Polycystic ovary syndrome
Endocrine disorder defined by the Rotterdam criteria: oligo- or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Any two of three criteria are required.
ICD-10 E28.24 drugs
Also known as: PCOS, Stein-Leventhal syndrome
Drugs used for this condition
- BMetforminAdd-on therapy · Biguanides. Oral antihyperglycemic agentsIn polycystic ovary syndrome metformin is used as an adjunct to lifestyle change in patients with metabolic features (insulin resistance, impaired glucose tolerance, overweight). The 2023 international ESHRE guideline and NICE CKS support metformin for metabolic components of PCOS and for ovulation restoration in a subset of patients. The 2020 Cochrane review demonstrated a modest but clinically meaningful effect on ovulation and pregnancy rates when combined with clomiphene.
- CMyo-inositolAdd-on therapy · Inositol stereoisomer, supplement. Has evidence base in polycystic ovary syndrome (PCOS)Myo-inositol is the only supplement with relatively convincing evidence in polycystic ovary syndrome (PCOS). Pundir 2018 (BJOG) meta-analysis of 13 RCTs in 1472 patients: myo-inositol 4 g/day × 3–6 months restores ovulation in 70% of PCOS patients vs 33% on placebo, reduces LH and testosterone and improves insulin sensitivity. ESHRE 2023 PCOS guideline classifies inositols as experimental therapy with possible effect for irregular cycles and insulin resistance in PCOS, requiring further RCTs; conditional recommendation. SEGO 2017 (Spanish PCOS consensus) lists hormonal contraceptives or metformin first-line for anovulation; myo-inositol is additional option. If pregnancy planned – optimal combination is myo-inositol + folic acid under gynaecology supervision.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DD-chiro-inositolNot recommended · Inositol stereoisomer, supplement. Usually used combined with myo-inositol in 40:1 ratioD-chiro-inositol as monotherapy in PCOS has no quality evidence base. Most inositol PCOS RCTs used either myo-inositol monotherapy or myo:D-chiro 40:1 combination (Inofolic Combi, Ovasitol). The Pundir 2018 (BJOG) meta-analysis pooled inositols as a class and did not directly compare the 40:1 combination against myo-inositol monotherapy. ESHRE 2023 PCOS guideline classifies inositols (without specifying form) as experimental therapy with possible effect. In PCOS the goal matters: combined oral contraceptives address cycle regulation and hyperandrogenism, while for ovulation induction when seeking pregnancy the first line is letrozole (ESHRE 2023), with metformin as an adjunct. If D-chiro-inositol monotherapy was recommended for PCOS, myo-inositol monotherapy or 40:1 combination under gynaecology supervision is preferable.
- FDiindolylmethane (DIM)Not recommended · Indole-3-carbinol metabolite from cruciferous vegetables, supplement. AEMPS does not register as medicineDIM is sold to women with PCOS as a «natural antiandrogen» on the androgen receptor partial blockade hypothesis. No evidence base: no quality RCTs in PCOS patients with testosterone, LH or hirsutism scale (Ferriman-Gallwey) endpoints. ESHRE 2023 PCOS guideline does not mention DIM. SEGO 2017 lists hormonal contraceptives or metformin first-line for PCOS; for marked androgenic features – spironolactone, cyproterone. If DIM was recommended for PCOS instead of standard therapy and workup, consider seeking a second opinion from a gynaecologist-endocrinologist.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit