Folic acid is a common prenatal supplement, but what about folic acid and PCOS? We take a look at the research behind folic acid, also known as B9, and the evidence linking folic acid and PCOS. Can folic acid improve fertility outcomes in people with PCOS? Keep reading to find out, plus find our top recommendations for folic acid supplementation.
What is PCOS?
Polycystic ovary syndrome, more commonly referred to as PCOS, is a common endocrine disorder with metabolic and reproductive consequences. It can display as a collection of symptoms including; acne, oily skin, lack of or irregular periods, lack of ovulation, excess hair growth, insulin resistance, increased testosterone levels and trouble getting pregnant.
>> Read more | PCOS 101: a beginner’s guide to PCOS
What is folic acid?
Folic acid, the synthetic version of Vitamin B9 or Folate, is a water-soluble vitamin vital for DNA formation, involved in protein metabolism and during periods of rapid growth.
Folic acid vs folate
Folate is the naturally occurring form of vitamin B9 whereas folic acid is a synthetic form of vitamin B9 which is known as pteroylmonoglutamic acid.
Folic acid during preconception and pregnancy
Folic acid is important when it comes to the topic of conception and pregnancy. It is recommended that you take it during preconception and up until you are 12 weeks pregnant. This is to reduce the risk of problems in the baby’s development in the early weeks of pregnancy.
Folate is an essential nutrient for the development of the neural tube and is known for its role in preventing defects in this area. This structure often begins forming before women find out they’re pregnant, which is why it’s important to consume preconception. It is important for oocyte quality (an egg before maturation) and maturation mediated by the effects of folate in the reduction of reactive oxygen species and limiting homocysteine levels.
Therefore, a preconception diet rich in folate is recommended if you’re trying to conceive. Folate can be found in dark green leafy vegetables like broccoli and spinach and in many different kinds of legumes.
>> Read more | Best fertility supplements for PCOS
Benefits of folic acid for PCOS
In a study conducted on 54 people of childbearing age with PCOS, up to 70% of individuals were at risk of insufficient intake of folic acid. This suggests, when considering nutrition, folic acid intake may need to be increased in people with PCOS. Whilst this study was small, if you’re trying to conceive, your folic acid intake is something to be mindful of.
Additionally, folate appears key for oocyte quality, which has been found to be poorer in individuals with PCOS.
In a 2014 study, researchers found that folate (the active form) had beneficial effects on metabolic profiles in people with PCOS. In the study, a 5mg dosage resulted in improved glucose metabolism and cholesterol biomarkers compared to a 1mg or placebo dose.
So, is folic acid good for PCOS? Well, more high-quality research is required to understand the direct impact of folic acid on PCOS symptoms. But in those trying to conceive, supplementing with folic acid is essential to prevent neural tube defects.
Side effects of folic acid
Side effects of consuming folic acid are often mild and include nausea, loss of appetite and bloating or wind.
In very rare cases, folic acid can cause a serious allergic reaction.
If you have ever had an allergic reaction to folic acid or any other medicine, have low vitamin B12 levels, have cancer, are having a type of kidney dialysis called haemodialysis or have a stent in your heart, talk to your doctor before supplementing with folic acid.
Folic acid dosage
The dosage for folic acid depends on why you’re using it. Folic acid is not considered a “primary” supplement for PCOS as more research is required so there is no dosage recommendation for those trying to manage symptoms of PCOS with folic acid.
Dosage for conception
In the UK, it is recommended to take 400 micrograms once per day whilst trying to get pregnant, and the during the first 12 weeks of pregnancy. Those at risk of anaemia or are anaemic may be advised by their healthcare professional to take folic acid throughout pregnancy.
In the US, the recommendation is to take 400 micrograms once per day by all people of reproductive age assigned female at birth.
If you have a higher chance of foetal neural tube defects then your doctor may recommend an increased dose of 5mg.
>> Read More | PCOS and pregnancy: the ultimate guide to conceiving with PCOS
Dosage for preventing folate deficiency anaemia
To prevent anaemia, the usual dose for adults is 5mg taken every 1 to 7 days, but the dose may vary depending on your diet, age and medication.
Those taking metformin should consider taking folic acid to prevent deficiency. Speak with your healthcare professional.
Inositol and folic acid
Inositol is a common supplement for PCOS. Inositol is considered an insulin sensitiser and may improve symptoms linked to insulin resistance. There is some interested evidence surrounding taking inositol and folic acid together.
There is evidence to suggest some neural tube defects (NTDs) are not responsive to folic acid and subsequently are defined as folate (or folic acid) resistant. A pilot study by Great Ormond Street Hospital found that inositol taken alongside folic acid before and during pregnancy could be more effective at preventing NTDs than folic acid alone. This combination is particularly recommended for individuals who may have experienced pregnancies with NTDs before.
In another study, people with PCOS who consumed 2 x 2000 mg myo-inositol and 2 x 200 μg folic acid per day, were found to have improved symptoms and fertility outcomes. 70% of participants had restored ovulation, and overall the treatment resulted in better fertilisation rates and better embryo quality.
Folic acid supplements for PCOS
If you are considering supplementing with folic acid, you may want to consider taking a prenatal supplement because it combines all of the vitamins and minerals you may need, rather than taking separate supplements.
All-in-one myo-inositol and preconception combination supplement.
- Preconception includes 2000mg of Myo-inositol and a balanced blend of micronutrients, including Chromium, N-Acetyl Cysteine, L-Arginine, Alpha Lipoic Acid, and Coenzyme Q10. It also contains essential vitamins B12 and D3, and 400mcg of Folate.
- Take 2 tablets in the morning and 2 tablets in the evening
- Vegan
Blend of myo-inositol, d-chiro-inositol, folate and chromium in optimal levels.
- 2000mg Myo-inositol, 300mg D-chiro-inositol, 400ug Folate (Quatrefolic®), 100ug Chromium Picolinate. Capsule Shell: Pullulan.
- Vegan, free from soy, gluten and additives
- Take 4 capsules daily, 2 in the morning and 2 in the evening
The popular Pregnacare brand has ‘Pregnacare Conception’ containing 400 µg folic acid and 50mg inositol as a complete supplement.
- Vitamin B12 (Cobalamin), Inositol, Coenzyme Q10, Vitamin D3 (Niacin), Vitamin B9 (Folic Acid)
- Vegetarian
- Recommended level of folic acid
- Take one tablet daily after the main meal
FAQ: Folic acid for PCOS
Folic acid is the synthetic version of folate. Common folate-rich foods include wholegrain carbohydrates, beans, dark green vegetables, fruit and peanuts.
Yes, there is no evidence to suggest that inositol and folic acid together. Many prenatal supplements combine folic acid and inositol. In fact, evidence suggests that taking folic acid and inositol may improve PCOS symptoms and fertility outcomes.
Yes, folic acid and metformin can be taken together and there are no contraindications. In fact, people taking metformin are recommended to supplement with vitamin B12 and folic acid because long-term metformin usage is known to reduce intestinal absorption of vitamin B12 and folate.
Although we need more high-quality evidence specifically in people with PCOS, folate has been linked to improved reproductive outcomes. Folate appears to improve oocyte (developing egg in the ovary) quality which may be lower in people with PCOS.
As with all supplements or medications, follow your healthcare professionals and the manufacturer’s advice. There is no good time to take folic acid, so take folic acid when suits you. You may want to take folic acid alongside foods rich in B6 to increase the efficiency of the conversion of folic acid to the active form. Foods high in B6 include fish, beef liver, potatoes and fruits.
Key takeaways: folic acid and PCOS
Folic acid is an essential vitamin if you are trying to conceive or in the first 12 weeks of pregnancy. The evidence surrounding folic acid and PCOS is limited, and more high-quality research is required. But, there is promising evidence surrounding inositol and folic acid including improved fertility outcomes. Always speak to a healthcare professional before trying a new supplement.
