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Myo-inositol, Folate, Vitamin D3, Vitamin E, Vitamin C, Thiamine (Vitamin B1), Riboflavin (Vitamin B2), Niacin (Vitamin B3), Vitamin B6, Vitamin B12, Biotin, Pantothenic acid, Iodine, Magnesium, Iron, Zinc, Copper, Selenium, Chromium, N-Acetyl Cysteine, L-Arginine, Alpha Lipoic Acid, Coenzyme Q10 (Ubiquinol), Beta-carotene. 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
The clinical applications of myo-inositol are already wide ranging and it’s likely, as research in the area gathers momentum, more may be added. For women with PCOS though, research shows that myo-inositol is a useful consideration as part of their treatment protocol. Because many of our customers are trying to conceive, or plan to in the future, we want to ensure that we offer the most effective solution. Combining Preconception with Myoplus Over 20 nutrients to support your reproductive health and fertility. Each vitamin and mineral has been nutritionally formulated to nourish your body in preparation for a healthy pregnancy. Pooja Singh SB, Santosh Kumar Verma. A prospective randomised controlled study on the effects of myoinositol on ovarian functions and metabolic factors in women with polycystic ovarian syndrome. Int J Reprod Contracept Obstet Gynecol. 2020;9(12):4912–7. 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].
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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
Rocha AL, Oliviera FR et al. Recent advances in the understanding and management of polycystic ovary syndrome. F1000 Research. 2019 Apr 26; 8: F1000 Faculty-Rev-565 The present systematic search was performed in CENTRAL, MEDLINE, and Embase from the inception until October 20th, 2021. Eligible randomized controlled trials (RCTs) included women diagnosed with PCOS and compared any inositols with metformin or placebo. Our primary outcome was cycle normalization, whereas secondary outcomes were body mass index (BMI), parameters of carbohydrate metabolism and clinical and laboratory hyperandrogenism. Results are reported as risk ratios or mean differences (MDs) with 95% confidence intervals (CIs). Results Compared to placebo, inositols significantly reduced total testosterone levels (MD = -20.39 ng/dl, CI: -40.12; -0.66, Figure S 3a.). Two studies showed an advantageous effect of DCI for this outcome. On the other hand, free testosterone was significantly reduced by inositol treatment compared to placebo (MD = -0.41 ng/dl, CI: -0.69; -0.13, Figure S 4.). SHBG levels were significantly increased by inositols (MD = 32.06 nmol/l, CI: 1.27; 62.85, Figure S 5a.). Androstenedione was also significantly reduced after inositol treatment (MD = -0.69 ng/ml, CI: -1.16; -0.22, Figure S 6.). Myoinositol, compared to placebo, also seems to have a beneficial effect on androstenedione (MD = 0.89 ng/ml, CI: -1.56; -0.22, Figure S 6.). DCI reduced DHEAS levels (MD = -168.48 μg/dl, CI-281.15; -55.82, Figure S7a.). However, the combined analysis of different inositols did not reach the level of significance. Finally, only one study investigated the effect of inositol on the FG-score [ 15]. Currently, the evidence to support using myo-inositol in PCOS is rapidly emerging and promising particularly with regard to hormonal, ovulatory and metabolic benefits. As with many aspects of nutrition-based interventions however, the research is still considered to be limited by small study group sizes. According to the International PCOS Network, inositol (in any form) should be considered an experimental therapy in PCOS, “as this agent is freely available as a nutritional supplement, at low to moderate cost and appears to have a limited side effect profile, it may warrant consideration for use despite limited and low quality evidence. As with other supplements or complementary therapies, women taking this agent are encouraged to advise their health care team.” 36 Carlomagno & Unfer (2011), Inositol safety: clinical evidences. Eur Rev Med Pharmacol Sci, 15: 931-936The 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]. Team, RC. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2021. Inositol can be used to produce molecules that are involved in insulin’s action in your cells ( 9). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–7. Milewska EM, Czyzyk A, Meczekalski B, Genazzani AD. Inositol and human reproduction. From cellular metabolism to clinical use. Gynecol Endocrinol. 2016;32(9):690–5.
According to the present meta-analysis, inositols have a beneficial effect on all aspects of PCOS. First, inositols reduce serum total and free testosterone and androstenedione levels, increase SHBG levels, and normalize cycle length compared to placebo. On the other hand, in all these parameters, they were not inferior to metformin. Furthermore, a significant decrease was found in fasting glucose and AUC insulin levels and BMI in the inositol-treated groups. Of the analyzed isomers, myoinositol has the most supported benefit. Finally, compared to metformin, inositols showed fewer side effects. In the treatment of PCOS, metformin is the gold standard metabolic treatment [ 4, 10]. However, metformin may induce mild to severe gastrointestinal side effects such as nausea, diarrhea, vomiting, and flatulence [ 11]. Therefore, alternative treatment with fewer side effects would be beneficial in managing these patients. In recent years, several studies have analyzed the potential effects of inositol supplementation, suggesting that inositols are potent alternatives for metformin in treating PCOS [ 12, 13, 14, 15, 16]. Baillargeon JP, Iuorno MJ et al. Uncoupling between insulin and release of a D-chiro-inositol-containing inositol phosphoglycan mediator of insulin action in obese women with polycystic ovary syndrome. Metab Syndr Relat Disord. 2010 Apr;8(2):127-36. Iuorno MJ, Jakubowicz DJ, Baillargeon JP, Dillon P, Gunn RD, Allan G, et al. Effects of d-chiro-inositol in lean women with the polycystic ovary syndrome. Endocr Pract. 2002;8(6):417–23. Compared to metformin, myoinositol significantly increased SHBG levels (MD = 2.78 nmol/l, CI: 0.02; 5.54, Figure S 5a.). However, metformin seemed more effective in decreasing FG-score (MD = 0.6, CI: 0.24; 0.96, Figure S 8) than inositol. In the case of total testosterone levels, inositol was non-inferior compared to metformin (Figure S 3b.). However, only one RCT reported on DHEAS [ 12], and no articles compared inositol to metformin regarding free testosterone and androstenedione levels. Glucose metabolism in PCOSFor continuous variables, baseline and after treatment mean and standard deviation (SD) values were extracted, and in the case of missing SD p-values from paired t-test were collected as well. Sometimes we all need a little extra help, even when we’re doing everything we can to exercise and eat right. Our Preconception supplement has been especially formulated to provide you with the most essential nutrients for fertility - meaning it’s the only Preconception supplement you need. Women with PCOS are at a higher risk of several diseases and can experience infertility issues ( 15). IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol. 2014;14:25.
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