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Figure 2 4.1 Mechanisms of TCM formulas and herbs in regulating PCOS via gut microbiota 4.1.1 Regulate hormone metabolism PCOS is characterized by specific endocrine features, such as high levels of androgens, increased luteinizing hormone (LH), normal follicle-stimulating hormone (FSH) levels, and a relatively high LH/FSH ratio (76)

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However, scientists still have many unanswered questions

These effects occur in a minority of users and rarely require stopping

Users stopping niacinamide typically experience very gradual benefit decline over 1-3 months without dramatic reversal, maintaining 40-60% of improvements long-term if treatment lasted 6+ months, and tolerating breaks or cycling without rebound effects or significant regression concerns