Putative Complementary Compounds to Counteract Insulin-Resistance in PCOS Patients

Abstract

Polycystic ovary syndrome (PCOS) is the most frequent endocrine-metabolic disorder among women at reproductive age. The diagnosis is based on the presence of at least two out of three criteria of the Rotterdam criteria (2003). In the last decades, the dysmetabolic aspect of insulin resistance and compensatory hyperinsulinemia have been taken into account as the additional key features in the etiopathology of PCOS, and they have been widely studied. Since PCOS is a complex and multifactorial syndrome with different clinical manifestations, it is difficult to find the gold standard treatment. Therefore, a great variety of integrative treatments have been reported to counteract insulin resistance. PCOS patients need a tailored therapeutic strategy, according to the patient's BMI, the presence or absence of familiar predisposition to diabetes, and the patient's desire to achieve pregnancy or not. The present review analyzes and discloses the main clinical insight of such complementary substances.

Keywords: L-arginine; N-acetyl cysteine; PCOS; antioxidants; carnitines; inositols; insulin resistance; lipoic acid.

Figure 1

Schematic representation on the role of metabolism impairments in triggering the endocrine impairments of PCOS. An inappropriate lifestyle and/or the coupling with familial diabetes are the main triggers of the insulin resistance that activates the compensatory hyperinsulinemia. Various reduced enzymatic expressions occur in case of familial diabetes and are responsible of the insulin resistance due to peripheral reduced insulin sensitivity.

Figure 2

Representation of the role of inositols and alpha lipoic acid in insulin post-receptor signaling, modified from [17].

Figure 3

Molecular structures of Tocopherols and Tocotrienols. Modified from [163].