EFFICACY OF MYO-INOSITOL AND D-CHIRO-INOSITOL COMBINATION ON MENSTRUAL CYCLE REGULATION AND IMPROVING INSULIN RESISTANCE IN YOUNG WOMAN WITH POLYCYSTIC OVARY SYNDROME (CASE STUDY)
Keywords:
PCOS, inositols, insulin resistance, hyperandrogenemia, anovulationAbstract
Polycystic ovary syndrome is a complex condition characterized by oligo/amenorrhea, signs of hyperandrogenemia (hirsutism, acne, alopecia) and ovaries that on ultrasound show the presence of multiple cysts, characteristically distributed in the periphery of the ovary( known as the "string of pearls" sign.) The clinical presentation of PCOS varies widely. To establish a diagnosis of polycystic ovary syndrome, it is necessary to have at least two of the three so-called Rotterdam criteria, which include: 1.Irregularities of the menstrual cycle - oligomenorrhea, amenorrhea or prolonged menstrual bleeding. 2.Hyperandrogenemia (proven clinically or laboratory) - hirsutism is the most common clinical presentation of hyperandrogenemia and occurs in up to 70% of women with this syndrome. Evaluation of hirsutism is with use of a modified Ferriman-Gallwey score system. With this system we evaluate hair growth in seven regions: upper lip, chin/face, chest, back, abdomen, arms and thighs. In about 90% of women that have normal menstrual cycle and hirsutism, during an ultrasound exam, it can be found that they have polycystic ovaries. 3.Polycystic ovaries (presence of ≥ 12 follicles 2-9 mm in size and/or ovarian volume > 10 mL) The most of the patients with PCOS have insulin resistance that leads to hyperinsulinemia. A paradox present in PCOS patients is that the ovaries remain insulin sensitive despite the universal insulin resistance. The increased androgen production is not so much due to remained insulin sensitivity of the ovaries as to compensatory hyperinsulinemia. Compensatory hyperinsilinemia increases pulsatile secretion of GnRH which can cause increased secretion of LH and lower the secretion of FSH. Insulin resistance and compensatory hyperinsulinemia affect about 65-70% of women with PCOS, of which 70-80% are obese and 20-25% are of normal body mass. The most authors suggest that that insulin resistance is the primary defect in patients with PCOS and hyperandrogenemia is secondary to that Our purpose is to evaluate the efficacy of treatment with myo-inositol (MI) and D-chiro-inositol (DCI) in ratio 40:1 , in the therapy of polycystic ovary syndrome (PCOS). Case study of 22 year-old female who presented to the clinic for irregular menstrual cycle , acne and hirsutism. Transvaginal ultrasound showed anteverted uterus, proliferative endometrium d-7mm and more than 12 antral follicles on right and left ovary.Hormonal investigations showed increase fasting insulin level and testosterone level. She was advised to start treatment with combination of myo-inositol and D chiro-inositol (ratio 40:1) 2 g per day during three months. Hormonal investigation after 3 months treatment with myo-insoitol/D- chiroinsoitol showed a decrease in the values of IRI 9.3 uU /ml , Testosteron 48,8ng/dl, Prolactine 19,3ng/ml. Also the treatment with combination od myo-insotiol/D- chiroinsotiol in ratio 40:1 contributed to regulation of menstrual cycle. Myo-inositol and D-chiro-inositol in combination (40:1 ratio) are effective in regularizing menstrual cycles in PCOS patients, improving insulin resistance and decreasing of hyperandrogenemia. The combination of myo-insoitol/D- chiroinositol (40:1) ratio should be considered as first line treatment in women with PCOS.
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