Insulin sensitisers clearly have a role in the management of PCOS and its associated symptoms, particularly for those women looking to restore (or maintain) their normal ovulatory cycle with a view to falling pregnant.
The two most widely utilised options to date have been metformin and thiazolidinediones, which have been shown to improve ovulation and reduce metabolic symptoms. However, both exhibit significant side effects, including gastrointestinal complaints in the case of metformin and weight gain in the case of the thiazolidinediones and therefore, patient compliance can be low. An association between the thiazolidinediones and liver toxicity, led to this class of drugs being removed from the market.
Interestingly, it has been proposed that the beneficial effects of metformin are secondary to an increase in inositol availability. Furthermore, alternative research has suggested that the metabolism of inositol (MI to DCI conversion) is severely disrupted in obese PCOS patients who are insulin resistant. Currently, this data has not been replicated in lean women; however, the information to date is sufficient to suggest a possible therapeutic role for the inositols in alleviating insulin resistance.