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Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. It is characterized by hormonal imbalances, menstrual irregularities, and the formation of ovarian cysts. Recent studies have shown that PCOS is associated with abnormalities in calcium and phosphate metabolism, which play a significant role in the development and progression of the condition. This comprehensive review aims to explore the role of calcium in PCOS and its potential implications for treatment and management.

The Link between PCOS and Calcium Metabolism

Several studies have indicated that women with PCOS exhibit abnormalities in calcium and phosphate metabolism. These abnormalities include elevated levels of parathyroid hormone (PTH) and decreased levels of vitamin D. PTH is responsible for regulating calcium levels in the blood, and its elevated levels in PCOS patients suggest an imbalance in calcium homeostasis. Additionally, low levels of vitamin D, which is crucial for calcium absorption and utilization, further contribute to calcium dysregulation in PCOS.

Impact of Calcium on Insulin Resistance

Insulin resistance is a key feature of PCOS and is closely related to abnormalities in calcium metabolism. Calcium plays a crucial role in insulin signaling and glucose metabolism. Studies have shown that low calcium levels can impair insulin sensitivity and lead to insulin resistance, which is a hallmark of PCOS. In contrast, adequate calcium intake and optimal vitamin D levels have been associated with improved insulin sensitivity and glucose control in PCOS patients.

Calcium and Ovulation Induction

One of the primary concerns for women with PCOS is ovulation induction, as anovulation is a common characteristic of the condition. The use of letrozole, an aromatase inhibitor, has been recommended as a first-line treatment for ovulation induction in PCOS. Interestingly, letrozole is also known to influence calcium metabolism. However, studies have shown inconsistent results regarding the relationship between letrozole, calcium metabolism, and ovulation induction in PCOS patients. Further research is needed to elucidate this relationship.

Calcium and Reproductive Function

Calcium has been shown to have a significant impact on reproductive function in women with PCOS. Adequate calcium intake has been associated with improved follicular maturation, menstrual regularity, and hyperandrogenism in PCOS patients. Calcium supplementation, along with vitamin D, has been found to be effective in weight loss, regulation of menstrual abnormalities, and improvement of hyperandrogenism in infertile women with PCOS. These findings suggest that calcium plays a crucial role in optimizing reproductive function in PCOS.

Vitamin D and Calcium: A Synergistic Relationship

Vitamin D, a fat-soluble vitamin, is essential for calcium absorption and utilization. Studies have shown that women with PCOS often have low levels of vitamin D, which can further exacerbate calcium dysregulation and insulin resistance. Vitamin D supplementation, along with calcium, has been found to improve insulin sensitivity, decrease androgen levels, and enhance ovulatory function in women with PCOS. The synergistic relationship between vitamin D and calcium highlights the importance of maintaining optimal levels of both nutrients in PCOS management.

Calcium and Bone Health

Beyond its role in reproductive function and insulin sensitivity, calcium also plays a crucial role in maintaining bone health. Women with PCOS are at an increased risk of developing osteoporosis due to hormonal imbalances and calcium dysregulation. Adequate calcium intake, along with weight-bearing exercises and vitamin D supplementation, is essential for preserving bone density and reducing the risk of osteoporosis in PCOS patients.

Calcium Supplementation: A Promising Approach

Given the association between calcium dysregulation and PCOS, calcium supplementation has emerged as a potential therapeutic approach for managing the condition. Studies have shown that calcium supplementation, as well as supplementation of vitamin D, can improve weight loss, follicle maturation, menstrual regularity, and hyperandrogenism in infertile women with PCOS. Additionally, calcium supplementation has been found to compensate for vitamin D deficiency and enhance insulin sensitivity in PCOS patients. These findings suggest that calcium supplementation may be a promising adjunct therapy for PCOS management.

Recommended Calcium Intake for PCOS Patients

The recommended daily calcium intake for women with PCOS is similar to that for the general population. The National Institutes of Health (NIH) recommends a daily calcium intake of 1000-1300 mg for women aged 19-50 years. It is important for PCOS patients to consume calcium-rich foods such as dairy products, leafy greens, and fortified foods. Additionally, vitamin D supplementation may be necessary to ensure optimal calcium absorption and utilization.


In conclusion, calcium plays a critical role in the pathogenesis and management of PCOS. Abnormalities in calcium and phosphate metabolism are commonly observed in women with PCOS and are closely associated with insulin resistance, reproductive dysfunction, and bone health. Calcium supplementation, as well as supplementation of vitamin D, has shown promising results in improving weight loss, follicle maturation, menstrual regularity, and hyperandrogenism in infertile women with PCOS.

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