Inositols in clinical practice of managing a patient with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder caused by genetic, hormonal, and epigenetic factors. Its worldwide relevance stems from its prevalence, which ranges from 10% to 13%, as well as the development of associated conditions that negatively impact a woman’s health and well-being: infertility, dermatological manifestations of hyperandrogenism (hirsutism, acne), cardiovascular pathologies, and metabolic and psychoemotional disorders. Compensatory hyperinsulinemia due to insulin resistance is observed in approximately 80% of women with PCOS and obesity, and in 30–40% of normosthenic women diagnosed with PCOS. Therefore, insulin sensitizers are widely used to correct carbohydrate metabolism disorders in women with PCOS. In addition to metformin, the use of inositol for the prevention of metabolic disorders in women with PCOS is actively discussed in the literature and clinical guidelines (both international and Russian). In the last decade, various studies have shown that insulin resistance can be caused by a defect in the second messenger inositol phosphoglycan (IPG), with altered metabolism of inositol or IPG mediators potentiating insulin resistance. Inositol is a vitamin B complex and is epimerized in the body into nine stereoisomers, of which myo-inositol and D-chiro-inositol are the most biologically significant and studied. Myo- and dechiro-inositols can influence intracellular metabolic processes by activating key enzymes involved in oxidative and non-oxidative glucose metabolism. In recent decades, the role of inositols in the regulation of menstrual and ovulatory function has been actively discussed, including in patients with PCOS. The article presents a review of modern Russian and international publications regarding the positive effects of inositol stereoisomers in patients with PCOS in reproductive age.

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