The 7 Best Supplements for PCOS (Now PMOS): An Evidence-Based Guide for Clinicians

Editor’s note: On May 12, 2026, Polycystic Ovary Syndrome (PCOS) was officially renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS), due to the misleading nature of the original name. PMOS more accurately reflects the nature of the condition’s multisystem pathophysiology. The contents of this blog post have been updated to reflect the change, though the references retain the former terminology.

In a Nutshell

• Insulin resistance and chronic low-grade inflammation are key drivers of PMOS (formerly PCOS), contributing to its metabolic, hormonal, and reproductive effects.
• Inositol, magnesium, berberine, and N-acetyl-cysteine (NAC) have evidence supporting their use as insulin-sensitizing supplements in patients with PMOS.
• Fish oil (omega-3), vitamin D, and CoQ10 may help address inflammation and associated metabolic dysfunction, with research showing benefits across insulin, lipid, hormonal, and inflammatory markers.
• Supplements are not a cure for PMOS, but evidence supports their use as part of a comprehensive management approach alongside lifestyle modification and pharmacotherapy when indicated.

As a provider who treats PMOS (formerly known as PCOS), the conventional protocol—oral contraceptives, spironolactone, and ovulation induction agents—is likely familiar. While these medications serve important roles in specific clinical scenarios (assisted reproduction, acne, hirsutism management), they do not fully address the underlying pathophysiology of PMOS, namely hyperinsulinemia, insulin resistance, and chronic low-grade inflammation.[1][2][3] Consequently, they may fall short in preventing long-term complications such as cardiovascular disease and type 2 diabetes.[4][5]

• Best Supplements for PCOS/PMOS
• Supplement Categories
• Insulin-sensitizing Supplements
• Anti-Inflammatory Supplements
• The Bottom Line
• FAQs
• References

Best Supplements for PCOS/PMOS

A growing body of evidence supports the use of targeted nutritional supplements that address these root causes. Although most clinicians are trained to manage PMOS pharmacologically, the supplements discussed here are backed by randomized controlled trials, systematic reviews, and meta-analyses published in peer-reviewed journals such as the European Journal of Endocrinology, the Journal of Clinical Endocrinology and Metabolism, and the British Journal of Nutrition.[6][7][8] Given that PMOS is best managed with a comprehensive, multidisciplinary approach, supplements have a legitimate place in the treatment plan when the evidence supports their use.

Supplement Categories

The supplements discussed here fall into two categories: insulin-sensitizing and anti-inflammatory. This article will feature four insulin sensitizers, and briefly touch on three anti-inflammatory supplements. Together, these seven supplements have some of the most relevant clinical research for managing PMOS (formerly PCOS), including research related to infertility, secondary symptoms such as hirsutism, and long-term complications such as type 2 diabetes 

Insulin-Sensitizing Supplements for PCOS/PMOS

Supplements and drugs that promote insulin sensitivity allow insulin to work more effectively so that smaller amounts are needed. Hyperinsulinemia can drive the ovaries to produce excessive testosterone in some women and disrupt other key hormones—luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and progesterone—perpetuating a self-reinforcing cycle of reproductive and metabolic dysfunction.[9][2][3] Reducing both fasting and postprandial insulin levels therefore improves PMOS across multiple domains. The supplements below work through different mechanisms, but all improve the body's responsiveness to insulin, which in turn improves PMOS outcomes. 

Inositol 

Inositol is a sugar alcohol and vitamin-like compound that improves the function of insulin receptors.[10] Two isomeric forms—myo-inositol (MI) and D-chiro-inositol (DCI)—are clinically relevant. Taking both in the correct ratio offers more benefit than either alone; notably, excessive DCI relative to MI may worsen certain PMOS parameters.[11] Proper prescribing ratios are therefore essential.

Beyond improving insulin sensitivity, inositol has been shown to reduce inflammation, improve oocyte and embryo quality, increase fertilization and pregnancy rates, and decrease the risk of gestational diabetes.[10][12] A 2023 systematic review and meta-analysis of 26 RCTs (1,691 patients) found that inositol significantly improved menstrual cycle regularity, reduced BMI, lowered free and total testosterone, decreased fasting glucose, and increased sex hormone-binding globulin (SHBG) compared with placebo—with non-inferiority to metformin on most outcomes.[13] A 2025 umbrella review of 13 meta-analyses confirmed significant improvements in HOMA-IR, fasting insulin, LH, testosterone, SHBG, live birth rates, and ovulation rates compared with placebo.[14]

An umbrella review of RCT meta-analyses also found moderate-certainty evidence that inositol supplementation reduces fasting insulin and increases ovulation rates in subfertile women with PMOS.[12] However, the 2023 international evidence-based PCOS guidelines noted that while there are potential benefits, the overall evidence remains limited and clinicians should engage in shared decision-making with patients regarding its use.[6]

Inositol is one of the most heavily researched supplements for PMOS and is arguably the single most important nutraceutical in this space. 

Magnesium 

Many women with PMOS have lower serum magnesium concentrations compared with controls, particularly those who are overweight or obese.[15][16] Magnesium is the second most abundant intracellular cation in the human body and plays a vital role in glucose metabolism and insulin signaling.[17] A cross-sectional analysis of 1,000 women with PMOS found that lower serum magnesium was independently associated with greater insulin resistance and higher testosterone levels.[18] Women with PMOS also have lower dietary magnesium intake compared with women without the condition.[19]

Magnesium supplementation has been shown to improve insulin resistance, and deficiency has been associated with an increased risk for type 2 diabetes.[17] A systematic review of 12 clinical trials found that magnesium supplementation reduced fasting glucose, fasting insulin, and HOMA-IR values, particularly in patients with hypomagnesemia.[17]

In a randomized, double-blind, placebo-controlled trial of 60 women with PMOS, magnesium supplementation (250 mg magnesium oxide daily) for eight weeks resulted in favorable decreases in BMI and testosterone levels compared with placebo.[20] When co-supplemented with vitamin E, magnesium has also been shown to significantly reduce serum insulin, HOMA-IR, triglycerides, hirsutism scores, and hs-CRP in women with PMOS.[21][22] However, a systematic review noted that magnesium supplementation alone did not consistently improve markers of inflammation, oxidative stress, or metabolism, and that combination supplementation appeared more effective.[23]

Magnesium status can be assessed with a serum magnesium level, though this reflects only extracellular stores. Good dietary sources include dark leafy greens, avocados, dark chocolate, legumes, meat, fish, and whole grains. Selecting a highly bioavailable form that minimizes gastrointestinal side effects is important for patient adherence. 

Berberine 

Berberine—an isoquinoline alkaloid isolated from herbs such as Oregon grape and goldenseal—has demonstrated insulin-sensitizing effects comparable to metformin.[7][24] In a three-month RCT of 89 women with PMOS and insulin resistance, berberine (500 mg TID) reduced waist circumference, waist-to-hip ratio, total cholesterol, triglycerides, and LDL cholesterol compared with metformin, while also increasing HDL cholesterol and SHBG.[7] 

A systematic review and meta-analysis of 12 RCTs found that berberine significantly decreased total testosterone and the LH/FSH ratio compared with placebo, and improved waist circumference, waist-to-hip ratio, and total cholesterol compared with metformin.[25] A meta-analysis of 9 RCTs in PMOS patients with insulin resistance found no significant difference between berberine and metformin in alleviating insulin resistance, improving glycolipid metabolism, or improving reproductive endocrine parameters—suggesting comparable efficacy.[24]

A retrospective study found that adjunctive berberine therapy significantly reduced fasting insulin, fasting blood sugar, HOMA-IR, total testosterone, and inflammatory markers (CRP, TNF-α, IL-6) in women with PMOS.[26] Berberine also has potential benefits for nonalcoholic steatohepatitis—a common long-term complication of PMOS—through its effects on liver fat, triglycerides, and liver enzymes.[27]

Importantly, berberine did not increase the incidence of gastrointestinal adverse events compared with placebo in pooled analyses, which may represent an advantage over metformin for some patients.[25] 

N-Acetyl-Cysteine (NAC) 

NAC is an antioxidant that functions as both an insulin sensitizer and anti-inflammatory agent. It enhances intracellular antioxidant defenses by promoting glutathione synthesis and improves insulin responsiveness.[28][2] A landmark study by Fulghesu et al. concluded that NAC treatment improves insulin sensitivity in women with hyperinsulinemic PMOS, suggesting it may serve as a novel therapeutic approach for this population.

A systematic review and meta-analysis of 18 RCTs involving 2,185 women with PMOS demonstrated that NAC significantly reduced total testosterone levels and increased FSH levels.[8] This is a clinically important finding because many women with PMOS have an elevated LH-to-FSH ratio, which limits follicle growth at the start of a cycle and results in either anovulation or release of an immature oocyte.

A 2024 randomized controlled clinical study of 230 women with PMOS found that NAC supplementation (1.8 g/day) significantly enhanced ovulation induction efficacy when combined with sequential letrozole and urinary FSH, resulting in greater clinical pregnancy rates per cycle and cumulative pregnancy rates per patient compared with controls.[29] NAC also significantly reduced the required gonadotropin dosage and duration.[29]

Two reviews of the evidence have confirmed that NAC, whether used alone or in combination with other medications, has the potential to counteract oxidative stress, reduce inflammation, and offer benefits in managing PMOS through multiple mechanisms including effects on insulin signaling pathways.[28][30] 

Anti-Inflammatory Supplements for PCOS/PMOS

Chronic low-grade inflammation is a key feature of PMOS and can compound the insulin resistance, metabolic dysfunction, and hormonal imbalances associated with the condition. Supplements with anti-inflammatory and antioxidant effects may help address these underlying processes while also supporting metabolic and reproductive health. The supplements below—fish oil, vitamin D, and CoQ10—work through different mechanisms, but each has evidence supporting its role in improving inflammatory, metabolic, or hormonal outcomes in women with PMOS.

Fish Oil (Omega-3)

An umbrella review of RCT meta-analyses found moderate-certainty evidence that fish oil supplementation decreases fasting insulin and HOMA-IR, reduces triglycerides, and increases adiponectin (with high certainty) in women with PMOS.[12] A network meta-analysis found omega-3 to be superior in reducing HOMA-IR compared with other nutritional supplements.[31]

Vitamin D

A meta-analysis of 10 RCTs found that vitamin D supplementation significantly reduced HOMA-IR, fasting insulin, hs-CRP, and total testosterone in women with PMOS compared with placebo.[32] Vitamin D deficiency is highly prevalent in this population and is associated with worsened insulin resistance and hyperandrogenism.[33] High-dose supplementation (≥4,000 IU daily) for at least 12 weeks appears to yield the most consistent benefits.[34] 

CoQ10

A systematic review and meta-analysis of 9 RCTs (1,021 patients) found that CoQ10 supplementation significantly improved HOMA-IR, fasting insulin, fasting glucose, testosterone, FSH, and lipid profiles in women with PMOS.[35] A network meta-analysis ranked CoQ10 as the most effective nutritional supplement for reducing triglycerides, total cholesterol, and LDL cholesterol in this population.[36]

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