INOSITOLS IN POLYCYSTIC OVARY SYNDROME: MECHANISMS, EFFICACY AND SAFETY – A NARRATIVE REVIEW

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine–metabolic disorder characterized by hyperandrogenism, anovulation and heightened cardiometabolic risk. Insulin resistance is central to its pathophysiology. Myo-inositol (MI) and D-chiro-inositol (DCI) are physiological insulin sensitizers increasingly used in PCOS management. Objective: To summarize the pharmacology, mechanisms of action, clinical efficacy and safety of inositols in PCOS. Methods: A narrative review of randomized trials, mechanistic studies and major reviews on MI and DCI was conducted using PubMed and Scopus. Search terms included “myo-inositol”, “D-chiro-inositol”, “polycystic ovary syndrome”, and “insulin resistance”. Results: MI, the predominant ovarian isomer, improves insulin signalling, enhances follicle-stimulating hormone responsiveness and supports aromatase activity. DCI predominantly influences metabolic insulin pathways. Clinical evidence shows that MI improves ovulation, menstrual cyclicity, biochemical hyperandrogenism and insulin resistance. The MI:DCI 40:1 combination, reflecting the physiological ovarian ratio, demonstrates superior reproductive and metabolic outcomes. Inositols are consistently well tolerated. Conclusion: MI and DCI are safe, evidence-based adjuncts that address both reproductive and metabolic components of PCOS. MI alone or MI:DCI 40:1 represents a rational therapeutic option alongside lifestyle modification and standard pharmacotherapy.