Fruzzetti, F., Perini, D., Russo, M., Bucci, F., & Gadducci, A. (2017). Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS). Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, 33(1), 39-42. https://doi.org/10.1080/09513590.2016.1236078
Fruzzetti F, Perini D, Russo M, Bucci F, Gadducci A. Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS). Gynecol Endocrinol. 2017;33(1):39-42. doi:10.1080/09513590.2016.1236078
Fruzzetti, Franca, et al. "Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS)." Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, vol. 33, no. 1, 2017, pp. 39-42.
Metformin and myo-inositol improved PCOS insulin sensitivity similarly
In a small Pisa trial, metformin and myo-inositol improved insulin sensitivity and BMI similarly in women with PCOS. The 6-month trial randomly assigned 50 women to one drug or the other. About half the women in each group ended up with normal cycles. PCOS is also called PMOS (polyendocrine metabolic ovarian syndrome).
Key Findings
BMI fell in both groups: from 28.4 to 26.8 with metformin and from 27.3 to 25.3 with myo-inositol, with no difference between the groups.
Insulin resistance and insulin sensitivity measures improved in both groups, and the percent changes were no different.
At 6 months, cycles of normal length occurred in 53% of women on metformin and 44% on myo-inositol.
Androgen levels showed no significant change in either group. No change in hirsutism was reported by 76% of the metformin group and 80% of the myo-inositol group.
Three women in the metformin group dropped out because of diarrhea and abdominal pain. One woman in the myo-inositol group dropped out for poor compliance.
Interpretation
This randomized trial followed 50 women with PCOS, aged 18 to 28, all with insulin resistance or high insulin levels. Doctors used the Rotterdam criteria to diagnose PCOS. The trial ran at one university clinic. 46 women finished the 6 months. Metformin and myo-inositol worked about the same. Both improved insulin sensitivity and BMI. Similar shares of women got back cycles of normal length. The findings support larger studies of this approach.
RRM Context
The authors say insulin resistance sits at the center of PCOS. Restorative reproductive medicine looks for drivers like this as part of a cause-based evaluation. Charted cycles can show whether ovulation has returned, along with cycle length.
Our editorial summary of this paper, not the article's abstract.
Abstract
Insulin resistance (IR) plays a pivotal role in PCOS. Insulin-sensitizer agents such as metformin and inositols have been shown to improve the endocrine and metabolic aspects of PCOS. The purpose of this study is to compare their effects on the clinical and metabolic features of the women with PCOS. Fifty PCOS women with IR and/or hyperinsulinemia were randomized to treatment with metformin (1500 mg/day) or myo-inositol (4 g/day). IR was defined as HOMA-IR >2.5, while hyperinsulinemia was defined as a value of AUC for insulin after a glucose load over the cutoff of our laboratory obtained in normal women. The Matsusa Index has been calculated. The women have been evaluated for insulin secretion, BMI, menstrual cycle length, acne and hirsutism, at baseline and after 6 months of therapy. The results obtained in both groups were similar. The insulin sensitivity improved in both treatment groups. The BMI significantly decreased and the menstrual cycle was normalized in about 50% of the women. No significant changes in acne and hirsutism were observed. The two insulin-sensitizers, metformin and myo-inositol, show to be useful in PCOS women in lowering BMI and ameliorating insulin sensitivity, and improving menstrual cycle without significant differences between the two treatments.
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