According to some research, polycystic ovary syndrome (PCOS) has affected 1 in 15 women over the earth. 1 It is characterized by increased insulin levels as well as increased androgens which affect a women’s skin (including acne and hirsutism-increased hair growth), weight, reproductive system, and can put a woman at a higher risk for diabetes later in life. I’ve seen first hand how this can affect women and wanted to offer a few suggestions for relief.
The primary cause of PCOS is still unknown. It is attributed to environmental factors, possibly dysfunction in the hypothalmic-pituitary axis, or possibly from abnormal insulin activity. 1 I personally believe all of these probably come into play to some degree and are all related. Environment is probably the hardest of these factors to change because you literally have to live somewhere else which may not be possible. Lifestyle is the factor that can be the most readily changed depending on the motivation of the person doing the change.
There are a couple of things that are important and should be discussed. Seeing as how PCOS is a problem characterized by insulin problems it is necessary that a woman get a strong handle on what is going to increase and decrease her blood sugars. Junk carbs (refined carbs-white bread, most anything that comes in plastic, junk food, food with added sugar) and excessive use of carbohydrate should be avoided. I think most people know this but I said it anyway. Repition is important to learning! Eating lots of processed food also has the downfall of usually having junk fat in them too. Soybean oils, sunflower oils, corn oils and others that are man made should be avoided.
Another important thing to remember is that even though one can change his/her lifestyle, it may still take time to make the changes in the body. Some may come more quickly than others, patience and perseverance are important when tackling something like this.
I want to discuss a couple of supplements that may be beneficial if you are suffering from PCOS. I want to make it clear though that although they have been shown to be beneficial, a lifestyle/diet change is the most powerful thing a person can do long term, especially since these supplements are a little pricey.
The first supplement is myo-inositol (referred to as inositol for the rest of this article series). It was once considered of the B-vitamins but it can be produced by the body. Apparently inositol and d-chiro-inositol (another form) have insulin-sensitizing capabilities.2 3 This has shown to be helpful for women with PCOS. Lets take a look at the studies.
The first looked at women with oligomenorrhea or amenorrhea (infrequent or completely absent periods) gave them 2gm of inositol and 200mcg of folic acid twice daily. The women were followed for 6 months. 18 women maintained ovulation during the 6 month follow up and 10 pregnancies resulted. There were 2 spontaneous abortions. Not bad, the only real big problem was this study was placebo controlled so we don’t know if there would have been a significant difference if compared to women on placebo. 4
In another uncontrolled study, 46 women were given the same regimen as above plus 3mg melatonin/day. These women had undergone in-vitro fertilization but due to poor oocyte (egg) quality were unable to conceive. After being treated with the inositol, oocyte quality improved and 13 pregnancies occured. Four resulted in spontaneous abortion. 5
46 women with hirsutism were given inositol in another study for 6 months. Several labs were compared at 6 months with baseline in each women. Hirsutism decreased significantly after therapy. Total androgens (like testosterone), FSH and LH (hormones that stimulate sex hormone production) concentrations decreased while oestradiol concentrations increased. Insulin resistance was significantly decreased after therapy.6
In yet another study 47 women were randomized to placebo of folic acid and 45 women were given 4gm inositol and 400mcg folic acid daily. Ovulation frequency in the treatment group was significantly greater than placebo, 25% vs 15%. The effect of the inositol was rapid according to the researchers. Leptin levels were also reduced. There was no difference in fasting glucose concentrations or insulin levels between groups but leptin levels were decreased in the treatment group.7
D-chiro-Inositol (DCI for this article)
This is the other form of inositol that appears to have benefit for insulin sensitivity. Lets take a look at some of the studies for this form.
Researchers looked at 44 obese women, 22 randomized to placebo and 22 were given DCI at 1200mg/day, for 6 weeks. Testosterone, blood pressure and triglycerides were measured during this time. All 3 endpoints decreased significantly in the DCI group, but no change was noted in the placebo group. It is also noteworthy that 19 of the 22 women in the DCI group ovulated, while only 6 in the control group ovulated. 8
In a placebo controlled trial, 10 lean women were given 600mg DCI daily and 10 other lean women were given placebo. They were followeed for 6-8 weeks. Plasma insulin after an oral glucose test was reduced in the DCI group and remained the same in the placebo group. Free testosterone was reduced by 73% in the DCI group and 6 women in the DCI group ovulated while only 2 did in the placebo group.9 It’s really too bad that this study was only 20 women. But they are positive and should give us a good reason to try this in a larger population.
Women with PCOS appear to excrete DCI at a higher rate from the kidneys than women without PCOS. Researchers looked at 26 normal women compared with 23 women with PCOS and measured the output of DCI and inositol. The DCI was excreted at about 6x the rate in PCOS as normal controls. Inositol appeared to have no significant difference, although I must admit I’d be interested to see what it would be if they population they looked at was larger. 10
Buckwheat farinetta is a more natural source of DCI for those that are interested. I’ve read that certain brands can have 600mg per 1/2 cup. I can’t substantiate those claims but it may be an alternative for those who don’t want to buy supplements and would rather use food. Since I can’t tell you exactly how much DCI is in every cup I can’t recommend any particular recipe. But the brand Buckwheat Farinetta is reported to have the level I just listed. So a batter made with 3 cups of that flour that yields say 12 muffins would give you a total of 300mg per muffin. So you’d need to eat 2-3 muffins a day to get a dose around what the studies were using. So some food for thought.
I hope this information is useful because I know of the heartache some couples have had in trying to conceive with this problem. If you have an experience with d-chiro-inositol or myo-inositol please let me know. I’d love to hear if it has been useful to you.
2.Corrado, F., et al. “The effect of myoinositol supplementation on insulin resistance in patients with gestational diabetes.” Diabetic Medicine 28.8 (2011): 972-975.
3.Larner, Joseph. “D-chiro-inositol–its functional role in insulin action and its deficit in insulin resistance.” Experimental Diabetes Research 3.1 (2002): 47-60.
4.Papaleo, Enrico, et al. “Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction.” Gynecological Endocrinology 23.12 (2007): 700-703.
5.Unfer, Vittorio, et al. “Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective, longitudinal, cohort study.” Gynecological Endocrinology 27.11 (2011): 857-861.
6.Minozzi, M., G. D’Andrea, and V. Unfer. “Treatment of hirsutism with myo-inositol: a prospective clinical study.” Reproductive biomedicine online 17.4 (2008): 579-582.
7.Nestler, John E., et al. “Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome.” New England Journal of Medicine 340.17 (1999): 1314-1320.
8.Gerli, S., et al. “Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS.” Eur Rev Med Pharmacol Sci 11.5 (2007): 347-354.
9. Iuorno MF, et al. “Effects of d-chiro-inositol in lean women with polycystic ovary syndrome” Endocr Pract. 2002 Nov-Dec;8(6):417-23
10.Baillargeon, Jean-Patrice, et al. “Altered D-chiro-inositol urinary clearance in women with polycystic ovary syndrome.” Diabetes Care 29.2 (2006): 300-305.