PCOS—also called polycystic ovarian syndrome—is a common endocrine condition affecting women of reproductive age. It’s characterized by hormonal imbalances, irregular periods, and often high levels of androgens. Those shifts in hormone levels can increase oil production and cell growth in the skin, driving acne vulgaris (what most people call “pcos acne”). If you’re new to the topic and want a deeper dive on what PCOS is and how it connects to skin, you can check out my recent blog on the topic here. I cover diagnostic criteria, symptoms of pcos, how hormones shift across the cycle, and why breakouts happen.

Before we talk ingredients and capsules, it’s important to acknowledge that supplements are just one piece of pcos management. Thoughtful lifestyle changes—like a balanced diet, regular exercise, stress reduction, and good sleep—support hormone balance and healthy weight. Supplements can complement those moves and your treatment options, not replace a conversation with a health care provider who knows your medical history.

Know your PCOS type 

Not all women of reproductive age with polycystic ovary syndrome (PCOS) look the same on labs or symptoms. PCOS can show up with different primary drivers—insulin resistance, post-pill hormone rebound, chronic low-grade inflammation, or adrenal stress. Many people have overlap, so use this as a guide, not a box, to help you and your health care provider choose the right treatment options, blood tests, and dietary supplements for you.

Insulin-Resistant PCOS (the most common)

What drives it: Reduced insulin sensitivity makes the pancreas pump out more insulin. Higher insulin levels lower sex hormone-binding globulin (SHBG) and can push the ovaries toward more androgen production.

How it may look:

• Classic pcos symptoms: irregular periods or anovulatory cycles, pcos acne/adult acne, excessive hair growth (hirsutism) or unwanted hair growth, thinning hair/hair loss, and weight gain or “resistant” body weight.
• Metabolic clues: elevated fasting insulin, impaired glucose metabolism or higher blood sugar levels/blood glucose levels, higher triglycerides—sometimes falling into metabolic syndrome territory.
• Longer-term risks: higher odds of type 2 diabetes, cardiovascular disease, and high blood pressure if unaddressed.

Helpful labs: Fasting glucose, fasting insulin, HbA1c, lipid panel, SHBG, total/free testosterone, follicle-stimulating hormone (FSH)/LH. Your clinician may also consider c-reactive protein (CRP) to check for low-grade inflammation that often accompanies insulin resistance.

Where supplements fit: Myo-inositol ± D-chiro-inositol, berberine, alpha-lipoic acid (ALA), omega-3 fatty acids (fish oil supplements), zinc, and vitamin D3 (especially with low levels of vitamin D or vitamin D deficiency) are common anchors for improving insulin resistance, hormone balance, and skin.

 

Post-Pill PCOS (post-contraceptive androgen rebound)

What drives it: After stopping hormonal birth control (oral contraceptives or hormone-releasing devices), there can be a transient surge in androgen levels while your own hormone production restarts. Most cycles normalize within months, but for some, ovulation suppression and irregular menstrual cycles persist longer—leading to a PCOS diagnosis even though the original trigger was the medication transition.

How it may look:

• Timing: acne flares, oiliness, and irregular periods showing up after discontinuing birth control pills or devices.
• Skin & hair: breakouts, sometimes excess hair growth; occasionally shedding or texture changes as hormone levels rebalance.
• Metabolic profile: may be closer to normal than in insulin-resistant PCOS unless there’s overlap.

Helpful labs: Total/free testosterone, SHBG, androstenedione; cycle tracking to confirm ovulation. Discuss medical history around contraception type and timing.

Where supplements fit: Myo-inositol (+/- D-chiro-inositol) to encourage ovulation, DIM to support estrogen metabolism, omega-3s for inflammation, and a quality b-vitamin complex (vitamin B / b vitamins, including folic acid if pregnancy is possible). Most people improve with time plus targeted support.

 

Inflammatory PCOS (sometimes called “immune PCOS”)

What drives it: Chronic low-grade inflammation and oxidative stress can suppress ovulation and nudge the ovaries toward higher androgen levels. Gut-skin-immune crosstalk often plays a role (think: gut microbiota imbalances, food intolerances, or leaky-gut patterns alongside skin flares).

How it may look:

• Whole-body signs: digestive issues (e.g., IBS-like symptoms), brain fog, fatigue, headaches, joint pain.
• Skin: eczema or psoriasis along with acne vulgaris.
• History clues: recurrent infections, thyroid imbalances, gluten sensitivity, or a family history of autoimmune disorders.
• Labs: elevated c-reactive protein (CRP) or other inflammatory markers; normal glucose on paper—but inflammation still aggravates hormone levels and pcos acne.

Helpful labs: hs-CRP, ferritin (when appropriate), vitamin D, thyroid panel, and standard PCOS hormone work-up. Consider stool or food-sensitivity testing only when clinically indicated.

Where supplements fit: Omega-3 supplements (EPA/DHA), vitamin D supplementation, zinc, and adaptogens like reishi (as part of a broader plan) can help calm inflammatory signaling. Antioxidants such as vitamin C, vitamin E, and alpha-lipoic acid support oxidative stress balance. Pair with lifestyle changes: a balanced diet emphasizing whole foods, gentle blood sugar control, and regular exercise.

 

Adrenal PCOS (stress-predominant; less common)

What drives it: The adrenal glands, not the ovaries, are the main source of androgen excess—often under chronic stress or cortisol dysregulation. This type is estimated around ~10% of PCOS presentations.

How it may look:

• Labs: elevated DHEA-S (an adrenal androgen) with normal ovarian androgens (testosterone and androstenedione) is the hallmark lab pattern.
• Triggers: insufficient caloric intake, extreme workouts, under-recovery, chronic psychological stress.
• Symptoms: acne and oily skin; hair changes; sometimes sleep disruption, anxiety, or midday crashes.

Helpful labs: DHEA-S, morning cortisol (and sometimes a diurnal cortisol pattern), total/free testosterone, androstenedione, SHBG. Review training load, nutrition, and stress in your medical history.

Where supplements fit: Stress-modulating tools—reishi and omega-3s—plus micronutrient basics (vitamin D, magnesium, b vitamins) can support resilience. Nutrition to reach adequate calories and protein is essential. Some people also do well with gentle mind-body practices to normalize cortisol and improve hormone levels.

 

How to use these “types”

• Expect overlap. Many PCOS patients fit more than one pattern (e.g., insulin resistance + inflammatory). That’s normal.
• Test, don’t guess. A targeted panel clarifies your drivers: glucose/insulin markers for insulin resistance; CRP or other inflammatory markers for low-grade inflammation; DHEA-S vs testosterone/androstenedione to evaluate adrenal versus ovarian sources of androgen excess; SHBG to gauge free testosterone levels.
• Personalize your plan. Match supplements and lifestyle changes to the main driver(s):
  • Insulin-resistant focus: myo-inositol, D-chiro-inositol, berberine, ALA, omega-3s, vitamin D3; steady meals (sometimes a low-carbohydrate diet), physical activity, and weight-neutral habits that still favor a healthy weight over time.
  • Post-pill focus: inositols, DIM, omega-3s, b-complex; time and regular exercise.
  • Inflammatory focus: omega-3s, vitamin D, zinc, antioxidants; gut-supportive, balanced diet; sleep and stress care.
  • Adrenal focus: adequate calories, deloads from extreme training, reishi, omega-3s; nervous-system support.

Why this matters for skin: When insulin levels fall and inflammation calms, SHBG often rises and free androgens drop—leading to a significant reduction in oiliness and breakouts. In clinical trials and systematic review summaries (e.g., on omega-3 fatty acids and inositols), many pcos patients see positive effects on acne and cycle regularity, though results vary and should be monitored with your provider.

 

Supplements with the most promise

Below are popular dietary supplements used by pcos patients in the United States. I’ll explain why someone might use each one, the potential positive effects, and safety notes or side effects. None of this is medical advice. Always review any new product with your clinician, especially if you’re pursuing fertility treatment, like in vitro fertilization (sometimes written simply as “vitro fertilization”), or taking prescription medications.

Myo-Inositol

Why consider it: Myo-inositol is a vitamin-like molecule that signals inside cells. In PCOS it’s been studied for improving insulin sensitivity, restoring ovulation, and reducing androgen levels. Many clinical trials report a significant improvement in cycle regularity and a significant reduction in acne severity for some users.

How it may help: Better glucose metabolism can reduce insulin resistance, which in turn can lower ovarian androgen production and support sex hormone-binding globulin. That hormone balance can help with pcos symptoms like irregular periods, pcos acne, unwanted hair growth, and weight gain related to metabolic syndrome.

Notes & dose: Typical amounts range from 2–4 grams daily, often divided. Look for clean formulas and pair with lifestyle changes like a low-carbohydrate diet if appropriate. Talk with your provider about monitoring blood sugar levels and blood glucose levels.

Safety: Generally well tolerated; occasional GI upset. As with all b vitamins and vitamin-like compounds, quality control matters.

D-Chiro-Inositol

Why consider it: D-chiro-inositol is another inositol isomer. In some clinical study designs, combining myo-inositol with D-chiro-inositol in a physiological ratio appears to support ovulation and improve metabolic markers.

How it may help: By supporting insulin sensitivity and glucose metabolism, D-chiro-inositol may further reduce androgen excess and steady hormone levels.

Notes & dose: Common combos provide myo:D-chiro at 40:1, mirroring normal tissue ratios in the human body. Again, coordinate with blood tests when you can.

Safety: Similar to myo-inositol; mild digestive side effects possible.

 

Berberine

Why consider it: Berberine is an alkaloid found in several herbal medicines. Studies suggest beneficial effects on insulin resistance, blood sugar control, and lipid profiles, making it a compelling option for PCOS tied to metabolic disorders.

How it may help: Improved insulin sensitivity can increase sex hormone-binding globulin and lower free testosterone levels, translating into clearer skin and more regular cycles. Some data compare berberine favorably to metformin in pcos patients for metabolic outcomes.

Notes & dose: Often 500 mg two to three times daily with meals. It can interact with medications; review with your health care provider. Not recommended during pregnancy without medical supervision.

Safety: Possible GI upset and rare adverse effects on liver enzymes—use reputable brands and monitor.

Alpha-Lipoic Acid (ALA)

Why consider it: ALA is an antioxidant that participates in mitochondrial energy reactions and may reduce oxidative stress. In PCOS, ALA has been studied for improving insulin sensitivity and inflammatory markers.

How it may help: By supporting glucose utilization, ALA can assist with insulin resistance and blood sugar control, two pillars for acne and weight loss goals in PCOS.

Notes & dose: 300–600 mg/day is common. If you’re on thyroid medication or chemotherapy agents, talk with your clinician about timing and interactions.

Safety: Generally safe; may lower blood sugar—monitor if you use insulin or sulfonylureas.

Omega-3 Fatty Acids (Fish Oil)

Why consider it: Omega-3 supplements provide EPA/DHA fatty acids that modulate inflammatory pathways. A systematic review of omega-3 supplements notes positive effects on triglycerides and markers of low-grade inflammation.

How it may help: Calming inflammation can reduce acne flares and support cardiovascular disease risk reduction. Some studies note a significant difference in c-reactive protein with fish oil supplements, which may support hormone balance indirectly.

Notes & dose: Aim for a combined 1–3 grams of EPA/DHA daily unless your provider suggests otherwise. Choose purified, third-party-tested fish oil supplements to minimize contaminants.

Safety: Can thin the blood at high doses; caution with anticoagulants. Mild fishy aftertaste is the most common side effect.

Vitamin D3

Why consider it: Vitamin D deficiency is common in PCOS. Vitamin D supplementation may support insulin sensitivity, ovulatory function, and immune regulation.

How it may help: Adequate vitamin D levels may improve hormone balance and reduce inflammatory signaling relevant to acne. There’s also interest in vitamin D for blood sugar, though results vary by clinical trial.

Notes & dose: Dosing should be based on labs. Many pcos patients require 2,000–4,000 IU daily, but your needs depend on blood tests. Pair with vitamin K2 if your provider recommends. This is a case where consistent vitamin D supplementation over months matters more than one large dose.

Safety: Avoid megadoses unless supervised. Watch for fat-soluble vitamin interactions with vitamin A and vitamin E.

Zinc

Why consider it: Zinc is a trace mineral involved in immune function, skin healing, and androgen metabolism. Some clinical trials suggest zinc may reduce acne lesion counts and support hair growth quality.

How it may help: By moderating 5-alpha-reductase activity, zinc may subtly influence testosterone levels and sebum production—useful for acne vulgaris and androgen excess.

Notes & dose: 15–30 mg/day of elemental zinc is typical. Balance with copper if supplementing for more than a few months.

Safety: Nausea on an empty stomach is common. Long-term high dosing can lower HDL or cause copper deficiency.

DIM (Diindolylmethane)

Why consider it: DIM is a compound from cruciferous vegetables. It supports Phase I estrogen metabolism, potentially assisting hormone balance when estrogen pathways feel “stuck.”

How it may help: For Post-Pill PCOS or patterns with estrogen-androgen cross-talk, DIM may assist in restoring regular menstrual cycles and reducing symptoms like breast tenderness while indirectly helping acne.

Notes & dose: Typical doses range from 100–200 mg/day. Include plenty of leafy greens and a healthy diet rich in fiber to support clearance. Some people also consider vitamin C for additional antioxidant support and b vitamins for methylation pathways.

Safety: Can interact with medications via CYP enzymes; discuss with your provider. Some report headaches or changes in menses as side effects.

Reishi Mushroom

Why consider it: Reishi is a functional mushroom used in traditional herbal medicines. Preliminary research suggests adaptogenic support for stress pathways and immune modulation.

How it may help: For adrenal pcos patterns, reishi may help the stress-and-skin loop, supporting calmer oil production and fewer stress-triggered breakouts.

Notes & dose: Look for full-spectrum fruiting-body extracts standardized for beta-glucans.

Safety: Generally well tolerated; mild digestive effects possible. Avoid if you have mushroom allergies.

Saw Palmetto

Why consider it: Saw palmetto is an herb with 5-alpha-reductase–modulating effects. It’s sometimes used for acne, excess hair growth, and hair loss patterns linked to high local DHT.

How it may help: By tamping down the conversion of testosterone to DHT, some users notice improvements in pcos acne and unwanted hair growth. Effects are usually subtle and take months.

Notes & dose: Common dose is 160–320 mg/day of a standardized extract.

Safety: Can interact with hormones or anticoagulants and may cause mild GI side effects.

 

Putting it together: evidence, expectations, and personalization

Not every clinical study agrees, and supplement research varies in quality. When you read a systematic review, check if the included trials are small, short, or of mixed quality. Authors like Arentz S and colleagues have reviewed herbal approaches; conclusions are promising but emphasize the need for more rigorous trials. That’s normal in nutrition science. To include a literal keyword for searchers: arentz s is often cited in discussions of PCOS and herbal medicines.

Building your plan

1. Start with labs and a plan. Partner with a health care provider to run appropriate blood tests: fasting insulin, fasting glucose, HbA1c, lipids, vitamin D levels, and sex hormone panels including sex hormone-binding globulin, follicle-stimulating hormone, LH, and total/free testosterone. These help pinpoint risk factor clusters like metabolic syndrome or high blood pressure and guide dosing.
2. Choose 1–3 core supplements. For insulin-resistant presentations: myo-inositol ± D-chiro-inositol, berberine, and omega-3s are common anchors. For inflammatory signals: omega-3s, vitamin D3, and zinc. For post-pill shifts: inositols and DIM. For adrenal emphasis: reishi plus nervous-system-friendly practices. Which pcos supplements are the best supplements for you depends on your labs, symptoms, and personal response.
3. Stack with lifestyle. A balanced diet rich in fiber, lean proteins, and complex carbs supports steady blood sugar levels. Some people do well with a low-carbohydrate diet; many do best with moderate carbs and regular physical activity. Weight loss is not required to heal your skin, but gentle body weight changes toward your personal healthy weight can improve hormone levels and acne outcomes.
4. Mind interactions and timing. Space zinc away from iron. Take fish oil with food. If you’re using oral contraceptives or planning pregnancy, loop in your OB-GYN about supplement choices and folic acid or broader b vitamins support. Vitamin E and vitamin C can be helpful supporting players for oxidative stress.
5. Track outcomes. Look for meaningful skin changes at 8–12 weeks: fewer inflammatory papules, less oiliness, and a significant reduction in new deep cysts. Also track energy, cycles, and hair changes.

Adjunct micronutrients and practical details

Vitamin C and vitamin E are classic antioxidants; while they are not primary PCOS interventions, they may support oxidative stress defenses, especially alongside omega-3 fatty acids and vitamin D supplementation. If you are planning pregnancy, you’ll also want folic acid on board; your clinician may recommend a prenatal with b vitamins tailored to your needs. Remember, supplements work best in the context of real food, sunlight exposure (as appropriate), hydration, and consistent sleep. These small habits create space for positive effects to accumulate steadily and sustainably.

What to expect for skin

When insulin levels drop and insulin sensitivity improves, androgen levels often moderate. That can mean less sebum, fewer clogged pores, and less acne. Omega-3 fatty acids calm cytokine signaling; vitamin D and zinc support barrier function and immune balance. Together with a smart topical routine, many see positive effects.

Remember that acne is multi-factorial. If you have persistent breakouts, combine internal work with a strategic, non-comedogenic topical routine. Avoid pore-clogging ingredients and keep benzoyl peroxide, salicylic acid (BHA), or mandelic acid in your skincare toolbox.

 

Safety notes and side effects

• Medication interactions: Berberine, saw palmetto, DIM, omega-3s, and even reishi can interact with medications. Always inform your provider.
• Pregnancy & fertility: If you’re trying to conceive or undergoing in vitro fertilization, supplement decisions become more nuanced. Some clinicians use inositols and omega-3s to support pregnancy rate in select cases; others pause certain herbs. Personalize with your team.
• Adverse effects: Most supplements are well tolerated at standard amounts, but any can trigger adverse effects in sensitive people. Start low, go slow, and stop if you notice concerning changes.
• Quality matters: Choose brands that publish third-party testing for identity and purity. Omega-3 supplements should be oxidatively stable. The supplement space in the United States is regulated differently than pharmaceuticals; do your homework.

Quick reference table

• Insulin resistance focus: Myo-inositol, D-chiro-inositol, berberine, alpha-lipoic acid, omega-3 fatty acids, vitamin D3 (especially with low levels of vitamin D).
• Inflammation focus: Omega-3s, vitamin D, zinc, reishi; pair with a balanced diet and physical activity.
• Post-pill focus: Myo-inositol, DIM, b vitamins support, and time.
• Adrenal focus: Reishi, omega-3s, gentle mind-body work.

Final thoughts

There isn’t a single magic capsule for PCOS or acne. But when you match supplements to your presentation—insulin-resistant, post-pill, inflammatory, adrenal, or a blend—you can support clearer skin and reproductive health over time. Combine smart dietary supplements with regular exercise, a healthy diet, and a topical plan that respects your barrier. Keep your clinician in the loop, especially if you have high blood pressure, heart disease, or are considering pregnancy. Small, consistent steps tend to add up faster than you expect. With patience, data-guided choices, and a calm, steady routine, most people see clearer skin and more predictable cycles over time.

Quick lab note: When insulin levels come down, sex hormone-binding globulin tends to rise, binding more free testosterone. That shift can precede changes. Re-test labs every 8–12 weeks; use markers to guide changes.

Educational only, not medical advice. Talk to your provider before changing skincare, meds, diet, or supplements. May interact with medications; not for pregnancy/nursing without clearance. Not FDA-evaluated. In emergencies call 911. — Skin Plus Clinical Skin Care, Austin, TX