Research
Study: Nutrient Deficiency in PCOS Patients
Nutrient deficiencies significantly affect reproductive health in PCOS, with many women lacking essential vitamins and minerals critical for fertility.
June 14, 2025
·
13
Nutrient deficiencies significantly affect reproductive health in PCOS, with many women lacking essential vitamins and minerals critical for fertility.
Did you know? Up to 85% of women with PCOS face vitamin D deficiency, and many also lack magnesium, zinc, vitamin B12, and folate. These deficiencies worsen PCOS symptoms like irregular periods, infertility, and insulin resistance.
Nutrient deficiencies not only worsen PCOS but also affect reproductive health. Addressing these gaps through targeted supplementation and dietary changes can improve overall health, fertility, and pregnancy outcomes.
Want to know how to tackle these deficiencies and improve your health? Let’s dive in.
Studies reveal that individuals with PCOS frequently lack essential nutrients, even when following a seemingly balanced diet. The most commonly deficient nutrients include vitamin D, magnesium, zinc, vitamin B12, and folate.
Vitamin D is a major concern, with up to 85% of PCOS patients experiencing low levels. This vitamin plays a key role in regulating reproductive hormones like follicle-stimulating hormone (FSH), progesterone, and anti-Mullerian hormone (AMH), all of which can impact fertility and pregnancy outcomes. Additionally, low vitamin D is linked to insulin resistance and higher rates of obesity in women with PCOS.
Magnesium is another nutrient often lacking in PCOS patients. It supports metabolism, blood sugar regulation, blood pressure, and muscle function. However, metabolic issues associated with PCOS can hinder the body’s ability to absorb magnesium effectively.
Zinc deficiencies are frequently seen in individuals who follow vegetarian or vegan diets. Zinc is crucial for menstrual cycle regulation and fertility, but its levels can drop further with the use of hormonal birth control.
Vitamin B12 deficiency poses significant challenges, as this nutrient is essential for red blood cell production, DNA synthesis, and nerve health. Women on vegetarian or vegan diets are at greater risk, and those taking metformin to manage insulin resistance face an additional risk of B12 depletion.
Folate, another critical nutrient, helps reduce chronic inflammation and supports balanced blood sugar and lipid levels. For women with PCOS planning to conceive, maintaining adequate folate levels is especially important.
These deficiencies can arise from a variety of factors, which are explored below.
Several factors contribute to nutrient deficiencies in PCOS, including dietary habits, metabolic challenges, psychological influences, and medication side effects.
Insulin resistance is a primary driver. PCOS-related insulin resistance, combined with obesity in some cases, disrupts the body’s ability to process and utilize nutrients effectively.
Psychological factors, such as binge eating and cravings for nutrient-poor, calorie-dense foods, further exacerbate the problem. These eating patterns can worsen hormonal and metabolic imbalances.
Medications also play a role. Birth control pills can deplete magnesium and zinc levels, while metformin, commonly prescribed for insulin resistance, is linked to a higher risk of vitamin B12 deficiency, particularly with prolonged use.
Obesity adds another layer of complexity. With 40–80% of women with PCOS categorized as overweight or obese, excess weight can impair nutrient absorption and increase the body’s demand for certain vitamins and minerals.
The prevalence of these deficiencies among U.S. women with PCOS highlights the importance of targeted nutritional assessments.
Vitamin D deficiency is particularly widespread in PCOS patients. This is concerning because vitamin D plays a key role in fertility, and its deficiency may contribute to infertility in this population.
Magnesium deficiency is also a frequent issue, though it’s often underdiagnosed. Standard blood tests may not accurately reflect magnesium levels, as most of it is stored in bones and tissues rather than circulating in the blood.
Zinc deficiency is more common among women who follow plant-based diets or use hormonal contraceptives.
Vitamin B12 deficiency is prevalent among women taking metformin for insulin resistance. Those on vegetarian or vegan diets are at an even higher risk due to limited dietary sources of B12.
Folate deficiency remains a concern, especially for women of childbearing age with PCOS. Although grain fortification has reduced folate deficiency in the general population, the metabolic challenges of PCOS can still increase the risk.
"Women with PCOS tend to be nutrient deficient in many common vitamins and minerals, thought to be associated with the psychological (depression, anxiety, etc.) and physiological (insulin resistance, diabetes, infertility, etc.) sequelae of the condition." - Simon Alesi et al.
Blood tests can help uncover these deficiencies, enabling healthcare providers to create personalized plans to address them. Unfortunately, many women remain unaware of their nutrient deficiencies until comprehensive testing is done as part of their PCOS care. Identifying these deficiencies is a key step toward improving overall health and fertility outcomes.
The endometrium, which lines the uterus, depends on specific nutrients to function properly and support a potential pregnancy. For women with PCOS, deficiencies in key nutrients can negatively affect endometrial health.
Vitamin D is essential for endometrial decidualization - the process where uterine cells transform to support embryo implantation and placenta formation. Without enough vitamin D, this process is disrupted, and calcium regulation suffers, which can impair follicle development and ovulation. Research has shown that supplementing with vitamin D and calcium can help restore regular menstrual cycles and improve ovulation in women with PCOS who are deficient in vitamin D.
Selenium also plays an important role, acting as a component of selenoproteins involved in antioxidant and redox processes. This is particularly critical because oxidative stress can damage follicles and reduce egg quality, making successful embryo implantation less likely.
Together, these nutrient deficiencies can lead to irregular menstrual cycles and increased inflammation, further complicating reproductive health.
Nutrient deficiencies can disrupt menstrual cycles and contribute to systemic inflammation, especially in women with PCOS. For instance, a lack of vitamin D has been linked to a significantly higher likelihood - 13 times greater - of experiencing irregular periods.
Other deficiencies, such as magnesium, omega-3 fatty acids, folate, and inositol, can worsen insulin resistance, increase inflammation, and exacerbate hyperandrogenism, all of which contribute to irregular cycles. These disruptions not only make cycles unpredictable but also affect overall fertility and pregnancy outcomes.
The relationship between nutrient deficiencies and menstrual irregularities extends to fertility challenges. Vitamin D deficiency, in particular, is a major factor in PCOS-related infertility. Studies show that supplementing with vitamin D can improve hormone levels, balance hormone ratios, and increase pregnancy rates.
A study published in Reproductive BioMedicine Online (August 2024) found that vitamin D supplementation helped normalize serum 25-(OH)D levels, lowered the LH/FSH ratio, and reduced levels of LH and testosterone in PCOS patients undergoing ovulation-induction therapy. Women who received vitamin D supplements also had higher pregnancy rates compared to those on a placebo.
The same study highlighted that women with severe vitamin D deficiency - defined as 25(OH)-vitamin D levels below 15 ng/mL - were nearly four times more likely to require cesarean delivery, and those with levels under 20 ng/mL faced an increased risk of miscarriage.
Additionally, selenium supplementation has been shown to improve follicle quality in PCOS patients, especially in cases where oxidative stress affects egg viability. These findings emphasize the need for thorough nutritional assessments and personalized supplementation plans to manage PCOS effectively and improve reproductive outcomes.
For more evidence-based insights on addressing nutrient deficiencies and managing PCOS, visit PCOSHelp.
Using targeted supplements can help fill nutrient gaps and promote endometrial health in individuals with PCOS.
Vitamin D plays a crucial role in improving outcomes for women with PCOS, particularly those who are deficient. A daily intake of 2,000–5,000 IU, adjusted based on individual test results to maintain levels between 30–100 ng/mL, has shown positive effects. In one study of 13 women with vitamin D deficiency, combining vitamin D with calcium normalized 25(OH)D levels within 2–3 months. Out of nine women, seven experienced restored menstrual cycles - two became pregnant, and four maintained regular cycles.
For women with endometriosis, higher vitamin D levels have been associated with a 24% lower risk of developing the condition, while deficiencies are linked to larger ovarian cysts. Vitamin D supports the production of steroid hormones necessary for egg development and enhances the endometrium's ability to receive an embryo. Additionally, a regimen of 50,000 IU taken biweekly for 12 weeks has been shown to reduce pelvic pain by boosting antioxidant activity.
In addition to vitamin D, other micronutrients like selenium also play a role in reproductive health.
Selenium is a trace element with powerful antioxidant and anti-inflammatory properties, essential for the functioning of selenoproteins involved in redox processes. Research shows that taking 200 μg of selenium daily for 8 weeks improves reproductive biomarkers like DHEA, hs-CRP, and MDA.
This supplementation has been shown to improve reproductive outcomes, reduce inflammation, and combat oxidative stress. For individuals facing poor follicle quality due to oxidative stress or preparing for IVF, selenium may enhance follicular health. Data from meta-analyses also suggest that selenium increases total antioxidant capacity and supports enzymes involved in lipid metabolism.
Additional supplements can complement these benefits by addressing insulin sensitivity and inflammation.
Certain supplements can further support endometrial health and alleviate PCOS symptoms when paired with a balanced diet and healthy lifestyle.
Dr. Jolene Brighten highlights the broader benefits of supplementation:
"Supplements can be an effective way to fast track healing and support healthy hormones. A balanced hormonal system can create more predictable periods, glowing skin, healthy hair, and reduced PCOS symptoms."
"Hormones are at the core of health - including reproductive health. Women suffering from PCOS have a hormonal imbalance that is rooted in inflammation, gut health, and blood sugar regulation. Supplements step in to help the body rebuild its natural functions to rebalance and renew the endocrine system."
Other options, like vitamin E, have been shown to reduce insulin resistance markers (HOMA-IR), lower LH and testosterone levels, and increase FSH and progesterone. Probiotics may also positively influence hormonal health. However, supplements are most effective when combined with an anti-inflammatory diet and a healthy lifestyle. Always consult a healthcare provider before starting any supplementation for PCOS management .
This section delves into personalized management strategies for PCOS while highlighting critical gaps in current research. Given the intricate nature of PCOS, addressing nutrient deficiencies requires a careful, individualized approach, and the lack of comprehensive studies underscores the need for further exploration.
PCOS affects 15% to 18% of women of reproductive age. The condition manifests with a variety of symptoms that can evolve throughout a woman's life, often influenced by factors like weight gain. In some cases, different phenotypes may even coexist in the same individual. This variability makes personalized treatment essential for managing PCOS and addressing nutrient deficiencies effectively. Many women with PCOS struggle with unbalanced diets, which can exacerbate both nutrient deficiencies and metabolic challenges.
Recent findings suggest that sustainable, personalized dietary changes are more effective than rigid calorie-restricted diets. As a result, healthcare providers are increasingly focusing on creating dietary plans that are not only healthy but also align with individual preferences and lifestyles.
In addition, insulin resistance is a common issue, affecting 50% to 75% of those with PCOS. These numbers highlight why one-size-fits-all recommendations often fall short in meeting the unique needs of individuals.
Despite progress in understanding PCOS, significant gaps remain, particularly regarding abnormal endometrial function. Several areas require more thorough investigation, such as the role of iron metabolism in endometriosis and the connection between magnesium levels and PCOS development. Future studies should also aim to identify new molecular targets for therapeutic interventions related to PCOS and associated endometrial conditions.
For example, research by Zhang et al. points to high rates of anovulation and endometrial hyperplasia in PCOS, suggesting a link to persistent estrogen stimulation. This further highlights the need for deeper exploration. Additionally, pregnant women with PCOS face a 3–4 times higher risk of gestational hypertension and preeclampsia, along with a twofold increase in preterm birth rates compared to women without PCOS. The risk of endometrial carcinoma is also approximately three times higher in individuals with PCOS.
These findings underline the importance of conducting large-scale clinical trials to refine recommendations for nutrient supplementation and complementary therapies in PCOS. Clinicians need evidence-based guidelines that address the specific nutritional and health needs of patients, particularly when managing comorbidities. Filling these research gaps will help create more effective and individualized treatment plans.
Given the challenges in PCOS research, having access to trustworthy, evidence-based resources is crucial for personalized care. PCOSHelp (https://pcoshelp.com) provides up-to-date information on managing PCOS, including nutritional strategies and supplement protocols.
The platform highlights the importance of tailored interventions. Because PCOS symptoms can vary widely, individualized plans for diet and exercise are essential. Some approaches may even incorporate artificial intelligence to create recommendations based on a person’s unique profile. Mental health is another key focus, as women with PCOS often experience depression, anxiety, and reduced quality of life, which can impact their ability to stick with lifestyle changes.
PCOSHelp offers comprehensive guidance on improving fertility, managing medications, addressing symptoms, and reducing stress. By combining the latest research with patient-specific strategies, it serves as a valuable tool for navigating the complexities of PCOS care. The platform bridges current knowledge gaps and underscores the importance of personalized approaches in improving outcomes for those living with PCOS.
Nutrient deficiencies play a significant role in the health challenges faced by women with PCOS, particularly in terms of endometrial health and reproductive outcomes. Research shows that up to 85% of women with PCOS experience vitamin D deficiency, a rate notably higher than in those without the condition.
As discussed earlier, nutrient imbalances in PCOS require a tailored approach. Vitamin D deficiency, for instance, impacts hormonal balance and ovulation, contributing to menstrual irregularities and fertility issues that affect about 75% of women with PCOS. Additionally, low levels of magnesium, zinc, selenium, and B vitamins can further exacerbate hormonal disruptions, inflammation, and endometrial dysfunction.
Targeted nutritional strategies have shown encouraging results. For example, vitamin D supplementation has been linked to improved pregnancy rates, better hormonal regulation, and reduced inflammation. Pairing supplements with nutrient-dense foods, such as Brazil nuts, leafy greens, and fortified dairy products, can further enhance these benefits.
Since individual responses to interventions vary, personalized care is crucial. Addressing specific nutritional deficiencies on a case-by-case basis ensures more effective management of PCOS symptoms and overall health.
"Diet and physical activity should be the first line nutrition intervention for polycystic ovary syndrome (PCOS). Weight loss of 5% to 10% of total body weight has been shown to improve both metabolic and reproductive aspects of PCOS."
- Erica Smolinski, MS, RDN, CDN, Buffalo Nutrition and Dietetics, PLLC
If you think nutrient deficiencies might be linked to your PCOS symptoms, it’s a good idea to talk to your healthcare provider about blood tests. These tests can check for important vitamins and minerals like vitamin D, vitamin B12, folate, magnesium, zinc, and iron - all of which are commonly low in people with PCOS. Identifying these deficiencies can provide valuable insights into your health.
It’s also worth discussing tests for hormone levels and insulin resistance, as these issues often tie into nutrient imbalances in PCOS. With your test results in hand, your provider can suggest specific supplements or dietary adjustments to help improve your health and manage your symptoms effectively.
To tackle nutrient deficiencies often linked to PCOS, it's a good idea to include foods rich in vitamin D, B12, folate (B9), magnesium, and potassium in your meals. These nutrients are essential for maintaining hormonal balance, improving insulin sensitivity, and supporting overall health.
Here are some excellent food sources to consider:
By focusing on these nutrient-packed foods, you can help improve metabolic health, support hormone regulation, and boost your overall well-being. Pairing them with a balanced diet based on whole foods is a practical approach to addressing deficiencies and promoting better health for those managing PCOS.
While supplements like vitamin D, magnesium, and selenium can play a role in supporting overall health, taking too much of them can lead to unwanted side effects.
To avoid these risks, it's crucial to consult a healthcare professional before adding supplements to your routine for managing PCOS. They can help determine the right dosage based on your individual health needs and conditions.
