in PCOS where inflammation and oxidative stress impair ovulation.

Who it’s best for:

• Insulin-resistant PCOS

• PCOS with infertility

• Women resistant to Clomiphene

Recommended Dose:

• 1,800–2,400 mg per day, divided

• During ART cycles: ~2 grams daily on cycle days 3–7 (under medical supervision)

3. Vitamin D (Often Overlooked, Extremely Important)

What it is: Vitamin D acts more like a hormone than a vitamin and plays a role in insulin signaling, inflammation, and ovarian function.

What it does in PCOS:

• Improves insulin sensitivity

• Reduces inflammation

• Supports ovulation and cycle regularity

• Supports mood and immune function

Vitamin D deficiency is extremely common in PCOS.

Who it’s best for:

• Anyone with low or unknown vitamin D levels

• PCOS with fatigue, insulin resistance, or irregular cycles

Target Blood Levels:

• 95–110 nmol/L (38–44 ng/mL)

Typical Supplemental Dose:

• 2,000–4,000 IU daily, adjusted based on labs

• Pair with Vitamin K2 (90–120 mcg) for calcium metabolism

4. Omega-3 Fatty Acids

What they are: EPA and DHA are anti-inflammatory fatty acids found in fish oil or algae oil.

What they do in PCOS:

• Reduce inflammation

• Improve triglycerides and cholesterol

• Support insulin sensitivity

• May reduce androgen activity

Omega-3s are foundational for long-term cardiometabolic health in PCOS.

Recommended Dose:

• 1,000–2,000 mg combined EPA + DHA daily

Especially important if you’re also navigating PCOS and cholesterol risk.

Additional Supplements That May Be Helpful (Context Matters)

These supplements may be beneficial depending on your specific symptoms, labs, and metabolic profile—but they are not universally required.

Berberine

What it is: A plant-derived compound that activates AMPK, a key metabolic regulator.

What it does in PCOS:

• Improves insulin sensitivity

• Lowers fasting glucose

• Reduces androgen levels

• Improves lipid profiles

Often compared to metformin—but not identical.

Who it’s best for:

• Insulin-resistant PCOS

• Elevated blood sugar or lipids

• Those who can’t tolerate metformin

Recommended Dose:

• 500 mg, 2–3 times daily with meals

• Cycle use is often recommended

Full breakdown in Berberine for PCOS: Benefits, Safety & Dosing.

Magnesium (Type Matters)

What it does: Supports nervous system regulation, sleep, insulin sensitivity, and muscle relaxation.

Best Forms:

• Glycinate: Stress, anxiety, sleep

• Malate: Fatigue

• Citrate: Constipation

Dose:

• 200–400 mg elemental magnesium daily

Learn more in Nervous System Nutrition for PCOS.

Zinc

What it does:

• Supports androgen metabolism

• Helps acne and hair health

Dose:

• 15–30 mg per day (short-term)

Spearmint

What it does: May reduce free testosterone and hirsutism.

Dose:

• 1–2 cups spearmint tea daily

Featured in How to Lower Androgens Naturally.

Gut Health & Hormone Detox Support (Optional, Symptom-Dependent)

Beyond insulin and ovarian signaling, gut health influences estrogen metabolism, inflammation, and hormone recycling. For some women with PCOS, gut-targeted supplements can be supportive—especially when digestive symptoms are present.

These supplements should always follow food-first fiber strategies, which I outline in the PCOS Plate Blueprint, before being layered in.

Probiotics

What they are: Beneficial bacteria that support gut integrity, immune regulation, and hormone metabolism.

Why they may help in PCOS:

• Support estrogen clearance

• Reduce inflammation

• Improve insulin sensitivity

• Support digestion and nutrient absorption

Who they’re best for:

• PCOS with bloating, constipation, or IBS-type symptoms

• History of frequent antibiotic use

• Estrogen-dominant symptoms

Recommended Dose:

• 10–50 billion CFUs daily

Clinical note: Not everyone with PCOS tolerates probiotics well, particularly those with suspected SIBO.

Prebiotics

What they are: Fermentable fibers that feed beneficial gut bacteria.

Who they’re best for:

• Constipation-predominant PCOS

• Low fiber intake

• Those without significant bloating

Recommended Dose:

• 2–6 grams daily, starting low

Food-based fiber strategies are often better tolerated long-term.

Mitochondrial, Energy & Fertility Support Supplements

PCOS is associated with increased oxidative stress and impaired cellular energy production, particularly in ovarian tissue. For some women, this contributes to persistent fatigue, reduced exercise tolerance, metabolic inflexibility, and fertility challenges—even when nutrition and sleep are addressed.

The supplements below support mitochondrial function and cellular energy production. They are not first-line PCOS treatments, but may be helpful in specific contexts.

Coenzyme Q10 (CoQ10)

Evidence strength: Moderate and growing
(CoQ10 has the strongest evidence in this category)

What it is:
A fat-soluble antioxidant essential for mitochondrial ATP (energy) production.

What it does in PCOS:

• Supports egg quality and ovarian function

• Reduces oxidative stress

• Improves insulin sensitivity

• Supports cardiovascular health

Several studies suggest CoQ10 supplementation may improve metabolic markers and ovulatory outcomes, particularly in fertility-focused PCOS care.

Who it’s best for:

• PCOS with persistent fatigue

• Fertility-focused PCOS

• PCOS with cardiometabolic risk factors

Recommended Dose:

• 100–300 mg daily

• Use ubiquinol for better absorption

• Take with a fat-containing meal

L-Carnitine

Evidence strength: Moderate
(More evidence for metabolic and fatigue outcomes than fertility)

What it does:
L-carnitine transports fatty acids into mitochondria so they can be used for energy.

Potential benefits in PCOS:

• Improved fatigue and exercise tolerance

• Support for metabolic flexibility

• Possible improvements in insulin sensitivity

Some studies suggest benefits for weight management, fatigue, and lipid profiles, though results are mixed.

Who it’s best for:

• PCOS with fatigue or low exercise tolerance

• Metabolic PCOS

• Those struggling with energy despite adequate intake

Recommended Dose:

• 1,000–3,000 mg per day, divided

Acetyl-L-Carnitine (ALCAR)

Evidence strength: Limited to emerging
(Potentially helpful, not first-line)

What it is:
A neurologically active form of carnitine that more readily crosses the blood–brain barrier.

Why it may help in PCOS:

• Supports mitochondrial energy production

• May help with mental fatigue or brain fog

• May support mood-related energy issues

Evidence in PCOS specifically is limited, but ALCAR has been studied for fatigue, cognitive function, and mitochondrial support in other populations.

Who it may be helpful for:

• PCOS with mental fatigue or brain fog

• Mood-related fatigue

• Those not responding to standard energy strategies

Recommended Dose:

• 500–1,500 mg daily, divided

Alpha-Lipoic Acid (ALA)

Evidence strength: Limited to moderate
(Potentially helpful, overlapping benefits with other supplements)

What it is:
A mitochondrial antioxidant involved in energy metabolism and insulin signaling.

What it may do in PCOS:

• Improve insulin sensitivity

• Reduce oxidative stress

• Support mitochondrial enzyme activity

Some studies suggest ALA may improve insulin resistance, but benefits often overlap with inositol, NAC, or lifestyle interventions.

Who it may be helpful for:

• PCOS with insulin resistance and fatigue

• Those who cannot tolerate metformin or berberine

Recommended Dose:

• 300–600 mg daily, divided

Clinical note:
ALA is not superior to inositol or NAC and is generally considered adjunctive, not foundational.

B-Complex or Targeted B Vitamins

Evidence strength: Context-dependent
(Helpful if deficient or at risk; not universally needed)

Why B vitamins matter:
B vitamins act as cofactors in mitochondrial energy production and hormone metabolism.

Most relevant for PCOS:

• Vitamin B12 (especially with metformin use)

• Vitamin B6 (progesterone metabolism, PMS support)

• Folate (5-MTHF) (fertility and methylation support)

Who it’s best for:

• PCOS with fatigue

• Metformin use

• Fertility planning

• Known deficiencies

Recommended Dose:

• B-complex at RDA-range doses

• Avoid megadosing unless deficiency is confirmed

Important Perspective on This Category

These supplements:

• Are not required for everyone with PCOS

• Are not substitutes for adequate calories, protein, sleep, or stress regulation

• Work best when foundational strategies are already in place

If fatigue persists despite addressing nutrition, blood sugar, iron status, sleep, and stress, mitochondrial support may be worth considering.

For deeper context, see Why PCOS Causes Fatigue (and How to Get Your Energy Back).

Bottom Line

• CoQ10 and L-carnitine → reasonably evidence-supported for energy and metabolic support

• ALCAR, ALA, and B-complex → potentially helpful, not essential, and highly individualized

Supplements to Be Cautious With

These are often recommended online but are not universal PCOS solutions:

• Iron (only if deficient)

• Ashwagandha (caution with thyroid conditions)

• Saw palmetto (short-term use only)

• Fertility teas & hormone powders (supportive rituals, not treatment)

• Apple cider vinegar, pink salt, peptides (not PCOS treatment)

PCOS, Supplements, and Cost: The Bigger Picture

Many women hesitate to invest in supplements—but unmanaged PCOS can lead to:

• Fertility treatments

• Type 2 diabetes

• Cardiovascular disease

• Chronic fatigue and burnout

Strategic supplementation paired with nutrition support can reduce long-term healthcare costs.

Final PCOS Supplement Ranking: What to Prioritize, What’s Conditional, and What’s Optional

Not all supplements play the same role in PCOS management. Some address root metabolic drivers, others support specific symptoms, and some are adjunctive tools that may be helpful only in certain contexts.

Below is a clear, evidence-aligned ranking of all supplements discussed in this guide, organized by priority and strength of evidence.

Tier 1: Foundational PCOS Supplements

(Highest Priority | Strongest Evidence | Broadest Benefit)

These supplements address the core drivers of PCOS, including insulin resistance, inflammation, ovulatory dysfunction, and long-term cardiometabolic risk.

1. Myo-Inositol

• Supports insulin signaling, ovulation, and ovarian hormone balance

• Strong evidence across PCOS phenotypes (including lean PCOS)

• Dose: 4 g/day (often in a 40:1 myo-inositol:D-chiro-inositol ratio)

2. Omega-3 Fatty Acids (EPA + DHA)

• Anti-inflammatory and cardioprotective

• Improves triglycerides, cholesterol, and insulin sensitivity

• Dose: 1,000–2,000 mg combined EPA + DHA daily

3. Vitamin D (With K2)

• Hormone-like effects on insulin sensitivity and ovarian function

• Deficiency is extremely common in PCOS

• Dose: 2,000–4,000 IU/day (adjusted to labs)

• Pair with Vitamin K2 (90–120 mcg)

Tier 2: Core Adjuncts

(Strong Evidence | Context-Dependent | High Impact When Indicated)

These supplements are not required for everyone, but can be highly effective when matched to symptoms and labs.

4. N-Acetyl Cysteine (NAC)

• Improves insulin sensitivity, ovulation, and oxidative stress

• Particularly helpful in fertility-focused PCOS

• Dose: 1,800–2,400 mg/day (divided)

5. Berberine

• Activates AMPK to improve insulin sensitivity and lipid metabolism

• Often compared to metformin (not identical)

• Best for: Insulin-resistant PCOS, elevated glucose or lipids

• Dose: 500 mg, 2–3x/day with meals

Tier 3: Mitochondrial, Energy & Fertility Support

(Moderate to Emerging Evidence | Symptom-Dependent)

These supplements support cellular energy production and oxidative balance. They are adjunctive, not foundational.

6. Coenzyme Q10 (CoQ10)

• Best evidence in this category

• Supports mitochondrial ATP production, egg quality, and cardiometabolic health

• Dose: 100–300 mg/day (ubiquinol form, with fat)

7. L-Carnitine

• Supports fatty acid transport into mitochondria

• May improve fatigue, exercise tolerance, and metabolic flexibility

• Dose: 1,000–3,000 mg/day

8. Acetyl-L-Carnitine (ALCAR)

• Neurologically active form of carnitine

• May help mental fatigue or brain fog

• Evidence: Limited to emerging

• Dose: 500–1,500 mg/day

9. Alpha-Lipoic Acid (ALA)

• Mitochondrial antioxidant with insulin-sensitizing effects

• Benefits overlap with inositol and NAC

• Evidence: Limited to moderate

• Dose: 300–600 mg/day

Tier 4: Nervous System & Symptom-Specific Support

(Helpful When Indicated | Not Universal)

These supplements address specific PCOS symptoms, not root causes.

10. Magnesium (Form Matters)

• Nervous system regulation, sleep, insulin sensitivity

• Dose: 200–400 mg elemental/day

• Glycinate (stress/sleep), Malate (fatigue), Citrate (constipation)

11. B-Complex / Targeted B Vitamins

• Supports mitochondrial enzymes and hormone metabolism

• Best for: Metformin use, fertility planning, known deficiencies

• Dose: RDA-range dosing unless deficient

12. Zinc

• Supports androgen metabolism, acne, and hair health

• Dose: 15–30 mg/day (short-term)

13. Spearmint (Tea)

• May reduce free testosterone and hirsutism

• Symptom management only

• Dose: 1–2 cups/day

Tier 5: Gut & Hormone Detox Support

(Optional | Highly Individualized)

These supplements may support estrogen metabolism and inflammation when GI symptoms are present.

14. Probiotics

• Gut integrity, immune regulation, estrogen clearance

• Dose: 10–50 billion CFUs/day

• Not tolerated by everyone

15. Prebiotics

• Feed beneficial gut bacteria

• Dose: 2–6 g/day (start low)

• Food-first fiber strategies preferred

Tier 6: Use With Caution or Limited Role in PCOS

These are commonly recommended online but are not foundational PCOS treatments:

• Iron (only if deficient)

• Ashwagandha (caution with thyroid conditions)

• Saw palmetto (short-term use only)

• Fertility teas & hormone powders

• Apple cider vinegar

• Pink salt

• Peptides

Simplified Priority Summary

If you want the most impact with the least overwhelm:

1. Myo-inositol

2. Omega-3 fatty acids

3. Vitamin D (with K2)

4. NAC

5. Berberine (if insulin resistance present)

6. CoQ10

7. L-carnitine / ALCAR / ALA (symptom-dependent)

8. Magnesium (form-specific)

9. B-complex (if indicated)

10. Spearmint (symptom-specific)

If You Can Only Afford 3 Supplements for PCOS

Priority Order:

1. Myo-Inositol (4 g/day)

2. Omega-3s (1–2 g EPA+DHA)

3. Vitamin D (with K2)

If symptoms persist:

• Add NAC next

The Bottom Line: Supplements Should Be Personalized

PCOS is not a one-size-fits-all condition—and your supplement plan shouldn’t be either.

What works for one woman may be unnecessary or even counterproductive for another.

Supplements work best when they are:

• Matched to your labs and symptoms

• Paired with food-first strategies

• Used intentionally—not reactively

Always inform your healthcare provider before starting any new supplement regimen.

If you want support creating a personalized PCOS supplement + nutrition plan, this is exactly what I do inside my private practice.

👉 Explore PCOS nutrition counseling and holistic hormone support here.