Myo-Inositol & PCOS - In A Nutshell
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder and leading cause of infertility in women of reproductive age. Currently 1 in 15 women are affected, however, numbers are expected to soar, alongside rising obesity rates.
The term ‘polycystic ovary syndrome’ (PCOS) describes a complex disorder with a range of symptoms and no single known cause. Many body systems are affected, resulting in several health complications including menstrual dysfunction, infertility, miscarriage, acne, oily skin, depression, obesity, hirsutism, hair loss, metabolic syndrome and increased risk of cardiovascular disease.
Polycystic ovary syndrome is commonly difficult to diagnose and often missed completely. Nutrition has much to offer women affected by this debilitating disorder.
Natural support often centres around the following four key areas:
• Weight management
• Blood sugar balance and insulin function normalization
• Hormone balance
• Ovarian health support
Myo-inositol & PCOS
Myo-inositol is a little known, naturally occurring substance that the body makes from glucose and has recently shown much promise for PCOS sufferers. Best described as a vitamin-like substance, myo-inositol is often considered to be a member of the B complex group of vitamins.
Low levels of myo-inositol have been found in women with PCOS and research has shown myo-inositol to be effective at improving fertility in women with PCOS. It’s use is not limited to PCOS however, it has also been found to be beneficial in a range of female health problems including PMS and PMDD (a severe form of PMS).
Current research suggests that women with PCOS may benefit from supplementing with 2000mg myo-inositol combined with folic acid, taken 1-2 times daily for 3 months. It is also considered that clinical doses of myo-inositol are best achieved in supplemental powdered form. The benefits demonstrated by clinical research so far have involved myo-inositol in supplemental form rather than from food sources; it is also unlikely that food sources can supply high enough levels to achieve a therapeutic effect.
See below for more information on Myo-inositol & PCOS, full details of the research studies carried out so far on this breakthrough natural substance and a comprehensive list of clinical references.
Myo-Inositol for PCOS - Full Research Details & References
Polycystic ovary syndrome is the most common endocrine disorder and the leading cause of female infertility in women of reproductive age, worldwide. Research carried out at South Australia’s University of Adelaide and published in The Lancet in 2007 has predicted that the global scale of this disorder, which currently affects 1 in 15 women (of reproductive age), is set to worsen, as obesity rates continue to soar1. The term ‘polycystic ovary syndrome’ (PCOS) describes a complex disorder with a range of symptoms, with the main feature being the presence of multiple underdeveloped tiny sacs (follicles) on the ovaries - often these underdeveloped follicles are unable to release an egg which means ovulation doesn’t take place.
In addition, a large proportion of women also have excessive androgen secretion or activity (hyperandrogenism) and abnormal insulin activity2. Many body systems are affected in polycystic ovary syndrome, resulting in several health complications including menstrual dysfunction, infertility, miscarriage, acne, oily skin, depression, obesity, hirsutism, hair loss, metabolic syndrome and increased risk of cardiovascular disease2. Since there is no single known cause and an ongoing medical debate about a conclusive definition, polycystic ovary syndrome is commonly difficult to diagnose and often missed completely. Polycystic ovary syndrome is the most common endocrine disorder and the leading cause of female infertility in women of reproductive age, worldwide. Research carried out at South Australia’s University of Adelaide and published in The Lancet in 2007 has predicted that the global scale of this disorder, which currently affects 1 in 15 women (of reproductive age), is set to worsen, as obesity rates continue to soar1. The term ‘polycystic ovary syndrome’ (PCOS) describes a complex disorder with a range of symptoms, with the main feature being the presence of multiple underdeveloped tiny sacs (follicles) on the ovaries - often these underdeveloped follicles are unable to release an egg which means ovulation doesn’t take place.
Nutrition & PCOS
From a clinical perspective, nutrition has much to offer women affected by this debilitating disorder. Whilst every case is unique, and requires an individualized and multi-factorial approach, effective treatment protocols commonly centre around the nutritional support of these key areas:
• Weight management
• Blood sugar balance and insulin function normalization
• Hormone balance
• Ovarian health support
Patients often experience significant improvement in symptoms when these areas are addressed with targeted dietary strategies and supplementation with specific nutrients and botanicals.
Myo-Inositol – An exciting breakthrough for PCOS
Much of the most recent research in this area has focused on the clinical application of myo-inositol in women with PCOS. Viewed as somewhat of a breakthrough among health experts dealing with PCOS, what’s particularly exciting is that the results collectively demonstrate that this novel supplement has the potential to provide support for many of these key areas.
What is Myo-Inositol?
Myo-inositol is one of nine different types of inositol. It is a naturally occurring substance produced in the human body from glucose, although it is not a sugar. Better described as a ‘vitamin-like’ substance, myo-inositol is often considered to be a member of the B complex group of vitamins. However, because it is produced by the body in amounts considered sufficient to support health, it is not officially termed an essential nutrient. In addition to the body’s own production from glucose, myo-inositol is also found naturally in many foods such as organ meats, fruit, grains, nuts and beans.
Myo-inositol - Key role in insulin signalling
Myo-inositol is a key factor involved in insulin signalling. It is an immediate precursor to another type of inositol, D-chiro-inositol, which interacts with select sugars in the body to form inositol phosphoglycans – these play an important role in mediating the actions of insulin3-6. Whilst myo-inositol can be made by the body and also found in foods, low levels can occur, and this can have an adverse impact on the body’s insulin-signalling pathways.
Low levels of myo-inositol, D-chiro-inositol and inositol phosphoglycans have been observed in individuals with impaired insulin sensitivity and PCOS3-6.
Myo-inositol & PCOS
A number of recent studies have demonstrated that myo-inositol is a very effective treatment for PCOS due to its ability to improve insulin sensitivity, restore hormonal balance and positively influence ovarian function. Research has also shown myo-inositol to be effective at improving fertility among women with PCOS; and since the syndrome is the leading cause of female infertility, these results are particularly encouraging7-16.
So what’s the evidence?
• In a 2009 double blind clinical trial, 42 women with PCOS received myo-inositol (4 grams daily plus 400mcg folic acid) or placebo (folic acid alone). Results showed that myo-inositol increased insulin sensitivity, improved glucose tolerance and decreased glucose-stimulated insulin release. In addition, the researchers noted a positive effect on ovulation - 16 out of 23 women in the myo-inositol group ovulated, compared to 4 out of 19 women in the placebo group. In these women, there was also a 66% reduction of serum total testosterone and a 73% reduction of serum free testosterone concentrations. Cardiovascular markers, systolic and diastolic blood pressures, plasma triglycerides and total cholesterol concentrations also decreased in the myo-inositol group7.
• Another study in 20 overweight women with PCOS found that 12 weeks of supplementationwith myo-inositol improved insulin sensitivity and reproductive hormone balance and completely restored the menstrual cycle in all amenorrheic and oligomenorrheic subjects8.
• Research carried out in 2011 showed a combination of the contraceptive pill and myo-inositol (4 grams daily for 12 months) to be more effective in controlling the endocrine, metabolic and clinical profile in patients with PCOS than the contraceptive pill alone, the same study also found myo-inositol reduced insulin levels and insulin resistance9.
• In a prospective clinical study carried out in Rome in 2008, researchers investigated the effects of myo-inositol on two of the most common features of PCOS, hirsutism and hyperandrogenism. In the study, 46 women were evaluated at baseline and then again, following treatment with myo-inositol for 6 months. Results showed that treatment with myo-inositol significantly reduced hirsutism, hyperandrogenism and insulin resistance10.
• In a double blind trial published in 2011 in the European Review for Medical and Pharmacological Sciences, researchers compared the effects of supplementation with 2g myo-inositol and 200 mcg folic acid compared to 200 mcg folic acid taken twice daily for 3 months in women with PCOS undergoing IVF and ovulation induction. At the end of the treatment, in the group taking myo-inositol, both the number and quality of oocytes (immature egg cells) was greatly improved. The authors concluded, “these data suggest that myo-inositol may be useful in the treatment of PCOS patients undergoing ovulation induction, both for its insulin sensitizing activity, and its role in oocyte maturation.”11 Additional research has found myo-inositol to be useful for improving oocyte quality, ovulation and pregnancy outcomes12-16.
Myo-Inositol – From Research to Clinical Application
As you will no doubt be gathering by now, there is significant scope for the use of myo-inositol in practice. For women suffering with the many debilitating faces of PCOS; from insulin resistance to excess androgens, anovulation and more, myo-inositol has the potential to offer significant and wide-ranging benefits, backed by consistent research. And whilst myo-inositol has demonstrated significant benefits in women with PCOS, its use is not limited here.
Myo-inositol may be of benefit for a range of applications related to female health, and additional research in the area has shown this to be the case. Clinical studies have shown benefits of using myo-inositol in patients with premenstrual dysphoric disorder (a severe form of PMS) and in postmenopausal women with metabolic syndrome17-19. Research shows that myo-inositol also has an integral role in the activation of serotonin receptors (the ‘feel-good’ neurotransmitter), thus supporting its use for mood balance in the premenstrual phase of the menstrual cycle and also potential uses in depression and panic disorder20.
The clinical applications of myo-inositol are already wide ranging and it’s likely, as research in the area gathers momentum, more may be added. For women with PCOS though, research shows that myo-inositol is now essential to consider including as part of their treatment protocol.
Myo-Inositol – How Much to Take?
Current research suggests that for women with PCOS, 2000mg myo-inositol combined with folic acid, taken 1-2 times daily for 3 months is an effective protocol to begin with before reviewing the programme7-16, 23. It is also considered that clinical doses of myo-inositol are best achieved in supplemental powdered form. The benefits demonstrated by clinical research so far have involved myo-inositol in supplemental form rather than from food sources; it is also unlikely that food sources can supply high enough levels to achieve a therapeutic effect.
Myo-Inositol – Is it Safe?
Myo inositol appears to be safe and well tolerated by most. There have been some mild reported side effects in the scientific literature, which include mild gastrointestinal side effects such as nausea, flatulence and diarrhoea, and dizziness, tiredness and headache21-24 but these appear to occur at doses higher than are generally recommended23. Patients with bi-polar disorder are also advised to avoid supplementation with myo-inositol before further research can determine its safety21-24. As with all supplementation, patients with existing medical conditions or taking prescribed medication should always consult a healthcare practitioner before starting to take myo-inositol.
1. Norman RJ, Dewailly D et al. Polycystic ovary syndrome. The Lancet, Volume 370, Issue 9588, Pages 685-697, 25 August 2007 doi. 10. 1016/S0140-6736(07) 61345-2
2. Hirschberg AL. (2009) Polycystic ovary syndrome, obesity and reproductive implications. Womens Health (Lond Engl). Sep; 5(5):529-40
3. Susuki S et al. Urinary chiro-inositol excretion is an index marker of insulin sensitivity in Japanese type II diabetes. Diabetes Care. 1994 Dec;17(12):1465-8.
4. Jung TS et al. Determination of urinary Myo-/chiro-inositol ratios from Korean diabetes patients. Yonsei Med J. 2005 Aug 31;46(4):532-8.
5. Cheang KI, Baillargeon JP, Essah PA, et al. Insulin-stimulated release of D-chiro-inositol-containing inositol phosphoglycan mediator correlates with insulin sensitivity in women with polycystic ovary syndrome. Metabolism. 2008 Oct;57(10):1390-7.
6. Baillargeon JP, Iuorno MJ et al. Uncoupling between insulin and release of a D-chiro-inositol-containing inositol phosphoglycan mediator of insulin action in obese women with polycystic ovary syndrome. Metab Syndr Relat Disord. 2010 Apr;8(2):127-36.
7. Costantino D, Minozzi G et al Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10.
8. Genazzani AD, Lanzoni C et al. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol. 2008 Mar;24(3):139-44.
9. Minozzi M, Costantino D et al. The effect of a combination therapy with myo-inositol and a combined oral contraceptive pill versus a combined oral contraceptive pill alone on metabolic, endocrine, and clinical parameters in polycystic ovary syndrome. Gynecol Endocrinol. 2011 Nov;27(11):920-4.
10. Minozzi M, D'Andrea G et al. Treatment of hirsutism with myo-inositol: a prospective clinical study. Reprod Biomed Online. 2008 Oct;17(4):579-82.
11. 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 May;15(5):509-14.
12. Rizzo P, Raffone E, Benedetto V. Effect of the treatment with myo-inositol plus folic acid plus melatonin in comparison with a treatment with myo-inositol plus folic acid on oocyte quality and pregnancy outcome in IVF cycles. A prospective, clinical trial. Eur Rev Med Pharmacol Sci. 2010 Jun;14(6):555-61.
13. 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 May;91(5):1750-4.
14. Papaleo E, Unfer V et al. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007 Dec;23(12):700-3. Epub 2007 Oct 10.
15. Gerli S, Mignosa M, et al. 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. 2003 Nov-Dec; 7(6):151-9.
16. Papaleo E, Unfer V et al. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007 Dec; 23(12):700-3.
17. Gianfranco C, Vittorio U, Silvia B, Francesco D. Myo-inositol in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol. 2011 Oct; 26(7):526-30. doi: 10.1002/hup.1241.
18. Cunningham J, Yonkers KA, O'Brien S, Eriksson E. Update on research and treatment of premenstrual dysphoric disorder. Harv Rev Psychiatry. 2009; 17(2):120-37.
19. Giordano D, Corrado F, Santamaria A, Quattrone S, Pintaudi B, Di Benedetto A, D'Anna R. Effects of myo-inositol supplementation in postmenopausal women with metabolic syndrome: a perspective, randomized, placebo-controlled study. Menopause. 2011 Jan;18(1):102-4
20. Benjamin J, Agam G, Levine J, Bersudsky Y, Kofman O, Belmaker RH. Inositol treatment in psychiatry. Psychopharmacol Bull. 1995;31(1):167-75.
21. Nierenberg AA, Ostacher MJ et al. Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. Am J Psychiatry. 2006;163:210–216.
23. Carlomagno & Unfer (2011), Inositol safety: clinical evidences. Eur RevMed Pharmacol Sci, 15: 931-936
24. Iovieno, N, Dalton, ED et al. Second-tier natural antidepressants: Review and critique. Journal of Affective Disorders. 130 (2011): 343-357.