PCOS and Melatonin

Individuals with PCOS have altered levels of melatonin and melatonin supplements may offer benefits for insulin resistance, androgen levels, sleep and ovulation.[1] In this article, we explore the potential benefits of melatonin supplements for individuals with PCOS.

Melatonin is a hormone or chemical messenger that is produced by the pineal gland, a tiny gland in the brain,[2] and other tissues in response to darkness.[3],[4] Melatonin’s primary role is to help with the timing of your circadian rhythm (your 24-hour internal clock) and with sleep.[5] Melatonin levels typically rise roughly two hours before bedtime, creating a quiet awake state that makes it easier to fall asleep.[6]

Individuals with PCOS have been shown to have altered levels of melatonin:[7],[8],[9]

Elevated levels of melatonin in the blood at night and in the morning;
Less difference in the level of melatonin in the blood between sleep and waking hours; and
Relatively low levels of melatonin in the follicular fluid, the fluid the surrounds the developing oocyte or egg.[10]

In individuals with PCOS, melatonin supplements may offer benefits through a variety of mechanisms,[11] noting that most clinicians only recommend melatonin for short-term use:

Reducing hyperinsulinemia, elevated levels of insulin the blood,[12] by enhancing insulin sensitivity in peripheral tissues, such as fat and muscle;[13]
Reducing the level of androgens, by encouraging conversion of androgens to estradiol, a form of estrogen;[14] and
Improving the duration and quality of sleep and corresponding improvements on mental and physical wellbeing.[15]

A number of other potential roles of melatonin beyond circadian rhythm have also been suggested based on its anti-oxidative effects.[16] Melatonin molecules bond with free radicals, unstable oxygen molecules that can cause damage to cells in your body,[17] without themselves becoming oxidative.[18] Melatonin’s metabolites, the by-products it produces when it breaks down food,[19] are also able to have an anti-oxidative effect without becoming oxidative.

The concentration of melatonin within the follicular fluid, the biological fluid that surrounds the developing oocyte or egg,[20] is usually 3x the concentration of melatonin in blood serum.[21] The concentration of melatonin in the follicular fluid rises significantly as the follicles become mature, peaking just before ovulation occurs.[22],[23]

Melatonin is believed play several key roles in support of ovulation:[24]

Regulating the hormones across the hypothalamic-pituitary-ovarian axis (HPO axis), inhibiting the production of gonadotrophin releasing hormone (GnRH) and increasing the production of luteinizing hormone (LH);[25]
Protecting the oocyte against oxidative stress, particularly around the time of ovulation (with this protection also continue to the developing embryo);[26],[27] and
Delay of ovarian aging.[28]

In one research study, melatonin supplementation (in combination with myo-inositol) was shown to increase oocyte quality in individuals going through the IVF process.[29] It is worth noting that high doses of melatonin supplementation, alone or in combination with progestin, have been shown to prevent ovulation.[30]

Melatonin is available in many countries without a prescription and comes in a variety of forms, including tablets, gummies and transdermal patches. Whereas tablets and gummies are often formulated to act quickly to help you fall asleep faster, patches often have an extended release to help you stay asleep longer.[31]

Unlike many sleep medications, melatonin is unlikely to be habit-forming so is a relatively safe option for short-term use.[32] It is generally not recommended as a long-term solution for sleeplessness or to exceed a daily dose of more than 10mg.[33],[34],[35] Since melatonin can cause drowsiness, it should not be taken for at least 5 hours before driving or operating heavy machinery.[36]

The most common side-effects of taking melatonin include nausea, headache, dizziness and daytime drowsiness.[37] Other, less common, side effects can include:[38],[39],[40]

Mood changes, including short-term feelings of depression, irritability and mood swings;
Upset digestion, including stomach cramps, diarrhea, constipation and reduced appetite;
Changes to consciousness, including vivid dreams/nightmares, confusion or disorientation, low blood pressure and reduced alertness;
Blurred vision;
Urinary incontinence at night (bed wetting);
Dry or itchy skin and/or dry mouth;
Pains in your arms and legs;
Unexplained bruising or blood in the urine;
Increased risk of falls; and
Increased risk of seizures.

Melatonin is not recommended for certain individuals, including those with:[41],[42],[43]

Chronic insomnia (1 month or more);
Restless less syndrome;
Dementia;
A previous allergic reaction to melatonin or another medication;
Liver or kidney problems;
An autoimmune condition such as rheumatoid arthritis, multiple sclerosis and/or lupus;
In combination with alcohol; or
Those who are pregnant or breastfeeding.

Melatonin should also not be taken if you’re taking certain types of medication, including:[44]

Anti-seizure medication;
Anti-coagulants;
Blood pressure medicine;
Oral contraceptives;
Diabetes medicine;
Immunosuppressants; and
Other medicine that is broken down by the liver.

Reviewed by Riya Ganguly PhD., MBA, ICD.D, expert on technology transfer, new venture development and research facilitation

Sources

[10] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://touroscholar.touro.edu/cgi/viewcontent.cgi?article=1138&context=sjlcas#

[21] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://touroscholar.touro.edu/cgi/viewcontent.cgi?article=1138&context=sjlcas#

PCOS and Melatonin