A PCOS Paradox: Does Inositol Therapy Find a Rationale in All the Different Phenotypes?

Overview

Journal Int J Mol Sci

Publisher MDPI

Specialties Biochemistry
Chemistry
Molecular Biology

Date 2023 Apr 13

PMID 37047186

Authors

Vittorio Unfer

Simona Dinicola

Michele Russo

Affiliations

Soon will be listed here.

Abstract

A recent evaluation of the published data regarding the PCOS topic has highlighted a paradox in the definition of this condition. Even though the name of the syndrome refers to ovarian dysfunction, it seems that patients diagnosed with PCOS are more likely affected by an endocrine and metabolic issue. The term PCOS might not be appropriate to indicate the phenotypes described by the Rotterdam criteria, since the only phenotype with a gynecological issue alone is PCOS phenotype D. This novel perspective regarding how PCOS is currently defined leads the way to a reinterpretation of the entire pathological context and the treatment prescribed, such as inositols. A new point of view on the etiopathogenesis of the disease completely changes the current meaning of PCOS and consequently the therapeutic rationale evaluated to date.

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References

Mirabelli M, Chiefari E, Arcidiacono B, Corigliano D, Brunetti F, Maggisano V . Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients. 2020; 12(4). PMC: 7230471. DOI: 10.3390/nu12041066. View

Shang Y, Zhou H, Hu M, Feng H . Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2020; 105(10). DOI: 10.1210/clinem/dgaa425. View

Di Guardo F, Ciotta L, Monteleone M, Palumbo M . Male Equivalent Polycystic Ovarian Syndrome: Hormonal, Metabolic, and Clinical Aspects. Int J Fertil Steril. 2020; 14(2):79-83. PMC: 7382675. DOI: 10.22074/ijfs.2020.6092. View

Russo M, Forte G, Oliva M, Lagana A, Unfer V . Melatonin and Myo-Inositol: Supporting Reproduction from the Oocyte to Birth. Int J Mol Sci. 2021; 22(16). PMC: 8395120. DOI: 10.3390/ijms22168433. View

Nordio M, Basciani S, Camajani E . The 40:1 myo-inositol/D-chiro-inositol plasma ratio is able to restore ovulation in PCOS patients: comparison with other ratios. Eur Rev Med Pharmacol Sci. 2019; 23(12):5512-5521. DOI: 10.26355/eurrev_201906_18223. View

Palomba S . Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper. Hum Reprod. 2021; 36(9):2421-2428. DOI: 10.1093/humrep/deab181. View

Cheang K, Baillargeon J, Essah P, Ostlund Jr R, Apridonize T, Islam L . Insulin-stimulated release of D-chiro-inositol-containing inositolphosphoglycan mediator correlates with insulin sensitivity in women with polycystic ovary syndrome. Metabolism. 2008; 57(10):1390-7. PMC: 2574418. DOI: 10.1016/j.metabol.2008.05.008. View

Benelli E, Del Ghianda S, Di Cosmo C, Tonacchera M . A Combined Therapy with Myo-Inositol and D-Chiro-Inositol Improves Endocrine Parameters and Insulin Resistance in PCOS Young Overweight Women. Int J Endocrinol. 2016; 2016:3204083. PMC: 4963579. DOI: 10.1155/2016/3204083. View

Facchinetti F, Unfer V, Dewailly D, Kamenov Z, Diamanti-Kandarakis E, Lagana A . Inositols in Polycystic Ovary Syndrome: An Overview on the Advances. Trends Endocrinol Metab. 2020; 31(6):435-447. DOI: 10.1016/j.tem.2020.02.002. View

10.

Monastra G, Vucenik I, Harrath A, Alwasel S, Kamenov Z, Lagana A . PCOS and Inositols: Controversial Results and Necessary Clarifications. Basic Differences Between D-Chiro and Myo-Inositol. Front Endocrinol (Lausanne). 2021; 12:660381. PMC: 8056130. DOI: 10.3389/fendo.2021.660381. View

11.

Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale H, Franks S, Gambineri A . The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol. 2014; 171(4):P1-29. DOI: 10.1530/EJE-14-0253. View

12.

Barrea L, Arnone A, Annunziata G, Muscogiuri G, Laudisio D, Salzano C . Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients. 2019; 11(10). PMC: 6836220. DOI: 10.3390/nu11102278. View

13.

Yen H, Chang Y, Yee F, Huang Y . Metformin Therapy for Acne in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis. Am J Clin Dermatol. 2020; 22(1):11-23. DOI: 10.1007/s40257-020-00565-5. View

14.

Szczuko M, Kikut J, Szczuko U, Szydlowska I, Nawrocka-Rutkowska J, Zietek M . Nutrition Strategy and Life Style in Polycystic Ovary Syndrome-Narrative Review. Nutrients. 2021; 13(7). PMC: 8308732. DOI: 10.3390/nu13072452. View

15.

Amiri M, Nahidi F, Bidhendi-Yarandi R, Khalili D, Tohidi M, Ramezani Tehrani F . A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial. Hum Reprod. 2020; 35(1):175-186. DOI: 10.1093/humrep/dez255. View

16.

Luque-Ramirez M, Ortiz-Flores A, Nattero-Chavez L, Escobar-Morreale H . A safety evaluation of current medications for adult women with the polycystic ovarian syndrome not pursuing pregnancy. Expert Opin Drug Saf. 2020; 19(12):1559-1576. DOI: 10.1080/14740338.2020.1839409. View

17.

Witchel S, Oberfield S, Pena A . Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc. 2019; 3(8):1545-1573. PMC: 6676075. DOI: 10.1210/js.2019-00078. View

18.

Pkhaladze L, Russo M, Unfer V, Nordio M, Basciani S, Khomasuridze A . Treatment of lean PCOS teenagers: a follow-up comparison between Myo-Inositol and oral contraceptives. Eur Rev Med Pharmacol Sci. 2021; 25(23):7476-7485. DOI: 10.26355/eurrev_202112_27447. View

19.

Hoeger K, Dokras A, Piltonen T . Update on PCOS: Consequences, Challenges, and Guiding Treatment. J Clin Endocrinol Metab. 2020; 106(3):e1071-e1083. DOI: 10.1210/clinem/dgaa839. View

20.

. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004; 81(1):19-25. DOI: 10.1016/j.fertnstert.2003.10.004. View