Metabolic Improvements From CoQ10 and ALA in PCOS Patients
DOI:
https://doi.org/10.21070/ijhsm.v2i2.197Keywords:
Polycystic Ovary Syndrome, Metformin, Alpha Lipoic Acid, Co-Enzyme Q10Abstract
Background: As more women search for natural solutions or prescription medications to manage their symptoms, supplements like Alpha Lipoic Acid and CoQ10 are growing in popularity. Combining these with a personalized plan can lead to better health outcomes and a higher quality of life. Aim of the study: the aim of the current research project is to evaluate the effect of combined administration of metformin, ALA and CoQ10 on PCOS metabolic and fertility parameters. Patients and methods: This clinical trial, which was randomized, single-blind, and actively controlled, took place in Diwaniyah, Iraq, from October 2024 to June 2025. Participants were randomly assigned to three different groups. The random assignment was carried out using computer-generated random numbers. Patients in Group Met. received Glucophage (500 mg; Merck, West Drayton, UK) three times per day; Group Met.+ALA patients were given metformin as in the first group along with ALA (600 mg, Batch no. 6N5483; Holzkrichen, Bavaria, Germany) three times daily; Group Met.+ALA+CoQ10 patients received metformin and ALA as in the second group, along with 200 mg of CoQ10 each day. All treatments were provided over a duration of 12 weeks. Result: Post-treatment, all three forms of management showed significant decline in average free Testosterone, LH and LH:FSH ratio, GnRH anti-body and ovarian volume (p < 0.001); the effect of Met. plus ALA plus CoQ10 was significantly more profound when contrasted to other 2 modes of therapy (p < 0.05). However, none of these treatment approaches was able to affect serum levels of FSH, prolactin and TSH significantly (p > 0.05).Conclusion: The combined use of metformin therapy, CoQ10 supplements and ALA supplements is associated with the most optimum hormonal and ultrasound characteristic in PCOS women by reducing the pathogenic effect of anti GnRHR antibody level.
Highlights:
- Combined Metformin, ALA, and CoQ10 improved hormonal and ultrasound parameters in PCOS.
- Significant reductions were observed in LH, free testosterone, LH:FSH ratio, and ovarian volume.
- No significant changes were found in FSH, prolactin, or TSH levels.
Keywords: Polycystic Ovary Syndrome, Metformin, Alpha Lipoic Acid, Co-Enzyme Q10
References
[1] D. Deswal, V. Narwal, A. Dang, and C. S. Pundir, “The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review,” Journal of Human Reproductive Sciences, vol. 13, no. 4, pp. 261–271, Oct.–Dec. 2020, doi: 10.4103/jhrs.JHRS_95_18.
[2] N. Salari et al., “Global Prevalence of Polycystic Ovary Syndrome in Women Worldwide: A Comprehensive Systematic Review and Meta-analysis,” Archives of Gynecology and Obstetrics, vol. 310, no. 3, pp. 1303–1314, Sep. 2024, doi: 10.1007/s00404-024-07607-x.
[3] N. Ligocka et al., “Quality of Life of Women With Polycystic Ovary Syndrome,” Medicina (Kaunas), vol. 60, no. 2, p. 294, Feb. 2024, doi: 10.3390/medicina60020294.
[4] J. A. Lentscher and A. H. Decherney, “Clinical Presentation and Diagnosis of Polycystic Ovarian Syndrome,” Clinical Obstetrics and Gynecology, vol. 64, no. 1, pp. 3–11, Mar. 2021, doi: 10.1097/GRF.0000000000000563.
[5] A. Purwar and S. Nagpure, “Insulin Resistance in Polycystic Ovarian Syndrome,” Cureus, vol. 14, no. 10, p. e30351, Oct. 2022, doi: 10.7759/cureus.30351.
[6] Y. Xu and J. Qiao, “Association of Insulin Resistance and Elevated Androgen Levels With Polycystic Ovarian Syndrome (PCOS): A Review of Literature,” Journal of Healthcare Engineering, vol. 2022, p. 9240569, Mar. 2022, doi: 10.1155/2022/9240569.
[7] V. Calcaterra et al., “Polycystic Ovary Syndrome in Insulin-Resistant Adolescents With Obesity: The Role of Nutrition Therapy and Food Supplements as a Strategy to Protect Fertility,” Nutrients, vol. 13, no. 6, p. 1848, May 2021, doi: 10.3390/nu13061848.
[8] E. S. Dason et al., “Diagnosis and Management of Polycystic Ovarian Syndrome,” Canadian Medical Association Journal, vol. 196, no. 3, pp. E85–E94, Jan. 2024, doi: 10.1503/cmaj.231251.
[9] G. M. Attia, M. M. Almouteri, and F. T. Alnakhli, “Role of Metformin in Polycystic Ovary Syndrome (PCOS)-Related Infertility,” Cureus, vol. 15, no. 8, p. e44493, Aug. 2023, doi: 10.7759/cureus.44493.
[10] R. Dumitrescu et al., “Metformin–Clinical Pharmacology in PCOS,” Journal of Medicine and Life, vol. 8, no. 2, pp. 187–192, Apr.–Jun. 2015.
[11] H. Shamim et al., “Role of Metformin in the Management of Polycystic Ovarian Syndrome-Associated Acne: A Systematic Review,” Cureus, vol. 14, no. 8, p. e28462, Aug. 2022, doi: 10.7759/cureus.28462.
[12] A. L. G. Notaro and F. T. L. Neto, “The Use of Metformin in Women With Polycystic Ovary Syndrome: An Updated Review,” Journal of Assisted Reproduction and Genetics, vol. 39, no. 3, pp. 573–579, Mar. 2022, doi: 10.1007/s10815-022-02429-9.
[13] S. Alesi et al., “Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome,” Advances in Nutrition, vol. 13, no. 4, pp. 1243–1266, Aug. 2022, doi: 10.1093/advances/nmab141.
[14] X. Cheng and B. He, “Clinical and Biochemical Potential of Antioxidants in Treating Polycystic Ovary Syndrome,” International Journal of Women’s Health, vol. 14, pp. 467–479, Apr. 2022, doi: 10.2147/IJWH.S345853.
[15] A. K. Kiani et al., “Dietary Supplements for Polycystic Ovary Syndrome,” Journal of Preventive Medicine and Hygiene, vol. 63, no. 2 Suppl 3, pp. E206–E213, Oct. 2022, doi: 10.15167/2421-4248/jpmh2022.63.2S3.2762.
[16] A. Guarano et al., “Alpha Lipoic Acid Efficacy in PCOS Treatment: What Is the Truth?,” Nutrients, vol. 15, no. 14, p. 3209, Jul. 2023, doi: 10.3390/nu15143209.
[17] A. D. Genazzani et al., “Modulatory Effects of Alpha-Lipoic Acid (ALA) Administration on Insulin Sensitivity in Obese PCOS Patients,” Journal of Endocrinological Investigation, vol. 41, no. 5, pp. 583–590, May 2018, doi: 10.1007/s40618-017-0782-z.
[18] T. Zhang et al., “Efficacy and Safety of Coenzyme Q10 Supplementation in the Treatment of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis,” Reproductive Sciences, vol. 30, no. 4, pp. 1033–1048, Apr. 2023, doi: 10.1007/s43032-022-01038-2.
[19] M. Liu et al., “Efficacy of Coenzyme Q10 Supplementation on Glucose Metabolism, Lipid Profiles, and Biomarkers of Inflammation in Women With Polycystic Ovary Syndrome: A Protocol for a Systematic Review and Meta-analysis,” Medicine (Baltimore), vol. 99, no. 46, p. e23130, Nov. 2020, doi: 10.1097/MD.0000000000023130.
[20] M. Nasiri et al., “Modulation of Hormonal, Metabolic, Inflammatory and Oxidative Stress Biomarkers in Women With Polycystic Ovary Syndrome Following Combined (Resistant and Endurance) Training: A Randomized Controlled Trial,” BMC Endocrine Disorders, vol. 25, no. 1, p. 1, Jan. 2025, doi: 10.1186/s12902-024-01793-0.
[21] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, “Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS),” Human Reproduction, vol. 19, no. 1, pp. 41–47, Jan. 2004, doi: 10.1093/humrep/deh098.
[22] M. L. Lima et al., “Assessment of Ovarian Reserve by Antral Follicle Count in Ovaries With Endometrioma,” Ultrasound in Obstetrics & Gynecology, vol. 46, no. 2, pp. 239–242, Aug. 2015, doi: 10.1002/uog.14763.
[23] T. Kazerooni and M. Dehghan-Kooshkghazi, “Effects of Metformin Therapy on Hyperandrogenism in Women With Polycystic Ovarian Syndrome,” Gynecological Endocrinology, vol. 17, no. 1, pp. 51–56, Feb. 2003.
[24] A. Izadi et al., “Hormonal and Metabolic Effects of Coenzyme Q10 and/or Vitamin E in Patients With Polycystic Ovary Syndrome,” Journal of Clinical Endocrinology & Metabolism, vol. 104, no. 2, pp. 319–327, Feb. 2019, doi: 10.1210/jc.2018-01221.
[25] M. Karamali and M. Gholizadeh, “The Effects of Coenzyme Q10 Supplementation on Metabolic Profiles and Parameters of Mental Health in Women With Polycystic Ovary Syndrome,” Gynecological Endocrinology, vol. 38, no. 1, pp. 45–49, Jan. 2022, doi: 10.1080/09513590.2021.1991910.
[26] R. Jannatifar et al., “Combination of Alpha Lipoic Acid and Metformin Supplement Improve Assisted Reproductive Technologies Outcomes in Polycystic Ovary Syndrome Patients,” Anatomy & Cell Biology, vol. 55, no. 2, pp. 239–246, Jun. 2022, doi: 10.5115/acb.21.242.
[27] G. Pratama et al., “Mechanism of Elevated LH/FSH Ratio in Lean PCOS Revisited: A Path Analysis,” Scientific Reports, vol. 14, no. 1, p. 8229, Apr. 2024, doi: 10.1038/s41598-024-58064-0.
[28] P. Jindal, R. Mehandiratta, A. Sharma, V. Takkar, and P. T. Kapila, “Effect of Metformin on FSH, LH and Prolactin Levels in Patients With Polycystic Ovarian Syndrome,” International Journal of Medical Research Professionals, vol. 2, no. 5, pp. 176–179, 2016.
[29] J. E. Nestler, D. J. Jakubowicz, W. S. Evans, and R. Pasquali, “Effects of Metformin on Spontaneous and Clomiphene-Induced Ovulation in the Polycystic Ovary Syndrome,” New England Journal of Medicine, vol. 338, no. 26, pp. 1876–1880, Jun. 1998, doi: 10.1056/NEJM199806253382603.
[30] A. Genazzani et al., “Effects of a Combination of Alpha Lipoic Acid and Myo-Inositol on Insulin Dynamics in Overweight/Obese Patients With PCOS,” Endocrinology & Metabolic Syndrome, vol. 3, no. 3, pp. 1–7, 2014.
[31] N. Torge et al., “Polycystic Ovary Syndrome in Adolescence: New Therapeutic Approach With Inositol and Alpha-Lipoic Acid,” in Proc. 55th Annual ESPE, Paris, France, Sep. 2016, pp. 10–12.
[32] A. Abu-Zaid et al., “The Effect of Alpha-Lipoic Acid Supplementation on Anthropometric, Glycemic, Lipid, Oxidative Stress, and Hormonal Parameters in Individuals With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis of Randomized Clinical Trials,” Obstetrics & Gynecology Science, vol. 67, no. 1, pp. 17–29, Jan. 2024, doi: 10.5468/ogs.23206.
[33] F. J. Femi-Olabisi et al., “Alpha-Lipoic Acid Regulates Pro-Inflammatory Cytokines and Hormones in Letrozole-Induced Polycystic Ovary Syndrome in Rats,” Endocrine and Metabolic Science, vol. 18, p. 100245, Jun. 2025.
[34] A. El Refaeey, A. Selem, and A. Badawy, “Combined Coenzyme Q10 and Clomiphene Citrate for Ovulation Induction in Clomiphene-Citrate-Resistant Polycystic Ovary Syndrome,” Reproductive BioMedicine Online, vol. 29, no. 1, pp. 119–124, Jul. 2014, doi: 10.1016/j.rbmo.2014.03.011. [Retracted in: Reprod. Biomed. Online, vol. 47, no. 5, Nov. 2023]
[35] H. Li et al., “Increased Testosterone and Proinflammatory Cytokines in Patients With Polycystic Ovary Syndrome Correlate With Elevated GnRH Receptor Autoantibody Activity Assessed by a Fluorescence Resonance Energy Transfer-Based Bioassay,” Endocrine, vol. 74, no. 1, pp. 163–171, Oct. 2021, doi: 10.1007/s12020-021-02761-7.
[36] D. C. Kem et al., “The Role of GnRH Receptor Autoantibodies in Polycystic Ovary Syndrome,” Journal of the Endocrine Society, vol. 4, no. 8, p. bvaa078, Aug. 2020, doi: 10.1210/jendso/bvaa078.
[37] S. S. Mahdi and S. A. A. Kadhim, “Effects of Letrozole and Metformin Versus Metformin Alone on Incretin in Iraqi Patients With PCOS,” ACE Journal of Public Health and Community Medicine, vol. 4, no. 2, pp. 48–52, 2024.
[38] A. Petrasca et al., “Metformin Has Anti-Inflammatory Effects and Induces Immunometabolic Reprogramming via Multiple Mechanisms in Hidradenitis Suppurativa,” British Journal of Dermatology, vol. 189, no. 6, pp. 730–740, Nov. 2023, doi: 10.1093/bjd/ljad305.
[39] H. B. Zeyneloglu et al., “Metformin Decreases Ovarian Volume in Lean Patients With Polycystic Ovary Syndrome (PCOS),” Fertility and Sterility, vol. 82, p. S301, Sep. 2004.
[40] C. Liang and V. Gomez-Lobo, “Metformin Therapy Restores Normal Menstrual Cycles, Reduces the Ovarian Size and Volume, but Failed to Prevent Recurrent Ovarian Torsions in an Adolescent With PCOS,” Journal of Pediatric and Adolescent Gynecology, vol. 22, no. 2, pp. e32–e33, Apr. 2009.
[41] B. Banaszewska et al., “Simvastatin and Metformin Reduce Ovarian Volume in Women With PCOS: Results of Randomized Clinical Trial,” Fertility and Sterility, vol. 92, no. 3, p. S31, Sep. 2009.
[42] D. Romualdi et al., “Metformin Effects on Ovarian Ultrasound Appearance and Steroidogenic Function in Normal-Weight Normoinsulinemic Women With Polycystic Ovary Syndrome: A Randomized Double-Blind Placebo-Controlled Clinical Trial,” Fertility and Sterility, vol. 93, no. 7, pp. 2303–2310, May 2010, doi: 10.1016/j.fertnstert.2009.01.114.
[43] M. Farimani Sanoee, N. Neghab, S. Rabiee, and I. Amiri, “Metformin Therapy Decreases Hyperandrogenism and Ovarian Volume in Women With Polycystic Ovary Syndrome,” Iranian Journal of Medical Sciences, vol. 36, no. 2, pp. 90–95, Jun. 2011.
[44] M. Gharakhani, N. Neghab, and M. Farimani, “Is Reducing Ovarian Volume in Polycystic Ovarian Syndrome Patients After Administration of Metformin Associated With Improving Cardiovascular Risk Factors?,” International Journal of Fertility & Sterility, vol. 5, no. 2, pp. 90–95, Jul. 2011.
[45] H. F. Ria, H. A. Mohammed, and H. I. Hemida, “Effect of Metformin and Myo-Inositol in Patients With Polycystic Ovary Syndrome,” Al-Azhar International Medical Journal, vol. 4, no. 11, p. 37, 2023.
[46] T. A. Abdulameer and S. A. Kadhim, “Effects of Coenzyme Q10 Combined With Metformin on Ovarian Function Compared to Metformin Alone in Iraqi PCOS Patients,” South Eastern European Journal of Public Health, pp. 689–694, 2024.
[47] R. Rago et al., “Effect of Myo-Inositol and Alpha-Lipoic Acid on Oocyte Quality in Polycystic Ovary Syndrome Non-Obese Women Undergoing In Vitro Fertilization: A Pilot Study,” Journal of Biological Regulators and Homeostatic Agents, vol. 29, no. 4, pp. 913–923, Oct.–Dec. 2015.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Dhirgham Saif Aldean Hussein, Sinaa Abdul Amir Kadhim, Asma Abdul Jaleel Swadi

This work is licensed under a Creative Commons Attribution 4.0 International License.