Wondering how to support ovarian health and hormonal balance? Read on to learn more about inositol and hormone balance. 


By OBGYN and reproductive health specialist Dr. Mare Mbaye

Perhaps you’ve heard of inositol as a recommendation to improve ovarian health for people with polycystic ovarian syndrome (PCOS). In recent years, different types of inositol have been shown to be effective as a primary treatment for people with PCOS. Read on to see how this supplement can be beneficial towards treating the symptoms of PCOS and boosting overall ovarian health.

What is ovarian health anyway?

Ovaries are reproductive glands that are found in the pelvis (lower abdomen). Most people are born with two ovaries, one on either side of the uterus (womb). The ovaries are responsible for ovulation and producing the hormones estrogen, progesterone, and testosterone. Ovulation is when an egg is released by an ovary for reproduction. Each menstrual cycle, one of your ovaries will send an egg through the fallopian tubes and into the uterus. If the egg is fertilized, that egg develops into a fetus. If it’s not, then you go on to have your next period. 

Problems in your ovaries can lead to ovarian conditions like ovarian cancer, ovarian cysts, PCOS. None of these conditions are necessarily preventable. In the case of ovarian cancer and cysts, there are ways to decrease the chances of getting them. PCOS is also not preventable (and the causes are not well understood), but it is a very manageable condition.  

The health of your ovaries affects your body’s hormone balance as well as your fertility, or your ability to conceive a biological child. Typically, heterosexual couples who have been having regular, unprotected sex for 12 months or more without getting pregnant are considered infertile and should see a specialist to investigate.

PCOS 101

PCOS affects at least 1 in 10 people of reproductive age, if not more. It is the most common cause of infertility in the US. Its presentation can vary widely so signs of PCOS are different from person to person. Some people have no symptoms while others can experience weight gain, hirsutism (male-pattern hair growth such as hair on the chin and face), as well as hair loss, acne, irregular or missed menstrual periods, and infertility.

PCOS is diagnosed based on specific criteria. The three criteria that providers look for are signs of increased male hormones (called androgens), irregular ovulation (usually manifests as irregular periods), and more than 12 follicles (or cysts) on each ovary on ultrasound. If you have signs of at least two of these three, you qualify for the diagnosis of PCOS. Based on these criteria, it should come as no surprise that people with PCOS tend to have issues that stem from hormone imbalances.

People with PCOS are 30% more likely to be insulin resistant. This means their bodies can make insulin, but can’t use it effectively. Over time, this increases the risk of diabetes, infertility, unhealthy weight gain, and high cholesterol. High insulin levels also cause the ovaries to make too much testosterone leading to even more hormone imbalances. In particular, the ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH). Both of these hormones are released by the brain to tell the ovaries when to do what. Too much LH also contributes to high levels of androgens and too little FSH affects the ovaries’ ability to develop healthy eggs and ovulate regularly.   

Read more about PCOS.

Inositol 101

Now that we have an understanding of PCOS, let’s talk about inositol. Inositol is a natural sugar that our bodies make. It exists in several forms known as isomers.  Myo-inositol (MI) and D-chiro-inositol (DCI) are the two main types that are used in fertility supplements because they have the biggest impact. Inositol is involved in several different reproductive processes, chemical messaging in the brain, cell membrane function, and it participates in insulin signaling and glucose metabolism.

In healthy people, most body tissue has an MI to DCI ratio of approximately 40 (MI) to 1 (DCI). This ratio is much higher in people with PCOS because the mechanism that converts MI to DCI is not as effective. This results in lower levels of inositol which increases the risk of insulin resistance and high blood sugar. These imbalances impact all of the bodily processes above and have profound effects on fertility

Why hormone balance is important and how inositol can help

Before we dig deeper into hormone imbalances, let’s review some basics about insulin. Insulin is produced by the body to help process sugars that you consume. In people with insulin resistance, there are high levels of insulin in the body due to reduced sensitivity to certain functions of insulin. 

Research on inositol has been shown to improve almost all aspects of PCOS. As mentioned before, inositol seems to be important in insulin signaling and glucose metabolism. Research has shown that supplementing with inositol can improve insulin-receptor activity and help to decrease insulin resistance in people with PCOS by up to 70%! This in turn leads to lower levels of insulin and total testosterone. Lower testosterone levels can help to correct the hormonal imbalances that lead to irregular ovulation, which means improved fertility.

In addition, inositol is involved in numerous biochemical pathways within the actual eggs themselves. One study looking at egg quality in people going through IVF found that people who were on inositol were able to produce more eggs, better quality embryos, and they had a higher number of successful embryo transfers. Another study found similar results with their PCOS patients who were undergoing IVF; inositol therapy in people with PCOS resulted in better fertilization rates and better embryo quality. Other studies have produced even more results in support of inositol supplementation to improve pregnancy rates. 

Inositol for cycle regularity for people with PCOS

If you’re not necessarily looking to get pregnant, inositol can still be incredibly helpful in regulating ovulation and periods. People with PCOS often have irregular periods or no periods at all because they are anovulatory (they do not ovulate regularly). Anovulation means you haven’t released an egg and without this important step, the uterus doesn’t get the signal to shed its lining and you never (or rarely) have a period. Not having a period sounds pretty fantastic, I know, but it’s unfortunately not safe (unless you’re taking medications like certain types of birth control). There is an increased chance of uterine cancer (cancer of the lining of the uterus) over time if you don’t have regular periods because the lining builds up more than it should. 

Ovulation only happens after an egg has fully matured. The research shows that people with PCOS make less mature eggs than people without it. This has been specifically linked to having too little MI and too much DCI in the follicular fluid, which surrounds the eggs as they grow inside the ovaries. As mentioned before, the MI to DCI ratio in general body tissues of healthy menstruators is 40 to 1. This ratio is 100 to 1 in their follicular fluid. In infertile people with PCOS, the average ratio of MI to DCI in this same fluid is 0.2 to 1. Taking inositol supplementation in the right dosage to correct this ratio may help restore ovulation and periods. 

How to take inositol 

Now that we’ve gone through the what, why, and how of inositol, how do you actually take it? Taking inositol correctly is essential to getting the benefits you want–too high doses of DCI can negatively affect your eggs and prevent the body from absorbing MI.

When choosing an inositol supplement, the combination of both MI and DCI is ideal and recommended. This is because MI functions to improve ovulation while DCI reduces insulin levels in the body. The exact dosage of inositol is not yet agreed upon but a 40 to 1 MI to DCI ratio is optimal for restoring ovulation in people with PCOS.

To sum it up

Supplementing with inositol can have many health benefits. When taken at the right dosage and ratio and in consultation with your healthcare provider, it may support healthy hormone levels, egg health, and cycle regularity.

As with all supplements, be sure to look for products that contain high-quality and bioavailable ingredients in the appropriate dosage. And always talk to your healthcare provider before starting any supplements!


Featured Image by Karolina Grabowska