DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20200176

A prospective study of metformin versus myoinositol plus d-chiroinositol combination therapy in polycystic ovarian syndrome

Sukhmani Jaura, Inderpal Kaur, Jatinder Singh, Anita Madan

Abstract


Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Insulin resistance and resultant hyperinsulinemia contribute to hyperandrogenism in these patients. Weight loss or pharmacologic interventions that lower insulin levels reduce androgen levels. This study was planned to evaluate efficacy of metformin versus myoinositol plus d-chiroinositol combination therapy in PCOS patients and its effects on clinical, hormonal and radio diagnostic dimensions.

Methods: This was a prospective study for nine months. 50 newly diagnosed PCOS patients from the Department of Obstetrics and Gynaecology, Government Medical College (GMC), Amritsar, were randomly divided into 2 groups. One group was given metformin 500 mg twice daily and another myoinositol plus d-chiroinositol 1000 mg twice daily for 9 months. Follow up was done at 3, 6, 9 months. At each visit, ultrasonography and hormone levels were evaluated. Informed consent was taken. The approval of the Institutional Ethics Committee, GMC, Amritsar was also obtained.

Results: The percentage change in free testosterone levels (22.46±6.47) and insulin levels (34.24±15.02) show statistically significant decrease in group 2 (p<0.001). There was statistically significant (p<0.05) fall in AMH levels (22.41±7.78) in group 1. There was no statistically significant difference between the 2 groups in ovarian volume on ultrasonography, random blood glucose levels, luteinizing hormone (LH), follicle-stimulating hormone (FSH) levels, estrogen and progesterone levels.

Conclusions: It was observed that both treatments are equally effective in the treatment of polycystic ovarian syndrome with better tolerability in myoinositol and d-chiroinositol group.


Keywords


PCOS, Metformin, Myoinositol, d-chiroinositol

Full Text:

PDF

References


Bharathi RV, Swetha S, Neerajaa J, Madhavica JV, Janani DM, Rekha SN, et al. An epidemiological survey: Effect of predisposing factors for PCOS in Indian urban and rural population. Middle East Fertility Society Journal. 2017;22(4):313-6.

Grundy SM. Obesity, metabolic syndrome, and coronary atherosclerosis. Circulation. 2002;105(23):2696–8.

Sun T, Heimark DB, Nguygen T, Nadler JL, Larner J. Both myo-inositol to chiro-inositol epimerase activities and chiro-inositol to myo-inositol ratios are decreased in tissues of GK type 2 diabetic rats compared to Wistar controls. Biochem Biophys Res Commun. 2002;293(3):1092–8.

Nestler JE, Unfer V. Reflections on inositol(s) for PCOS therapy: steps toward success. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2015;31(7):501–5.

Fauser BCJM, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97(1):28-38.e25.

Gharakhani M, Neghab N, Farimani M. Is Reducing Ovarian Volume in Polycystic Ovarian Syndrome Patients after Administration of Metformin Associated with Improving Cardiovascular Risk Factors? Int J Fertil Steril. 2011;5(2):90–5.

Zeyneloglu HB, Haydardedeoglu B, Bagis T, Kilicdag E. Metformin decreases ovarian volume in lean patients with polycystic ovary syndrome (PCOS). Fertil Steril. 2004;82:S301.

Ozay AC, Emekci Ozay O, Okyay RE, Cagliyan E, Kume T, Gulekli B. Different effects of myoinositol plus folic acid versus combined oral treatment on androgen levels in PCOS women. International J Endocrinol. 2016; 2016.

Nehra J, Kaushal J, Singhal SR, Ghalaut VS. A comparative study of myo inositol versus metformin on biochemical profile in polycystic ovarian syndrome in women. Int J Pharmaceut Sci Res. 2017;8(4):1664.

Artini PG, Di Berardino OM, Papini F, Genazzani AD, Simi G, Ruggiero M, et al. Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2013;29(4):375–9.

Troisi J, Cinque C, Giugliano L, Symes S, Richards S, Adair D, et al. Metabolomic change due to combined treatment with myo-inositol, D-chiro-inositol and glucomannan in polycystic ovarian syndrome patients: a pilot study. J Ovarian Res. 2019;12(1):25.

Regidor PA, Schindler AE. Myoinositol as a safe and alternative approach in the treatment of infertile PCOS women: a German observational study. Int J Endocrinol. 2016.

Tiwari N, Pasrija S, Jain S. Randomised controlled trial to study the efficacy of exercise with and without metformin on women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2019;234:149–54.

Pradas I, Rovira-Llopis S, Naudí A, Bañuls C, Rocha M, Hernandez-Mijares A, et al. Metformin induces lipid changes on sphingolipid species and oxidized lipids in polycystic ovary syndrome women. Sci Rep. 2019;9(1):16033.

Shokrpour M, Foroozanfard F, Ebrahimi FA, Vahedpoor Z, Aghadavod E, Ghaderi A, et al. Comparison of myo-inositol and metformin on glycemic control, lipid profiles, and gene expression related to insulin and lipid metabolism in women with polycystic ovary syndrome: a randomized controlled clinical trial. Gynecol Endocrinol. 2019;35(5):406–11.

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 Off J Int Soc Gynecol Endocrinol. 2017;33(1):39–42.

Madsen HN, Lauszus FF, Trolle B, Ingerslev HJ, Tørring N. Impact of metformin on anti-Müllerian hormone in women with polycystic ovary syndrome: a secondary analysis of a randomized controlled trial. Acta Obstet Gynecol Scand. 2015;94(5):547–51.

Tagliaferri V, Romualdi D, Immediata V, Cicco SD, Florio CD, Lanzone A, et al. Metformin vs myoinositol: which is better in obese polycystic ovary syndrome patients? A randomized controlled crossover study. Clin Endocrinol (Oxf). 2017;86(5):725–30.