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Mediterranean Journal of Medical Research
https://app.periodikos.com.br/journal/mjpe/article/doi/10.5281/zenodo.18203319

Mediterranean Journal of Medical Research

Original article Medicine

Inositol has a beneficial effect in the management of polycystic ovary syndrome: Special data for Libyan patients

Balsam J. AL-belazi, Lujain M. Aldiab, Fathi M. Sherif

http://dx.doi.org/10.5281/zenodo.18203319 Mediterr J Med Res, vol.3, n1, p.14-26, 2026
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Abstract

Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder characterized by anovulation, infertility, obesity, insulin resistance, and polycystic ovaries. This study aims to overview of PCOS pathophysiology and therapy, focusing particularly on the therapeutic role of inositol, followed by an evaluation of a specific clinical intervention in Libyan patients. The study assessed the effects of inositol in combination with metformin on hormonal and metabolic parameters in Libyan patients with PCOS. This study was conducted at the Tripoli Infertility Treatment Hospital between August and October 2025. The study included 80 women diagnosed with infertility associated with PCOS according to the Rotterdam criteria, with 42 participants having complete data. Participants were divided into two groups who received treatment for three months: 21 patients received myo-inositol plus d-chiro-inositol, and 21 patients received inositol combined with metformin. The findings showed a reduction in LH, LH/FSH ratio, AMH, HOMA-IR, and HbA1c, along with increased estradiol. FSH, prolactin, and TSH remained unchanged. No differences were observed between myo-inositol and combination therapy. This study suggests that inositol is an effective supplement therapy for Libyan patients with PCOS, improving ovarian function and metabolic health. The benefits are likely mediated by enhanced insulin sensitivity, which helps restore gonadotropin balance and alleviate symptoms.

Keywords

Food supplement, hormonal imbalance, menstrual irregularities, metformin, PCO

References

  1. Dong J, Rees DA. Polycystic ovary syndrome: pathophysiology and therapeutic opportunities. The British Medical Journal. 2023; 2(1): e000548. doi: 10.1136/bmjmed-2023-000548
  2. Xu Y, Qiao J. Association of insulin resistance and elevated androgen levels with polycystic ovarian syndrome: A review of literature. Journal of Healthcare Engineering. 2022; 2022: 9240569. doi: 10.1155/2022/9240569
  3. Dapas M, Lin FTJ, Nadkarni GN, Sisk R, Legro RS, Urbanek M, et al. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. Public Library of Science Medicine. 2020; 17(6): e1003132. doi: 10.1371/journal.pmed.1003132
  4. Alharati SH, Elbakay JAM, Hermann A, Gbaj AM. Polycystic ovary syndrome: Molecular modeling study on potential Lepidium sativum bioactive compounds in modulating kiss-1 gene function. Mediterranean Journal of Medical Research. 2025; 2(3): 129-140. doi: 10.5281/zenodo.17069661
  5. Rotterdam ESHRE/ASRM-Sponsored Polycystic Ovary Syndrome Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility. 2004; 81(1): 19-25. doi: 10.1016/j.fertnstert.2003.10.004
  6. Espinosa ME, Sánchez R, Otzen T, Bautista-Valarezo E, Aguiar S, Corrales-Gutierrez I, et al. Phenotypic characterization of patients with polycystic ovary syndrome in a population from the Ecuadorian Andes: A cross-sectional study. Journal of Clinical Medicine. 2024; 13(8): 2376. doi: 10.3390/jcm13082376
  7. Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome: The hypothesis of polycystic ovary syndrome as functional ovarian hyperandrogenism revisited. Endocrine Reviews. 2016; 37(5): 467-520. doi: 10.1210/er.2015-1101
  8. Lonardo MS, Cacciapuoti N, Guida B, Di Lorenzo M, Chiurazzi M, Damiano S, et al. Hypothalamic-ovarian axis and adiposity relationship in polycystic ovary syndrome: Physiopathology and therapeutic options for the management of metabolic and inflammatory aspects. Current Obesity Reports. 2024; 13(1): 51-70. doi: 10.1007/s13679-023-00543-7
  9. Benelli E, Del Ghianda S, Di Cosmo C, Tonacchera M. A combined therapy with myo-inositol and d-chiro-inositol improves endocrine parameters and insulin resistance in polycystic ovary syndrome young overweight women. International Journal of Endocrinology. 2016; 2016: 3204083. doi: 10.1155/2016/3204083
  10. Cannarella R, Rubulotta M, Leonardi A, Crafa A, Calvo A, Barbagallo F, et al. Effects of ketogenic diets on polycystic ovary syndrome: a systematic review and meta-analysis. Reproductive Biology and Endocrinology. 2025; 23(1): 14. doi: 10.1186/s12958-025-01411-1
  11. Jaaida NA, Smeda HA, Alhrish RA. Use of weight-reducing products among Libyans: Pharmacist intervention in obesity management. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2022; 2(4): 54-64. doi: 10.5281/zenodo.7479770 4
  12. Rababa’h AM, Matani BR, Yehya A. An update of polycystic ovary syndrome: causes and therapeutics options. Heliyon. 2022; 8(10): e11010. doi: 10.1016/j.heliyon.2022.e11010
  13. Saadati S, Mason T, Godini R, Vanky E, Teede H, Mousa A. Metformin use in women with polycystic ovary syndrome: Opportunities, benefits, and clinical challenges. Diabetes, Obesity and Metabolism. 2025; 27(Suppl 3): 31-47. doi: 10.1111/dom.16422
  14. Livadas S, Diamanti-Kandarakis E. Polycystic ovary syndrome: definitions, phenotypes and diagnostic approach. Frontiers of Hormone Research. 2013; 40: 1-21. doi: 10.1159/000341673
  15. Baba T. Polycystic ovary syndrome: Criteria, phenotypes, race and ethnicity. Reproductive Medicine and Biology. 2025; 24(1): e12630. doi: 10.1002/rmb2.12630
  16. Kulkarni S, Gupta K, Ratre P, Mishra PK, Singh Y, Biharee A, et al. Polycystic ovary syndrome: Current scenario and future insights. Drug Discovery Today. 2023; 28(12): 103821. doi: 10.1016/j.drudis.2023.103821
  17. Silva MSB, Campbell RE. Polycystic ovary syndrome and the neuroendocrine consequences of androgen excess. Comprehensive Physiology. 2022; 12(2): 3347-3369. doi: 10.1002/cphy.c210025
  18. Wang X, Xie W, Zhao D, Liu M, Li W, Wang R, et al. Molecular subtypes of ovarian cancer based on lipid metabolism and glycolysis reveals potential therapeutic targets. Frontiers in Bioscience-Landmark. 2023; 28(10): 253. doi: 10.31083/j.fbl2810253
  19. Ramanand SJ, Ghongane BB, Ramanand JB, Patwardhan MH, Ghanghas RR, Jain SS. Clinical characteristics of polycystic ovary syndrome in Indian women. Indian Journal of Endocrinology and Metabolism. 2013; 17(1): 138-145. doi: 10.4103/2230-8210.107858
  20. Liu X, Wang L, Zuo X, Li C, Teng Y. Women with polycystic ovary syndrome with a history of early pregnancy loss show a higher risk of gestational diabetes mellitus. International Journal of General Medicine. 2021; 14: 6409-6416. doi: 10.2147/IJGM.S334666
  21. Arentz S, Smith CA, Abbott J, Fahey P, Cheema BS, Bensoussan A. Combined lifestyle and herbal medicine in overweight women with polycystic ovary syndrome: A randomized controlled trial. Phytotherapy Research. 2017; 31(9): 1330-1340. doi: 10.1002/ptr.5858
  22. Wang J, Wu J, Zhang Y, Zhang J, Xu W, Wu C, et al. Growth hormone protects against ovarian granulosa cell apoptosis: Alleviation oxidative stress and enhancement mitochondrial function. Reproductive Biology. 2021; 21(2): 100504. doi: 10.1016/j.repbio.2021.100504
  23. Kicińska AM, Maksym RB, Zabielska-Kaczorowska MA, Stachowska A, Babińska A. Immunological and metabolic causes of infertility in polycystic ovary syndrome. Biomedicines. 2023; 11(6): 1567. doi: 10.3390/ biomedicines11061567
  24. Armanini D, Boscaro M, Bordin L, Sabbadin C. Polycystic ovary syndrome, an inflammatory, systemic, lifestyle endocrinopathy. Journal of Endocrinological Investigation. 2018; 41(10): 1153-1158. doi: 10.1007/s 40618-018-0868-y
  25. Sarrar AM, Rafieda AM, Shaglouf DH, Elshwain WM. Venous and arterial thrombosis during oral contraceptive use in Libyan women. Mediterranean Journal of Medical Research. 2025; 2(4): 259-268. doi: 10.5281/zenodo. 17863440
  26. Ahmed R, Uddin Md M, Hoque M. Nutraceuticals: Food-based therapeutics and health benefits. Mediterranean Journal of Medicine and Medical Sciences. 2025; 1(1): 22-30. doi: 10.5281/zenodo.15771921
  27. Ahmed R, Khandaker MS. Natural products as nutraceuticals treatment for neurological disorders: An overview. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(2): 62-69. doi: 10.5281/ zenodo.15226021
  28. Akhlaq M, Alum MK, Alam MM. Anti-inflammatory potential of medicinal plants. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2022; 2(1): 13-21. doi: 10.5281/zenodo.6399381
  29. Sulong NA, Nasir NS, Misamiruddin R, Lee VS, Azad AK. Cytotoxicity study of aqueous extract of Asam Gelugur (Garcinia cambogia) against Vero cell line: Implications for nutraceutical safety. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(2): 36-42. doi: 10.5281/zenodo. 15164035
  30. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism. 2023; 108(10): 2447-2469. doi: 10.1210/clinem/dgad463
  31. Walli RR, Drbal AA, Altabib MN. Body mass index and vitamin D in Libyan women. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2024; 4(2): 64-68. doi: 10.5281/zenodo.12171291
  32. Elhadi AA, Ahmed AA. Correlation of vitamin D with glycemic control and body mass index in patients with type II diabetes mellitus. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2022; 2(1): 28-36. doi: 10.5281/zenodo.6399450
  33. Msalati AA, Bashein A , Aljaloh E , Ghrew M, Sedaa K, Zaid A. Prevalence of vitamin D deficiency in medical students. Mediterr J Pharm Pharm Sci. 2022; 2 (1): 69-78. doi: 10.5281/zenodo.6399784
  34. Cheng X, He B. Clinical and biochemical potential of antioxidants in treating polycystic ovary syndrome. International Journal of Woman’s Health. 2022; 14: 467-479. doi: 10.2147/IJWH.S345853
  35. Mohan A, Haider R, Fakhor H, Hina F, Kumar V, Jawed A, et al. Vitamin D and polycystic ovary syndrome: a review. Annals of Medicine and Surgery. 2023; 85(7): 3506-3511. doi: 10.1097/MS9.0000000000000879
  36. Regidor PA, Schindler AE, Lesoine B, Druckman R. 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; 34(2):/j/hmbci.2018.34.issue-2/hmbci-2017-0067/hmbci-2017-0067.xml. doi: 10.1515/ hmbci-2017-0067
  37. Melo V, Silva T, Silva T, Freitas J, Sacramento J, Vazquez M, et al. Omega-3 supplementation in the treatment of polycystic ovary syndrome: a review of clinical trials and cohort studies. Endocrine Regulations. 2022; 56(1): 66-79. doi: 10.2478/enr-2022-0008
  38. Canosa S, Paschero C, Carosso A, Leoncini S, Mercaldo N, Gennarelli G, et al. Effect of a combination of myo-inositol, alpha-lipoic acid, and folic acid on oocyte morphology and embryo morphokinetics in non- polycystic ovary syndrome overweight/obese patients undergoing IVF: A pilot, prospective, randomized study. Journal of Clinical Medicine. 2020; 9(9): 2949. doi: 10.3390/jcm9092949
  39. Clements RS, Darnell B. Myo-inositol content of common foods: development of a high-myo-inositol diet. The American Journal of Clinical Nutrition. 1980; 33(9): 1954-1967. doi: 10.1093/ajcn/33.9.1954
  40. Zhao J, Dong L, Lin Z, Sui X, Wang Y, Li L, et al. Effects of selenium supplementation on polycystic ovarian syndrome: A systematic review and meta-analysis on randomized clinical trials. BMC Endocrine Disorders. 2023; 23(1): 33. doi: 10.1186/s12902-023-01286-6
  41. Unfer V, Carlomagno G, Dante G, Facchinetti F. Effects of myo-inositol in women with polycystic ovarian syndrome: A systematic review of randomized controlled trials. Gynecological Endocrinology. 2012; 28(7): 509-515. doi: 10.3109/09513590.2011.650660
  42. Unfer V, Nestler JE, Kamenov ZA, Prapas N, Facchinetti F. Effects of inositol(s) in women with polycystic ovarian syndrome: a systematic review of randomized controlled trials. International Journal of Endocrinology. 2016; 2016: 1849162. doi: 10.1155/2016/1849162
  43. Heimark D, McAllister J, Larner J. Decreased myo-inositol to chiro-inositol (M/C) ratios and increased M/C epimerase activity in polycystic ovarian syndrome theca cells demonstrate increased insulin sensitivity compared to controls. Endocrine Journal. 2014; 61(2): 111-117. doi: 10.1507/endocrj.ej13-0423
  44. Laganà AS, Garzon S, Casarin J, Franchi M, Ghezzi F. Inositol in polycystic ovary syndrome: restoring fertility through a pathophysiology-based approach. Trends in Endocrinology and Metabolism. 2018; 29(11): 768-780. doi: 10.1016/j.tem.2018.09.001
  45. Nordio M, Basciani S, Camajani E. The 40:1 myo-inositol/D-chiro-inositol plasma ratio is able to restore ovulation in PCOS patients: comparison with other ratios. European Review for Medical and Pharmacological Sciences. 2019; 23(12): 5512-5521. doi: 10.26355/eurrev_201906_18223
  46. Monastra G, Unfer V, Harrath AH, Bizzarri M. Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients. Gynecological Endocrinology. 2017; 33(1): 1-9. doi: 10.1080/09513590.2016.1247797
  47. Akbari Sene A, Tabatabaie A, Nikniaz H, Alizadeh A, Sheibani K, Mortezapour Alisaraie M, et al. The myo-inositol effect on the oocyte quality and fertilization rate among women with polycystic ovary syndrome undergoing assisted reproductive technology cycles: a randomized clinical trial. Archives of Gynecology and Obstetrics. 2019; 299(6): 1701-1707. doi: 10.1007/s00404-019-05111-1
  48. Nizamuddin SFS. Polyphenol-rich black chokeberry (Aronia melanocarpa) and its therapeutic potential in type 2 diabetes mellitus: A comprehensive review. Mediterranean Journal of Medicine and Medical Sciences. 2025; 1(3): 31-42. doi: 10.5281/zenodo.17619107
  49. Elmiladi SA. Presentation and character for adult patients with diabetes in Libya. Mediterr J Pharm Pharm Sci. 2022; 2(1): 79-86. doi: 10.5281/zenodo.6399891
  50. Artini PG, Di Berardino OM, Papini F, Genazzani AD, Simi G, Ruggiero M, et al. Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecological Endocrinology. 2013; 29(4): 375-379. doi: 10.3109/09513590.2012.743020
  51. Ravn P, Gram F, Andersen MS, Glintborg D. Myoinositol vs. metformin in women with polycystic ovary syndrome: a randomized controlled clinical trial. Metabolites. 2022; 12(12): 1183. doi: 10.3390/metabo 12121183
  52. Kalra B, Kalra S, Sharma JB. The inositols and polycystic ovary syndrome. Indian Journal of Endocrinology and Metabolism. 2016; 20(5): 720-724. doi: 10.4103/2230-8210.189231
  53.  Armanini D, Boscaro M, Bordin L, Sabbadin C. Controversies in the pathogenesis, diagnosis and treatment of polycystic ovary syndrome: focus on insulin resistance, inflammation, and hyperandrogenism. International Journal of Molecular Sciences. 2022; 23(8): 4110. doi: 10.3390/ijms23084110
  54.  Monastra G, Vucenik I, Harrath AH, Alwasel SH, Kamenov ZA, Laganà AS, et al. Polycystic ovary syndrome and inositols: controversial results and necessary clarifications. Basic differences between D-chiro and myo-inositol. Frontiers in Endocrinology. 2021; 12: 660381. doi: 10.3389/fendo.2021.660381
  55.  Gerli S, Papaleo E, Ferrari A, Di Renzo GC. Randomized, double-blind placebo-controlled trial: Effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. European Review for Medical and Pharmacological Sciences. 2007; 11(5): 347-354. doi: 10.26355/eurrev_202309_33752
  56. Fitz V, Graca S, Mahalingaiah S, Liu J, Lai L, Butt A, et al. Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines. The Journal of Clinical Endocrinology and Metabolism. 2024; 109(6): 1630–1655. doi: 10.1210/clinem/dgae588
  57. Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Endocrine Connections. 2017; 6(8): 647-658. doi: 10.1530/EC-17-0243
  58. Ozay AC, Emekci Ozay O, Okyay RE, Cagliyan E, Kume T, Gulekli B. Different effects of myoinositol plus folic acid versus combined oral treatment on androgen levels in polycystic ovary syndrome women. International Journal of Endocrinology. 2016; 2016: 3206872. doi: 10.1155/2016/3206872
  59. Campbell RK. Role of the pharmacist in diabetes management. American Journal of Health-System Pharmacy. 2002; 59(suppl_9): S18-21. doi: 10.1093/ajhp/59.suppl_9.S18 22
  60. Uddin MM, Rahman MM, Rafi IK, Khandaker MS. Health problems in Bangladesh: A struggle for equitable and accessible healthcare. Mediterranean Journal of Medicine and Medical Sciences. 2025; 1(1): 1-7. doi. 10.5281/zenodo.15606021
  61. Paul SK. Assessment of knowledge and attitude of adverse drug reactions among healthcare professionals in Bangladesh. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(2): 70-78. doi: 10.5281/ zenodo.15275065 21
  62. Taghizadeh P. The role of pharmacists in managing conditions like hypertension: The case of Northern Cyprus. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(3): 28-37. doi: 10.5281/zenodo. 15921080

Submitted date:
10/20/2025

Reviewed date:
01/05/2026

Accepted date:
01/10/2026

Publication date:
01/09/2026

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