Approximately 4 to 8% of women in the United States suffer from Polycystic Ovary Syndrome (PCOS). PCOS is an endocrine disorder that’s the most common cause of female infertility. Although PCOS is not a condition that is exclusive for women with obesity, most women with PCOS also suffer from obesity, almost 50% of them. It has been proven that losing a 5 to 10% of body weight corrects most of the symptoms of this disorder and leads to a higher quality of life. However, losing weight, even a small percentage as 5%, is not that easy. Most lifestyle intervention programs fail during their first year, and average individuals are usually unable to maintain a 5% of weight loss in the long term. As bariatric surgery has clearly established itself as the most efficient method for losing weight in the short and long-term, its benefits on patients with PCOS should be seriously considered. When patients with obesity and PCOS have failed to lose the weight they need to improve their chances to conceive and get pregnant, bariatric surgery might be a valid alternative for a more successful treatment.
At LIMARP International Center of Excellence for Obesity we offer integral weight loss programs that focus on prevention, education, treatment and continuous follow-up that seek long-term results. Our leader surgeon, Dr. Liza María Pompa González, has been recognized as Surgeon of Excellence by the American Surgical Review Corporation. She’s the first female surgeon to be recognized with this distinction worldwide. If you would like to know more about the benefits of bariatric surgery on PCOS patients, don’t hesitate and give us a call. Our team of experts will be very glad to help you.
Definition of Polycystic Ovary Syndrome (PCOS)
According to the American Society for Reproductive Medicine Criteria, a patient has PCOS when she has at least 2 of the following symptoms:
- Oligomenorrhea and/or anovulation.Oligomenorrhea is a condition in which menstrual periods are highly irregular, but mostly infrequent. Taking longer than 35 days to menstruate might be a symptom of oligomenorrhea. Anovulation happens when the ovaries don’t release an oocyte during the menstruation cycle. In other words, ovulation fails to take place. For some women, this might happen during a single and random cycle, and that’s no reason to worry. However, when this happens more frequently, it leads to chronic anovulation and infertility. Both of these symptoms, oligomenorrhea and anovulation are usually related, although one may happen without the other.
- Hyperandrogenism. This is a condition in which females experience high levels of androgens, such as testosterone. Hyperandrogenism manifests in symptoms like hair loss, excess growth of body or facial hair, or acne. It also leads to absence or lower frequency of menstrual cycles.
- Polycystic ovaries. This condition consists in the presence of more than 12 follicles in each ovary, or increased ovarian volume. Follicles are small collections of fluids, gathered together in the ovary. Having polycystic ovaries is not the only symptom that’s considered for the diagnosis of Polycystic Ovary Syndrome. Not all PCOS patients have cysts in their ovaries, and many healthy women without PCOS do have small cysts in their ovaries. Cysts may be seen in 25% of healthy women.
The mechanisms of PCOS are insulin resistance, which leads to increased production of insulin levels or hyperinsulinemia, and elevated levels of luteinizing hormone, due to excess of leptin.
PCOS is linked with type 2 diabetes mellitus. 35 to 45% of patients with PCOS will have impaired glucose tolerance, and 7 to 10% actually suffer from diabetes. The syndrome is also linked with endometrial carcinoma, metabolic syndrome, and cardiovascular diseases.
Polycystic Ovary Syndrome and Obesity
50 to 65% of PCOS patients suffer from obesity. Obesity has been linked to type 2 diabetes and cardiovascular diseases, as well as PCOS; however, the link between PCOS and obesity remains uncertain.
Weight loss is the first-line treatment in women with obesity and PCOS, who have failed at their attempts of getting pregnant. It has been reported that patients with PCOS and obesity are greatly benefited with a body weight loss of 5%. Weight loss improves insulin resistance and leptin levels, which in turn improves ovulatory function. Weight loss also helps regulating the menstrual cycle. Other treatments include lifestyle modifications, taking contraceptive pills, anti-androgens, and insulin sensitizers, but these don’t usually work by themselves in patients with obesity.
The European Society of Endocrinology recommended considering bariatric surgery as treatment for patients with morbid obesity and PCOS, on 2014. More recently, on 2017, the American Society for Metabolic and Bariatric Surgery, along with the American College of Obstetricians and Gynecologists and the Obesity Society, endorsed bariatric surgery as a safe and effective treatment for women struggling with obesity and infertility.
If you’re interested in knowing if bariatric surgery is the right option for you, please call our clinic, located at Tijuana, Mexico. Our team will provide you with all the information you need.
Bariatric surgery for PCOS
The impact of bariatric surgery on PCOS has been proven beneficial in the alleviation of many of its symptoms. Although the risks and benefits of bariatric surgeries in patients with obesity have been widely studied in short-term and long-term randomized control trials, only a few studies have focused on the specific effects of bariatric surgery in PCOS.
A meta-analysis of 13 studies, involving a total of 2,130 female patients who underwent bariatric surgery, gathered evidence of the effects of bariatric surgery on PCOS. From that sample, 45.6% of the patients had PCOS before their operation. At 12-month follow up after surgery, only 6.8% of the patients persisted with PCOS. Other benefits were also registered. 56.2% of the patients had reported irregular menstrual cycles before their surgery; 12 months after their surgical procedure, only 7.7% still had this irregularity. Before surgery, 67% of the patients had hirsutism, the excessive growth of facial and body hair; after surgery, at the 12-month follow up, incidence of hirsutism had decreased to 38.6%, and to 32% at the study end. Furthermore, the incidence of preoperative infertility was 18.2%, which significantly decreased to 4.3% at study end.
These findings are in line with a more recent study, with a sample of 50 Indian females, out of which 18 (36%) were diagnosed to have PCOS, and an additional 8 women (16%) had irregular cycles, before their surgery. The effects of bariatric surgery in PCOS were more than positive. Bariatric surgery resulted in the improvement of all parameters of PCOS, with complete resolution of irregular menstruation and metabolic syndrome at the 12-month follow up. Also, hirsutism and polycystic ovaries resolved in 44% and 55% respectively for the patients that had those conditions before surgery.
Bottom line, the effects of bariatric surgery on PCOS are highly positive, and they also manifest in the regulation of menstrual cycles, and the decrease of hirsutism and infertility. The presence of PCOS in patients does not affect the efficacy of weight loss surgery. Patients can rest assured that they will be obtaining the same benefits and results out of their surgical treatment.
Bariatric surgery, PCOS, fertility, and pregnancy
The British Fertility Society advices that fertility treatments should be provided to women with a body mass index (BMI) lower than 35, or under 30 if they are younger than 37 years of age. For women dealing with severe obesity, these fertility treatments are not at their reach. To obtain them, they need to lose a lot of weight. The typical candidate for weight loss surgery is a patient with a BMI higher than 40. Obese patients with a lower BMI, minimum 35, may also be candidates for weight loss surgery if they suffer from serious medical conditions, such as type 2 diabetes, hypertension, heart disease, or sleep apnea.
But bariatric surgery has shown great effects on infertility, even eliminating the need for these fertility treatments. Bariatric surgeries also influence on better outcomes in artificial reproductive techniques, and a decrease in miscarriage rates.
A systematic review of 75 studies looking at pregnancy and fertility after bariatric surgery on 2008 showed evidence of better pregnancy outcomes for female patients that underwent weight loss surgery. A study from 2004 reported that out of 298 female patients that had a delivery after bariatric surgery, 6.7% required a fertility treatment after their surgical intervention. Another study of that same year showed that, from a sample of 32 women who were unable to get pregnant before surgery, 15 (46.9%) were able to get pregnant after surgery. However, more evidence is needed to track constant tendencies in bariatric surgery outcomes in fertility and PCOS, since there are no randomized control trials exploring this subject. The limited evidence we have now does show congruent results between studies, but more research is still needed.
Studying fertility outcomes is a complicated matter, because one cannot isolate that variable from others that might also be involved. Infertility is influenced by many different factors. For example, if a female patient with PCOS and obesity has an obese male partner, “infertility” might be the result of low fertility rates in both female and male subjects. The female patient might increase her fertility after surgery, but this will not show with a male partner who is still struggling with infertility. Another example is age. Measuring fertility rates is complicated in populations of females with different ages, because lower fertility rates are to be expected as age increases.
However, women struggling with obesity can rest assured that pregnancy after weight loss surgery is possible and a viable choice. It’s safe to get pregnant after having weight loss surgery, but it should be delayed to at least 1 year of post-operation, preferably 18 months or more. Currently, the Centers for Disease Control recommends the usage of contraception during the first 2 years of post-operation.
Women who get pregnant after a bariatric surgery face higher risk of anemia due to micro-nutrient deficiencies, especially vitamin B12. Women who have undergone weight loss surgery should check with their doctor about nutritional testing, as well as dietary requirements and supplements.
Dr. Liza María Pompa González has performed more than 3,000 weight loss surgeries at LIMARP. Our clinic has been accredited as one of the first International Centers of Excellence for Obesity outside the United States by the American Surgical Review Corporation. Give us a call to know more about our obesity treatment programs and services.
Added benefits for weight loss
Surgical treatments for obesity significantly diminish the risks of developing gestational diabetes, hypertension, and pre-eclampsia, once the patient gets pregnant.
Bariatric surgeries have also shown to prevent fetal macrosomia, in which the newborn baby weights more than 8 pounds, and reduce the baby’s chances to suffer from obesity-related diseases in early and late infancy.
Treatment with bariatric surgery has shown to be very effective in the reduction of euglycemia, insulin, and blood glucose levels, in just days after the procedure. It leads to the amelioration, and in some cases resolution, of the metabolic syndrome, joint pain relief, hypertension, cardiovascular diseases, and remission of type 2 diabetes.
The benefits of weight loss surgery are plenty, but they are not solely achieved by the surgery. It’s very important to acknowledge that the outcomes of bariatric surgery highly depend on the kind of surgical intervention, as malabsorptive and restrictive procedures have different impacts in the patients’ metabolic system, and, most importantly, they depend on the patients’ compromise in maintaining a healthy lifestyle. Patients who receive weight loss surgery should follow a healthy diet, exercise regularly and maintain responsible habits.
Proper evaluation
Bariatric surgery in PCOS patients should be preceded by a proper evaluation to discard any other illnesses that might affect expected outcomes. An endocrinologist evaluation should rule out pituitary or thyroid disease as the cause of anovulation. Diabetic and cardiac evaluations are also important.
Does Bariatric Surgery Cure PCOS?
The effects of bariatric surgery on PCOS are highly positive as they significantly alleviate its symptoms through the benefits of weight loss. However, there is no cure for PCOS. The syndrome may be treated, with great results, even with the resolution of infertility and irregular menstruation, but the pathophysiology of PCOS will still be present.
How do I know if I’m eligible for bariatric surgery?
If you suffer from severe obesity and you have exhausted all your options for losing weight, you might be eligible for bariatric surgery. If you have a BMI above 40, you might be a candidate for a gastric sleeve. If you have a BMI of 40, but you also suffer from severe metabolic conditions, you might be eligible for a gastric bypass. Patients with a BMI higher than 50 might need a combination of procedures, like the duodenal switch. Adolescents might also be eligible, if they have a BMI of 35 or higher and face life threatening medical conditions.
Your eligibility for bariatric surgery will depend on many different factors. To know if you’re eligible for weight loss surgery, call our clinic for a consultation. An interview with your doctor and previous testing will be needed to assess the most convenient treatment for your case. If you are not eligible for bariatric surgery because you don’t meet some of the needed criteria, you can ask for our others non-surgical treatments for obesity. At LIMARP, we are committed with helping you reach your health and weight loss goals, just as you are.
Contact us for more information about bariatric surgery and PCOS
If you’re interested in knowing more about the effects of bariatric surgery in PCOS, you can contact our clinic, LIMARP International Center of Excellence for Obesity. Our facilities have been recognized for their excellence and quality care, meeting international standards. We provide integral obesity treatments that include, not only the surgical treatment, but nutrition plans, exercise and physical activity programs, psychological therapy, and long-term follow up consults. We also offer non-invasive obesity treatments.
Our clinic is located at Tijuana, Mexico, just 15 minutes away from the International Border Crossing of San Ysidro. Our treatments are all-inclusive, with hospitalization stay, but also with access to the luxury hotel next door Grand Hotel Tijuana. You’ve never experienced care like this before. Our focus is on high excellence and certified medical care, but we also take pride in providing a relaxing environment. Our recovery rooms have breathtaking views to the Tijuana’s Country Club Golf Course. Our services are affordable, and comply with international requisites for insurance coverage. Ask for our financing plans, we will find the best option to fit your needs.
To schedule a consultation with Dr. Liza María Pompa González and to learn more about our treatments, message our office today. You can get in contact with us through any of our social media pages. You can leave us a message in our Facebook page, Instagram or Twitter, or you can call the following numbers:
From Mexico, dial (664) 686-2542
From USA, dial (619) 373-0229
For a toll free number from USA, dial (866) 279-8327
Call us today, we’ll be very glad to help!