Combination of metformin and myoinositol: a powerful weapon to combat polycystic ovary syndrome

Authors

  • Pragati Sharma Dr. Pragati’s IVF Centre, Pathankot, Punjab, India
  • Abhijeet Malvi Department of Medical Affairs, Eris Lifesciences, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20250023

Keywords:

Insulin resistance, Insulin sensitizers in PCOS, Infertility associated with PCOS

Abstract

Polycystic ovary syndrome (PCOS) affects up to 13% of women of reproductive age, causing symptoms like menstrual irregularities, insulin resistance, and infertility. Insulin resistance is the root cause of PCOS. Metformin, an insulin-sensitizing drug, and Myo-inositol, a natural compound that enhances ovarian function and also an insulin sensitising agent, have both shown benefits in PCOS management. When combined, these agents act synergistically, that results in improved menstrual cycle regularity, reduction in hyperandrogenic symptoms, and enhancement in fertility outcomes. Recent clinical evidence supports this dual approach, and its approval for PCOS-related infertility treatment in India, along with endorsement by FOGSI, underscores its effectiveness as a promising therapeutic option for women with PCOS.

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References

Teede HJ, Tay CT, Laven J, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertil Steril. 2023;120(4):767-93. DOI: https://doi.org/10.1016/j.fertnstert.2023.07.025

Bharali MD, Rajendran R, Goswami J, Singal K, Rajendran V. Prevalence of polycystic ovarian syndrome in India: a systematic review and meta-analysis. Cureus. 2022;14(12). DOI: https://doi.org/10.7759/cureus.32351

World Health Organization. Poly cystic ovary syndrome. 2023. Available at: https://www.who.int/ news-room/fact-sheets/detail/polycystic-ovary-syndrome. Accessed on 27 October 2024.

Centers for Disease Control and Prevention. PCOS (Polycystic Ovary Syndrome) and Diabetes. PCOS (Polycystic Ovary Syndrome) and Diabetes. 2022. Available at: https://www.cdc.gov/diabetes/basics/ pcos.html#:~:text=Women%20with%20PCOS%20are%20often,risk%20for%20type%202%20diabetes. Accessed on 27 October 2024.

Lee J, Pilch PF. The insulin receptor: structure, function, and signaling. Am J Physiol-Cell Physiol. 1994;266(2):C319-34. DOI: https://doi.org/10.1152/ajpcell.1994.266.2.C319

Boucher J, Kleinridders A, Kahn CR. Insulin receptor signaling in normal and insulin-resistant states. Cold Spring Harbor Perspectives in Biology. 2014;6(1):a009191. DOI: https://doi.org/10.1101/cshperspect.a009191

Tabassum R, Imtiaz F, Sharafat S, Shukar-ud-din S, Nusrat U. Prevalence and clinical profile of insulin resistance in young women of poly cystic ovary syndrome: A study from Pakistan. Pak J Med Sci. 2013;29(2). DOI: https://doi.org/10.12669/pjms.292.3180

Yang Q, Li Z, Li W, Lu L, Wu H, Zhuang Y, et al. Association of total testosterone, free testosterone, bioavailable testosterone, sex hormone–binding globulin, and hypertension. Medicine. 2019;98(20):e15628. DOI: https://doi.org/10.1097/MD.0000000000015628

Namavar Jahromi B, Borzou N, Ebrahim Parsanezhad M, Anvar Z, Ghaemmaghami P, Sabetian S. Associations of insulin resistance, sex hormone-binding globulin, triglyceride, and hormonal profiles in polycystic ovary syndrome: A cross-sectional study. Int J Reprod Biomed. 2021;19(7):653-62. DOI: https://doi.org/10.18502/ijrm.v19i7.9476

Mitrašinović-Brulić M, Buljan M, Suljević D. Association of LH/FSH ratio with menstrual cycle regularity and clinical features of patients with polycystic ovary syndrome. Middle East Fertil Soc J. 2021;26(1):40. DOI: https://doi.org/10.1186/s43043-021-00085-0

Pratama G, Wiweko B, Asmarinah, Widyahening IS, Andraini T, Bayuaji H, et al. Mechanism of elevated LH/FSH ratio in lean PCOS revisited: a path analysis. Sci Rep. 2024;14(1):8229. DOI: https://doi.org/10.1038/s41598-024-58064-0

Lei R, Chen S, Li W. Advances in the study of the correlation between insulin resistance and infertility. Front Endocrinol. 2024;15:1288326. DOI: https://doi.org/10.3389/fendo.2024.1288326

Xing C, Li C, He B. Insulin Sensitizers for Improving the Endocrine and Metabolic Profile in Overweight Women With PCOS. J Clin Endocrinol Metab. 2020;105(9):2950-63. DOI: https://doi.org/10.1210/clinem/dgaa337

Zhu D, Chen Y, Huang J, Deng H, Shen X, Lu D, et al. Effects of metformin on pregnancy outcome, metabolic profile, and sex hormone levels in women with polycystic ovary syndrome and their offspring: a systematic review and meta-analysis. Ann Transl Med. 2022;10(7):418. DOI: https://doi.org/10.21037/atm-22-909

Xu H, Zhou Y, Liu Y, Ping J, Shou Q, Chen F, et al. Metformin improves hepatic IRS2/PI3K/Akt signaling in insulin-resistant rats of NASH and cirrhosis. J Endocrinol. 2016;229(2):133-44. DOI: https://doi.org/10.1530/JOE-15-0409

Zhou G, Myers R, Li Y, Chen Y, Shen X, Fenyk-Melody J, et al. Role of AMP-activated protein kinase in mechanism of metformin action. J Clin Invest. 2001;108(8):1167-74. DOI: https://doi.org/10.1172/JCI200113505

Morley LC, Tang T, Yasmin E, Norman RJ, Balen AH. Insulin‐sensitising drugs (metformin, rosiglitazone, pioglitazone, D‐chiro‐inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2017;11(11):CD003053. DOI: https://doi.org/10.1002/14651858.CD003053.pub6

El Maghraby HA, Nafee T, Guiziry D, Elnashar A. Randomized controlled trial of the effects of metformin versus combined oral contraceptives in adolescent PCOS women through a 24 month follow up period. Middle East Fertil Soc J. 2015;20(3):131-7. DOI: https://doi.org/10.1016/j.mefs.2014.10.003

Raj P, Samal S, Chandrasekaran S, Prabhu K, Sen M. Comparison of Metformin and Myoinositol on Clinical, Hormonal and Metabolic Profile of Patients with Polycystic Ovarian Syndrome: An Open-label Randomised Clinical Trial. J Clin Diagn Res 2024;18(1):18-22. DOI: https://doi.org/10.7860/JCDR/2024/67746.18978

Guan Y, Wang D, Bu H, Zhao T, Wang H. The Effect of Metformin on Polycystic Ovary Syndrome in Overweight Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol. 2020;2020:1-12. DOI: https://doi.org/10.1155/2020/5150684

Abdalla MA, Shah N, Deshmukh H, Sahebkar A, Östlundh L, Al-Rifai RH, et al. Impact of metformin on the clinical and metabolic parameters of women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials. Ther Adv Endocrinol Metab. 2022;13:20420188221127142. DOI: https://doi.org/10.1177/20420188221127142

Etrusco A, Laganà AS, Chiantera V, Buzzaccarini G, Unfer V. Myo-inositol in assisted reproductive technology from bench to bedside. Trends Endocrinol Metab. 2024;35(1):74-83. DOI: https://doi.org/10.1016/j.tem.2023.09.005

DiNicolantonio JJ, H O’Keefe J. Myo-inositol for insulin resistance, metabolic syndrome, polycystic ovary syndrome and gestational diabetes. Open Heart. 2022;9(1):e001989. DOI: https://doi.org/10.1136/openhrt-2022-001989

Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, De Santis L. Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Fertil Steril. 2009;91(5):1750-4. DOI: https://doi.org/10.1016/j.fertnstert.2008.01.088

Zeng L, Yang K. Effectiveness of myoinositol for polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;59(1):30-8. DOI: https://doi.org/10.1007/s12020-017-1442-y

Regidor PA, Schindler AE. Myoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational Study. Int J Endocrinol. 2016;2016:1-5. DOI: https://doi.org/10.1155/2016/9537632

Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Gynecol Endocrinol. 2010;26(4):275-80. DOI: https://doi.org/10.3109/09513590903366996

Recommendations of the SEC (Reproductive & Urology) made in its 82nd meeting held on 25.05.2023 at CDSCO (HQ), New Delhi. Available at: https://cdsco.gov.in/opencms/resources/Upload CDSCOWeb/2018/UploadCommitteeFiles/Recommendations%20Reproductive%20&%20Urology%2025.05.2023.pdf. Accessed on 27 October 2024.

FOGSI Focus PCOS practice points Algorithms for Obs & Gynae. Available at: https://www.fogsi.org/ wp-content/uploads/2024/11/Fogsi-Focus-PCOS-Practice-Points_PCOS-and-Infertility.pdf. Accessed on 27 October 2024.

Kriplani A, Tank P, Singh P, Maini N, Kaitala S, Kantha GL, et al. A Phase III, Double-Blind, Randomized, Multicenter, Clinical Trial to Evaluate the Efficacy and Safety of a Fixed-Dose Combination of Metformin Hydrochloride and Myo-Inositol Compared to Metformin in Patients With Polycystic Ovary Syndrome. Cureus. 2024;16(12):75616. DOI: https://doi.org/10.7759/cureus.75616

Samatha A. A Study on Insulin Sensitizers in PCOS Using Anonymous Data. Afr J Biomed Res. 2024;11:1930-40. DOI: https://doi.org/10.53555/AJBR.v27i1S.1750

Alnisani ZA, Abdulrida MK. Effectiveness of Myoinositol alone or in Companion with Metformin in Improving Hormonal, Metabolic, and Clinical Features of PCOS Women. Iraqi J Pharm Sci. 2023;32:61-73. DOI: https://doi.org/10.31351/vol32issSuppl.pp61-73

Rani C, Deeba F, Ishrat S, Banu J, Jahan S, Nazneen S, et al. Effects of metformin plus myo-inositol compared to metformin alone as pre-treatment of ovulation induction in polycystic ovary syndrome with insulin resistance. Int J Reprod Contracept Obstet Gynecol. 2022;11(11):3005. DOI: https://doi.org/10.18203/2320-1770.ijrcog20222785

Agrawal A, Mahey R, Kachhawa G, Khadgawat R, Vanamail P, Kriplani A. Comparison of metformin plus myoinositol vs metformin alone in PCOS women undergoing ovulation induction cycles: randomized controlled trial. Gynecol Endocrinol. 2019;35(6):511-4. DOI: https://doi.org/10.1080/09513590.2018.1549656

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Published

2025-01-16

How to Cite

Sharma, P., & Malvi, A. (2025). Combination of metformin and myoinositol: a powerful weapon to combat polycystic ovary syndrome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(2), 671–676. https://doi.org/10.18203/2320-1770.ijrcog20250023

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Review Articles