NAC Supplements for PCOS, Fertility, and More

N-acetylcysteine, or NAC for short, is a popular nutritional supplement for good reason. It's safe, inexpensive, and widely available, and has many applications in integrative medicine. Further, NAC offers potential benefits for various women’s health concerns, including fertility, pregnancy, and recurrent miscarriages.

It’s an easy intervention to add to a comprehensive protocol for my patients. As always, please speak with your TārāMD practitioner or other healthcare provider for personalized supplement guidance.

Today’s article will dive into the research behind NAC for women’s health and offer practical information. Keep reading to learn more about:

• What is NAC?
• NAC health benefits
• NAC and PCOS
• NAC and fertility
• NAC and pregnancy loss
• NAC and immune health
• NAC and brain health
• Is NAC right for you?

What is NAC?

NAC (N-acetylcysteine) is a precursor to the amino acid l-cysteine. Cysteine is found naturally in whole foods, including chicken, fish, garlic, yogurt, and eggs.

In the body, NAC is a powerful antioxidant. It helps protect cells by neutralizing free radicals, thereby decreasing oxidative stress. Additionally, NAC promotes glutathione synthesis. Glutathione is the body’s master antioxidant, involved in detoxification, regenerating vitamin E, and cellular processes.

In addition to its antioxidant effects and promotion of glutathione synthesis, it’s also a powerful anti-inflammatory compound that can reduce inflammatory signaling in cells. Doctors consider NAC a mucolytic drug because it breaks up and thins mucus.

As an oral supplement, glutathione is popular and widely available. Despite its poor absorption (less than 10% reaches the body), it offers many health benefits, especially for women.

NAC and PCOS

Polycystic Ovarian Syndrome, PCOS, is the most common endocrine disorder women face during the reproductive years, affecting 5-10% of women. Women with PCOS may experience a decline or halt to ovulation, increased testosterone levels, and insulin resistance, leading to metabolic dysfunction and cardiometabolic disease. Additionally, PCOS can make it hard to get pregnant and stay pregnant.

Women with PCOS tend to have increased inflammation and fewer circulating antioxidants, making NAC a helpful supplement. In PCOS, NAC also supports healthy insulin levels, decreases total testosterone, and increases follicle-stimulating hormone (FSH), a hormone involved in ovulation.

NAC and Fertility

Inflammation, oxidative stress, microbiome imbalances, and toxin exposures are just a few reasons fertility rates are declining. From an integrative perspective, I seek to understand the root causes of infertility for my patients and address those. However, in conjunction with other strategies, NAC offers a helpful tool for improving egg quality by increasing antioxidant protection for developing egg cells.

NAC, along with vitamin E, vitamin A, and essential fatty acids, increases antioxidant protection of female eggs, and improves ovulation, egg quality, and pregnancy rates in women with PCOS or unexplained infertility. 

NAC and Pregnancy Loss

Recurrent pregnancy loss is a medical term describing the loss of three or more pregnancies before 20 weeks. When miscarriages are recurrent, it’s important to dive deeper and explore what may be contributing. Still, an answer isn’t always straightforward.

One study suggests oxidative stress as a reason behind unexplained recurrent miscarriages and investigated NAC as a possible therapy. The study compared two groups of women where one group received 600 mg NAC and 500 mcg folic acid daily, and the other group only received NAC. The NAC group had a staggering 190% greater chance of their pregnancy continuing past 20 weeks. Further, the use of NAC during pregnancy shows no fetal or maternal harm.

NAC supplementation has been investigated heavily in women with PCOS undergoing fertility treatments. PCOS is a contributor to subfertility and miscarriages. When given NAC along with fertility drugs (clomiphene citrate or letrozole), NAC helps increase ovulation, egg quality, and pregnancy rates.

NAC and Immune Health

As mentioned, NAC is mucolytic substance to help thin and clear mucus. It’s FDA-approved for this purpose. Because NAC is also anti-inflammatory and an antioxidant, it likely addresses immune issues from many angles and has been found beneficial for:

• Upper respiratory infections (colds and flu)
• Covid
• Chronic bronchitis
• Autoimmune diseases, including ulcerative colitis
• Asthma

Having NAC on hand is helpful during cold season, especially if your little ones bring home all the germs. Women are also more likely to get autoimmune diseases because of a complex interplay between the X chromosomes and hormonal shifts. Stay tuned for an in-depth article on this topic.

NAC and Brain Health

Brain health is something women think about a lot, whether experiencing “mommy brain” when pregnant or nursing or the debilitating brain fog and memory changes in perimenopause. We know sex hormones influence brain health, and prevention of neurodegenerative diseases becomes a focus of many women as they age.

Alzheimer's disease and Parkinson's disease have multiple contributing factors but share the contribution of oxidative damage to the brain, affecting mitochondria, the parts of cells that make energy (and your brain requires a lot of energy).

In Alzheimer’s disease, NAC and lipoic acid supplementation decreases oxidative stress and protects mitochondria in the brain. In Parkinson’s disease, animal models suggest NAC increases glutathione in the brain and reduces oxidative damage.

Is NAC Right for You?

Cysteine is a critical amino acid in the body and is found naturally in the diet by consuming protein-rich foods like meat, fish, poultry, dairy, eggs, legumes, and sunflower seeds. Choose organic, pasture-raised, and other high-quality options often for optimal benefits.

Many women may desire higher doses of cysteine only found in supplements to support specific conditions or health goals, like improving fertility, PCOS, or immune health. NAC is one of my favorite supplements because of its anti-inflammatory, antioxidant, and glutathione-promoting actions!

NAC is inexpensive, widely available, and may support overall and reproductive health. Toxicity from NAC is uncommon, even at high dosages. A standard dose is 500 to 600 mg once or twice daily.

Although I’m a doctor, I may not be your doctor. Please take this information as education only. Please talk with your doctor or knowledgeable healthcare provider about the supplements you take and would like to try. This conversation is critical if you take medication or have a medical condition.

Please schedule a TārāMD appointment today; your initial appointment will include a thorough review of supplements and we can help you determine if NAC, other supplements, and other approaches are right for you.

References:

1. Mokhtari, V., Afsharian, P., Shahhoseini, M., Kalantar, S. M., & Moini, A. (2017). A Review on Various Uses of N-Acetyl Cysteine.Cell journal, 19(1), 11–17.
2. Averill-Bates D. A. (2023). The antioxidant glutathione.Vitamins and hormones, 121, 109–141.
3. Tenório, M. C. D. S., Graciliano, N. G., Moura, F. A., Oliveira, A. C. M., & Goulart, M. O. F. (2021).N-Acetylcysteine (NAC): Impacts on Human Health. Antioxidants (Basel, Switzerland), 10(6), 967.
4. Shahveghar Asl, Z., Parastouei, K., & Eskandari, E. (2023). The effects of N-acetylcysteine on ovulation and sex hormones profile in women with polycystic ovary syndrome: a systematic review and meta-analysis.The British journal of nutrition, 130(2), 202–210.
5. Sandhu, J. K., Waqar, A., Jain, A., Joseph, C., Srivastava, K., Ochuba, O., Alkayyali, T., Ruo, S. W., & Poudel, S. (2021). Oxidative Stress in Polycystic Ovarian Syndrome and the Effect of Antioxidant N-Acetylcysteine on Ovulation and Pregnancy Rate.Cureus, 13(9), e17887.
6. Amin, A. F., Shaaban, O. M., & Bediawy, M. A. (2008). N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss.Reproductive biomedicine online, 17(5), 722–726. Izquierdo-Alonso, J. L., Pérez-Rial, S., Rivera, C. G., & Peces-Barba, G. (2022). N-acetylcysteine for prevention and treatment of COVID-19: Current state of evidence and future directions. Journal of infection and public health, 15(12), 1477–1483.