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Genazzani AD, Lanzoni C et al. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol. 2008 Mar;24(3):139-44. 15. Minozzi M, Costantino D et al. The effect of a combination therapy with myo-inositol and a combined oral contraceptive pill versus a combined oral contraceptive pill alone on metabolic, endocrine, and clinical parameters in polycystic ovary syndrome. Gynecol Endocrinol. 2011 Nov;27(11):920-4. Department of Obstetrics and Gynecology, Semmelweis University, 1182, Budapest, Üllői Út 78/A, Hungary The effect of inositol treatment compared to placebo or metformin was analyzed. If possible, subgroup analysis was carried out based on different inositol isomers and their combinations (D-chiro-inositol, myoinositol, or a combination of the two). Zeng et al. also analyzed the effect of inositols on SHBG. However, they only included two articles and showed that myoinositol might have a better effect on SHBG compared to placebo [ 54].
Weight - M Nordio, E Proietti The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone Eur Rev Med Pharmacol Sci. (2012 May)Carlomagno & Unfer (2011), Inositol safety: clinical evidences. Eur Rev Med Pharmacol Sci, 15: 931-936 The pathogenesis of PCOS is still not fully understood. On the other hand, insulin resistance (IR) has a central role in its pathogenesis [ 5, 6, 7]. According to a cross-sectional study, IR is present in 75% of lean and 95% of overweight women with PCOS [ 8]. It is important to emphasize that 60–70% of women with PCOS are overweight [ 9]. Moreover, IR is more severe in obese women [ 7]. IR and compensatory hyperinsulinemia can, directly and indirectly, lead to irregular menstrual cycles and hyperandrogenism. Higher insulin levels reduce the sex hormone binding globulin (SHBG) production of the liver. Reduced SHBG levels lead to increased free testosterone levels worsening the symptoms of hyperandrogenism. In addition, hyperinsulinemia stimulates the androgen overproduction of ovarian theca cells [ 10]. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6–15.
Minozzi M, D'Andrea G et al. Treatment of hirsutism with myo-inositol: a prospective clinical study. Reprod Biomed Online. 2008 Oct;17(4):579-82. 17. Ciotta L, Stracquadanio M, et al. Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial. Eur Rev Med Pharmacol Sci. 2011 May; 15(5): 509-14. The systematic search was carried out with the following predefined search key: (PCOS OR PCOD OR polycystic ovar* disease OR "polycystic ovary syndrome" OR polycystic ovar* syndrom*) AND (inositol OR inositols OR metformin OR myoinositol OR chiroinositol). Filters or language restrictions were not applied during the search. Selection process
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In a 2017 randomised controlled trial published in Gynecological Endocrinology, researchers compared the effects of metformin and myo-inositol on the clinical and metabolic features in PCOS. Fifty women with PCOS and either insulin resistance or hyperinsulinaemia were randomised to receive treatment with either metformin (1500 mg/day) or myo-inositol (4g / day). Results in both groups were similar: insulin sensitivity and BMI significantly improved in both groups, and the menstrual cycle was normalised in about 50% of the women. The researchers concluded that both metformin and myo-inositol have been demonstrated to be useful in women with PCOS for lowering BMI, improving insulin sensitivity, and improving menstrual cycle, without significant differences between the two treatments. 24 Monastra G, Unfer V, Harrath AH, et al. Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients. Gynecol Endocrinol. 2017;33(1):1–9. Kiani AK, Paolacci S, Calogero AE, Cannarella R, Di Renzo GC, Gerli S, Della Morte C, Busetto GM, De Berardinis E, Del Giudice F, Stuppia L, Facchinetti F, Dinicola S, Bertelli M From Myo-inositol to D-chiro-inositol molecular pathways. Eur Rev Med Pharmacol Sci. (2021-Mar)
A 2017 randomised controlled crossover study was carried out to investigate which is more effective between metformin and myo inositol on hormonal, clinical and metabolic parameters in obese patients with PCOS. In the study, 34 PCOS obese women were randomised to receive metformin (850mg twice daily) or myo-inositol (1000mg twice daily) for 6 months. After a 3-month washout period, the same subjects received the other compound for the following 6 months. Results showed that both treatments improved the glyco-insulinaemic features of obese PCOS patients, but only metformin seems to exert a beneficial effect on the endocrine and clinical features of the syndrome. 27
References
Always consult your GP before taking nutritional supplements if you are taking medication or are under medical supervision. If pregnant or lactating please consult your doctor before using food supplements. Current research suggests that for women with PCOS, 2000mg myo-inositol taken 1-2 times daily for 3 months is an effective protocol to begin with before reviewing the programme. 13-22,32 32 Clinical doses of myo-inositol may be best achieved in supplemental powdered form. Myo-inositol may also be taken along with folic acid. The benefits demonstrated by research so far have involved myo-inositol in supplemental form rather than from food sources; it is also unlikely that food sources can supply high enough levels to achieve a therapeutic effect. Contains added active ingredients such as N-acetyl cysteine (NAC), Alpha-lipoic acid (ALA), and Co-enzyme Q10. The pregnancy rate was reported in eight RCTs, while in four articles, the inositol therapy was followed by additional therapy such as letrozole or a combination of rFSH and HCG injection. The overall pregnancy outcome was heterogenous regarding its definition, carrying a significant risk of bias.
For dichotomous data, events for the outcomes and total numbers of patients were used on both arms. Study risk of bias assessment Clements RS, Darnell B Myo-inositol content of common foods: development of a high-myo-inositol diet. Am J Clin Nutr. (1980-Sep) Inositols have long been debated as a potential alternative for metformin in treating PCOS. Therefore, the present systematic review aimed to evaluate the efficacy and safety of inositols in treating PCOS. Methods Papaleo E, Unfer V et al. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007 Dec; 23(12):700-3. Insulin resistance, a problem with your body’s ability to respond to insulin, is considered one of the key factors associated with conditions like metabolic syndrome ( 8).
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Certain nutrients which are essential in supporting your reproductive health. Zinc contributes to normal fertility and reproduction whilst vitamin B6 contributes to the regulation of hormonal activity. In a 2017 review on using inositols in PCOS, and published in Gynecological Endocrinology, the authors found combined treatment with myo-inositol and d-chiro inositol to be effective in restoring ovary function and metabolic balance in PCOS. 25 Facchinetti F, Orrù B, Grandi G, Unfer V. Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials. Gynecol Endocrinol. 2019;35(3):198–206. AziziKutenaei M, Hosseini Teshnizi S, Ghaemmaghami P, Eini F, Roozbeh N. The effects of myo-inositol vs. metformin on the ovarian function in the polycystic ovary syndrome: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(7):3105–15. Problems with insulin sensitivity may be one of the causes of reduced fertility in women with PCOS. Since inositol may improve insulin sensitivity, it has been studied as a potential treatment ( 14).
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