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Myoinositol (MI) and D-chiroinositol (DCI), used in the therapy of menstrual disorders, polycystic ovarian syndrome (PCOS), hirsutism, acne, gestational diabetes, and other diseases, are required for intracellular signal transduction from insulin and other hormone receptors. Clinical practice shows that, for instance, MI and DCI in the treatment of PCOS improve the condition of skin, hair, and nails. These effects of MI and DCI are related to the normalization of insulin signaling and support of differentiation and growth of various skin cell types (keratinocytes, fibroblasts, epitheliocytes, etc.). The effects of MI and DCI on the skin and its appendages, including in wound healing, can be enhanced by manganese, which provides an antioxidant effect and improves the connective tissue matrix of the skin, and folic acid, which is involved in amino acid metabolism, proliferation, and differentiation of dividing cells.

Background. Abnormal uterine bleeding (AUB) occurs in one-third of women of reproductive age and has a significant impact on women's lives, causing anemia, impaired social adaptation and professional activity. AUB-O (ovulatory dysfunction) is often caused by an excessive body mass (BM) and obesity (especially visceral). The most effective option for restoring menstrual cycle (MC) in obese women is BM reduction. There is evidence that the combination of inositols myoinositol (MI) and D-chiroinositol (DCI) has a beneficial effect on BM loss, ovulation frequency and getting pregnant in women with polycystic ovary syndrome. Aim. To study the effect of MI and DHI in a 5:1 ratio in combination with diet and exercise on the regulation of MC in overweight and obese women. Materials and methods. The study has been conducted in clinics of Moscow, Kazan and Tyumen for 20202021. It is a descriptive study assessing an efficacy of lifestyle modification (diet and exercise) plus a nutritional support with a combination of 1000 mg MI and 200 mg DCI (ratio 5:1) for 24 months in 353 women of reproductive age with AMK-O and overweight or obesity. Efficacy criteria include: MC regularity, BM index (BMI), waist circumference (WC), levels of serum glucose, free testosterone, follicle-stimulating hormone, luteinizing hormone. Results. The study showed a significant shortening of MC to its physiological duration 3112.04 days (vs 4419.51 days at the 1st visit; p=0.001), a decrease in the rate of heavy bloody vaginal discharge by 2.57 times (p=0.001), an increase in the rate of moderate bloody vaginal discharge by 1,62 times (p=0.001), an increase in the proportion of patients with regular MC by 2.69 times (p=0.001). These changes were accompanied by a decrease in BM (-3 kg; p=0.001), a decrease in WC (-2.5 cm; p=0.001). Laboratory tests revealed a decrease in serum glucose (-1.3 mmol/L; p0.05), free testosterone (-0.4 pg/L; p0.05), luteinizing hormone (-0.8 mIU/ml; p0.05), and an increase in follicle-stimulating hormone (+0.1 mIU/ml; p0.05) levels. Conclusion. The results obtained (a decrease in BM, a decrease in BMI, WC, as well as MC restoration; p0.05) make it possible to recommend Dikirogen containing MI and DCI in a 5:1 ratio as a part of comprehensive therapy for overweight and obese women with AUB-O.

We conducted an observational descriptive study evaluating the effectiveness of therapeutic modification of lifestyle with adding of 1000 mg of myo-inositol and 200 mg of D-chiro inositol combination (ratio 5:1) for nutritional support in 104 women of reproductive age with polycystic ovary syndrome (classic phenotype and nonclassical phenotypes in the presence of hyperandrogenism) for 6 months. Revealed changes in anthropometric parameters (decrease in body mass index by 0.89 kg/m2; p0.05 and waist circumference by 3.0 cm; p0.05), skin status (decrease in the incidence of acne from 96.2 up to 58.6%; p0.05 and seborrhea from 34.6 to 5.8%; p0.05), hormonal profile (statistically significant change in all studied parameters; p0.05: decrease in total testosterone to 1.27 nmol/L and a free androgen index up to 4.12% under an increase in globulin binding sex hormones), carbohydrate metabolism (normalization of glucose tolerance without the development of hypoglycemia) and restoration of menstrual cycle (MC) parameters (regular MC in 76.9 %; p0.05, MC duration 33.4 days; p0.05) indicate a significant role of stage I therapy in patients with polycystic ovary syndrome and the possible benefits of 1000 mg of myo-inositol and 200 mg of D-chiro inositol combination as a nutritional support.

D-chiroinositol (DCI) is one of the 9 inositol isomers that forms inositol phosphoglycans, which are mediators of the action of insulin. The metabolism of DCI and myo-inositol (MI) is impaired against the background of insulin resistance, including the patients with polycystic ovary syndrome (PCOS). Aim. Highlight the most characteristic pharmacological properties of DCI. Materials and methods. Systematic computer analysis of 45 600 publications on the biological roles of inositol by methods of the topological theory of pattern recognition and systems biology analysis of human proteome. Results. A complex of interactions between metabolic disorders of DCI, PCOS, ovulation disorders, obesity associated with numerous hormonal disorders is described. Supplements with DCI and MI increase the sensitivity of cells to insulin and normalize the metabolism of androgens. An important difference between DCI and MI is the presence of DCI in the composition of inositol phosphoglycans that mediate the action of insulin on cells, as well as its participation in the realization of the therapeutic effects of metformin. The use of the MI+DCI combination allows achieving positive dynamics in reducing excess body weight, normalizing blood lipids, glucose and insulin levels, restoring the ovulatory menstrual cycle, improving oocyte quality, and helps prevent gestational diabetes in pregnant women and macrosomia of the fetus. DCI is more effective than MI in reducing the risk of folate-resistant neural tube defects. Conclusion. The therapeutic potential of DCI in combination with MI for treating PCOS and hyperandrogenism is evident. Depending on the therapeutic expediency, various ratios of MI:DCI can be used for the treatment of PCOS and disorders of carbohydrate and lipid metabolism.A