Berberine for PCOS: Benefits and Side Effects

Berberine is a supplement used to treat a number of conditions, including polycystic ovary syndrome (PCOS). PCOS is a condition that involves the development of multiple follicles, often referred to as cysts, on the ovaries, which can lead to fertility problems.

Berberine is an alkaloid (a kind of organic compound) extracted from certain herbs such as Hydrastis cacadensis (goldenseal) and Berberis aquifolium (oregon grape).

Other conditions berberine is sometimes used for include diabetes, diarrhea, and infertility. Although most uses for berberine have not yet been proven, some research has found evidence to support its use in people with PCOS.

This article explains how berberine may help with fertility and weight management in PCOS, and what women need to know before trying it.

Berberine and PCOS

Berberine is thought to offer benefits to people with PCOS, including improved fertility, assistance with weight loss, and lowered risk for metabolic complications associated with the condition. However, more research is needed to prove its effects.

Improving Fertility

At least two studies have looked at the benefits of berberine for fertility. In one pilot study, 98 anovulatory (those who do not ovulate) people assigned female at birth with PCOS took berberine. Ovulation improved by an average of 25% after four months.

A study published in Clinical Endocrinology showed that people assigned female at birth with PCOS who were randomly selected to take berberine had higher pregnancy rates than those who took metformin (an insulin-sensitizing medication) or placebo.

They also felt fewer side effects 12 weeks prior to in vitro fertilization (IVF) treatment.

Berberine may be an option for those concerned about problems PCOS can be associated with during pregnancy, including:

• Miscarriage
• Gestational diabetes
• Preeclampsia
• Cesarean section (C-section)

Taking berberine in no way guarantees that someone will become pregnant. But it could help them feel more proactive and relaxed about the prospect. And some research suggests a link between stress and frustrated efforts at conceiving.

Increasing Insulin Sensitivity

Perhaps berberine’s biggest role is as a potent insulin sensitizer. People with PCOS typically have insulin resistance. Insulin allows the body's cells to use sugar for energy. With insulin resistance, the cells don't respond well to insulin, so insulin levels and blood sugar can rise.

Metformin is a medication that is often prescribed to people with PCOS to help manage insulin and glucose levels. However, many experience side effects such as diarrhea, nausea, and stomach cramping with metformin. Long-term metformin use has also been shown to affect the absorption of vitamin B12.

The benefits of berberine have been compared to metformin in those with PCOS. In a study published in the European Journal of Endocrinology, researchers randomly selected 89 people assigned female at birth with PCOS to receive either berberine (500 milligrams, three times a day), metformin (500 mg, three times a day), or a placebo for three months.

A nutritionist told the study participants to reduce their intake of carbohydrates and fats. A calorie range was not provided. Study participants were also instructed to do moderate to intense exercise for 30 minutes each day.

After three months of treatment, the study participants with PCOS who took berberine saw greater drops in body fat than those who took metformin or placebo. Berberine lowered insulin and glucose levels about as well as metformin.

Study participants with PCOS who took berberine also experienced significant drops in total cholesterol, LDL (bad cholesterol) levels, and triglycerides. They also recorded better HDL (good cholesterol) levels.

Assisting With Weight Loss

Many with PCOS would say that losing weight is harder because of their condition. Weight loss is more difficult for many reasons, including increased insulin resistance and strong cravings for carbohydrates.

Berberine may offer hope to people with PCOS who struggle with their weight. Berberine has been shown to reduce the secretion of leptin, an appetite-stimulating hormone.

Berberine has also shown to be effective at assisting with weight and body fat loss by inhibiting the enzyme lipoprotein lipase, which is responsible for fat storage.

Many studies report weight loss, especially in the midsection of the body.

Reducing Fatty Liver

People with PCOS also face an increased risk of having fatty liver disease due to the relationship with high insulin levels. Berberine has been shown to reduce fatty liver.

A review of six randomized control trials involving 500 individuals found that berberine significantly reduced fatty liver in those with metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as non-alcoholic fatty liver disease or NAFLD).

Berberine lowered triglycerides (the primary form of fat in the body) and liver function enzymes and improved overall liver functioning.

Berberine also improves MASLD by preventing liver fat buildup and promoting fatty acid oxidation, or the breakdown of fatty acids. This is important because it releases energy.

Berberine Side Effects and Interactions

Many people tolerate berberine well. But it can cause nausea and constipation, particularly when taken in high doses.

Berberine may not interact well with other medications, such as antidepressants, MAOIs, blood thinners, and beta blockers. Regular monitoring of liver function tests is recommended for those taking berberine.

Since berberine is an insulin sensitizer, it may cause low blood sugar, especially when combined with other insulin-lowering medications, such as metformin, or supplements like inositol or n-acetylcysteine.

This is why it's important to consult with a healthcare provider before taking berberine. 

Berberine is not intended for long-term use. No data are available regarding the safety of berberine among young people assigned female at birth or in early pregnancy. And nobody should take berberine while they're pregnant, breastfeeding, or chestfeeding.

How Much Berberine Should You Take?

Berberine can be taken in capsule or liquid form. The typical dosage of berberine is 500 mg, three times each day (similar to that of metformin dosing). To avoid stomach upset, it may be best to inch up to that dosage by taking 500 mg per day the first week and then adding another 500 mg the second and third weeks. Check with your healthcare provider on how much you should take.

Unlike medications, supplements aren't regulated by the Food and Drug Administration. When buying berberine, check the label for a product tested by a third party, such as the U.S. Pharmacopeia, NSF International, or ConsumerLab.

Summary

Like all supplements, berberine's effects can be difficult to trace. But research suggests that it could help those with PCOS conceive, manage their insulin and glucose levels, lose weight, and improve their liver health. Berberine can cause stomach upset, especially if it's taken in high doses.