Inositol: Evidence-Based Benefits and Uses in PCOS Management

Polycystic Ovary Syndrome (PCOS) is a complex chronic condition, especially when it comes to understanding and managing it through nutrition and supplements. Inositol, a naturally occurring substance in the human body, has been a point of focus in PCOS treatment.

Inositol: A Key Player in PCOS

Inositol, a vitamin-like substance found in our bodies, plays a crucial role in several bodily functions, particularly in cell signaling, insulin regulation, and ovulation. Women with PCOS often experience altered Inositol metabolism. To put it simply- they don’t make enough at a rate that can support ovulation. We currently think that this is due to a genetic variation in this metabolic pathway. Could supplementing with Inositol be the key to managing PCOS symptoms? Let's find out.

The Multifaceted Benefits of Myo-Inositol for Health and Well-being

Myo-inositol, a naturally occurring substance belonging to the vitamin B complex group, plays a crucial role in various biological processes in the human body. Its benefits extend from enhancing cellular communication to supporting mental health, making it a vital nutrient for overall well-being. Here's a closer look at the myriad benefits Myo-inositol offers:

Promotes Ovarian Health and Fertility: Myo-inositol is particularly renowned for its positive impact on ovarian health. It helps to regulate menstrual cycles and has been shown to improve fertility in women with Polycystic Ovary Syndrome (PCOS), a condition characterized by insulin resistance and hormonal imbalances. By improving insulin sensitivity, Myo-inositol helps to lower elevated androgen levels, which can improve ovulatory function. (1)(5)(7)

Supports Mental Health: Myo-inositol plays a role in neurotransmitter signaling, including that of serotonin and dopamine, which are crucial for mood regulation. Supplementing with Myo-inositol has been linked to reduced symptoms of conditions such as depression and anxiety, making it a supportive nutrient for mental health.(7)(9)

Aids in Insulin Regulation: Insulin resistance is a common issue in conditions like PCOS and type 2 diabetes. Myo-inositol helps to improve the body's response to insulin, aiding in glucose uptake and utilization. This regulatory effect on insulin not only supports metabolic health but also reduces the risk factors associated with diabetes.(1)(3)

Enhances Cellular Function: As a component of cell membrane signaling, Myo-inositol ensures proper communication between various cellular functions. This includes influencing the action of insulin, neurotransmitter activity, and calcium concentration within cells. (7)

Contributes to Cardiovascular Health: By influencing lipid metabolism, Myo-inositol can help manage levels of triglycerides and cholesterol in the blood, contributing to better cardiovascular health. Its role in reducing insulin resistance also indirectly supports heart health by affecting one of the risk factors for cardiovascular diseases. (7)

Supports Neurological Development: Myo-inositol is crucial for brain health and development, playing a role in processes that ensure proper nerve growth, maintenance, and function. Its influence on neurotransmitters further emphasizes its importance in maintaining neurological health. (7)

Understanding the Types of Inositol: Myo-inositol vs D-chiro-inositol

Inositol exists in various forms in the body known as stereoisomers, each with unique roles. Myo-inositol and D-chiro-inositol are particularly significant forms, especially in the context of PCOS.

Aspect	Myo-inositol	D-chiro-inositol
Primary Function	Governs glucose uptake, crucial for ovarian functions	Involved in glucose storage, affects skeletal muscle and liver
Action in the Body	Improves metabolic markers in PCOS Enhances ovulation rates Regulates menstrual cycles Reduces androgens Improves oocyte quality	Can inhibit the aromatase enzyme in ovaries, leading to reduced estrogen synthesis and increased testosterone levels
Choosing Supplements	Look for supplements with Myo-inositol as the only ingredient to ensure targeted support for ovarian function and metabolic health.	Avoid supplements that list D-Chiro-Inositol or claim a 40:1 ratio of Myo-inositol to D-Chiro-Inositol, as they may not provide the desired effects and could lead to hormonal imbalances.

Two Different Functions

Inositol plays a crucial role in the body's glucose management. Myo-inositol is key in glucose uptake, especially impacting the ovaries, making it a vital component in managing PCOS symptoms. D-chiro-inositol, conversely, focuses on glucose storage, mainly affecting skeletal muscle and liver function.

The Inositol Balance in PCOS

Women with PCOS exhibit an altered inositol ratio, diverging from the typical 40:1 Myo-inositol to D-chiro-inositol balance found in those without the condition. This shift can significantly affect how the body, particularly the ovaries, functions in PCOS.

Risks of Imbalanced Inositol Supplementation

Excessive D-chiro-inositol, particularly in the ovaries, may hinder the aromatase enzyme responsible for estrogen production, potentially raising testosterone levels.(14) This imbalance can exacerbate PCOS symptoms, such as irregular menstrual cycles and hirsutism. It's important to understand the specific impacts of each inositol type on PCOS to avoid unintended consequences.(5)(11)

Choosing the Right Inositol Supplement

When selecting inositol supplements for PCOS, the composition is key. Myo-inositol, given its direct benefits for ovarian function and metabolic symptoms associated with PCOS, is often recommended. It's essential to examine supplement labels to ensure they contain primarily Myo-inositol. Some products may include D-chiro-inositol or mix both forms in ratios that might not be optimal for managing PCOS effectively.(5)(6)(11)

Key Considerations:

• Myo-inositol's Benefits: Myo-inositol has been shown to improve metabolic markers in PCOS, enhance ovulation rates, regulate menstrual cycles, reduce androgens, and improve oocyte quality, especially when combined with fertility treatments.

• Dosing and Administration: Most studies suggest a beneficial effect within 2-3 months of supplementation, with a general recommendation of 4 grams per day alongside folate.

• Supplement Labels: Look for supplements where Myo-inositol is the primary or sole ingredient. This form is closely linked to improved ovarian function and better metabolic health outcomes in PCOS.

RESEARCH INSIGHTS

Inositol in Combination with Oral Contraceptive Pills (OCP)

The majority of women who are being treated conventionally for PCOS opt to take oral contraceptive pills. A novel approach to the treatment of PCOS involves the use of Inositol in conjunction with Oral Contraceptive Pills (OCP). This combination therapy has been the subject of various studies, including a notable one by Minozzi in 2011.

Key Findings from the Minozzi Study (2011)

• Study Design: In this study, 155 women with PCOS were randomized into two groups. One group received OCP (containing 50 ug of Ethinylestradiol and 75 ug of gestodene), while the other group received a combination of OCP, 4 grams of Inositol, and 400 mcg of folic acid.

• Reduction in Androgens and Acne: Both groups observed a reduction in the Ferriman-Gallwey (FG) score, which measures the severity of hirsutism (excessive hair growth). The reduction was significantly more pronounced in the group receiving the Inositol combination.

• Hormonal Improvements: The Inositol group showed a significant decrease in free testosterone, Androstenedione, and DHEA, indicating a notable improvement in hormonal balance.

• Glucose Metabolism: While both groups saw improvements in baseline glucose levels and HOMA-IR (a measure of insulin resistance), there was no significant difference between the two groups in these parameters.

• Lipid Profile Changes: A notable finding was the increase in LDL cholesterol in the OCP-only group, contrasted with a decrease in the Inositol-combination group, marking a significant difference in lipid profile outcomes between the groups.

Commentary: This study suggests that combining Inositol with OCP could enhance the treatment's effectiveness in managing PCOS symptoms, particularly in reducing androgen levels and improving the skin's condition. Furthermore, the combination therapy might offer advantages in modulating the lipid profile, especially in lowering LDL cholesterol, which is often a concern with OCP use.

Inositol vs. Metformin in PCOS Treatment

Understanding the effectiveness of different treatments for PCOS is an emerging area of research. A meta-analysis by Azizi Kutenaei in 2021 sheds light on how Inositol compares to a commonly prescribed medication, Metformin, in treating PCOS.

Key Takeaways from the Azizi Kutenaei Meta-Analysis (2021)

1. Effectiveness in Improving Metabolic and Hormonal Markers:

   • Both Inositol and Metformin were found to be effective in improving fasting blood sugar (FBS), fasting insulin levels, and the HOMA index (a measure of insulin resistance).

   • They also positively impacted estradiol and SHBG (sex hormone-binding globulin) levels. However, neither treatment showed a significant effect on reducing ovarian volume in PCOS patients.

2. Differences in Hormonal Regulation:

   • Myo-inositol proved more effective in reducing levels of DHEA and testosterone, which are often elevated in PCOS and can cause symptoms like hirsutism and acne.

   • Metformin, on the other hand, was more effective in lowering 17-OHP (17-Hydroxyprogesterone), a precursor to testosterone.

   • Additionally, Metformin was better at reducing levels of LH (Luteinizing Hormone), LH/FSH (Follicle-Stimulating Hormone) ratio, and prolactin – hormones that play key roles in menstrual and ovarian function.

3. Impact on Pregnancy Rates:

   • Of the studies reviewed, only three reported on pregnancy rates. In these studies, Inositol was found to be superior to Metformin in enhancing fertility outcomes.

Commentary: The comparison between Inositol and Metformin reveals that both have their strengths in managing different aspects of PCOS. While Inositol is more effective in regulating certain androgens like testosterone, Metformin excels in adjusting specific reproductive hormones.

Inositol and Fertility

Research has been exploring how Myo-inositol can help women facing fertility challenges. Here's a summary of two significant studies that show the positive effects of Inositol on fertility.

The Simi Study (2019) on Inositol and IVF Cycles

• Overview: This study looked at how Myo-inositol affects women undergoing In Vitro Fertilization (IVF).

• Key Findings:

  • Starting Myo-inositol three months before ovarian stimulation for IVF showed improvements in how the body responds to hormonal treatments.

  • It helped reduce the amount of Follicle-Stimulating Hormone (FSH) needed for developing follicles properly and achieving the right estradiol levels on the day of ovulation triggering.

  • There was a lower risk of a condition called ovarian hyperstimulation syndrome (OHSS), which can be a complication of fertility treatments.

  • Fewer IVF cycles were canceled.

  • There was a positive correlation with the number of eggs retrieved during the IVF process.

The Regidor Study (2016) on Inositol and Infertility

• Overview: This observational study involved 3,602 couples dealing with infertility.

• Intervention: The women were given a combination of 2 grams of Inositol and 200 micrograms of folate twice a day.

• Results:

  • Out of the 3,602 women, 2,520 (about 70%) saw improvements in their menstrual cycle regularity.

  • 545 pregnancies were achieved, which is about 15.1% of all the women who used Inositol and folic acid.

Commentary: These studies indicate that Myo-inositol, especially when combined with folic acid, can be a valuable aid in improving fertility outcomes, whether in natural conception or assisted reproductive techniques like IVF. It highlights the potential of Myo-inositol as a supplement to support women in their journey towards conception and maintaining regular menstrual cycles.

The Integrative Medicine Perspective: Beyond Nutrient Supplementation

In integrative medicine, a common approach to treating disorders like PCOS involves observing the differences in nutrient levels between healthy individuals and those with the condition and then administering those nutrients as a targeted treatment. Inositol supplementation in PCOS management is a prime example of this strategy, and there is a large and continually growing body of research to support its effectiveness. However, let’s address some nuances of using isolated nutrients as a treatment strategy:

1. The Complexity of PCOS: PCOS is a multifaceted condition characterized by a variety of symptoms like insulin resistance, hormonal imbalances, and menstrual irregularities. While Inositol plays a significant role in cell signaling and insulin action, PCOS encompasses a broader spectrum of metabolic and endocrine disruptions. Therefore, supplementing with Inositol, while beneficial, might not address all the underlying complexities of PCOS.

2. Individual Variability: Each individual with PCOS has a unique physiological makeup, which means the response to Inositol supplementation can vary widely. Some may experience significant improvements in symptoms, while others may see minimal changes. This variability challenges the one-size-fits-all approach and underscores the need for personalized treatment plans.

Using Myo-Inositol In Your PCOS Management Plan

Myo-inositol supplementation offers a ray of hope in managing the complexities of PCOS, but it's essential to view it as one component of a multifaceted treatment approach. Remember, managing PCOS is a journey of understanding and adapting to your body's unique needs throughout the various seasons of your life. Recognizing the uniqueness of each PCOS case is crucial; what works for one individual may not be as effective for another. Tailoring your management plan to align with your personal health goals and needs is key. As always, consult with your healthcare professional before starting any supplementation to ensure its safety and effectiveness.

Curated Wellness Essentials: Trusted Picks from Our Dispensary

Did you find this information helpful? Pin it for later!

---

Resources:

1. Azizi Kutenaei, M., Hosseini Teshnizi, S., Ghaemmaghami, P., Eini, F., & Roozbeh, N. (2021). The effects of myo-inositol vs. metformin on the ovarian function in the polycystic ovary syndrome: A systematic review and meta-analysis. European Review for Medical and Pharmacological Sciences, 25(7), 3105–3115. https://doi.org/10.26355/eurrev_202104_25565

2. Colak, E., Ozcimen, E. E., Tohma, Y. A., & Ceran, M. U. (2020). May myo-inositol and d-chiroinositol (40:1) treatment be a good option on normal-weighted polycystic ovary syndrome patients without insulin resistance? The Journal of Obstetrics and Gynaecology Research. https://doi.org/10.1111/jog.14505

3. Fruzzetti, F., Perini, D., Russo, M., Bucci, F., & Gadducci, A. (2017). Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS). Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology, 33(1), 39–42. https://doi.org/10.1080/09513590.2016.1236078

4. Garzon, S., Laganà, A. S., & Monastra, G. (2019). Risk of reduced intestinal absorption of myoinositol caused by D-chiro-inositol or by glucose transporter inhibitors. Expert Opinion on Drug Metabolism & Toxicology, 15(9), 697–703. https://doi.org/10.1080/17425255.2019.1651839

5. Gateva, A., Unfer, V., & Kamenov, Z. (2018). The use of inositol(s) isomers in the management of polycystic ovary syndrome: A comprehensive review. Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology, 34(7), 545–550. https://doi.org/10.1080/09513590.2017.1421632

6. Genazzani, A. (2020). Inositols: Reflections on how to choose the appropriate one for PCOS. Gynecological Endocrinology, 36(12), 1045–1046. https://doi.org/10.1080/09513590.2020.1846697

7. Gerli, S., Papaleo, E., Ferrari, A., & Di Renzo, G. C. (2007). Randomized, double blind placebocontrolled trial: Effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. European Review for Medical and Pharmacological Sciences, 11(5), 347–354.

8. Jamilian, M., Farhat, P., Foroozanfard, F., Afshar Ebrahimi, F., Aghadavod, E., Bahmani, F., Badehnoosh, B., Jamilian, H., & Asemi, Z. (2017). Comparison of myo-inositol and metformin on clinical, metabolic and genetic parameters in polycystic ovary syndrome: A randomized controlled clinical trial. Clinical Endocrinology, 87(2), 194–200. https://doi.org/10.1111/cen.13366

9. Kamenov, Z., & Gateva, A. (2020). Inositols in PCOS. Molecules, 25(23). https://doi.org/10.3390/molecules25235566

10. Minozzi, M., Costantino, D., Guaraldi, C., & Unfer, V. (2011). 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. Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology, 27(11), 920–924. https://doi.org/10.3109/09513590.2011.564685

11. Monastra, G., Vucenik, I., Harrath, A. H., Alwasel, S. H., Kamenov, Z. A., Laganà, A. S., Monti, N., Fedeli, V., & Bizzarri, M. (2021). PCOS and Inositols: Controversial Results and Necessary Clarifications. Basic Differences Between D-Chiro and Myo-Inositol. Frontiers in Endocrinology, 12, 660381. https://doi.org/10.3389/fendo.2021.660381

12. Regidor, P.-A., & Schindler, A. E. (2016). Myoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational Study. International Journal of Endocrinology, 2016. https://doi.org/10.1155/2016/9537632

13. Simi, G., Genazzani, A. R., Obino, M. E. R., Papini, F., Pinelli, S., Cela, V., & Artini, P. G. (2017). Inositol and In Vitro Fertilization with Embryo Transfer. International Journal of Endocrinology, 2017. https://doi.org/10.1155/2017/5469409

14. Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials [Research article]. International Journal of Endocrinology. https://doi.org/10.1155/2016/1849162

Medical Disclaimer: The content provided on this blog, including text, graphics, images, and other material, is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The information on this blog is not intended to replace a one-on-one relationship with a qualified healthcare professional and is not intended as medical advice. Please consult your healthcare provider before making any changes to your health regimen.