PCOS: 1 in 5 women are affected by this: can Inositol help?
This article is a look at a common issue in women that can cause infertility: PCOS. More crucially, this is a deep dive into a supplement: Inositol: that has shown evidence of reducing some of the symptoms, specifically symptoms that can make a healthy natural conception harder. We look at what this can do, how it works and whether the science rates this as something a sufferer of PCOS should consider.
If you have irregular periods, or very long cycles, you could be affected by Polycystic Ovarian Syndrome which according to recent NHS data now impacts as many as 1/5 women. This is essentially a hormonal imbalance that can cause a number of potential symptoms (depending on the person) but crucially can make getting pregnant more of a challenge, largely, because you typically have fewer periods and ovulation happens potentially less, if at all.
It can also impact egg quality and increase risk of gestational diabetes.
Alarmingly, statistics also show that as many as half of women who have this condition don't even realise they have it - I was one of them! Whilst you can have many symptoms you can also have very few, I for example only have one symptom: irregular periods with long cycles - which I used to think was a bonus, until of course I tried to get pregnant…
Click here for more, but, before we get on to discussing the all important: ‘what can you do about it’, here are a few of the other symptoms that you may want to watch out for if you think you may have it:
small follicles which are essentially underdeveloped eggs known as ‘cysts’
Anovulation (lack of ovulation which may be picked up by test kits)
Acne and an excess of body hair (caused by an imbalance of male hormones) Excess body hair (known as hirsutism)
Weight gain, particularly around the waist
Insulin resistance (70% of people who have PCOS suffer with this)
So what can you do about it?
There is good and bad news here. The bad news is that there is no ‘cure’ per se, however, you can eliminate the symptoms which I have managed to do. There are various different ways to do this from working hard to rebalance your hormones (click here for more), to exercise, to cutting out high levels of sugar in your diet. Bizarrely caffeine in moderation - as long as it is not from a soft drink - has shown some positives. Click here for more.
Here is another tool for the armoury!
Inositol: the supplement that if you have PCOS you should know about:
Firstly, what is it?
It’s actually naturally occurring, a vitamin-like compound that belongs to the vitamin-B complex. There are as many as nine different types found in:
the body (which produces its own)
Fruits (principally citrus)
Why do we care about this if we have PCOS?
70% of women who have PCOS have insulin resistance or metabolic syndrome (which is a collective term that describes diabetes, high blood pressure and obesity) (2) which is when the cells of the body don't respond to insulin - the hormone that effectively controls blood sugar, allowing it in (or not) to a cell.
How does this impact fertility?
You may be wondering why sugar and insulin matters for fertility? Good question…
In PCOS specifically, it appears that the cells in the body are less efficient in allowing glucose in which means you get higher insulin levels which in turn causes the ovaries to overproduce testosterone. Testosterone is typically seen as the male hormone and responsible for some of the symptoms like excess hair, acne as well as irregular periods and issues with ovulation. So, the theory goes, if we can control this better then theoretically we can ease the symptoms and help along the path to conception.
How can Inositol help?
This is where the two types come in. Let’s start with Myo-inositol. This can be specifically used to treat symptoms of PCOS such as high levels of testosterone and lack of ovulation. It seems to show meaningful benefit: an Italian research group found that after six months of myo-inositol supplementation both excess hair and acne were ‘significantly’ reduced and this happened because there was a reduction in the blood plasma of LH, testosterone and insulin (3)
Now - for people with a high BMI - the other form: d-chiro-inositol can often be in deficiency in the body. Myo-inositol gets converted to d-chiro-inositol (there can be a deficiency in people with PCOS as there is not enough myo-inositol for this produced in the ovaries) (4) and a deficiency has been shown to contribute to insulin resistance. Supplementing here with both Myo-inositol and d-chiro-inositol has had a number of positive effects:
reducing blood pressure
Reducing testosterone levels
Improving ovarian function (5)
How does it actually do this?
Once again it comes down to insulin control. Insulin has been shown to affect the ratio of LH and FSH which is needed to be in the right amount for ovulation. (13)
Further, if you have insulin resistance, it typically leads to lower levels of sex hormone binding globulin (also known as SHBG).
Why is this important? Well this is also responsible for mopping up excess testosterone in the body - another factor that will cause PCOS symptoms and potentially hurt ovulation if in excess. Results showed that 24 weeks of myo-inositol supplementation = higher SHBG. (5)
That’s not all: it can help with egg quality and implantation:
One of the issues with PCOS is that the follicles don’t develop properly, which is why you can have issues with ovulation and egg quality.
Research has shown that myo-inositol plays a role in follicular development with higher concentrations = more mature follicles and better egg quality (4) (6) as well as improving the chances of implantation.
Myo-inositol has also been linked to the activation of serotonin receptors, which can help relieve anxiety, improve mood and even help with appetite control and relieve depression. (12)
Too good to be true? Well of course as with any trial and supplement there are rarely any slam dunk results and not everyone will experience these results.
Patients with PCOS are at increased risk of developing diabetes during pregnancy - something known as gestational diabetes. This can be a potentially dangerous condition for both mother and baby.
Antenatal supplementation with myo-inositol for the prevention of gestational diabetes in overweight women or those with PCOS is a fairly new treatment but does show some promise (8) with 17% of those taking the supplement suffering from it vs 54% who took a placebo. (9) However, this didn't stop infants being born larger than normal.
What is best to take and how?
Well first and foremost as always you MUST consult with your doctor before taking this or any type of supplement, particularly if you are pregnant. It is also important not to use this as a substitute for improvements in diet and lifestyle.
You do not actually need a prescription and you can take myo-inositol or in combination with d-chiro-inositol in powder form from either a pharmacy or a health food store.
As with any supplement, it is best to start taking it several weeks to months before trying to conceive to get the most out of it. (4) (10)
Once again it is very important to follow the recommendations of the manufacturer but of course there are lots of different brands - click here for some of the pitfalls of supplements and how to navigate - and different dosage depending on the brand so some things for context:
Myo-inositol doses of 400mg daily throughout pregnancy has been shown to be well tolerated with limited side effects. Higher doses (up to 1200mg daily) can lead to side effects like nausea, flatulence and diarrhoea. Always better to start off with lower levels and see how you get on. Remember however to always follow the instructions of the manufacturer and consult with your doctor however(11)
If you’re taking in combination:
If you are taking myo-inositol in combination with d-chiro-inositol recent research has found that the majority of tissues in the body have a ratio of 40:1 (4) so it is best to take the supplements if combined in this ratio as an imbalance or too much d-chiro-inositol can actually end up having the reverse effect when it comes to egg quality and ovarian response.
Finally - as always - the results are not slam dunk and you have to be very careful with supplements, however, there are seemingly enough benefits here that are worth discussing with your doctor if you have PCOS, particularly if you are overweight and have insulin resistance.
(1) NHS Choices Health A-Z ‘Polycystic ovary syndrome’ 2016 www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
(2) Traub ML. Assessing and treating insulin resistance in women with polycystic ovarian syndrome. World J Diabetes 2011; 2(3):33-40.
(3) Zacche MM, Caputo L, Filippis S, Zacche G, Dindelli M, Ferrari A. Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Gynecol Endocrinol. 2009; 25(8):508-13.
(4) 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; 15(4):452-7. Unfer V, Facchinetti F, Orru B, Giordani B, Nestle J. Myo-inositol effects in women with PCOS: a meta-analysis of randomised controlled trials. Endocr Connect 2017; 6(8):647-658
(5) Kalra B, Kalra S, Sharma JB. The inositols and polycystic ovary syndrome. Indian J Endocrinol Metab. 2016; 20(5):720-4.
(6) Chiu TT, Rogers MS, Law EL, Briton-Jones CM, Cheung LP, Haines CJ. Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality. Human Reproduction 2002; 17(6): 1591–1596.
(7) Kuscu N, Bizzarri M, Bevilacqua A. Myo-Inositol Safety in Pregnancy: From Preimplantation Development to Newborn Animals. Int J Endocrinol 2016. doi: 10.1155/2016/2413857
(8) Crawford TJ, Crowther CA, Alsweiler J, Brown J. Antenatal dietary supplementation with myo‐inositol in women during pregnancy for preventing gestational diabetes. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD011507. DOI: 10.1002/14651858.CD011507.pub2.
(9) D’Anna R, Dr Benedetto V, Rizzo P, Raffone E, Interdonato ML, Corrado F, Di Benedetto A. Myo-inositol may prevent gestational diabetes in PCOS women. Gynecol Endocrinol 2012;28(6):440-2.
(10) Artini PG, Di Berardino OM, Papini F, Genazzani AD, Simi G, Ruggiero M, Cela V. Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecol Endocrinol 2013; 29(4):375-9.
(11) Regidor PA, Schindler AE, Lesoine B, Druckman R. Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature. Horm Mol Biol Clin Investig. 2018; doi: 10.1515/hmbci-2017-0067.
(12) Brink CB, Viljoen SL, de Kock SE, Stein DJ, Harvey BH. Effects of myo-inositol versus fluoxetine and imipramine pretreatments on serotonin 5HT2A and muscarinic acetylcholine receptors in human neuroblastoma cells. Metab Brain Dis. 2004; 19(1-2):51-70.
Brown J, Crawford TJ, Alsweiler J, Crowther CA. Dietary supplementation with myo-inositol in women during pregnancy for treating gestational diabetes. Cochrane Database Syst Rev 2016. Issue 7 Art. No.: CD012048. doi: 10.1002/14651858.CD012048.pub2.
Deswal R, Yadab A, Dang AS. Sex hormone binding globulin – an important biomarker for predicting PCOS risk: A systematic review and meta-analysis. Syst Biol Reprod Med 2018; 64(1):12-24.
(13) Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update 2008; 14(4):367-78.
Gerli S, Papaleo E, Ferrari A, Di Renzo GC. Randomized, double blind placebo-controlled trial: effects of Myo-inositol on ovarian function and metabolic factors in women with PCOS. European Review for Medical and Pharmacological Sciences 2007; 11: 347-354.
Matarrelli B. Vitacolonna E, D’Angelo M, Pavone G. Mattei PA, Liberati M, Celentano C. Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. J Matern Fetal Neonatal Med. 2013;26(10):967-72.
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; 23(12):700-3.
Showell MG, Mackenzie-Proctor R, Jordan V, Hodgson R, Farquhar C. Inositol for subfertile women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No.: CD012378. DOI: 10.1002/14651858.CD012378.pub2
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