By Amy Medling, founder of PCOS Diva
Updated July 2019
Myo-inositol, especially in the form of Ovasitol, is a very hot topic in the PCOS world. There is tons of very positive research coming out about myo-inositol for PCOS. Inositol is not a miracle pill, but used in conjunction with a healthy lifestyle it can help manage weight and appetite, promote normal blood sugar levels (insulin resistance) and menstrual cycles, normalize hormone levels, improve egg quality, resolve acne and hirsutism (hair where you don’t want it) and balance lipid levels – all things women with PCOS often struggle. In fact, PCOS has been linked to a deficiency in myo-inositol, triggering many of our PCOS symptoms.
The current research is very promising. One well-respected team of researchers analyzed the available date and concluded, “According to randomized controlled studies involving inositol supplementation in women with PCOS, inositol provides improvement in almost all pathologic conditions in PCOS such as recovery of reproductive abnormalities, decreased androgen levels, and improved insulin levels.” (7)
What is myo-inositol?
Myo-inositol is NOT a pharmaceutical drug. It is a naturally occurring substance produced in the human body that belongs to the vitamin B complex group. Myo-inositol is one of nine different types of inositol and can be found naturally in many foods such as fruits, nuts and beans. It is a precursor to a number of “signaling molecules” that essentially tell cells how to behave. Of the nine different types of inositol, two have insulin-sensitizing capabilities: myo-inositol and d-chiro-inositol. Together, these two inositols control countless tasks. Among other things, myo-inositol is integral to properly functioning insulin-receptors and has also been linked to the activation of serotonin (a “feel good” hormone) receptors, which could relieve depression and improve appetite, mood and anxiety (1, 2).
How Can Myo- Inositol Help With PCOS Symptoms?
1) Insulin Resistance
Insulin Resistance (IR) is a hallmark of PCOS, and one which cascades into many of our most frustrating symptoms. Myo- inositol has been proven to help (3). Myo-inositol can be synthesized by the body from food, but when we are already deficient, the lack of myo-inositol can impact the ability of the body to be sensitive to insulin. Women with PCOS are also known to have a defect in their insulin-signaling pathways which are heavily dependent upon inositol-containing substances (phosphoglycan mediators). We also have a Myo- inositol deficiency in our ovaries (3). Supplying extra myo-inositol appears to temporarily correct the malfunctioning insulin pathways and reduce the signs and symptoms of insulin resistance. A 2017 study put it this way, “The improvement of insulin sensitivity and the reduction of serum insulin demonstrated by Myo-inositol supply are of paramount importance for ameliorating the clinical features of women with PCOS.” (3)
In fact, the greatest benefit to controlling insulin resistance comes with the balanced (40/1 ratio) and combined us of Myo & D-chiro insositols. (3, 7, 8, 9) For more about D-chiro inositol read Uncovering the Secrets of D-chiro Inositol for PCOS.
Use of inositol may even surpass the popular drug, metformin, in controlling insulin. (6)
2) Reduces Testosterone
Women with PCOS often have an androgen excess. Dr. Fiona McCulloch describes it this way, “Androgen excess is often a central factor in PCOS – most women express either clinical signs of it including acne, hirsutism or androgenetic alopecia, or have lab work with high levels of hormones like testosterone, androstenedione, 17-OH Progesterone, DHEA-S or dihydrotestosterone.” Recent research indicated that myo-inositol, particularly in conjunction with D-chiro inositol significantly reduces levels of testosterone in your system (3) in as little as 12 weeks (6).
3) Helps Acne and Hirtuism
A study conducted in Italy with 50 PCOS women who took myo-inositol for three months, found that plasma LH, testosterone, free testosterone and insulin were significantly reduced. In 6 months of taking myo-inositol, both hirsutism and acne decreased. The researchers concluded, “MYO [inositol] administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne.”
4) Induces Menses and Increases Chances of Ovulation
In another study conducted in Italy in 2007, researchers followed 25 women with oligo-amenorrhea (irregular menses) or amenorrhea (no menses) due to PCOS. Myo-inositol and folic acid were given daily. Those treated had at least one menstrual cycle, and of these, seventy two percent continued ovulating normally. Forty percent of the women became pregnant and the study concluded that, “Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS. This therapy did not cause multiple pregnancy.” Since then,studies have shown similar results. As recently as 2018, researchers have found that Myo-inositol in combination with folic acid resulted in 70% restored ovulation. (6) Note:many women with PCOS require folates instead of folic acid. Learn more here.
5) Helps with Weight Loss and Appetite Control
A randomized double-blind trial which is the gold standard of research, gave 92 women either 400 mcg of folic acid as a placebo or 4 g myo-inositol plus 400 mcg folic acid. Researchers discovered that ovulation significantly increased, as did the frequency of normal progesterone values in the luteal phase and estradiol levels in the myo-inositol group.
This study noted less metabolic benefits to those women who were overweight, but also that the myo-inositol group lost a significant amount of weight and had lowered leptin (an appetite regulating hormone) levels. Further research agreed, stating that “Myo-inositol and d-chiro inositol in association with diet seems to accelerate the weight loss and the fat mass reduction with a slight increase of percent lean mass” (10). Some research indicates that use of inositol may be effective in reducing BMI even without lifestyle modification. (11)
6) Improves Egg Quality
Egg quality is a big concern for those trying (or planning to) conceive. An older study (5) showed that high levels of myo-inositol within follicles may be a marker for good follicular development and good oocyte or egg quality. The researchers stated, “We propose that higher concentrations of MI (Myo-inositol) and E2 (estradiol) in human FF (follicular fluid) appear to play a role in follicular maturity and provide a marker of good quality oocytes. In conclusion, follicles containing good quality oocytes have higher concentrations of MI (Myo-inositol) in FF (follicular fluid)”
More recent studies (4, 11) measured the effects of both myo-inositol and d-chiro-inositol in women undergoing fertility treatments. The results showed that women who received myo-inositol had better quality and more mature eggs. They also had more pregnancies than those who took d-chiro inositol.
7) Improves results of IVF
In 2018, researchers were not alone when they determined, “Myo-inositol has proven to be a new treatment option for patients with PCOS and infertility. The achieved pregnancy rates are at least in an equivalent or even superior range than those reported using metformin as an insulin sensitizer. No moderate to severe side effects were observed when myo-inositol was used at a dosage of 4000 mg per day. In addition, our evidence suggests that a myo-inositol therapy in women with PCOS results in better fertilization rates and a clear trend to a better embryo quality. As by the same way the number of retrieved oocytes was smaller in the myo-inositol group, the risk of a hyperstimulation syndrome in these patients can be reduced. Therefore, myo-inositol also represents an improvement in IVF protocols for patients with PCOS.” Other research indicates that the use of myo-inositol is very effective (10), but combining it in a 40:1 ratio with d-chiro inositol may be most effective. (9)
How Long Does Inositol Take to Work?
Research shows that while there may be improvement much earlier, it takes at least 6 months to see results (3). So, be patient!
Ask Your Doctor About Supplementing with Myo-inositol
Talk to your doctor about taking myo-inositol. Chances are your doctor may have never even heard of myo-inositol as a therapy for PCOS. My advice is to be, “a PCOS Diva at the doctor.” Advocate for yourself. Bring copies of these studies and articles to your appointment. Ask for their support. If they aren’t receptive, think about whether this is a partnership you want to continue. When a supplement has minimal to no side effects and shows so many results, I think it is worth fighting for. I take a combination myo-inositol and d-chiro inositol called Ovasitol. You can read more about it here. It rounds out my supplement routine which also includes PCOS Diva Essentials, Ultra DHA and Vitamin D. You can order all three at 10% less here…
Amy Medling, best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness.
2.”Metabolic Brain Diseases”; Effects of myo-inositol versus fluoxetine and imipramine pretreatments on serotonin 5HT2A and muscarinic acetylcholine receptors in human neuroblastoma cells; Brink CB, et al; 2004
4. V. Unfer, G. Carlomagno, P. Rizzo, E. Raffone, S. Roseff. Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Eur Rev Med Pharmacol Sci. 2011 Apr; 15(4): 452–457.
5. Chiu, Tony T.y., et al. “Follicular Fluid and Serum Concentrations of Myo-Inositol in Patients Undergoing IVF: Relationship with Oocyte Quality.” Human Reproduction, vol. 17, no. 6, 2002, pp. 1591–1596., doi:10.1093/humrep/17.6.1591.
6. Regidor, Pedro-Antonio, et al. “Management of Women with PCOS Using Myo-Inositol and Folic Acid. New Clinical Data and Review of the Literature.” Hormone Molecular Biology and Clinical Investigation, 2018, doi:10.1515/hmbci-2017-0067.
7. Günalan, Elif, et al. “The Effect of Nutrient Supplementation in Management of Polycystic Ovary Syndrome Associated Metabolic Dysfunctions: A Critical Review.” Journal of the Turkish-German Gynecological Association, 2018, doi:10.4274/jtgga.2018.0077.
9. Gateva, Antoaneta, et al. “The Use of Inositol(s) Isomers in the Management of Polycystic Ovary Syndrome: a Comprehensive Review.” Gynecological Endocrinology, vol. 34, no. 7, 2018, pp. 545–550., doi:10.1080/09513590.2017.1421632.
10) Geril, 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, Eur Rev Med Pharmacol Sci, 2007, www.greenmedinfo.com/article/myo-inositol-plus-folic-acid-has-beneficial-effect-improving-ovarian-function.
11) Mendoza, N, et al. “Comparison of the Effect of Two Combinations of Myo-Inositol and D-Chiro-Inositol in Women with Polycystic Ovary Syndrome Undergoing ICSI: a Randomized Controlled Trial.” Gynecol Endocrinol, Gynecol Endocrinol, Aug. 2019, www.tandfonline.com/doi/abs/10.1080/09513590.2019.1576620.