Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in women. It is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction. The causes of this disorder remain largely unknown, but mounting evidence suggests that PCOS might be a complex disorder with strong environmental influences, including diet and lifestyle factors. PCOS is frequently associated with, lack of insulin functions, obesity, metabolic disorders, and cardiovascular risk factors.
The clinical and biochemical features are heterogeneous in PCOS with majority of women are overweight or obese. 1 in every 10 women suffers from PCOS worldwide with up to 36% of adolescents in India are the victim of this disorder.
Among many pathological features of PCOS, insulin resistance and hyperandrogenemia are the hallmarks and key pathological features in PCOS leading to irregular cycles, anovulation, infertility, hyperandrogenemia, and hirsutism which adversely affects the quality of life in women. Further, it also has a psychological impact on daily life including poor self-esteem.
In PCOS, insulin resistance leads to hyperinsulinemia. Hyperinsulinemia is believed to cause an increase in the luteinizing hormone which again increases androgen levels leading to hyperandrogenemia. Moreover, hyperinsulinemia reduces SHBG levels leading to again hyperandrogenemia. Further hyperandrogenemia increases free fatty acids levels and acts on visceral adipose tissues which cause again hyperinsulinemia and this cycle goes on Hyperinsulinemia also causes abnormal folliculogenesis causing oligoovulation or anovulation.
Hyperinsulinemia decreases estrogen levels and increases testosterone levels by decreasing SHBG. Increased testosterone and reduced estrogen impair the sensitivity of the hypothalamic pulse generator and interfere with progesterone feedback leading to increased GnRH pulse frequency and increased LH/FSH ratio which causes disruptive ovarian follicle maturation.
Conventional treatment for PCOS includes Clomiphene, Gonadotropins, Metformin, and Glitazones which have drawbacks, and often leads to suboptimal therapeutic outcomes. Moreover, current therapeutic gaps include poor tolerability, high cost, low patient compliance, and lack of long term safety. Currently, insulin sensitizers have shown remarkable outcomes in PCOS in terms of improving biochemical as well as symptomatic relief. When used along with mainstream therapy, insulin sensitizers improve therapy outcomes. Magnesium, Vitamin D, and myo-Inositol are dietary recommendations which significantly reported to improve hyperinsulinemia, hyperandrogenemia, and metabolic abnormalities in PCOS.
Several studies found subclinical magnesium deficiency (SMD) in this set of populations. SMD in turn leads to a lack of vitamin D absorption, transportation, and pharmacological actions. Both magnesium and vitamin D has a potential role as an insulin sensitizer, and in managing metabolic abnormalities along with hyperandrogenemia. It has been well established that, in PCOS women, magnesium deficiency found to be in the range of 14.5% to 81% and vitamin D deficiency in the range of 67%-85%. Deficiencies of both these nutritional factors hamper insulin action, metabolic control, and androgen control in PCOS which further viciously affect mainstream therapy outcomes.
Magnesium is crucial in increasing vitamin D levels and its actions. Of note, magnesium alone exerts its benefits on insulin resistance, metabolic control, and androgen excess. So, supplementing magnesium in PCOS not only improve vitamin D level and actions but also magnifies outcomes of existing mainstream therapy. Therefore, as evident from various studies, magnesium and vitamin D should be recommended as an adjunct therapy to existing primary therapy in PCOS for magnified clinical outcomes. Consult a doctor before starting any type of supplementation.
Disclaimer: For further information, contact your treating physician/doctor. The information provided here is not a recommendation for the treatment of disease. Please consult your doctor before starting any remedies.