Liver Function – The Missing Piece in Lean PCOS

PCOS is commonly regarded as a hormonal disorder – but one vital organ is often neglected: the liver. This is the organ responsible for hormone metabolism, clearance, and regulation. Studies have shown that many women with PCOS – including those of normal weight – can develop subclinical fatty liver disease. The consequences? Lower SHBG levels, higher free androgens, and hormonal dysregulation that may impair ovulation and fertility.

💡 What is SHBG?

SHBG stands for Sex Hormone-Binding Globulin – a protein produced by the liver that binds excess androgens (male hormones), thereby reducing their activity.

In addition, the liver is a major site for insulin clearance. In women with PCOS, hyperinsulinaemia is common – and when the liver is inflamed or burdened with excess fat, its ability to break down insulin declines. This can elevate insulin levels further, triggering increased androgen production in the ovaries and dysregulating the brain-hormone axis – a key mechanism in the pathophysiology of PCOS.

Chronic stress also plays a critical role: elevated cortisol can destabilise blood sugar and further impair liver function. Over time, this may promote fatty liver, insulin resistance, and hormonal imbalance. That’s why managing stress – alongside nutrition, movement, and micronutrient support – is essential for regulating the menstrual cycle and metabolic health in PCOS.

Supporting Liver Health in PCOS 

In lean PCOS – where body weight is normal – classic weight-loss strategies are often not applicable. In these cases, the liver may be a key therapeutic target. Studies have identified fatty liver changes and low SHBG levels in women with lean PCOS, both of which may contribute to persistent hormonal imbalance.

One of the most effective and underrated strategies is stress management. Chronic stress raises cortisol, increases inflammation, and places extra strain on the liver and endocrine system. Tools such as mindfulness, deep breathing, restorative movement, and adequate sleep can go a long way in rebalancing both mind and body.

Liver-friendly nutrition is another important pillar. A fibre-rich diet (e.g. vegetables, oats, legumes), bitter foods (e.g. rocket, artichokes, grapefruit), and a reduction in sugar and alcohol all help relieve pressure on the liver. A regular, anti-inflammatory eating pattern supports bile flow, promotes detoxification, and indirectly benefits hormonal regulation.

Vitamin D and Omega-3 Fatty Acids for Liver Health in PCOS

In addition to lifestyle changes, certain micronutrients can support liver function directly. Studies have shown that vitamin D and omega-3 fatty acids have anti-inflammatory effects, reduce liver fat, and improve liver enzyme activity – even in the absence of visible symptom improvement. A recent literature review revealed the following:

• Vitamin D (3200 IU/day) significantly reduced liver enzymes (ALT), hyaluronic acid, and fibrosis markers (ELF score) in a study by Javed et al.
• Omega-3 fatty acids (4 g/day) led to a notable reduction in liver fat according to Cussons et al., especially in patients with diagnosed steatosis. Triglycerides and blood pressure also dropped significantly.
• However, none of the studies showed a concurrent improvement in core PCOS symptoms such as menstrual regularity, ovulation, or androgen levels.

🔍 These findings suggest: improvements in liver health may not immediately resolve hormonal symptoms – but they can create a more favourable metabolic environment for recovery and fertility.

Targeted Micronutrient Support: Fertilovit® F PCOS

When dealing with complex metabolic profiles – as is often the case in PCOS – a more holistic approach may be needed. This is where specialised micronutrient formulas such as Fertilovit® F PCOS can make a difference.

The formulation includes:

• Myo- and D-chiro-inositol to improve insulin sensitivity
• N-acetylcysteine (NAC) to reduce oxidative stress
• Vitamin D and omega-3 fatty acids for liver support

This combination is particularly beneficial in women with metabolically driven PCOS, lean PCOS, or those struggling to conceive and looking to support liver health as part of their fertility journey.

Omega-3 and Fertility in PCOS – Promising New Data

But omega-3 can do even more. Recent studies show that these essential fatty acids not only support liver health – they may also improve fertility outcomes directly.

A randomised double-blind study from Israel (Trop-Steinberg et al., 2023) examined the effect of omega-3 supplementation on pregnancy rates in women with PCOS undergoing clomiphene treatment:

• 26.7% of treatment cycles in the omega-3 group resulted in pregnancy – compared to 13.3% in the placebo group.
• Among overweight women, the effect was even stronger: 29.6% vs. 5.3% (p < 0.04).
• No side effects were reported.

✨ These results support the use of omega-3 not just for liver support – but also as an effective adjunct in fertility-focused PCOS therapy.

❓ FAQ – PCOS, Liver Health & Micronutrients

Does liver support help even if PCOS symptoms remain unchanged?
Yes. Improving liver function can raise SHBG levels and reduce free androgens – even before symptoms visibly improve.

How fast do vitamin D and omega-3 work?
Studies observed measurable improvements in liver markers after just 8 weeks (omega-3) and 3 months (vitamin D).

Should lean women with PCOS also focus on their liver?
Absolutely. Research confirms that even women with lean PCOS may develop “silent” fatty liver, often without obvious symptoms.

Is diet alone enough?
A healthy, anti-inflammatory diet is the foundation – but targeted nutrients like inositol, NAC, vitamin D, and omega-3 can enhance and accelerate results.

How exactly does Fertilovit® F PCOS support women with PCOS?
It combines liver-active nutrients with ingredients shown to support hormonal balance and fertility – offering comprehensive support without pharmaceutical side effects.

Conclusion: It’s Time to Pay Attention to the Liver in PCOS

The liver is not just a passive detox organ – it’s a central player in hormonal regulation and insulin metabolism. In PCOS, especially in lean or treatment-resistant cases, liver health deserves far more attention.

Stress reduction, a liver-friendly diet, and the use of anti-inflammatory micronutrients like vitamin D and omega-3 can significantly improve liver function and lay the groundwork for hormonal and metabolic stability – even if results aren’t immediate.

For women seeking a gentle but effective way to support their fertility, Fertilovit® F PCOS offers a well-researched and practical solution that targets both liver function and hormonal health – without the side effects of medication.

References

Alhermi A, Perks H, Nigi V, Altahoo N, Atkin SL, Butler AE. The Role of the Liver in the Pathophysiology of PCOS: A Literature Review. Biomolecules. 2025 Jan 2;15(1):51. doi: 10.3390/biom15010051. PMID: 39858445; PMCID: PMC11764088.

Cussons AJ, Watts GF, Mori TA, Stuckey BG. Omega-3 fatty acid supplementation decreases liver fat content in polycystic ovary syndrome: a randomised controlled trial employing proton magnetic resonance spectroscopy. J Clin Endocrinol Metab. 2009 Oct;94(10):3842–8. doi: 10.1210/jc.2009-0870.

Javed Z et al. A Randomised, Controlled Trial of Vitamin D Supplementation on Cardiovascular Risk Factors, Hormones, and Liver Markers in Women with Polycystic Ovary Syndrome. Nutrients. 2019 Jan 17;11(1):188. doi: 10.3390/nu11010188.

Trop-Steinberg S et al. Omega-3 Intake Improves Clinical Pregnancy Rate in Polycystic Ovary Syndrome Patients: A Double-Blind, Randomised Study. Isr Med Assoc J. 2023 Feb;25(2):131–136. PMID: 36841983.