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Reproductive Endocrinology · Ovarian Hormones

Comparison of myo-inositol and metformin on clinical, metabolic and genetic parameters in polycystic ovary syndrome: A randomized controlled clinical trial

Jamilian M, Farhat P, Foroozanfard F, Afshar Ebrahimi F, Aghadavod E, Bahmani F, Badehnoosh B, Jamilian H, Asemi Z

Published August 2017 Clinical Endocrinology, 87(2), 194-200
DOI 10.1111/cen.13366 PMID 28485095

RRM Academy Synopsis

Myo-inositol lowered testosterone more than metformin in a PCOS trial

Myo-inositol lowered testosterone and hirsutism scores more than metformin did in a 12-week trial of 60 women with PCOS, none with diabetes. Women were assigned by chance to each treatment. The blood marker hs-CRP also fell more. Other hormone levels showed no significant difference. PCOS is now called polyendocrine metabolic ovarian syndrome (PMOS).

Key Findings

  • Sixty women were randomly assigned to myo-inositol (N=30) or metformin (N=30) for 12 weeks. Fifty-four finished (27 in each group), and all 60 were analyzed by intention to treat.
  • Total testosterone fell with myo-inositol and rose slightly with metformin (P=0.03). Modified Ferriman-Gallwey hirsutism scores changed by -1.1±0.7 with myo-inositol and -0.5±0.8 with metformin (P=0.01).
  • Serum hs-CRP fell with myo-inositol and changed little with metformin (P<0.001). IL-1 gene expression in blood immune cells was lower with myo-inositol (P=0.02).
  • The groups did not differ significantly on other hormone measures, plasma nitric oxide, or expression of the IL-8 and TNF-α genes.

Interpretation

This randomized trial followed 60 women with PCOS for 12 weeks, comparing myo-inositol to metformin. Adjusting for baseline values, age and BMI left the testosterone and hirsutism findings unchanged. The authors note that fertility was not the main issue for these mostly overweight women. The findings support larger studies of myo-inositol's effect on androgen and inflammatory markers in PCOS.

RRM Context

Restorative reproductive medicine considers the hormone pattern behind PCOS. PCOS has a new name now. The new name is PMOS. PMOS is short for polyendocrine metabolic ovarian syndrome. The results here on testosterone and inflammation fit that way of care.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To our knowledge, data on comparison of myo-inositol and metformin on clinical, metabolic and genetic parameters in subjects with polycystic ovary syndrome (PCOS) are limited. This study was carried out to compare myo-inositol and metformin on clinical, metabolic and genetic parameters in subjects with PCOS.

Design, Patients, and Measurements

This randomized controlled trial was conducted among 60 subjects with PCOS aged 18-40 years. Subjects were randomly allocated into two groups to receive either myo-inositol (N=30) or metformin (N=30) for 12 weeks. Gene expression of inflammatory cytokines was assessed in peripheral blood mononuclear cells (PBMCs) of PCOS women by RT-PCR.

Results

After the 12-week intervention, compared with metformin, myo-inositol intake significantly decreased serum total testosterone (-1.4±4.2 vs +0.7±1.4 nmol/L, P=.03), modified Ferriman-Gallwey (mF-G) scores (-1.1±0.7 vs -0.5±0.8, P=.01) and serum high-sensitivity C-reactive protein (hs-CRP) levels (-2.6±3.9 vs +0.2±1.5 mg/L, P<.001). RT-PCR demonstrated that compared with metformin, myo-inositol downregulated gene expression of interleukin-1 (IL-1) (P=.02) in PBMCs of subjects with PCOS. We did not observe any significant effect of myo-inositol intake compared with metformin on other hormonal profiles, plasma nitric oxide (NO) or gene expression of IL-8 and tumour necrosis factor alpha (TNF-α).

Conclusions

Overall, taking myo-inositol, compared with metformin, for 12 weeks in patients with PCOS with hyperinsulinism and normoinsulinism had beneficial effects on total testosterone, mFG scores, serum hs-CRP levels and gene expression of IL-1, but did not affect other hormonal profiles, NO levels or gene expression of IL-8 and TNF-α.

Topics

By this author

Related research

Reproductive Endocrinology › Ovarian Hormones › Androgens · Therapeutics › Metabolic and Endocrine Agents › Insulin Sensitizing Agents
Mehri Jamilian, Pegah Farhat, Fatemeh Foroozanfard, Faraneh Afshar Ebrahimi, Esmat Aghadavod, Fereshteh Bahmani, Bita Badehnoosh, Hamidreza Jamilian, Zatollah Asemi
M Jamilian, P Farhat, F Foroozanfard, F Ebrahimi, E Aghadavod, F Bahmani, B Badehnoosh, H Jamilian, Z Asemi
PMID 28485095 28485095 DOI 10.1111/cen.13366 10.1111/cen.13366 Jamilian et al. 2017, Jamilian 2017

Keywords

Adolescent, Adult, C-Reactive Protein/analysis, Cytokines/blood/genetics, Female, Gene Expression/drug Effects, Humans, Inositol/administration & Dosage, Interleukin-1/blood, Leukocytes, Mononuclear/metabolism, Metformin/administration & Dosage, Polycystic Ovary Syndrome/blood/drug Therapy, Testosterone/blood, Young Adult, Cytokines, Interleukin-1, Testosterone, Inositol, C-Reactive Protein, Metformin, Hormonal Status, Inflammation, Metformin, Myo-inositol, Oxidative Stress, Polycystic Ovary Syndrome

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