Prevalence and predictors of metabolic syndrome with comparison of myoinositol and metformin in PCOS women


  • Rupali Modak Department of Obstetrics and Gynecology, RG. Kar Medical College, Kolkata, West Bengal, India
  • Dilip Kumar Biswas Department of Obstetrics and Gynecology, Burdwan Medical College, Burdwan, West Bengal, India
  • Amitava Pal Department of Obstetrics and Gynecology, Burdwan Medical College, Burdwan, West Bengal, India
  • Tapan Kumar Mandal Department of Obstetrics and Gynecology, Burdwan Medical College, Burdwan, West Bengal, India



BMI, Metabolic syndrome, Myoinositol, Metformin, Polycystic ovarian syndrome


Background: The objective is to determine the prevalence of metabolic syndrome (MBS) and the effects of insulin sensitizers to improve the clinical and hormonal milieu for better reproductive outcome in PCOS women.

Methods: This prospective cross-sectional study was conducted on 50 PCOS women and 50 age matched control to determine the prevalence of the MBS in two tertiary hospitals over one year. Diagnosis of PCOS was based on at least two of ESHRE/ASRM criteria and diagnosis of MBS was based on at least three of NCEPATPIII criteria. Patients already diagnosed as PCOS were treated with insulin sensitizers myoionositol and metformin which were compared.

Results: The study revealed that the prevalence of MBS was 40 % (20/50) nearly 4-fold higher than that of control groups. Among PCOS women, the most prevalent MBS factors were high BMI (52%) and low serum HDL-C (42%). The least prevalent factor was high fasting serum glucose level (16%). The resumption of spontaneous regular menstrual cycle and pregnancy rate in infertile groups of PCOS patients with myoionositol and metformin were 61% vs. 26% and 50% vs.91% respectively. The myoionositol group did not require any extra ovulating agents for pregnancy, while 7 out of 11 patients in metfromin group needed clomiphen citrate for ovulation induction to achieve pregnancy.  With myoinositol there is significant reduction of weight, BMI, LH/FSH ratio and fasting insulin level; whereas metformin shows decrement of weight and BMI only.

Conclusions: The prevalence of MBS in PCOS is nearly 4 times in present study and there is significant improvement of symptom profile, weight, BMI and change of hormonal pattern in myoinositol group.


Banaszewska B, Duleba AJ, Spaczynski RZ, Pawelczyk L. Lipids in polycystic ovary syndrome: role of hyperinsulinemia and effects of metformin. Am J Obstet Gynecol. 2006;194(5):1266-72.

The Rotterdam ESHRE/ASRM- sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduct. 2004:19(1):41-7.

Vega GL .Results of expert meetings: Obesity and cardiovascular disease, Obesity, the metabolic syndrome, and cardiovascular disease. Am J Heart. 2001;142(6):1108-16.

Third Report of The National Cholesterol Education Program (NCEP) Expert panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Audit treatment Panel III) Final Report. Circulation 2002;106(25):3143-421

Diamanti KE,Kouli CR,Filandraf A et al. A survey of polycystic ovary syndrome in the Greek islands of Lesbos; hormonal and metabolic profile. J Clin Endocrinol Metab. 1999;84(11):4006-11.

Park HR, Choi Y, Lee HJ, Oh JY, Hong YS , Sung YA. The metabolic Syndrome in young Korean women with polycystic ovary syndrome. J Diab Res and Clin Prac. 2007;77(Suppl 1):5243-6

Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabol. 2003;52(7):908-15.

Dokras A, Bochner M, Hollinrake E, Markham S, Bradley, Vanvoorhis B et al. Screening women with polycystic ovary syndrome for metabolic syndrome. Obstet Gynecol 2005; 106(1):131-7.

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. Reproduct Biol Endocrinol. 2014;12(1):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 myoinositol 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.

Weerakiat S, Bunnag P, Phakdeekitcharoen B, Wansumrith S, Chanprasertyothin S, Jultanmas R et al. Prevelence of metabolic syndrome in Asian women with polycystic ovarian syndrome using the international Diabetic Federation Criteria. J Gynaecol Endocrinol. 2007;23(3):153-60.

Dey R, Mukherjee S, Roybiswas R, Mukhopadhyay A, Biswas SC. Association of metabolic Syndrome in Polycystic Ovarian Syndrome: an Observational Study. J Obstet Gynecol Ind. 2011;61(2):176-81

Glueck CJ, Morrison JA, Friedman LA, Goldenberg N, Stroop DM, Wang P. et al. Obesity, free testosterone, and cardiovascular risk factors in adolescents with polycystic ovary syndrome and regularly cycling adolescents. Metabolism 2006;55(4):508-14.

Azziz R. How prevalent is metabolic syndrome in women with polycystic ovarian syndrome? Nature Clin Prac Endocrinol and metab 2006;2(3):132.

Rajkhowa M, Neary RH, Kumpatla P, Game FL, Jones PW, Obhrai MS, et al. Altered composition of high-density lipoprotein in woman with polycystic ovary syndrome. J Clin Endocrinology 1997;82(10):3389-94.

Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, and Ghazzi MN: PCOS/ Triglitazone study group. Prevalence and Predictors of Metabolic Syndrome in women with Polycystic Ovarian Syndrome. J Clin Endocrinol Metab. 2006;91(1):48-53

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.

Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of Myo-inositol 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. Myoinositol in patients with poly cystic ovary syndrome: A novel method for ovulation induction, Gynecol endocrinol 2007;23(12):700-3.

Chirania K, Misra S, Behera S. A randomised clinical trial comparing myoinositol and metforminin PCOS. Int J Reprod Contracept Obstet Gynecol 2017;6(5):1814-20.






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