NAC for PCOS
Perhaps you had have heard about NAC for PCOS but you’re not quite sure what it is or if it might be helpful to you.
By the end of this article, you’ll understand what NAC is, what the current research tells us and how it can support PCOS.
What is NAC?
N-acetyl cysteine, or NAC, is a compound from the amino acid l-cysteine.
In the clinical setting, it has been traditionally used as a mucolytic agent (breaks up mucus) and as a treatment for acetaminophen (Tylenol) toxicity. (1)
NAC itself is a potent antioxidant that helps to inactivate free radicals that can cause damage to the body.
Also, cysteine acts as a precursor to formation of the body’s master antioxidant glutathione.
4 Reasons to use NAC for PCOS
Decrease oxidative stress and inflammation
Production of reactive, harmful compounds known as free radicals are a consequence of normal body processes.
Oxidative stress is when there exists a higher level of these compounds in the body, than there are antioxidants to counter them.
This is a common finding in PCOS driven by metabolic issues like insulin resistance, hyperglycemia (high blood sugar), abnormal lipids and obesity.
Increased levels of oxidative stress can worsen the already present inflammation that is characteristic of PCOS.
NAC, itself, acts as a neutralizer of free radicals and decreases the release of inflammatory cytokines like TNF-alpha which promote the inflammatory process. (2)
NAC, as a precursor to glutathione (the body’s master antioxidant), helps to support the overall antioxidant capacity of the body to deal with these reactive compounds.
Support fertility
PCOS is the leading cause of infertility in women, so much of the interventions are focused here.
Controlling oxidative stress and inflammation in the ovary is particularly important, when fertility is a point of focus.
NAC has been shown to improve egg quality and increase follicle size. The effects are likely largely due in part to the antioxidant actions we just discussed.
A 2014 review and meta-analysis (a comprehensive review of the current body of research), concluded that NAC led to “significant improvement” in the rates of spontaneous ovulation and live births. (3)
When used as an adjunct alongside clomiphene citrate (or letrozole), NAC has been shown to improve egg quality and increase the rate of ovulation and pregnancy in PCOS. (4)
Reduce fasting blood glucose and insulin
Insulin resistance and elevated blood insulin (or hyperinsulinemia), is a major root cause of the signs and symptoms of PCOS in up to 80% of cases. (5)
In two separate studies, NAC has been shown to improve insulin sensitivity and secretion (or release of insulin) better than metformin.
A 2019 randomized controlled trial (RCT) of 100 women found those receiving NAC had “significant improvements” in BMI, fasting blood glucose, and fasting insulin over metformin. (6)
Another 2015 RCT of 94 women found NAC improved both fasting blood sugar and fasting insulin over metformin. (7)
With improved insulin sensitivity, the body requires less insulin to do the job of removing glucose from the bloodstream.
And when blood levels of insulin decrease, so does testosterone production and inflammation.
Improve blood lipids
Dyslipidemia is another condition found commonly in women with PCOS and can contribute to increased cardiovascular risk.
This may look like elevated triglycerides and LDL-C, and lowered HDL-C.
In the same studies mentioned earlier comparing NAC to metformin, NAC was found to improve lipids better over metformin.
Decrease in androgens
A January 2023 review and meta-analysis of 18 studies and 2195 participants determined that NAC “significantly reduced” levels of total testosterone and increased follicle-stimulating hormone (FSH). (8)
Androgens excess is diagnostic of the syndrome and drives inflammation, insulin resistance, infertility and the distressing physical symptoms in PCOS.
They concluded “NAC supplementation might be effective in the improvement of reproductive system function in patients with PCOS.”
Safety and how to use
Dosing
In studies, NAC has been used at 1600-3000 mg per day in divided doses. A typical starting dose is 600 mg three times a day.
I generally recommend giving a supplement 3-6 months to gauge efficacy by monitoring symptoms and labs.
As always, you should discuss any supplement you are considering with YOUR provider.
Side effects
NAC is generally very well tolerated, but in some rare cases may cause gastrointestinal symptoms, typically at higher doses.
Safety, interactions and contraindications
Overall, NAC is a very safe compound to take. There are no major contraindications (or reasons not to use) NAC. Its use is possibly safe during pregnancy, and primarily used to address an acetaminophen toxicity.
Drug/supplement interactions
NAC may have interactions with nitroglycerin, activated charcoal, blood pressure medications, chloroquine, anti-clotting meds, ifosfamide, and rapid acting insulin.
It may have an additive effect with anticoagulants and blood pressure-lowering supplements.
Final Thoughts on NAC for PCOS
While we do have some promising research for NAC in PCOS, larger and longer controlled studies are needed to explore the potential applications.
NAC is a safe and accessible supplement. I use it often in my practice to support fertility, increase antioxidant status and promote glucose and insulin balance.
Adding a supplement to your treatment plan is always a very individual decision, and one to be made by you and YOUR practitioner.
If you and your provider decide to add NAC to your care plan, here are my favorite NAC supplements from Fullscript. Using the links below will apply 15% off to the order.*
Fullscript is an online dispensary where you can purchase medical-grade, third-party tested, SAFE supplements at a competitive price.
If you are having difficulty navigating the changes you need to make check out my PCOS Pro one-on-one program.
*I receive a small commission at no additional cost to you when you use these links to purchase