Berberine is an effective herbal supplement that shows great benefits for women with PCOS.

Berberine supplement has been used in China for thousands of years as an anti-bacterial and for type-2 diabetes, and more recently has been researched for its benefits in treating infertility in PCOS [1,2]. Berberine has been shown to have numerous benefits for PCOS including improving insulin resistance, fertility, weight loss and reducing inflammation [3]. 

Benefits of Berberine for PCOS

Polycystic Ovarian Syndrome (PCOS) has a number of underlying causes driving all PCOS symptoms - androgen excess, insulin resistance and inflammation. There are 4 PCOS types, and understanding which one you have is important to target the right nutrition, lifestyle and supplementation strategies to effectively manage and resolve PCOS symptoms. Knowing your PCOS type and underlying drivers may help you decide if Berberine is right for you.

Berberine is a plant-extract found in plants like barberry, goldenseal, Oregon grape and tree turmeric. It targets various cells in the body, providing a holistic approach to PCOS, without the side effects of commonly prescribed medications like Metformin.

Here's some of the ways Berberine is effective for PCOS:

Berberine supports weight loss in PCOS

Some PCOS women struggle with weight gain and find it really difficult to lose weight. Simply "eat less and move more" doesn't work for PCOS. That's because there can be a number of underlying causes of weight gain in PCOS including hormonal imbalance (high androgens), insulin resistance, high blood lipids, inflammation or thyroid dysfunction. It's important to find the underlying causes and address those to enable weight loss to happen. Nutrition and lifestyle strategies, alongside supportive supplementation are highly effective at addressing the root causes to help you lose weight, if that's a goal for you. 

A big benefit of Berberine is that it targets some of the underlying causes of PCOS weight gain including inflammation, lowering lipids and insulin resistance [3]. Berberine also inhibits fat storage [4]. Studies on Berberine for weight loss have shown its effectiveness for lowering BMI (body mass index) and significantly lowering hip to waist ratio [4]. 

Berberine lowers blood glucose & insulin

Insulin resistance occurs in approximately 70-80% of women with PCOS regardless of their body size. Too much insulin drives excess production of androgens that cause the symptoms of PCOS like irregular cycles, acne, hirsutism, thinning hair, sub-fertility. Insulin resistance can also contribute to fatigue, difficulty sleeping and cravings. Improving insulin sensitivity alleviates many of the symptoms of PCOS and aids in weight loss.

Berberine is a potent insulin sensitizer [5]. A recent 2020 review of 5 studies totalling over 1,000 PCOS women found that Berberine improved fasting insulin, fasting glucose and HOMA-IR scores, thereby reducing insulin resistance and improving insulin sensitivity, as effectively as Metformin [6].

Berberine lowers inflammation

Women with PCOS have chronic low-grade inflammation. Inflammation can impair the maturation of follicles in the ovaries, impacting ovulation and menstrual cycle regularity. Some inflammatory factors can also increase androgen production or contribute to insulin resistance. Berberine can reduce systemic inflammation and lower the inflammatory markers produced in PCOS [5].

Berberine reduces the risk of metabolic conditions

PCOS increases the risk of metabolic conditions including type-2 diabetes, cardiovascular disease, and fatty liver. Berberine has been found to improve abnormal lipid metabolism, inhibit the synthesis of triglycerides (a fatty acid in the blood that can contribute to insulin resistance and increased risk of cardiovascular disease), lower LDL cholesterol and triglycerides, and promote cholesterol excretion [5].

One study found supplementing with Berberine for 3 months resulted in a 29% reduction in total cholesterol, 25% reduction in LDL cholesterol, and 35% reduction in triglycerides [7]. Another study found Berberine performed better than Metformin in PCOS women at reducing LDL cholesterol and triglycerides [8].

Berberine lowers androgens in PCOS

Androgen excess is a hallmark feature in all PCOS types. Androgens including testosterone, androstenedione and DHEA-S cause the symptoms of PCOS. PCOS women have also been found to have lower sex hormone binding globulin (SHBG), which binds to hormones (including androgens) in the blood making them inactive.

Berberine has been shown to lower androgen in PCOS. One study found 3 months of Berberine supplementation significantly reduced total testosterone and free androgen excess, as well as increased SHBG [8]. The effect of Berberine at lowering androgens is similar to that of Metformin, however Berberine outperforms Metformin by increasing SHBG more than Metformin [8].

Berberine supports fertility

PCOS is one of the leading causes of infertility due to anovulatory cycles (no ovulation). However what is promising is nutrition, lifestyle and supportive supplementation may have beneficial effects on supporting fertility in PCOS by lowering androgens, inflammation and insulin resistance, improving ovulation rates, and increasing progesterone production. 

Berberine has been shown to improve ovulation and menstrual cyclicity, and improve fertility and pregnancy outcomes in women with PCOS [9]. One study also found Berberine improved IVF pregnancy rates in PCOS, lowered the risk of ovarian hyperstimulation syndrome, similar to Metformin, but surpassed Metformin for live birth rates without the side effects [10].

Safety, side effects and interactions

Berberine is a really potent supplement, and as with all supplements should be prescribed under the guidance of a qualified Clinical Nutritionist or Naturopath who is trained in supplementation. Whilst Berberine is considered safe when taken at the recommended doses, there are instances where Berberine shouldn't be used or may not be effective for you or your PCOS type. 

Berberine can interact with some medications including blood thinners, anti-diabetic medication and statins. Berberine is not safe to take during pregnancy or breastfeeding. 

References:

1. Liang, Yaping; Xu, Xiaojia; Yin, Mingjuan; Zhang, Yan; Huang, Lingfeng; Chen, Ruoling; Ni, Jindong  (2018). Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis. Endocrine Journal, doi:10.1507/endocrj.EJ18-0109     

2. Ionescu OM, Frincu F, Mehedintu A, Plotogea M, Cirstoiu M, Petca A, Varlas V, Mehedintu C. Berberine-A Promising Therapeutic Approach to Polycystic Ovary Syndrome in Infertile/Pregnant Women. Life (Basel). 2023 Jan 2;13(1):125. doi: 10.3390/life13010125. PMID: 36676074; PMCID: PMC9864590.

3. Zhang SW, Zhou J, Gober HJ, Leung WT, Wang L. Effect and mechanism of berberine against polycystic ovary syndrome. Biomed Pharmacother. 2021 Jun;138:111468. doi: 10.1016/j.biopha.2021.111468. Epub 2021 Mar 16. PMID: 33740526.

4. Mirzaee, Firoozeh; Razmjouei, Parisa; Shahrahmani, Hadis; Vafisani, Fahime; Najaf Najafi, Mona; Ghazanfarpour, Masumeh (2020). The effect and safety of Berberine on polycystic ovary syndrome: a systematic review. Journal of Obstetrics and Gynaecology, (), 1–6. doi:10.1080/01443615.2020.1787964 

6. Rondanelli M, Infantino V, Riva A, Petrangolini G, Faliva MA, Peroni G, Naso M, Nichetti M, Spadaccini D, Gasparri C, Perna S. Polycystic ovary syndrome management: a review of the possible amazing role of berberine. Arch Gynecol Obstet. 2020 Jan;301(1):53-60. doi: 10.1007/s00404-020-05450-4. Epub 2020 Feb 14. PMID: 32060683; PMCID: PMC7028834.

7. Kong W, Wei J, Abidi P, Lin M, Inaba S, Li C, Wang Y, Wang Z, Si S, Pan H, Wang S, Wu J, Wang Y, Li Z, Liu J, Jiang JD. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med. 2004 Dec;10(12):1344-51. doi: 10.1038/nm1135. Epub 2004 Nov 7. PMID: 15531889.

8. Mishra N, Verma R, Jadaun P. Study on the Effect of Berberine, Myoinositol, and Metformin in Women with Polycystic Ovary Syndrome: A Prospective Randomised Study. Cureus. 2022 Jan 31;14(1):e21781. doi: 10.7759/cureus.21781. PMID: 35251851; PMCID: PMC8890747.

9. Ionescu OM, Frincu F, Mehedintu A, Plotogea M, Cirstoiu M, Petca A, Varlas V, Mehedintu C. Berberine-A Promising Therapeutic Approach to Polycystic Ovary Syndrome in Infertile/Pregnant Women. Life (Basel). 2023 Jan 2;13(1):125. doi: 10.3390/life13010125. PMID: 36676074; PMCID: PMC9864590.

10. An Y, Sun Z, Zhang Y, Liu B, Guan Y, Lu M. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clin Endocrinol (Oxf). 2014 Mar;80(3):425-31. doi: 10.1111/cen.12294. Epub 2013 Aug 9. PMID: 23869585.

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