MTHFR and PCOS: Is there a Connection? | Methyl-Life®

MTHFR and PCOS: Is there a Connection? | Methyl-Life®

Katie Stone - Naturopath

Written By:

Katie Stone - Naturopath
Dr. Nare Simonyan - PhD Pharmaceutical Science

Medical Reviewer:

Dr. Nare Simonyan - PhD Pharmaceutical Science
Kari Asadorian - Bachelor of Science in Nursing

Edited By:

Kari Asadorian - Bachelor of Science in Nursing

Updated On:

March 30, 2025

Table of Contents

    MTHFR and PCOS: Is there a Connection?

    Polycystic ovary syndrome (PCOS) is the most common hormone-related disorder in women, affecting an estimated 7-10 percent (5-6 million) of women1 in the US. It is also the most common cause of infertility.


    Although the etiology of PCOS is largely unknown, recent research has revealed that MTHFR genetic mutations may be linked due to its involvement in the regulation of homocysteine. However, there is no specific evidence to show that MTHFR directly causes PCOS.


    Methylenetetrahydrofolate reductase (MTHFR) plays a key role in the metabolism of folate and DNA methylation, and RNA synthesis.


    MTHFR is required for the conversion of folic acid in plasma and tissues. However, a mutation in the MTHFR gene can result in low folate concentrations, leading to elevated homocysteine levels2.


    Decreased efficiency of the folate/homocysteine pathway appears to be prevalent in women with PCOS3, and that PCOS is often accompanied by high homocysteine levels.


    It has also been found that homocysteine levels in women with PCOS return to normal following folate supplementation4, which supports the theory that MTHFR is connected.


    This article will discuss what PCOS is and the links to MTHFR mutations. We will also cover the possible treatment for PCOS for those with MTHFR genetic mutations.

    What is PCOS?

    Polycystic ovarian syndrome5 (PCOS) is a complex condition characterized by hormonal imbalances, irregular menstruation, and/or small cysts on the ovaries. The increased levels of androgens in women with PCOS results can also inhibit follicular development, affecting fertility.


    It is estimated that PCOS has affected 116 million women (3.4%) worldwide6. The prevalence of PCOS between different countries is highly variable, ranging from 2.2% to as high as 26%.


    The severity of PCOS symptoms vary between women and can change throughout life. Common symptoms include:

    • Irregular menstruation
    • Very light periods or amenorrhea
    • Enlarged ovaries due to eggs that do not ovulate
    • Multiple cysts on the ovaries
    • Difficulty becoming pregnant
    • Excess hair on the face and body (hirsutism)
    • Thinning hair or hair loss on the scalp (alopecia)
    • Acne on the face and/or body that can be severe
    • Oily skin
    • Darkened or thickened patches of skin (acanthosis nigricans) in the armpits, back of the neck, under the breasts
    • Weight gain, usually around the abdomen
    • Skin tags on the neck or armpits
    • Mood changes: depression, anxiety, low self-esteem

    Risk Factors for PCOS

    While the exact cause is uncertain, many factors can increase the risk of developing PCOS. Nutritional status, obesity, insulin resistance, lifestyle, and environmental factors may play a part, along with genetics.


    Increased androgen production is the main cause of PCOS symptoms, which is linked to insulin resistance. Insulin resistance and the compensatory hyperinsulinemia affect around 65–70% of women with PCOS. Of these women, 70–80% have a BMI higher than 307, which is considered obese. Another 20–25% have a BMI of less than 25. As a result, PCOS is often linked to obesity and insulin resistance.


    Excess insulin in the bloodstream causes the body to store abdominal fat8, which is associated with higher levels of fasting insulin and LH (Luteinising Hormone). Hyperinsulinemia can then stimulate androgen production in the ovaries9, particularly as PCOS cells are more responsive to insulin than other cells. Increased insulin is also shown to activate androgen production10 in PCOS theca cells.


    Type 2 diabetes, glucose intolerance, dyslipidemia, and higher levels of inflammation are also more common in women with PCOS11.

    Conditions Related to PCOS

    • Type 2 diabetes and prediabetes
    • Cardiovascular disease
    • Metabolic syndrome
    • High blood pressure, high cholesterol, obesity, high fasting blood glucose
    • Endometrial cancer
    • Sleep apnoea
    • Infertility and pregnancy complications
    • Gestational diabetes

    Could an MTHFR Mutation Cause PCOS or Make Symptoms Worse?

    Evidence regarding the link between MTHFR and PCOS is mixed.


    A large meta-analysis in 2020 demonstrated that the C677T polymorphism contributed to an increased risk of PCOS, especially among Asian women12. However, the authors noted that further studies with larger population sizes are needed to confirm these results.


    A previous meta-analysis in 2017 hypothesized that the C677T would be strongly associated13 with the risks for PCOS in the Middle Eastern populations but found that the same polymorphism was protective in Caucasian populations. As a result, the authors suggested that the C667T variant can “increase, decrease, or have no effect” on the risks of PCOS, depending on the population’s ethnicity.


    A 2010 study involving Turkish patients found the C677T variant significantly higher14 in women with PCOS. The authors explained that insulin resistance and hyperinsulinemia might be central roles to various hormonal and metabolic imbalances that occur in PCOS, including elevated homocysteine. They also pointed out that dietary inadequacies (such as low intake of folate and B12) may have affected the homocysteine levels in PCOS patients.


    A large meta-analysis of 13 studies published in 201615 concluded that C677T does not influence the risk of PCOS and that MTHFR mutations were not clinically important in PCOS in most of the populations. They also noted that MTHFR was not correlated with obesity in PCOS.


    However, a number of studies have highlighted that women with PCOS tend to have elevated homocysteine16, which is a common outcome of an MTHFR mutation17. Women with PCOS are also at a higher risk of developing coronary artery disease18 due to hyperhomocysteinemia. MTHFR deficiency is the most common cause of hyperhomocysteinemia19, suggesting an association between PCOS and MTHFR C677T.


    Increased levels of homocysteine in PCOS women may also play a part in several conditions that could worsen PCOS, including cardiovascular disease and infertility20.

    Does Supplementation with Methylfolate Help with PCOS Symptoms?

    Homocysteine levels are significantly associated with insulin resistance and hyperinsulinemia21 in women with PCOS. Fortunately, this can be treated with methylfolate.


    Normally, excess homocysteine is removed from the body via the methylfolate pathway. The MTHFR enzyme is required for the conversion of a form of folate to 5-methyltetrahydrofolate, the primary active form of folate involved in the conversion of homocysteine into methionine. However, a mutation on the MTHFR gene can seriously affect the ability of the MTHFR enzyme to function normally22, which has severe implications for the homocysteine cycle.


    Imbalances of any of the above pathways result in the accumulation of homocysteine. However, supplementation with folate, vitamins B2, B3, B12, betaine, and zinc can support the methylation cycle23 and improve the elimination of homocysteine.


    Taking folate, B12, and B6 together24 has been shown to help lower homocysteine levels more effectively than taking folate alone.


    L-methylfolate is also found to increase peripheral sensitivity to insulin25 and maintain stable folate levels, which can help rebalance levels of homocysteine. Unlike folic acid, L-methylfolate is highly bioavailable and can bypass the MTHFR mutation.


    Studies have also highlighted the need for women with PCOS to supplement with thiamine, niacinamide, and folates with inositol in order to increase peripheral sensitivity to insulin26. Myo-inositol + folate supplementation in women with PCOS may result in better fertilization rates27 and improved embryo quality. It also appeared to reduce the risk of hyperstimulation syndrome. 

    Best Supplements for PCOS with MTHFR

    Treatment of PCOS should be with a multi-nutrient approach28 aimed at supporting all areas of concern. Along with reducing the symptoms of PCOS, it is important that the risk factors of cardiovascular disease be treated. Lowering homocysteine should be a priority.


    Numerous studies have indicated that elevated homocysteine is closely linked to low levels of plasma folate29. There are also links between blood levels of vitamin B12 and pyridoxal-5-phosphate (the active form of B6). Low B-vitamin status can cause homocysteine to accumulate30 while also reducing the availability of SAMe (S-Adenosyl methionine) for methylation processes.


    One of the most effective ways to reduce elevated homocysteine is by increasing the intake of activated B vitamins31, particularly L-methylfolate. Activated forms of folate, B12, and betaine may control or alleviate the risk of elevated homocysteine and can32 improve the efficiency of the conversion by bypassing genetic variants of MTHFR.


    L-methylfolate is more effective than folic acid33 in lowering homocysteine levels. Taking folate, B12, and B6 together34 has been shown to help lower homocysteine levels more effectively than taking folate alone.


    Some of the best methylfolate supplements for those with MTHFR mutations include Methyl-Life® products (B-Methylated II, Methylated Multivitamin, also Methylfolate 7.5+ or Methylfolate 15+). This product range has been created by a team of natural health experts and contains the purest, most stable, and most potent of the four world’s industry-leading patented L-Methylfolates. It is also suitable for vegans and those with cardiovascular risks.


    It should be noted that poor insulin management in PCOS can also lead to several health complications, including irregular menstruation, infertility, hirsutism, obesity, acne, and cardiovascular issues. A low-GI (Low-glycemic index)diet has been shown to improve glucose tolerance35 and menstrual regularity in women with PCOS. 

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    References

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    24. Martin den Heijer, Ingeborg A. Brouwer, Gerard M. J. Bos, Henk J. Blom, Nathalie M. J. van der Put, Anja P. Spaans, Frits R. Rosendaal, Chris M. G. Thomas, Hans L. Haak, Pierre W. Wijermans, Wim B. J. Gerrits; "Vitamin Supplementation Reduces Blood Homocysteine Levels : A Controlled Trial in Patients With Venous Thrombosis and Healthy Volunteers"; Arteriosclerosis, Thrombosis, and Vascular Biology; 1998 Mar

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    26. Małgorzata Szczuko, Iwona Szydłowska, Jolanta Nawrocka-Rutkowska; "A Properly Balanced Reduction Diet and/or Supplementation Solve the Problem with the Deficiency of These Vitamins Soluble in Water in Patients with PCOS"; Nutrients; 2021 Feb

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996738/

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      https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.114.013311

    32. Caterina Tinelli, Antonella Di Pino, Elena Ficulle, Serena Marcelli, Marco Feligioni; "Hyperhomocysteinemia as a Risk Factor and Potential Nutraceutical Target for Certain Pathologies"; Frontiers In Nutrients; 2019 Apr

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    33. The American Journal of Clinical nutrition

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    34. Martin den Heijer, Ingeborg A. Brouwer, Gerard M. J. Bos, Henk J. Blom, Nathalie M. J. van der Put, Anja P. Spaans, Frits R. Rosendaal, Chris M. G. Thomas, Hans L. Haak, Pierre W. Wijermans, Wim B. J. Gerrits; "Vitamin Supplementation Reduces Blood Homocysteine Levels : A Controlled Trial in Patients With Venous Thrombosis and Healthy Volunteers"; Arteriosclerosis, Thrombosis, and Vascular Biology; 1998 Mar

      https://www.ahajournals.org/doi/full/10.1161/01.atv.18.3.356

    35. Kate A Marsh, Katharine S Steinbeck, Fiona S Atkinson, Peter Petocz, Jennie C Brand-Miller; "Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome"; The American journal of clinical nutrition; 2010 Jul

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    Katie Stone - Naturopath

    About the Author

    Katie is a qualified Naturopath (BNatMed) and freelance writer from New Zealand. She specializes in all things health and wellness, particularly dietary supplements and nutrition. Katie is also a dedicated runner and has completed more half-marathons than she can count!

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