Endocrine Abstracts

Polycystic ovary syndrome (PCOS) is a highly prevalent and representing the most common endocrine-metabolic disorder in reproductive-aged women. PCOS ishighly correlated with insulin resistance and hyperandrogenism. Myo-inositol (MI) supplementation in women with PCOS has been evaluated over the last years. Many hormonal and reproductive impairments associated with this disorder seem relieved by the supplement.

Material and Methods: The meta-analysis was done using the systematic search performed in MEDLINE, EMBASE, PubMed and Research Gate from the inception until October 20th, 2021. Randomized controlled trials (RCTs) included women diagnosed with PCOS and groups having inositols, metformin and placebo.

Results: Twenty-six RCTs were identified, including data of 1691 patients (806 myoinositol, 311 with placebo, and 509 metformin groups). In patients treated with inositols, the risk of having a regular menstrual cycle was found by 1.79 higher than in the case of placebo. Moreover, the inositols showed noninferiority compared to metformin in this outcome. In the case of BMI (MD = -0.45; CI: -0.89; -0.02), free testosterone (MD = -0,41, CI: -0.69; 0.13), total testosterone (MD = -20.39, CI: -40.12; -0.66), androstenedione (MD = -0.69, CI: -1,16; -0.22), glucose (MD = -3.14; CI: -5.75; -0.54) levels and AUC insulin (MD =  -2081.05, CI: -2745.32; -1416.78) inositol treatment induced greater decrease compared to placebo. Inositol increased sexhormone-binding globulin significantly compared to placebo (MD = 32.06, CI:1.27; 62.85). The primary outcome was normalization of menstrual cycle 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). This increased production of androgens is increased by the surplus of LH and by hyperinsulinism. In PCOS, treatment with metformin (MET) ameliorated insulin sensitivity and decreased the androgens levels. Studies shown that MI leads to a decrease in LH and androgen levels, as well as a decrease in insulin resistance. Thus, MI is believed to be able to re-establish ovulatory menstrual cycles (especially in obese women with PCOS).

Conclusion: Polycystic ovarian syndrome is a highly inherited complex polygenic, multifactorial disorder. Insulin resistance increases the production of androgens by the theca cells. Elevated androgen levels play a significant role in menstrual cycle disrturbance and anovulation. These factors then become obstacles in occurrence of pregnancy. Myo-inositol (MI) increases insulin sensitivity, decreases hyperandrogenism and improves the menstrual cycle.