A randomised clinical trial comparing myoinositol and metformin in PCOS

Authors

  • Kishan Chirania Department of Obstetrics and Gynecology, SCB Medical College, Cuttack, Odisha, India
  • Sujata Misra Department of Obstetrics and Gynecology, SCB Medical College, Cuttack, Odisha, India
  • Sandhya Behera Department of Obstetrics and Gynecology, SCB Medical College, Cuttack, Odisha, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20171563

Keywords:

Insulin resistance, Metformin, Myoinositol

Abstract

Background: The medical management of PCOS is fast changing from the combination hormonal pills/progesterone for cycle regularisation, cosmetological treatment of acne and hirsutism to management of obesity and insulin resistance. This study evaluates the effects of the insulin sensitisers in improving the clinical and hormonal alterations in cases of PCOS and improving the reproductive outcomes.

Methods: This 3-arm prospective randomized comparative study was done from August 2015 to July 2016 in the Department of Obstetrics and Gynaecology at SCB MCH, Cuttack wherein patients of PCOS were studied based on treatment with metformin, myoinositol or both.

Results: Myoinositol helped in the resumption of spontaneous menstrual cycles in 66.66% of women with PCOS with menstrual complaints, whereas the same effect in patients who took metformin was only in 15.78%, which was not significant. Use of myoinositol in Infertile women with PCOS resulted in a pregnancy in 57.14% of women, without the need of any ovulation inducing agent while use of metformin gave a pregnancy in all the 9 patients, thought 5 out of them required clomiphene citrate for ovulation induction. With myoinositol there was a reduction in weight, BMI, LH/FSH ratio, acne and hirsutism. Metformin has resulted in a decrement of body weight, BMI and acne only.

Conclusions: This study conclusively proves that myoinositol has a definitive role in decreasing the ovarian dysfunction of PCOS. There has been a significant improvement in the symptom profile, weight loss and a significant change in the hormonal parameters.

References

Sirman SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013(18);6:1-13.

Liang SJ, Liou TH, Lin HW, Hsu CS, Tzeng CR, Hsu MI. Obesity is the predictor of impaired glucose tolerance and metabolic disturbance in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2012;91(10):1167-72.

Fritz MA, Speroff L. Clinical Gynecologic Endocrinology and Infertility, 8th edition (Lippincott Williams and Wilkins; 2010:505.

Ravn P, Haugen AG, Glintborg D. Overweight in polycystic ovary syndrome. An update on evidence based advice on diet, exercise and metformin use for weight loss. Minerva Endocrinol. 2013;38(1):59-76.

Palomba S, Falbo A, La Sala GB. Metformin and gonadotropins for ovulation induction in patients with polycystic ovary syndrome: a systematic review with meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2014(3);12:3.

Nordio M, Proietti E. 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;16(5):575-81.

Lujan ME, Chizen DR, Pierson RA. Diagnostic criteria for polycystic ovary syndrome: pitfalls and controversies. J Obstet Gynaecol Can. 2008;30(8):671-9.

Carmina E, Lobo RA. Do hyperandrogenic women with normal menses have polycystic ovary syndrome? Fertil Steril. 1999;71:319-22.

O'Reilly MW, Taylor AE, Crabtree NJ, Hughes BA, Capper F, Crowley RK et al. Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione. J Clin Endocrinol Metab. 2014;99(3):1027-36.

Vittorio U, Giuseppina P. Updates on the myo-inositol plus D-chiro-inositol combined therapy in polycystic ovary syndrome. Expert Rev Clin Pharmacol. 2014 Sep;7(5):623-31.

Ciotta L, Stracquadanio M, Pagano I, Carbonaro A, Palumbo M, Gulino F. Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial. Eur Rev Med Pharmacol Sci. 2011;15(5):509-14.

Carlomagano G, Unfer V. Inositol safety: clinical evidences. Eur Rev Med Pharmacol Sci. 2011;15:931-6.

Le Donne M, Alibrandi A, Giarrusso R, Lo Monaco I, Muraca U. Diet, metformin and inositol in overweight and obese women with polycystic ovary syndrome: effects on body composition. Minerva Ginecol. 2012;64(1):23-9.

Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of Myoinositol in women with Polycystic Ovary Syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009;13(2):105-10.

Papaleo E, Unfer V, Baillargeon JP, De Santis L, Fusi F, Brigante C et al. Myo-inositol in patients with polycystic ovary syndrome: A novel method for ovulation induction. Gynecol Endocrinol. 2007;23(12):700-3.

Gerli S, Papaleo E, Ferrari A, Di Renzo GC. Effects of Inositol on ovarian function and metabolic factors in women with PCOS: a randomized double blind placebo-controlled trial. Eur Rev Med Pharmacol Sci. 2007;11(5):347-54.

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.

Carlomagno G, Unfer V, Roseff S. The D-chiro-inositol paradox in the ovary. Fertil Steril. 2011;95(8):2515-6.

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Published

2017-04-27

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Original Research Articles