Comparative study on the use of myo-inositol and metformin in improvement of biochemical parameters in women with polycystic ovarian syndrome

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by hyperandrogenism, chronic anovulation, and polycystic ovarian morphology. Insulin resistance and metabolic dysfunction are central to PCOS pathophysiology, increasing the risk of type 2 diabetes, dyslipidemia, and cardiovascular disease. Metformin, an insulin-sensitizing agent, is widely used to improve metabolic and hormonal profiles, while Myo-inositol, a naturally occurring insulin sensitizer, has shown potential in enhancing ovarian function and biochemical parameters. This study aimed to compare the effects of Myo-inositol and Metformin on metabolic and hormonal markers in women with PCOS. Methods: Sixty women aged 18–35 years diagnosed with PCOS based on Rotterdam criteria were enrolled in this randomized, open-label study at Department of Obstetrics and Gynecology, Dr. Sirajul Islam Medical College and Hospital, Dhaka, Bangladesh from January to June 2025. Participants were allocated into two groups: Group A received Myo-inositol 2g twice daily, and Group B received Metformin 500 mg thrice daily for 12 weeks. Fasting glucose, fasting insulin, HOMA-IR, lipid profile (total cholesterol, LDL, HDL, triglycerides), and reproductive hormones (LH, FSH, total testosterone, SHBG) were measured at baseline and post-treatment. Results: Both groups demonstrated significant improvement in metabolic and hormonal parameters. Myo-inositol led to a greater reduction in fasting insulin (?6.5 ± 1.2 ?U/mL vs ?4.1 ± 1.0 ?U/mL, p=0.02) and HOMA-IR (?1.98 ± 0.45 vs ?1.22 ± 0.40, p=0.01), indicating superior improvement in insulin sensitivity. Metformin showed a more pronounced decrease in total cholesterol (?22 ± 10 mg/dL vs ?15 ± 8 mg/dL, p=0.04) and LDL (?15 ± 7 mg/dL vs ?10 ± 6 mg/dL, p=0.03). Both interventions significantly reduced total testosterone levels, with no statistically significant difference between groups. Conclusion: Myo-inositol and Metformin both effectively improve metabolic and hormonal profiles in women with PCOS. Myo-inositol demonstrates superior insulin-sensitizing effects, whereas Metformin provides greater improvement in lipid parameters. These findings support individualized therapeutic strategies based on predominant biochemical abnormalities.