A 12-week randomized controlled trial (RCT) demonstrated that, compared with metformin, myo-inositol had beneficial effects on multiple parameters related to polycystic ovary syndrome (PCOS) .
PCOS, an endocrine disorder characterized by infertility, menstrual dysfunction and metabolic disturbances such as insulin resistance and androgen excess, affects many women of reproductive age. Because insulin resistance has been shown to have a key role in the development of PCOS, insulin sensitizers such as metformin have been used as a therapeutic option for PCOS.
Recently, the combination of myo-inositol and folic acid has been proposed and studied as an alternative in the management of PCOS. Myo-inositol has demonstrated insulin sensitizing properties, and folic acid has been hypothesized to decrease inflammation through the reduction of homocysteine. However, there has been very limited information on the comparison of myo-inositol + folic acid and metformin in PCOS patients.
Researchers from the Research Center for Biochemistry and Nutrition in Metabolic Disease at Kashan University of Medical Sciences (Kashan, Iran) conducted an adequately-powered RCT to compare myo-inositol + folic acid and metformin on clinical, metabolic and genetic parameters in subjects with PCOS. Sixty women with PCOS (with hyperinsulinism or normoinsulinism) were randomized to (a) 500 mg of metformin three times a day or (b) 2 g of myo-inositol + 200 μg folic acid twice a day for 12 weeks.
Compared with metformin, myo-inositol + folic acid significantly decreased serum total testosterone, modified Ferriman-Gallwey scores (a clinical tool to assess hirsutism), and serum high-sensitivity C-reactive protein levels, as well as downregulating gene expression of interleukin-1 in peripheral blood mononuclear cells collected from participants.
Although the data were encouraging, the study investigators acknowledged that 12 weeks of intervention was short and they were unable to evaluate important clinical markers such as free testosterone levels, parameters of insulin resistance, and fertility.
The study results were published in the journal Clinical Endocrinology (August 2017).
Why is this Clinically Relevant?
- Lifestyle management that includes weight control is important for the management of PCOS. Pharmaceuticals may also be prescribed to balance hormonal levels
- Clinicians may consider the incorporation of myo-inositol and folic acid as part of the lifestyle program for women who experience adverse effects of metformin
 Jamilian, M., et al., Comparison of myo-inositol and metformin on clinical, metabolic and genetic parameters in polycystic ovary syndrome: A randomized controlled clinical trial. Clin Endocrinol (Oxf), 2017. 87(2): p. 194-200.