Polycystic ovarian syndrome, better known as PCOS has been and still remains a medical mystery with no direct route treatment that will completely cure its sufferers. As a result, a lot of women diagnosed with PCOS have been left struggling to receive effective and legitimate advice on how to manage their PCOS symptoms which can leave most feeling uncomfortable and destressed about their bodies and the future of their fertility. 

But what exactly is PCOS? The syndrome is a heterogeneous endocrine, reproductive and metabolic disorder, affecting at least 5–10% of the total population of reproductive-age women worldwide (Azziz R et al, 2004). 

Despite this, the one size fits all treatment for this metabolic disorder is still a mystery. According to the Rotterdam Criteria an individual most have evidence of 2-3 of the following criteria to be diagnosed with the syndrome. These include; Hyperandrogenism, Polycystic ovaries and finally, Oligo/ Anovulation, which puts in individual into one of three PCOS categorie types, Ovuatory PCOS, Classic PCOS or Non-hirsute PCOS (Please see Rotterdam Criteria diagram below). 

Characteristics vary in having reproductive, metabolic and psychological effects including several health complications which may include menstrual dysfunction, infertility, miscarriage, acne, oily skin, depression, obesity, hirsutism, hair loss, insulin resistance and increased risk of metabolic syndrome, cardiovascular disease, non-alcoholic fatty liver disease and chronic low grade inflammation (Rocha AL, Oliviera FR et al 2019).

Rotterdam Criteria diagram

While diet and exercise does play a big role in managing and reducing symptoms of the disorder, sufferers often find themselves taking on un-sustainable diets such as dairy free, gluten free and low carb without being given any real evidence or research to justify making these drastic lifestyle changes. Now during the research of low carb, intermittent fasting and low glycemic diets for PCOS there have been some findings to support the benefits of these diets but they can be complex to follow and just doesn’t suit the individual long term.  

A common medication prescribed to PCOS sufferers, is Metformin, which is an antidiabetic drug that may improve insulin sensitivity in obese women with PCOS by restoring an inositol-based signalling. Indeed, metformin, the most common insulin-sensitizing agent for PCOS, this medication can affect its users bodies by causing the onset of nausea, abdominal distress and diarrhea, which therefore can reduce an individuals adherence to their prescription cycle and therefore reduce the likelihood of seeing long term results (Lord JM et al, 2003). 

But can you blame them? PCOS can cause women to feel daily discomfort in their bodies without a drug contributing to this. While studies on this drug have shown improvements in both ovulation cycles and pregnancy  Based on the available evidence, however, metformin does not replace the need for lifestyle modification among obese and overweight PCOS women (Lashen H 2010).

 If an individual suffering with PCOS sees their only option for improving symptoms being to follow an unsustainable diet or take medication affecting their day to day life the reality of their disorder is going to seem as though they won’t be able to lead a normal life without enduring some kind of physical hardship whether that be through experiencing day to day unhappiness with their diet or physical discomfort due to medication intended for people with diabetes. 

This is where hope comes in for PCOS sufferers. Inositol has gathered a reputation in research as a further insulin-sensitizing supplement which could benefit women with PCOS. But what exactly is Inositol and what does it do? 

Inositol is sugary carbohydrate substance that is found in many plants and animals. It is also produced in the human body and can be made in a laboratory. Inositol can be found in many forms (called isomers). The most common forms are Myo-inositol and D-chiro-inositol. Over years of research, inositol has proven to reduce the symptoms of PCOS patients and in turn improve fertility rates. 

Some of the benefits of taking Inositol include

Studies have shown Inositol can not only improve insulin sensitivity but also reduce insulin resistance and manage blood glucose levels . One six-month study in 80 postmenopausal women with metabolic syndrome found that 4 grams per day of inositol improved insulin sensitivity, blood pressure and cholesterol levels more than a placebo (Giordano D, 2011 et al)

• We know due to research that PCOS patients have naturally got lower inositol levels and this in turn contributes to onset of harsh PCOS symptoms. In this way, taking inositol supplementation can reduce these symptoms. 
• Inositol helps with promoting ovulation and pregnancy in women with PCOS. Inositol can also help to improve clinical pregnancy rates in infertile women without PCOS. 
• Studies have found that inositol may be beneficial for improving the function of the ovaries and fertility in women with PCOS (Unfer V et al, 2015) These studies have typically used doses of 2–4 grams per day, and benefits have been seen in normal-weight, overweight and obese women.

The benefits of supplementing with Inositol have proven to improve both symptoms of PCOS through improved insulin resistance and fertility. Again, marketing and supplementation will push the idea that having to take specific supplementation with a ratio of 40:1 Myo-inositol and D-chiro-inositol will be what works best to see results, where in fact research has shown, standard Myo-inositol works just the same, but at a cheaper cost. In fact, supplementation companies such as My protein sell Inositol at a cheap price and if you read the reviews for yourself, has worked wonders for women experiencing PCOS symptoms. (Product ink below) 

From this post, it’s clear to see PCOS is a spider web and really there is no one size fits all. When It comes to making decisions about your body and your health, research where you will find the answers you need. It’s easy to trust internet gurus when they tell you take this magic pill, “try this specific diet take this pill” but the truth is, science never lies and unless they can back up the why and the how don’t trust its going to help you. 

I’m not saying that inositol s a magic cure either, but the side effects of inositol have been slim to none comparably to metformin. Supplementing with inositol, along side a healthy balanced diet that you have either done extensive research into or a registered nutritionist or dietitian has prescribed to you, as well as regular exercise, there is hope to reduce symptoms and improve quality of life for an individual struggling with PCOS. 

My Protein Inositol Link: https://www.myprotein.ae/sports-nutrition/100-inositol-powder/10530319.html

 Written by:  Ali Nolan

Reference list:

1. (The prevalence and features of the polycystic ovary syndrome in an unselected population. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO J Clin Endocrinol Metab. 2004 Jun; 89(6):2745-9)
2. Rocha AL, Oliviera FR et al. Recent advances in the understanding and management of polycystic ovary syndrome. F1000 Research. 2019 Apr 26; 8: F1000 Faculty-Rev-565
3. Lord JM, Flight IHK, Norman RJ. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, d-chiro-inositol) for polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2003.

4. Lashen H. Review: Role of metformin in the management of polycystic ovary syndrome Hany Lashen First Published August 11, 2010 Review Article Find in PubMed https://doi.org/10.1177/2042018810380215

5. Effects of myo-inositol supplementation in postmenopausal women with metabolic syndrome: a perspective, randomized, placebo-controlled study Domenico Giordano 1, Francesco Corrado, Angelo Santamaria, Simona Quattrone, Basilio Pintaudi, Antonino Di Benedetto, Rosario D'Anna Affiliations expandPMID: 20811299 DOI: 10.1097/gme.0b013e3181e8e1b1
6. https://medlineplus.gov/polycysticovarysyndrome.html 
7. Lisi F, Carfagna P, Oliva MM, Rago R, Lisi R, Poverini R, Manna C, Vaquero E, Caserta D, Raparelli V, Marci R, Moscarini M. Pretreatment with myo-inositol in non polycystic ovary syndrome patients undergoing multiple follicular stimulation for IVF: a pilot study. Reprod Biol Endocrinol. 2012 Jul 23;10:52. doi: 10.1186/1477-7827-10-52. PMID: 22823904; PMCID: PMC3416732.
8. Papaleo E, Unfer V, Baillargeon JP, De Santis L, Fusi F, Brigante C, Marelli G, Cino I, Redaelli A, Ferrari A. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007 Dec;23(12):700-3. doi: 10.1080/09513590701672405. Epub 2007 Oct 10. PMID: 17952759.
9. Unfer V, Carlomagno G, Rizzo P, Raffone E, Roseff S. Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):452-7. PMID: 21608442.