Polycystic Ovarian Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman's ovaries work.
The 3 main features of PCOS are:
- irregular periods – which means your ovaries do not regularly release eggs (ovulation)
- excess androgen – high levels of "male" hormones in your body, which may cause physical signs such as excess facial or body hair
- polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs (but despite the name, you do not actually have cysts if you have PCOS)
If you have at least 2 of these features, you may be diagnosed with PCOS.
Polycystic ovary syndrome (PCOS) is a major endocrinopathy among reproductive-aged women. It affects 4%–20% of women of reproductive age worldwide. Up to 10% of women are diagnosed with PCOS during gynecologic visits. In some European studies, the prevalence of PCOS has been reported to be 6.5-8%.
The exact cause of PCOS is unknown, but it often runs in families. It's related to abnormal hormone levels in the body, including high levels of insulin. Insulin is a hormone that controls sugar levels in the body. Many women with PCOS are resistant to the action of insulin in their body and produce higher levels of insulin to overcome this. This contributes to the increased production and activity of hormones like testosterone. Being overweight or obese also increases the amount of insulin your body produces.
Myo-inositol
Q10
A-lipoic acid
N-Acetyl-Cysteine
L-Carnitine
L-Arginine
Myo-inositol
Myo-inositol (MI) increases insulin sensitivity, decreases hyperandrogenism and improves the menstrual cycle. Its effect during assisted reproductive technologies (ART) has been studied by many authors. We conducted a review of the literature on the impact of MI administration in PCOS women in assisted reproductive technologies. Myo-inositol is effective in normalizing ovarian function, improving oocyte and embryo quality in PCOS
Reproductive Health volume 18, Article number: 13 (2021), Published: 19 January 2021
Because Myo-Inositol supplementation reduces the rFSH IU administrated during IVF cycles, it is likely that the putative Myo-Inositol deficiency in the ovary would also impair the FSH signaling, resulting in an increased risk of ovarian hyperstimulation syndrome for PCOS patients. Therefore, we could speak of a “D-Chiro-Inositol paradox”: indeed, although D-Chiro-Inositol paradox is useful in the treatment of PCOS patients to reduce Insulin Resistance, it has no effect at ovarian level as Myo-Inositol does.
Fertility and Sterility Volume 95, Issue 8, 30 June 2011, Pages 2515-2516, https://doi.org/10.1016/j.fertnstert.2011.05.027
Q10
After adjustment for potential confounders, supplementation with CoQ10 alone or in combination with vitamin E, compared with placebo, had significant effects on fasting blood sugar (FBS); vitamin E's effect on FBS was not significant. A significant reduction in homeostasis model assessment of insulin resistance (HOMA-IR) was observed in the CoQ10 and combined groups. CoQ10, vitamin E, and co-supplementation led to decreased serum total testosterone levels (P < 0.001) compared with those of the placebo group. CoQ10 supplementation in combination with vitamin E significantly improved in sex hormone-binding globulin (SHBG) levels compared with other groups (P = 0.008). Linear regression analysis revealed that changes in FBS, insulin, and HOMA-IR were predictors of change in free androgen index (P < 0.05).
Conclusion: CoQ10 with or without vitamin E supplementation among women with PCOS had beneficial effects on serum FBS and insulin levels, as well as HOMA-IR and total testosterone levels. However, only co-supplementation affected SHBG concentrations.
J Clin Endocrinol Metab . 2019 Feb 1;104(2):319-327. doi: 10.1210/jc.2018-01221.
A-lipoic acid
The aim of this retrospective study was to evaluate the effects of a treatment with α-lipoic acid (ALA) associated with two different doses of myo-inositol (MI) on clinical and metabolic features of women with polycystic ovary syndrome (PCOS). Eighty-eight women received the treatment, and 71 among them had complete clinical charts and were considered eligible for this study. All women were treated with 800 mg of ALA per day: 43 patients received 2000 mg of MI and 28 received 1000 mg of MI per day. In conclusion, ALA + MI positively affects the menstrual regularity of women with PCOS, regardless of their metabolic phenotype, with a more evident effect with a higher dose of MI. This effect seems to be insulin independent.
International Journal of Endocrinology, Volume 2020 | Article ID 2901393 | https://doi.org/10.1155/2020/2901393
Over the past decade, integrative treatments using inositols and alpha lipoic acid have been proposed and reported to be greatly effective on the dysmetabolic aspects of PCOS. In addition, these integrative treatments have been demonstrated to be greatly effective especially in PCOS patients who are overweight/obese and have a familial predisposition to diabetes.
GREM, 03/2020, Review , 146-157, DOI: doi.org/10.53260/GREM.201033
N-Acetyl-Cysteine
Objective, to review the benefits and harms of N-acetylcysteine (NAC) in women with polycystic ovary syndrome (PCOS). Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid), CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013) for the studies on women with PCOS receiving NAC. Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo
Obstet Gynecol Int. 2015; 2015: 817849. Published online 2015 Jan 8. doi: 10.1155/2015/817849
L-Carnitine
This study investigated the effects of L-carnitine on the clinical and laboratory findings of women with PCOS.
Eighty women diagnosed with PCOS between 2017 and 2018 by the Rotterdam Criteria were enrolled in the study; six were lost during the study. The participants were given L-carnitine 3 g daily (Pursinapharma, Iran) for three months. Blood samples were taken after overnight fasting at baseline and three months into the study to assess the levels of fasting glucose, insulin, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), free testosterone, dehydroepiandrosterone (DHEA), and the insulin resistance index (HOMA-IR). The patients were weighed before and after treatment and had their body mass index (BMI) calculated. Menstrual cycles and manifestations of hirsutism were also assessed.
The data showed a significant improvement in insulin sensitivity and decreases in serum LDL levels and the BMI after three months of treatment. There was a significant increase in serum HDL levels. More regular menstrual cycles and decreased hirsutism were also observed.
In Conclusion It appears that treatment with L-carnitine might decrease the risk of cardiovascular events by normalizing metabolic profiles and the BMI.
JBRA Assist Reprod. 2019 Oct-Dec; 23(4): 392–395. doi: 10.5935/1518-0557.20190033
L-Arginine
Eight patients with PCOS displaying oligo-amenorrhea from at least 1 yr underwent a combined treatment with N-acetylcysteine (NAC) (1200 mg/die) plus L-arginine (ARG) (1600 mg/die) for 6 months. Menstrual function, glucose and insulin levels, and, in turn, homeostasis model assessment (HOMA) index were monitored. Menstrual function was at some extent restored as indicated by the number of uterine bleedings under treatment (3.00, 0.18-5.83 vs 0.00, 0.00-0.83; p<0.02). Also, a well-defined biphasic pattern in the basal body temperature suggested ovulatory cycles. The HOMA index decreased under treatment (2.12, 1.46-4.42 vs 3.48, 1.62-5.95; p<0.05). In conclusion, this preliminary, open study suggests that prolonged treatment with NAC+ARG might restore gonadal function in PCOS. This effect seems associated to an improvement in insulin sensitivity.
J Endocrinol Invest . 2009 Dec;32(11):870-2. doi: 10.1007/BF03345763. Epub 2009 Apr 15. DOI: 10.1007/BF03345763
** All data above are published as clinical trials and do not refer to EFSA claims. This means that they do not intend to be medical or therapeutical advice.