Myoinositol in PCO

The  BMI  got reduced from 28+ 1.6 to 27.3 + 1.3 in the MYO  group  . However in the control  group  the insulin levels  increased from 26.6 + 2.1  to 27.5 + 1.7  

Menstrual   cyclicity was  restored in all amenorrheic  and oligomenorrheic   subjects  in the Myo  inositol group No changes  occurred in the patients treated  with folic acid.

Pregnancy  rate   was considerably higher in the treated  group  . 10   clinical  pregnancies developed in Group  A and 4 in Group B   while the delivery     rate was  8 versus  3   respectively 

MYO supplementation is efficient in changing  many  of the hormonal  disturbances of PCOS improving    insulin sensitivity of target  tissues  and positively  affecting the hormonal  functions. 

Myo-  inositol shows  2  times  improvement   in insulin sensitivity

Forty   two women   with PCOS were treated in a double  blind  trial  with MYO   inositol plus folic acid or folic  acid alone as placebo

After  randomization  23 women   received  4 gm of Myo  inositol plus  400  mcg of folic acid and  19 women received   400 mcg folic acid  alone as   placebo. The treatement was given for 12-16 weeks. In  the group    treated with MYO  inositol  the serum total testosterone  decreased  from 99.5+ 7 tpo 34.8 + 4.3  ng/dl  and serum free testosterone   from 0.85  + 0.1  to 0.24  + 0.33 ng/dl  . The area  under the   plasma   insulin curve after   oral administration of glucose  decreased from 8.54 + 1.149  to 5.535 + 1.792 ug /ml/min   . Plasma  triglycerides decreased from 195+ 20  to 95+ 17  mg /dl   The index of  composite  whole  body  insulin sensitivity   increased from 2.80 + 0.35  to 5.05 + 0.59  mg 2/dl-2   16 out of  23  women of Myo  inositol group  ovulated and only 4   out of 19 women treated with folic  acid were ovulated .

In conclusion treatment  of PCOS   patients  with Myo inositol provided a    decreasing  of circulating  insulin and serum total testosterone as well as an  improvement  in metabolic  factors.

Myo inositol shows 16-30 5  reduction in Hirsutism and 21-53% reduction   in acne

Zacche et al in a randomized clinical  study  stated  that Myo  inositol  administration is a simple  and safe  treatment  that  ameliorates the metabolic  profile of patients with PCOS reducing hirsutism and acne  . Fifty patients   with PCOS  were enrolled    in the study    Every  woman  presented signs  of hyperandrogenism   on the basis of the number of lesions on the face /chest  / back  they were    distinguished as moderate form severe  acne also  using a modification of the Ferriman   Gallway  score that quantifies  hairs  in nine body  areas hirsutism  was classified in mild   moderate    , severe

All patients were  evaluated for testosterone and insulin resistance was   measured  using homeostasis model   assessment

Patients  were  treated  orally with Myo inositol 2 g plus folic  acid 200 mg as twice  daily continuously for 6 months. Significantly  changes  were observed in biochemical features of patients  with PCOS  as shown

Hormonal  and metabolic  profile at baseline and after 3 months of myo inositol treatment

Testosterone   basal insulin levels     and consequently    and HOMA   index  were significantly  decreased.

Number   of cases and severity  of acne at baseline and after 3 and 6 months  of treatement  with myo inositol

Also  clinical    features improved  after  myo inositol  treatment  of 3 and  6  months    . all   patients   of our  study presented hirsutism before getting Myo  inositol    During  the observational   period  the hirsutism  score   decreased  after 3 months    and after 6 months of myo  inositol  treatement    

After  3 months  of myo inositol administration  plasma  testosterone  free testosterone insulin and HOMA  index were significantly  reduced,. Both  hirsutism  and acne  decreased after  6 months  of therapy.

Myo inositol is a  simple & safe  treatement  that ameliorates the metabolic  profile of patients   with  pcos  reducing  hirsutism & acne

 Myo inositol restores menstrual cycles in all amenorrheic  and  oligomenorrheic  patients   by reducing  insulin resistance

In a controlled  clinical study  20  overweight  PCOS patients    were  enrolled. All patients   underwent  hormonal  evaluations  and an oral   glucose  tolerance test before  and after 12 weeks of therapy  myo inositol 2 gm  plus  folic acid 200 ug every  day Group B    folic acid   200 ug every day    . PCOS    women treated with  myo inositol  for 3 months restores   menstrual cycle in all  amenorrheic  and oligomenorrheic  subjects . also  myo inositol   administration significantly reduced  insulin levels testosterone  levels   plasma  luteinizing hormone . Myo  inositol administration  significantly   reduce HOMA  index afar 3 months of therapy At baseline the HOMA  index  was 2.8  after treatment it came down  to 1.4

Myo inositol administration   positively affects  hyperinsulinemia  and hormonal  parameters in overweight  patients   with  polycystic ovary   syndrome. Myo  inositol  administration  improves  reproductive axis functioning in PCOS   patients reducing  the hyperinsulinemic  state that affects LH  secretion. Myo inositol  shows  62%  reduction  in free testosterone levels.

Papaleo  et al  in a randomized clinical  study  stated that myo inositol is a simple and safe treatment   that is capable of restoring  spontaneous   ovarian activity and consequently  fertility in most  patients  with PCOS

In this study these  researchers administered myo inositol combined with folic acid twice   a day for up to 6   months to 25  PCOS patients   of childbearing   age having age 28  to 38   years  with oligo or amenorrhea   hyperandrogenism   or hyperandrogenemia  .

While receiving myo   inositol  treatment   22 out of the 25   patients   had at least one  spontaneous    menstrual  cycle during  the 6 months treatment   period and 18 of these patients maintained  normal   ovulatory cycles  during the entire  6 months  study  period . All of them maintained spontaneous ovulation   activity  documented by follicular  growth   and increased   serum progesterone concentrations in the luteal  phase .

Furthermore after treatement   with MI  these women showed significantly decreased  concentrations of serum  total testosterone   and free  testosterone .

The length  of successive  cycles was improved to 31.7 + 3.2  days. Treatement   with Myo inositol in PCOS  patients   provided  decrease  in circulating  insulin and glucose  level  and serum total  testosterone  as well as an improvement    in metabolic factors. A total   of 10 singleton pregnancies    were  obtained. The  study  authors  concluded that  myoinositol  treatement is capable of restoring spontaneous ovarian activity  in most patients   with PCOS

Myo inositol restores ovulation improves lipid profile

Gerli et al assessed the effects of supplemental myo  inositol on ovarian  function in a randomized   double blind placebo controlled  trial  of oligomenorrheic  and polycystic   ovarian     women  Of the 92  subjects 45 were randomized to receive  myo inositol  plus  folic  acid / day   for 14 weeks  while  the remaining 47  received folic   acid per day  400 mcg folic   acid as a placebo Serum   samples  were obtained  twice weekly to assess   hormonal   concentrations  circulating   estradiol  concentrations increased  during  the  first week of treatment   only in the myo  inositol  group   indicating that there had  been a rapid  effect of myo inositol  on follicular   maturation . An improvement   in ovulation   frequency was  also observed between the women   receiving   myo  inositol    and those on placebo with  82%  of women on myo   inositol ovulating   at least  once during   the 14 week   period     and 63%   of women   on placebo   ovulating  at least  once during  the study period  . The  time to the first ovulation   was significantly  shorter  in  treated  patients    in these patients  the time  to first   ovulation   was   24.5  days   .

 Myo  inositol  treatment   also resulted in significantly increased  concentrations from baseline     in high   density  lipoprotein cholesterol no changes were  observed in the control group. Metabolic risk  factor benefits of inositol  treatement  were not observed   in  a morbidly obese   subgroup of patients  . The  authors  concluded   that supplemental myo inositol    improves  ovarian   function   in women   with  oligomenorrhea ad polycystic   ovaries.

Myo  inositol   provides follicular  maturity  and good   quality  oocytes

Unfer et al stated that  myo inositol  treatment    is able to improve oocyte   and embryo  quality during ovarian stimulation protocols. In this  study  Eighty  four euglycemic PCOS   patients undergoing   ovulation  induction  for ICSI were recruited Forty  three  participants  received  Myoinositol  2 g twice  a day and forty one patients   received  D chiro inositol  0.6  g twice  a   day , the number    of mature  oocytes was significantly  increased in the myo inositol     group compared to D chiro  inositol . Concurrently the number of   immature   oocytes   decreased  in myo  inositol  treated  patients . Furthermore    the myo inositol treated group  showed an increase in the mean number  of top quality   embryos   and in the total  number of pregnancies compared to  the D chiro  inositol  treated  group/ The presence  of high  concentrations   of myo inositol in the follicular  fluid has  become  a marker of good  quality oocytes it was observed  that high  concentrations of myo inositol in the follicular    fluid paly  in important   role in  follicular   maturation  and in embryonic  development   . In addition myo inositol decreases immature   oocytes  production

What does ESHRE 2008-mentions on myo inositol??

 Myo inositol , a simple  and safe first line treatment  in women  with  PCOS

Supplementation of myo inositol is positively related  to oocyte  maturity  in mouse while higher  concentrations  in human   follicular  fluids  are marker of  good  quality   oocytes . 75  infertile  women  with polycystic ovary  syndrome   to receive   continuously 4 g  myo inositol  plus 400  ug folic   acid orally  or 50 mg clomiphene   citrate daily   for 5 days eventually  increased to 100 mg if resistance occurred. During follow up period of 6  months ovulatory  activity  with ultrasound scan   and  hormonal   profile  ongoing pregnancy   and spontaneous abortion were  assessed.

Pregnancy  rate was 33.3%    in the myo  inositol group  ans 28.2 %    in clomiphene citrate group  among  pregnancies   the rate of multiple   pregnancy  was 18.1 %    in the clomiphene group  and 0%  in the   myo  inositol  group    . No side   effects were  reported with myo  inositol

Myo inositol is a simple and safe treatment   that is capable to restore a spontaneous  ovarian activity and consequently  fertility in most patients   with polycystic ovary    syndrome. This  therapy   did not cause multiple   pregnancy    and can be  evaluated  as primary  method  of inducing   ovulation  in PCO’s  women .

PCO  care  contains  Myo inositol  which takes care of the symptoms   of PCOS   and thus  provides a comprehensive  management  of PCOS

Composition

Each  tablet of PCO care contains  :

Myo inositol …. 1 gm

Myo inositol is an isomer of a  C6 sugar  alcohol that belongs  to the vitamin  B  complex group. The chemical   name of   myo  inositol is 1 R, 2R  , 3S  , 45  , 5R, 6S cyclohexane – 1,2,3,4,5,6- hexol

Clinical   pharmacology

Myo  inositol is metabolized to phosphatidylinositol which     acts as a precursor for phosphatidylinositol  3 kinases  a key  messenger responsible  for activation of glucose   transport so as to utilize glucose  and to liberate energy . It  helps  to improve insulin sensitivity in PCOS patient. Inositol deficiency is the basic pathophysiology for PCOS . Women   with PCOS  had a greater than  fivefold   increase  in urinary   clearance   of inositol  and circulating  plasma   concentration  of inositol  was reduced by half   in PCOS  women   as compared   to normal  women  . During  certain conditions  like polycystic   ovary syndrome  the physiological requirements of   myo inositol increases  The use of  myo inositol in PCOS patients   reduces insulin resistance   testosterone   levels and  improves    ovulation  Moreover   elevated  concentration of myoinositol  in human follicular   fluid  improves  follicular   maturity  and menstrual  frequency .

Pharmacokinetics

Myo  inositol  is absorbed from the  small intestine and is transported by the portal    circulation to the liver  and then by the systemic  circulation   to various  tissues   in the body  Within the  liver   and the  various tissues of the body myoinositol enters  into    a wide range  of biochemical   pathways   Myo  inositol reacts  with CDP  diacylglycerol  to form the    phospholipid    phosphatidylinositol  which   can be   incorporated     into membrane   structure   .Phosphatidylinositol  via kinase  reactions  from phosphatidyl   4,5  bisphosphate  which  is the precursor to inositol -1,4,5- triphosphate diacylglycerol  phosphatidylinositol  -3,4,5- triphosphate  etc. The myo  inositol   phosphates  can be  dephosphorylated  via phosphatases. 

Indications

PCO care  is indicated  for the ultimate  management  of insulin  resistance  in PCOS and its associated  symptoms

Menstrual irregularities 

Hyperandrogenism 

Obesity  / Weight gain

Anovulation