Comparison of Inositol, Metformin and Oral Contraceptives in Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects women in reproductive age and associates variable degrees of hyperandrogenism, anovulation and/or Polycystic Ovary Morphology (PCOM), generating different phenotypes. Due to its heterogenic etiology, there is no general treatment, but rather an individual approach for each case. The aim of this study is to detect possible variations in clinical and biochemical outcome in PCOS cases, after treatment with combined oral contraceptive pills, metformin or inositols. This prospective study presents 56 patients in fertile age (18–36 years old), diagnosed with PCOS, which received treatment with oral contraceptives (30mg Etinylestradiol+Dienogest), metformin (2x500mg) or inositols (2g Myoinositol). Patients were evaluated clinically and biochemically at baseline, at 3 and 6 months. In patients treated with contraceptive pills, LH levels decreased by 77.71% after 3 months, and LH:FSH ratio with 54.01% (p=0.0005) after 6 months. There was a 52% improvement in PCOM at ultrasound examination from 3 months treatment on (p<0.0001), but no significant decrease in menstrual cycle length. Metformin proved superior in decreasing abdominal circumference and HbA1c. The inositol group had the most significant improvement after 3 months, all parameters being significantly improved apart from Ferriman-Gallwey score; menstrual cycle pattern improved significantly after 3 months of treatment (54.7%, p=0.0008). There were significant differences in outcomes for clinical and biochemical parameters between the different treatments, yet none of them turned out superior in all main signs and symptoms, (hyperandrogenism, ovarian dysfunction and polycystic morphology). Treatment in PCOS patients should be individualised to patient’s symptoms and needs.