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How To Use Berberine for PCOS Treatment

Updated: May 2

If you are wondering how to use Berberine for PCOS treatment, we’ve got you covered. Berberine has been shown to have positive effects on women with PCOS. In this article, we will discuss what PCOS is and how Berberine can help as a natural support.


What is PCOS or Polycystic Ovary Syndrome?


PCOS stands for Polycystic Ovary Syndrome and is a hormonal condition that affects the menstrual cycles and ovarian function in women. It affects 5-10% of women.


It is characterized by an imbalance of hormones. Specifically we see 2 important characteristics:


  1. high levels of androgens (testosterone/DHT/DHEA). These high androgen levels can be associated with acne and excess facial and body hair growth. High testosterone can lead to various symptoms such as irregular menstrual cycles, weight gain, and difficulty conceiving.

  2. higher levels of insulin or reduced effectiveness of insulin at balancing blood sugar levels in the blood, and this is known as insulin resistance.

These  two important hormonal imbalances in PCOS can lead to an increased risk for other health conditions such as metabolic syndrome, high blood pressure, diabetes and heart disease.


Other symptoms that women with polycystic ovary syndrome experience include:


  • irregular periods, often quite long time intervals between periods and often a lack of ovulatory cycles.

  • high anti-mullerian hormone (AMH) and

  • multiple follicles visible on ultrasound scan.

What is Berberine?


Berberine is a natural plant alkaloid found in goldenseal, barberry, Oregon grape, and the rhizomes of Coptis chinensis. People have been using it for a long time in traditional Chinese medicine and in other countries such as Iran, because it has many health benefits. It has been used to fight infections, aid digestion, and treat skin conditions.


Currently scientists are taking a closer look at berberine's potential role in managing polycystic ovary syndrome (PCOS). Berberine has shown promise in addressing some of these symptoms.


Studies have found that berberine may help improve insulin sensitivity, which is crucial for managing PCOS. By enhancing insulin sensitivity, berberine lowers blood glucose. This may help regulate menstrual cycles and reduce the risk of developing type 2 diabetes and other metabolic conditions that are associated with PCOS.


Berberine's ability to modulate hormone levels and support weight management makes it an attractive option for women with PCOS. Hormonal imbalances, particularly elevated levels of testosterone, are common in PCOS and can contribute to symptoms like excess hair growth and acne. Berberine may help restore hormonal balance, leading to improvements in these symptoms.


latino woman with PCOS standing in front of lake

How can Berberine help with PCOS?


Berberine has been studied for its effects on PCOS. It has been shown to have multiple benefits for women with this condition.


Let's break down the benefits of berberine in women with PCOS:


Balancing Hormones


Berberine has been found to regulate  levels of insulin, testosterone, and therefore allowing better cyclical production of estrogen and progesterone. In particular regarding testosterone, berberine appears to:


  • reduce testosterone and free androgen index (FAI),

  • increase sex hormone binding globulin (SHBG), and

  • attenuate the clinical symptoms of androgen excess, including excess facial/body hair (hirsutism) and acne (Berberine in PCOS 2023).

Improving Insulin Sensitivity


Berberine enhances insulin sensitivity and improves glucose metabolism, leading to better blood sugar control. This can help reduce the risk of developing type 2 diabetes and metabolic syndrome.


Improving Ovulation for Fertility


Improved insulin sensitivity supports optimal ovary function. Insulin resistance interferes with ovulation. Insulin sensitivity supports ovulation, making it easier for your ovaries to release an egg each month, which is important if you're trying to get pregnant.


By improving ovulation, it increases your chances of having a baby.  Berberine can increase ovulation by 22% in one study which was not as good as letrozole, a fertility medication, but was still a good improvement (RCT: Letrazole and Berberine on fertility in PCOS 2016). 


Berberine is also as effective as metformin when used alongside IVF for pregnancy rates, improving metabolism and reducing ovarian hyperstimulation (Berberine, PCOS and IVF).


Improving Ovulation for Overall Health


For women not trying to conceive, having a regular period is important for the health of the uterus, mood, sleep, bone health and cardiovascular health.


In women with PCOS who have have chronic anovulation (no ovulation), berberine has been used and found to be effective in a pilot study to reduce insulin resistance to the restoration of regular periods and ovulation. 


Fourteen percent of women regained ovulatory cycles after 4 months of treatment regardless of weight. Overall 25 percent of cycles became ovulatory (Berberine, Menstrual Patterns, Ovulation, Hormones & Metabolism in Anovulatory Women with PCOS 2015).  


Reducing Belly Fat


Berberine helps move fat away from your belly. The medical term is visceral fat as it surrounds your abdominal organs (viscera). A summary of randomized controlled trials showed that berberine use:


  • promoted weight loss,

  • reduced BMI

  • reduced waist circumference, and

  • reduced c-reactive protein (CRP) a marker of inflammation (Berberine and Obesity 2020). 

Even if you don't lose weight overall, berberine can still help make your belly fat go down, which is associated with reduced risk of metabolic diseases (Berberine vs Metformin on Metabolism in PCOS 2012).


Better Cholesterol Levels


Berberine also helps improve your cholesterol levels.It is associated with lower LDL cholesterol and triglycerides and higher HDL cholesterol in women (Berberine For Dyslipidemia 2023).


As you lower your blood sugar levels, this increases fatty acid oxidation or your body's ability to burn fatty acids. Think of it as being more efficient at burning fatty acids and shuttling them around your body to be used as energy.


Supports Gut Health


Berberine has also been shown to have antimicrobial and anti-inflammatory properties, making it beneficial for gut health. It appears that berberine itself is poorly absorbed by into the body (Berberine Update 2015).


Gut bacteria metabolise berberine and the metabolites appear to be the substances that have beneficial impacts on hormones and metabolic health.


Reducing Fatty Liver Disease


Fatty liver disease is another metabolic condition associated with PCOS. Berberine has been shown to improve fatty liver disease by reducing inflammation and improving insulin sensitivity (Berberine For Fatty Liver Disease 2016).


Delaying or preventing fatty liver disease is important to reduce the risk of developing more serious liver conditions such as cirrhosis.


The Science behind Berberine for PCOS


Clinical studies and research have provided evidence of berberine's effectiveness in addressing various aspects of PCOS.


Berberine improves glucose metabolism by multiple pathways


  1. It increases the sensitivity of insulin receptors (InsR), which enhances uptake of glucose into cells.

  2. It activates adenosine monophosphate-activated protein kinase (AMPK) in muscle and fat cells. This is a key regulator of cellular energy metabolism, which helps improve insulin sensitivity and glucose uptake in cells.

  3. It up-regulates the expression of GLUT-4 receptor - the receptor that glucose binds to and transports glucose into fat and muscle cells for use.

  4. Berberine reduces glucose absorption in the gut by inhibiting an enzyme (𝛼-Glucosidase) that breaks down sugars.

Berberine also influences lipid metabolism


  1. It increases fatty acid oxidation or breakdown of fatty acids for utilisation in cells (Berberine and Obesity 2020).

How to Use Berberine for PCOS?


Incorporating berberine into your PCOS management plan can be helpful, but it's important to do it carefully and under the guidance of a healthcare professional.


The recommended dosage of berberine for PCOS typically ranges from 500 mg to 1500 mg per day, divided into two to three doses. Here are some tips on how to use berberine safely and effectively:


Start with a Low Dose


It's a good idea to begin with a low dose of berberine, such as 500 milligrams per day. This helps your body get used to the supplement and reduces the risk of side effects.


Gradually Increase the Dosage


After starting with a low dose, you can gradually increase the amount of berberine you take.


You might increase it to 1000 milligrams per day, divided into two doses. Some people may need up to 1500 milligrams per day, but it's essential to increase the dosage slowly to avoid side effects.


Divide the Dose


Taking berberine in divided doses throughout the day can help reduce the risk of stomach upset.


Monitor for Side Effects


While berberine is generally safe for most people, it can cause side effects in some individuals. As berberine is poorly absorbed and is actively metabolised by your gut bacteria, common side effects include stomach discomfort, such as diarrhea, constipation, or nausea.


If you experience any of these side effects, you may need to reduce your dose or stop taking berberine temporarily.


Consider Potential Interactions


Berberine may interact with certain medications, including blood thinners, cholesterol-lowering drugs, glucose-lowering medications such as those used for diabetes and medications metabolized by the liver. It's essential to talk to your doctor before starting berberine if you're taking any medications to avoid potential interactions.


Be Patient


It may take some time to see the effects of berberine on your PCOS symptoms. A typical menstrual cycle is 4 weeks so change to hormones and periods takes time. Many studies used for weight change or cholesterol change are at least 8 weeks long.


By following these tips and working closely with your healthcare provider, you can safely incorporate berberine into your PCOS management plan and potentially experience improvements in your symptoms and overall well-being.


Combine Berberine with Lifestyle Changes


Berberine works best when combined with healthy lifestyle changes. The body is always striving towards homeostasis or balance. Lifestyle changes that support homeostasis include:

  • a balanced diet,

  • regular exercise or movement, and

  • stress management.


These lifestyle modifications can enhance the effectiveness of berberine in managing PCOS symptoms.


Specifically, randomized control trials show that berberine and lifestyle changes improved cholesterol and HBA1C (a measure of diabetes) better than lifestyle changes alone (Meta-analysis: berberine for diabetes, hyperlipemia and hypertension 2015).



Expert Insights


Healthcare professionals specializing in PCOS and women's health recognize the potential benefits of berberine in managing PCOS symptoms.


Dr Deborah Brunt, a GP working in women's health  emphasizes the importance of lifestyle modifications, including diet, exercise, and supplements like berberine, in managing PCOS. She recommends berberine as part of a comprehensive treatment plan to improve insulin sensitivity and regulate menstrual cycles in women with PCOS.

 

Key Points About Berberine and PCOS


Berberine shows promise as a natural supplement for managing PCOS symptoms by:


  • improving insulin sensitivity,

  • reducing testosterone,

  • improving menstrual cycle +hormonal balance and therefore ovulation,

  • reducing cholesterol and

  • supporting weight management and healthy body composition changes.


It's essential to approach its use cautiously and under the guidance of a healthcare professional.


By incorporating berberine into a comprehensive PCOS treatment plan that includes lifestyle modifications and medical interventions, women with PCOS can take proactive steps towards better health and well-being.

_________


Dr Deborah Brunt is a female health and menopause doctor in Dunedin, New Zealand and also provides menopause health coaching internationally through her Meno Thrive program to support optimal health habits for aging well so you can live your best life.


Book a consult with Dr Deb Brunt | Ōtepoti Integrative Health | Book Now

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References


  1. Kong W, Wei J, Abidi P, et al. Berberine Is A Novel Cholesterol-Lowering Drug Working Through A Unique Mechanism Distinct From Statins. Nature Medicine. 2004;10(12):1344-1351. 

  2. Ionescu OM, Frincu F, Mehedintu A, et al. Berberine-A Promising Therapeutic Approach to Polycystic Ovary Syndrome in Infertile/Pregnant Women. Life (Basel). 2023 Jan 2;13(1):125.

  3. Wei W, Zhao H, Wang A, et al. A Clinical Study On The Short-Term Effect Of Berberine In Comparison To Metformin On The Metabolic Characteristics Of Women With Polycystic Ovary Syndrome. European Journal of Endocrinology. 2012;166(1):99-105. 

  4. Dong H, Zhao Y, Zhao L, et al. The Effects Of Berberine On Blood Lipids: A Systemic Review And Meta-Analysis Of Randomized Controlled Trials. Planta Medica. 2013;79(6):437-446. 

  5. Jurgiel J, Graniak A, Opyd P, et al. The role of berberine in polycystic ovary syndrome - a summary of knowledge. Ginekol Pol. 2023 Dec 18.

  6. Kumar A, Ekavali, Chopra K, et al. Current knowledge and pharmacological profile of berberine: An update. Eur J Pharmacol. 2015 Aug 15;761:288-97.

  7. Blais JE, Huang X, Zhao JV. Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Drugs. 2023 Apr;83(5):403-427.

  8. Asbaghi O, Ghanbari N, Shekari M, et al. The effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes: a systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition ESPEN. 2020;38:43-49.

  9. Lan J, Zhao Y, Dong F, et al. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J Ethnopharmacol. 2015 Feb 23;161:69-81.

  10. Li L, Li C, Pan P, et al. A Single Arm Pilot Study of Effects of Berberine on the Menstrual Pattern, Ovulation Rate, Hormonal and Metabolic Profiles in Anovulatory Chinese Women with Polycystic Ovary Syndrome. PLoS ONE. 2015;10:e0144072.

  11.  An Y, Sun Z, Zhang Y, et al. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clin. Endocrinol. 2014;80:425–431. doi: 10.1111/cen.12294. 

  12. Chang X, Wang Z, Zhang J, et al. Lipid profiling of the therapeutic effects of berberine in patients with nonalcoholic fatty liver disease. J Transl Med. 2016 Sep 15;14:266. doi:10.1186/s12967-016-0982-x

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