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Some supplements can worsen PMOS symptoms or interfere with treatment.

Reviewed by Dietitian Katey Davidson, M.Sc.FN, RD, CPT

Key Points

• Several supplements may worsen PMOS symptoms or interfere with treatment plans.
• DHEA, high-dose iodine, vitamin A, licorice root and St. John’s wort may pose risks.
• Safe supplement use in PMOS should be individualized and reviewed with a clinician.

Polyendocrine metabolic ovarian syndrome, or PMOS, is the new name for polycystic ovary syndrome, or PCOS. The condition affects about 10% to 13% of women and can influence ovulation, menstrual cycles, androgen levels and metabolic health. Because symptoms vary, management is usually built around your specific health priorities.

Nutrition, physical activity, sleep and prescribed medication may all be part of a treatment plan. Some supplements may also support PMOS management when selected according to your symptoms and treatment goals. However, others may worsen PMOS symptoms or interfere with medications. We spoke with three OB-GYNs about five supplements they recommend avoiding when living with PMOS.

1. DHEA (Dehydroepiandrosterone)

According to our experts, DHEA is the clearest supplement to avoid. This is because it can increase androgen exposure, and many people living with PMOS have elevated androgens. Symptoms associated with androgen activity include acne, unwanted facial or body hair, and scalp hair thinning.

“DHEA is androgenic,” says Li-Shei Lin, MD, Ph.D.. “It may magnify the symptoms of PCOS [PMOS] in patients who already have higher androgens.”

One meta-analysis found that DHEA supplementation increased testosterone in postmenopausal women, with larger increases at doses of 50 milligrams per day or more. While the subjects did not have PMOS, the findings suggest that DHEA can meaningfully raise testosterone, which is why experts are cautious about its use in a condition often marked by androgen excess.

2. High-Dose Iodine

Iodine is essential for thyroid hormone production, but large doses can disrupt normal thyroid function, warns Charles M. Carlsen, MD, FACOG. This can make high-dose iodine and “thyroid support” formulas potentially inappropriate for PMOS unless medically indicated.

If your clinician is evaluating irregular cycles or other hormone- symptoms, supplement-induced thyroid changes can also complicate the clinical picture, Carlsen adds.

The National Institutes of Health reports that excess iodine can cause hypothyroidism, hyperthyroidism or thyroiditis. The tolerable upper intake level for adults is 1,100 micrograms per day, though some individuals may experience adverse effects at lower doses.

3. High-Dose Preformed Vitamin A

Because acne is a common androgen- symptom of PMOS, some people may turn to supplements marketed for skin or acne support. However, these products may contain high doses of preformed vitamin A, which requires caution, says Sharrón L. Manuel, MD, Ph.D., FACOG. One review found that several over-the-counter acne supplements provided vitamin A at or above the adult upper limit.

Preformed vitamin A may appear on labels as retinol, retinyl acetate or retinyl palmitate. Unlike beta-carotene—a provitamin A carotenoid found in foods like sweet potatoes and carrots—preformed vitamin A is stored primarily in the liver and can become toxic when consumed in excess. The National Institutes of Health advises women who are pregnant or could become pregnant not to exceed 3,000 mcg RAE (10,000 IU) per day due to the risk of birth defects.

This is especially important for people with PMOS who have irregular ovulation or menstrual cycles, since the timing of conception may be difficult to predict. A high-dose supplement could therefore be taken during early pregnancy before it is recognized. Manuel recommends reviewing any skin, hair or fertility supplements with your clinician if you are trying to conceive or could become pregnant.

4. Licorice Root

Depending on your specific medical history, blood pressure may be important to monitor in PMOS, making licorice root a potentially harmful supplement. It is sometimes included in supplements marketed for adrenal or hormone support, but its active compound, glycyrrhizin, can cause the body to retain sodium and lose potassium. Over time, this may raise blood pressure and contribute to fluid retention, explains Manuel.

One study found that healthy adults who consumed licorice providing 100 mg of glycyrrhizic acid per day for two weeks experienced an increase in systolic blood pressure. Researchers also observed suppressed renin and aldosterone, two hormones involved in regulating blood pressure and fluid balance.

These effects can complicate care if you already have high blood pressure or take medications that influence blood pressure or potassium levels. Manuel recommends showing the exact product to your clinician or pharmacist before taking it, particularly if you use a diuretic, blood pressure medication or spironolactone.

5. St. John’s Wort

St. John’s wort is often marketed for mood support, but it may interfere with treatment in people with PMOS who use hormonal contraception. Manuel recommends discussing it with your health care provider before use because it can affect hormones used to regulate menstrual cycles and androgen- symptoms.

St. John’s wort can increase the activity of CYP3A4 and P-glycoprotein, enzymes involved in drug metabolism, including for hormonal contraceptives. This can accelerate the breakdown of estrogen and progestin, potentially reducing their effectiveness in suppressing ovulation.

This is especially relevant in PMOS, where hormonal contraceptives are commonly used to regulate menstrual cycles and manage symptoms. Available studies have observed breakthrough bleeding and signs that ovulation may not be fully suppressed when taking St. John’s wort.

Other Tips for Managing PMOS

• Eat a Balanced Diet. There is no single dietary pattern proven best for PMOS. Instead, build meals around foods that support your overall health and fit your preferences, culture and schedule rather than following a highly restrictive plan.
• Stay Active. Regular physical activity supports insulin sensitivity, cardiovascular health and overall well-being. No particular type of exercise is considered superior for PMOS, so choose activities you can do consistently, ideally both aerobic and strength-training exercise.
• Monitor Your Menstrual Cycle. Going several months without a period can allow the uterine lining to thicken. Let your OB-GYN know if your cycles are infrequent to discuss endometrial protection and cycle regulation.
• Stay Up to Date with Metabolic Screening. PMOS may affect glucose, cholesterol and blood pressure even without symptoms. Ask your clinician how often you need blood pressure checks, lipid testing and blood glucose screening based on your results and other risk factors.
• Get Help for Persistent Sleep Problems. People with PMOS have a higher risk of obstructive sleep apnea regardless of body weight. Tell your clinician if you regularly snore, wake feeling unrefreshed or experience daytime sleepiness so they can determine whether further screening is appropriate.

Our Expert Take

PMOS already involves a complicated mix of hormone and metabolic changes, which is why supplements marketed for “hormone balance” can be especially misleading. A product may sound tailored to the condition, but may actually worsen symptoms and interfere with treatment.

That doesn’t mean supplements have no role in PMOS care, but decisions should be specific and evidence-based rather than label-driven. The safest options are those that address your specific needs and are reviewed alongside medications, lab results and your overall care plan.