What is polycystic ovary syndrome and what can be used to treat it?
Polycystic ovary syndrome (PCOS) is an endocrine, metabolic and reproductive disorder affecting 5 – 10% of women in reproductive age. Women who suffer from this condition are very likely to also be insulin resistant which results in high insulin levels and consequently increases their risk for type 2 diabetes (Unfer et al., 2017).
Multiple cysts can be seen on the ovary.
Other symptoms and possible complications associated with PCOS include:
Polycystic ovaries
Overweight/ obesity
Acne
Hirsutism (excess male hormone causing male-pattern hair growth)
Inability/ difficulty to lose weight
Infertility
Psychological disturbances
Obstetric complications
Cardiovascular disease
Mood disorders
Irregular menstrual cycle
Inositol has been researched in the last decade as a treatment of PCOS. Inositol is produced by the human body and is a substance similar to a vitamin. Myo-inositol (MI) and D-chiro-inositol (DCI) are the most common types. In most healthy tissues, the physiological ratio is 40: 1 (MI:DCI). The ratio differs between healthy diseased states. Due to this observation, inositol therapy can be beneficial in the treatment of PCOS to obtain (and maintain) endocrine, metabolic and reproductive health (Troisi et al., 2019).
Inositols function as second messengers to insulin:
MI improves egg cell (oocyte) quality improving the uptake of glucose and signalling of FSH (follicle stimulating hormone)
DCI has insulin-like properties, is critical in the production of glycogen and increases glucose uptake in the cells. It also improves insulin sensitivity.
Supplementation of a combination of MI and DCI is recommended. Studies have shown that higher dosages of DCI can progressively worsen quality of the egg cell a response of the ovaries (Isabella & Raffone, 2012). Therefore DCI should not be supplemented on its own. MI has to compete with glucose for transporters in the cell. The lower cellular uptake and increased loss of MI in the urine may lead to increased blood glucose levels. Supplementation seems to be needed for at least 6 months to improve symptoms caused by PCOS, such as acne and hirsutism (Zacchè et al., 2009).
An infographic explaining how PCOS can lead to multiple side effects (CLICK ON THE INFOGRAPHIC TO ENLARGE)
On the South African market 2 of the products that are available to assist women who suffer from PCOS, are PCOSitol and Inofolic.
PCOSitol
PCOSitol is new on the market and is recommended to be used when women are not looking to fall pregnant, but have to manage their disease.
PCOSitol contains MI and DCI in a 40:1 ratio. As DCI lowers the quality of the egg cell, this supplement is not recommended if a woman is trying to fall pregnant. The 40:1 ratio is important to uphold as increasing the DCI will make the supplementation less effective. As the normal physiological ratio is 40:1, this is the most ideal (Nordio, Basciani & Camajani, 2019).
Furthermore PCOSitol contains other helpful substrates too assisting the woman’s health in multiple ways:
Co-enzyme Q10 This has been shown to be beneficial in glucose metabolism and the decrease of total and LDL cholesterol levels (Izadi et al., 2019).
Magnesium, zinc, calcium, vitamin D and vitamin K The co-supplementation of these are beneficial in decreasing inflammation and oxidative stress, improving insulin metabolism and decreasing cardiovascular risk (Elif, Yaba & Yilmaz, 2018). Magnesium deficiency is very common in PCOS patients.
Vitamin B12 (Methylcobalamin) PCOS patients are often on metformin therapy which decreases vitamin B12 levels and increases homocysteine levels. Higher homocysteine levels increases the cardiovascular disease risk. Methylcobalamin is easier to absorb and is more bioavailable.
Folic acid (vitamin B9) For the maintenance of folate levels, to restore normal homocysteine levels and to increase insulin sensitivity.
Chromium polynicotinate For the improvement of glucose levels and insulin sensitivity.
Inofolic
Inofolic contains only folic acid (vitamin B9) and MI. This combination improves the quality of the egg cells, helps regulate the menstrual cycle and improves fertility. Inofolic is recommended for women who want to increase their fertility when planning for pregnancy.
PCOS can be a debilitating disorder for many women, but by treating it with MI and DCI, the condition, its symptoms and complications can significantly improve. The improvement can subsequently benefit these women’s health and quality of life.
REFERENCES
Elif, G., Yaba, A. & Yilmaz, B. 2018. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review. Journal of the Turtkish German Gynecological Association, 19 (4).
Isabella, R. & Raffone, E. 2012. Does ovary need D-chiro-inositol? Journal of Ovarian Research, 5 (14).
Izadi, A. et al. 2019. Hormonal and Meabolic Effects of Coenzyme Q10 and/ or Vitamin E in Patients with Polycystic Ovary Syndrome. Journal of Endocrinology and Metabolism, 104 (2).
Nordio, M., Basciani, S. & Camajani, E. 2019. The 40:1 myo-inositol/ D-chiro-inositol plasma ratio is able to restore ovulation in PCOS patients: comparison with other ratios. European review for medical and pharmacological sciences, 23 (12).
Troisi, J. et al. 2019. Metabolomic change due to combined treatment with myo-inositol, D-chiro-inositol and glucomannan in polycystic ovarian syndrome patients: a pilot study. Journal of Ovarian Research, 12 (25).
Unfer, V. et al. 2017. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections, 6 (647–658)
Zacchè, M.M. et al. 2009. Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Gynecological Endocrinology, 25 (8).
