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Gastric Sleeve and Polycystic Ovary Syndrome (PCOS)

Posted by: Dr. Rosales

Gastric Sleeve Surgery

July 12, 2018
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To delve into this issue we must first define several characteristics of this syndrome that affects a large number of women worldwide, it is a disease that sometimes described as incurable but controllable, we will see the relationship between gastric sleeve surgery and weight loss surgery and the great benefits that this type of procedures bring for the improvement or even cure of this syndrome.



What is PCOS (Polycystic Ovary Syndrome)

Polycystic ovary syndrome (PCOS) is a common endocrine (hormonal) disorder characterized by:

  • Irregular menses
  • Hyperandrogenism (excess male hormones)
  • Polycystic ovaries

 

 

What is its prevalence?

The prevalence of PCOS varies depending on which criteria are used to make the diagnosis but is as high as 15%–20% as reported by the American Society for Reproductive Medicine



What are the signs and symptoms of PCOS?

  • Oligomenorrhea (infrequent menstrual periods)
  • Amenorrhea (abnormal absence of menstrual periods)
  • Hirsutism (abnormal growth of face and body hair)
  • Infertility (frequent)
  • Mild or severe acne


What are the risk factors on having PCOS?

Some of the most important risk factor of PCOS are Type 1 diabetes, type 2 diabetes, and gestational diabetes.


Insulin resistance affects 50%–70% of women with PCOS leading to a number of comorbidities including:

 

  • Metabolic syndrome
  • Hypertension
  • Dyslipidemia
  • Glucose intolerance and diabetes

In Type 2 diabetes patients, the prevalence of PCOS using the NIH/NICHD criteria has been estimated to be 26.7%


Studies show that women with PCOS are more likely to have increased coronary artery calcium scores which lead to coronary artery disease, in other words, increased risk of cardiac infarction.


Mental health disorders including depression, anxiety, bipolar disorder and binge eating disorder also occur more frequently in women with PCOS.

 

Prevalence estimates for PCOS, as defined by the NIH/NICHD criteria, indicate that PCOS is a common endocrinopathy affecting 4%–8% of women of reproductive age, family history of PCOS is also a risk factor for PCOS.

 

An increased prevalence of PCOS is associated with a number of conditions. A history of weight gain often precedes the development of the clinical features of PCOS and following a healthy lifestyle has been shown to reduce body weight, abdominal fat, reduce testosterone, improve insulin resistance, and decrease hirsutism in women with PCOS. Obese women referred for assistance with weight loss had a prevalence of PCOS of 28.3%

 

A number of factors that are associated with an increased risk of PCOS have been identified in children. Prenatal factors include high birth weight in girls born to overweight mothers, congenital virilization, and low birth weight.



Association of PCOS with other comorbidities

Although the demonstration of insulin resistance is not required to make the diagnosis of PCOS, the prevalence of insulin resistance in PCOS ranges from 50%–70% and occurs independently of obesity. The effect of obesity on insulin resistance is additive to that of PCOS. Consistent with the increased prevalence of insulin resistance, metabolic syndrome is also more common in women with PCOS.

 

In summary, the association of PCOS and other comorbidities are the following:

 

  • Type 2 Diabetes.

 

  • Dyslipidemia: Lipid abnormalities include reduced high density lipoprotein-cholesterol (HDL-C) (aka “good cholesterol”), increased triglycerides, and increased low density lipoprotein-cholesterol (LDL-C), (aka “bad cholesterol”).

 

  • Increased prevalence of hypertension ( 22% of women with PCOS).

 

  • Coronary artery calcium (CAC) scores and carotid artery wall thickness (CIMT), have demonstrated a greater prevalence of atherosclerosis in PCOS.

 

  • Increased risk of a number of mental health disorders including depression, bipolar disorder, anxiety, and eating disorders.

 

 

Weight loss surgery and infertility related to PCOS

Weight loss is recommended as first-line therapy for the management of infertility in overweight and obese women with PCOS. Anovulation and pregnancy loss are linked to obesity.

In addition, obesity is associated with a reduced response to all fertility treatments.

 

Observational studies indicate that weight loss of 5%–10% can increase ovulation and pregnancies. Bariatric surgery has been shown to improve cycle regularity, increase ovulation, and increase spontaneous conception.

 

 

Treatment for PCOS

Weight loss improves menstrual irregularities, symptoms of androgen excess, and infertility. Management of clinical manifestations of PCOS includes oral contraceptives for menstrual irregularities and hirsutism. Spironolactone and finasteride are used to treat symptoms of androgenic hormone excess.


Treatment options for infertility include: clomiphene, laparoscopic ovarian drilling, reproductive technology, etc. Proper diagnosis and management of PCOS is essential to address patient concerns but also to prevent future metabolic, endocrine, psychiatric, and cardiovascular complications.



The role of bariatric surgery in PCOS

In several studies performed with this purpose we have the following data:

 

  • After having weight loss surgery most women (70%) regained normal menstrual function and most (83%) had documented spontaneous ovulation.

 

  • Average weight loss was 41 kg.

 

  • Patients showed significant improvement in hirsutism, androgen profiles and about a 50% reduction in HOMA-IR (Insulin resistance test).

 

  • Additionally, women with Metabolic Syndrome undergoing weight loss surgery had follow up for more than 2 years showed that all women resumed normal menstrual cycles, half had resolution of hirsutism and HbA1C decreased from 8.2% to 5.1% within 3 months.

 

  • Dyslipidemia, hypertension and diabetes mellitus almost completely resolved.

 

  • Interestingly, within a short time frame, many women from that review became pregnant spontaneously after surgery.

 

 

Weight loss surgery for adolescents with PCOS

On other blog posts we will discuss with more detail the role of bariatric surgery in male and female adolescents.

 

Talking about PCOS, although patients and physicians may at first be wary of a young patient considering surgical weight loss, these patients have an important opportunity. Bariatric surgery may actually provide primary prevention of coronary artery disease, eliminate Metabolic Syndrome and cause meaningful, long term reduction in morbidity and mortality.

 

Young women with PCOS show evidence of atherosclerosis by abnormal carotid wall thickness measurements and the prevalence of diabetes mellitus before the age of 50 is exceptionally high and estimated at 3-4 times the general population prevalence. So, even some PCOS women aged 25-40 years with MS probably already have early coronary artery disease and thus are no longer candidates for primary prevention.

 

Finally after several years of debate, under specific considerations to be addressed on another blog post, the gastric sleeve and the gastric bypass have been approved by the FDA for the treatment of adolescent obesity and its comorbidities such as PCOS.


We can then conclude by the information we have on PCOS that one of the main factors that lead to this intrincated endocrine disease is Obesity, therefore weight loss surgery, such as the gastric bypass and the gastric sleeve certainly represent a very effective way to attack this disease and its related comorbidities.


Do you suffer from PCOS, infertility and obesity? Go ahead and make a free consultation for your weight loss surgery and get rid of this very high risk diseases!

 

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