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Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials

Nándor Ács, Szabolcs Várbı́ró, E Horváth, Acs N, Péter Hegyi, Anna E. Juhász, Péter Nyirády, Sunjune Park, Zoltán Sipos, Szilárd Váncsa, Alex Váradi, Dorina Greff, Julia Szinte, Szabolcs Várbíró

Open Access
  • Semmelweis University ROR
  • University of Pecs ROR
  • Baylor College of Medicine ROR
  • Department of Obstetrics and Gynecology, Semmelweis University, 1182, Budapest, Üllői Út 78/A, Hungary. varbiro.szabolcs@med.semmelweis-univ.hu.

Reproductive Biology and Endocrinology : RB&E, 21(1), 10

DOI 10.1186/s12958-023-01055-z PMID 36703143

Abstract

Background

Metformin is the gold standard insulin sensitizer, which is widely used to treat insulin resistance in polycystic ovary syndrome (PCOS). However, metformin may induce gastrointestinal side effects.

Objective

Inositols have long been debated as a potential alternative for metformin in treating PCOS. Therefore, the present systematic review aimed to evaluate the efficacy and safety of inositols in treating PCOS.

Methods

The present systematic search was performed in CENTRAL, MEDLINE, and Embase from the inception until October 20th, 2021. Eligible randomized controlled trials (RCTs) included women diagnosed with PCOS and compared any inositols with metformin or placebo. Our primary outcome was cycle normalization, whereas secondary outcomes were body mass index (BMI), parameters of carbohydrate metabolism and clinical and laboratory hyperandrogenism. Results are reported as risk ratios or mean differences (MDs) with 95% confidence intervals (CIs).

Results

Twenty-six RCTs were identified, including data of 1691 patients (806 inositol, 311 with placebo, and 509 metformin groups). In patients treated with inositols, the risk (CI: 1.13; 2.85) of having a regular menstrual cycle was found by 1.79 higher than in the case of placebo. Moreover, the inositols showed non-inferiority compared to metformin in this outcome. In the case of BMI (MD = -0.45; CI: -0.89; -0.02), free testosterone (MD = -0,41, CI: -0.69; -0.13), total testosterone (MD = -20.39, CI: -40.12; -0.66), androstenedione (MD = -0.69, CI: -1,16; -0.22), glucose (MD = -3.14; CI: -5.75; -0.54) levels and AUC insulin (MD = -2081.05, CI: -2745.32; -1416.78) inositol treatment induced greater decrease compared to placebo. Inositol increased sex-hormone-binding globulin significantly compared to placebo (MD = 32.06, CI:1.27; 62.85).

Conclusion

Inositol is an effective and safe treatment in PCOS. Moreover, inositols showed non-inferiority in most outcomes compared to the gold standard treatment; metformin.

Trial Registration

PROSPERO registration number: CRD42021283275.

Topics

PCOSReproductive Endocrinology
inositol PCOS treatment, myo-inositol polycystic ovary syndrome, insulin sensitizer PCOS, metformin alternative PCOS, D-chiro-inositol PCOS, PCOS insulin resistance inositol, ovulation induction inositol, PCOS hormonal profile inositol, systematic review inositol PCOS, meta-analysis inositol polycystic ovary
PMID 36703143 36703143 DOI 10.1186/s12958-023-01055-z 10.1186/s12958-023-01055-z

Cite this article

Greff, D., Juhász, A. E., Váncsa, S., Váradi, A., Sipos, Z., Szinte, J., Park, S., Hegyi, P., Nyirády, P., Ács, N., Várbíró, S., & Horváth, E. M. (2023). Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. *Reproductive biology and endocrinology : RB&E*, *21*(1), 10. https://doi.org/10.1186/s12958-023-01055-z

Keywords

Inositol, Hypoglycemic Agents, Metformin, Testosterone, Insulins

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