Nutrients as novel therapeutic approaches for metabolic disturbances in polycystic ovary syndrome

Androgen excess and metabolic disorders in women with PCOS: beyond the body mass index

BACKGROUND

Insulin resistance is a common feature among women with polycystic ovary syndrome (PCOS), especially in those patients with hyperandrogenism and chronic anovulation. PCOS women are at risk for developing metabolic syndrome, impaired glucose tolerance and type II diabetes mellitus (DM II).

OBJECTIVE

The aim of this review is to explore the existing knowledge of the interplay between androgen excess, pancreatic β-cell function, non-alcoholic fatty liver disease (NAFLD), intra-abdominal and subcutaneous (SC) abdominal adipocytes in PCOS, providing a better comprehension of the molecular mechanisms of diabetologic interest.

METHODS

A comprehensive MEDLINE^® search was performed using relevant key terms for PCOS and DM II.

RESULTS

Insulin-induced hyperandrogenism could impair pancreatic β-cell function, the SC abdominal adipocytes' lipid storage capacity, leading to intra-abdominal adipocyte hypertrophy and lipotoxicity, which in turn promotes insulin resistance, and could enhance NAFLD. Fetal hyperandrogenism exposure prompts to metabolic disorders. Treatment with flutamide showed to partially reverse insulin resistance.

CONCLUSIONS

Metabolic impairment seems not to be dependent only on the total fat mass content and body weight in women with PCOS and might be ascribed to the androgen excess.

Effectiveness of myoinositol for polycystic ovary syndrome: a systematic review and meta-analysis

PURPOSE

To assess the effectiveness and safety of myoinositol for patients with PCOS.

METHODS

In this meta-analysis, data from randomized controlled trials are obtained to assess the effects of myoinositol vs. placebo or western medicine in women with PCOS. The study's registration number is CRD42017064563. The primary outcomes included total testosterone, estradiol (E2) and the homeostatic model assessment (HOMA) of insulin resistance.

RESULT

Ten trials involving 573 patients were included. The meta-analysis results show that: compared with the control group, myoinositol may improve HOMA index (WMD -0.65; 95% CI -1.02, -0.28; P = 0. 0005) and increase the E2 level (WMD 16.16; 95% CI 2.01, 30.31; P = 0. 03); while there is no enough strong evidence that the myoinositol has an effect on the total testosterone level (WMD -16.11; 95% CI -46.08, 13.86; P = 0. 29).

CONCLUSION

Based on current evidence, myoinositol may be recommended for the treatment of PCOS with insulin resistance, as well as for improving symptoms caused by decreased estrogen in PCOS.

New Therapeutic Approaches in Obesity and Metabolic Syndrome Associated with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a pathophysiological disorder affecting reproductive and metabolic indices. PCOS is commonly associated with a high prevalence of insulin resistance and obesity; this association carries an increased risk of developing metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease. Guidelines recommend lifestyle modification, metformin, hormonal contraceptives (HCs), and bariatric surgery as the main treatment options in obese patients with PCOS. Studies are being conducted to test the efficacy of existing treatment options as well as to discover new therapies. This review focuses on the most recent advances in this regard and highlights new hypotheses and emerging studies to give a picture of the latest therapeutic trends in the treatment of obese patients with PCOS. In this respect, much attention is given to the role of inositols, the mediators of insulin action. A deficiency of d-chiro-inositol containing inositol-phospho-glycans may be the basis of insulin resistance frequently seen in PCOS patients. Moreover, evidence suggests the use of statins in obese women with PCOS, but guidelines call for further research. Adiponectin, quercetin, vitamin D, and anti-obesity drugs have also been studied and seem to have a useful role in the treatment of obesity and metabolic syndrome in PCOS. Many trials have been conducted on the use of non-pharmacological therapies. Therapies including resveratrol, acupuncture, and berberine have favorable effects in overweight PCOS patients. However, more research is needed to reveal the clinical complexity of PCOS and develop more effective treatment options.