Myoinositol or D-chiro-inositol for PCOS symptoms in adolescents: a narrative review.

BACKGROUND: Polycystic ovary syndrome (PCOS) treatment in adolescents currently focuses on lifestyle interventions, with pharmacological treatment options often limited to hormonal contraceptives. Several of these carry broad side-effect profiles and are not always accepted by young girls. There is growing interest in non-hormonal therapies for PCOS. We aimed to collate the evidence on the use of myoinositol or D-chiro-inositol in the improvement of PCOS symptoms in symptomatic adolescents. CONTENT: A systematic literature review identifying key articles from inception to March 2023. Participants: Female adolescents (aged 12-19 years) with PCOS or PCOS-like features. Intervention: Myoinositol or D-chiro-inositol with or without additional interventions. Comparison: Any other treatment, including lifestyle interventions, hormonal therapy, metformin or no treatment. The main outcome measure were improvement in symptoms, quality of life and adverse effects. SUMMARY: Eight studies were included: two randomised open-label trials, one quasi-randomised and three non-randomised interventional studies, one case-control study and one cohort study. All studies showed improvements in some biochemical markers, metabolic parameters or clinical symptoms, but these were not reproducible across all studies. OUTLOOK: The benefit of myoinositol in adolescents with PCOS remains unclear, with limited high-quality evidence. This review highlights the need for robustly conducted research to inform clinical practice.

Prioritisation of outpatient appointments and elective surgery in gynaecology.

The coronavirus disease 2019 (COVID-19) pandemic continues to be a global public health concern. It has posed a multitude of challenges from managing the supply chain of personal protective equipment (PPE), reducing the spread of the virus through national restrictions, disrupting the routine delivery of healthcare services to now the race in developing novel treatments and vaccines. As the National Health Service (NHS) considers a phased restoration of non-emergency services, it is imperative to consider the high volume of patients awaiting specialist reviews and surgical procedures. Gynaecology services have to be prioritised according to the patients' clinical needs rather than their individual waiting times. In this chapter, we look at the varying aspects of prioritising non-emergency gynaecology care, including outpatient appointments and elective surgery, how innovative pathways have evolved in response to necessity, what some of the barriers have been to implement these and how this has overall impacted on individual gynaecological specialties.