The supplement shelf, mapped honestly

What the evidence says

Inositol is the most studied supplement: a 2024 systematic review of 30 randomised trials, done for the 2023 international guideline, found the evidence limited and inconclusive. Spearmint tea lowered free testosterone in two small, short trials, and berberine and N-acetylcysteine each have some supportive studies, and the review cited here reports no clear benefit from vitamin D; all of this evidence is of low or very low certainty.

The 2024 review found the inositol evidence limited and inconclusive. Compared with metformin, inositol likely makes no difference to reproductive outcomes and likely causes fewer stomach side effects, while metformin does better on hirsutism and waist measurements. The guideline says inositol could be considered based on your own preferences, and that no specific type, dose or combination (including particular myo- to D-chiro-inositol ratios) can currently be recommended. The spearmint trials were 21 women with hirsutism (12 with the condition) over 5 days and 42 women with the condition over 30 days. In the 30-day trial, women rated their own hair growth as better, but the clinician-scored hair measure did not change, and neither trial tested insulin resistance or ovulation. The berberine trials are small and found no solid evidence of more live births. The guideline encourages telling your clinician about any supplement you take.

What this does not show

There is no evidence any of this will work for you specifically. There is what studies found in women like you, and the useful next step is knowing what your own record would need to show, and for how long, to find out. Nothing here is a recommendation: trial averages are not your expected effect, supplements interact with medications and conditions, and starting anything is worth a conversation with a clinician or pharmacist, especially alongside metformin or in pregnancy. No specific type, dose or combination of inositol can currently be recommended, so a product label is not evidence of the right dose for you. The spearmint trials are small and short, and neither tested insulin resistance or ovulation.

Sources, as Neta holds them

1. Fitz V, Graca S, Mahalingaiah S, Liu J, Lai L, Butt A, 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;109(6):1630-55. doi:10.1210/clinem/dgad762

   Systematic review · 2,230 participants

2. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-69. doi:10.1210/clinem/dgad463

   Guideline synthesis

3. Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010;24(2):186-8. doi:10.1002/ptr.2900

   marketing.learn.design.randomised_trial · 42 participants · 30 days observed

4. Akdoğan M, Tamer MN, Cüre E, Cüre MC, Köroğlu BK, Delibaş N. Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytother Res. 2007;21(5):444-7. doi:10.1002/ptr.2074

   marketing.learn.design.single_arm_trial · 21 participants · 5 days observed

5. Pundir J, Charles D, Sabatini L, Hiam D, Jitpiriyaroj S, Teede H, et al. Overview of systematic reviews of non-pharmacological interventions in women with polycystic ovary syndrome. Hum Reprod Update. 2019;25(2):243-56. doi:10.1093/humupd/dmy045

   Systematic review

6. Xie L, Zhang D, Ma H, He H, Xia Q, Shen W, et al. The effect of berberine on reproduction and metabolism in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized control trials. Evid Based Complement Alternat Med. 2019;2019:7918631. doi:10.1155/2019/7918631

   Systematic review