Gastric Sleeve and PCOS

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS can lead to obesity and a variety of other health conditions if left untreated. PCOS is estimated to affect approximately 5-10% of this population of women, including gastric sleeve and other bariatric patients.

PCOS is estimated to affect approximately 5-10% of this population of women

The problem is… there is currently no treatment for PCOS as a whole. So, you might be wondering what options do you have? Is a gastric sleeve really something to consider? Has the gastric sleeve helped other women like me? And… If I get the surgery then, what’s next?

This article will help you to understand the basics of PCOS, the research supporting the use of a gastric sleeve as a possible treatment option, and the potential benefits following surgery.

So, you might ask… what do ovaries have to do with the endocrine system?

PCOS and the endocrine system

Well, the endocrine system is made up of glands that produce hormones. These hormones regulate a variety of bodily functions including, metabolism, growth and development, sexual function, sleep, and more.

Women with PCOS produce higher levels of hormones called androgens, and these androgens play a role in reproductive function. Higher levels of androgens can have a negative impact on your ovaries and ovulation.

In women with a healthy menstrual cycle, their ovaries make the egg which is released each month as part of a healthy menstrual cycle.

In women with PCOS, the egg may not develop as it should, or it may not be released during ovulation resulting in missed or irregular menstrual periods. This can lead to difficulties in low fertility and even infertility.

Women with PCOS are also at a high risk of metabolic syndrome. Metabolic syndrome is a fancy term for a group of risk factors that increase your likelihood of developing heart disease, diabetes, stroke, and other health problems.

Both metabolic syndrome and obesity are commonly associated with PCOS and can lead to insulin resistance, diabetes, abnormal levels of lipids, and eventually heart disease.

Common symptoms of PCOS include things like irregular periods, difficulty getting pregnant, excessive hair growth, and weight gain. Because many women seek medical treatment for gynecological concerns of body image issues, many of the metabolic consequences of PCOS are often overlooked and undertreated by physicians.

Action Steps: “Know the signs and symptoms of PCOS and MS and remember that you are your strongest advocate”

Treatment for PCOS

Treatment for PCOS as a whole has not yet been determined. This is because the cause or origin of PCOS is still unknown. The current treatment plan for PCOS is specifically related to the symptoms that someone is experiencing.

There are two therapies that address the most common complaints, these treatments are weight loss and metformin therapy. Weight loss has been shown to help regulate hormones, like androgen and insulin, and it aids in regulating ovulation.

Weight loss can be achieved through lifestyle modifications, medical, or surgical interventions. The primary lifestyle modifications include a healthy, low carb diet and exercise, but there are other lifestyle factors that may need to be reduced or eliminated including alcohol consumption, psychosocial stressors, and smoking.

Short term weight loss has been shown to be successful in restoring ovulation and fertility and reducing insulin resistance. However, some people may experience challenges in losing weight through lifestyle modifications alone or experience difficulties in maintaining that weight loss.

The treatment of PCOS and MS can include any combination of medical therapy, psychological support, and lifestyle modifications, and oftentimes the treatment can be difficult and/or overwhelming for both patients and physicians.

Bariatric surgery and PCOS

Bariatric surgery can be an effective means of weight loss in women with PCOS, especially if lifestyle modifications have failed. Surgical techniques in bariatric surgery have improved over time, making it less invasive and safer overall, while still providing effective means of weight loss.

Studies have shown that bariatric surgery may prevent or reverse metabolic syndrome and could have reproductive benefits. Bariatric surgery can also be cost-effective when compared to the overall cost of medical care for PCOS and associated metabolic abnormalities like diabetes.

There can also be non-medical benefits to bariatric surgery. Studies indicate that women who had bariatric surgery experienced improvements in their emotions, body image, and quality of life.

These are some of the many reasons why bariatric surgery should be considered as the first-line of therapy along with medical and lifestyle modifications in women with PCOS that are obese and have metabolic syndrome.

With the improvements in surgical techniques, most bariatric procedures are performed laparoscopically. This means a smaller incision, decreased surgical time, a shorter hospital stay, and a faster recovery.

The 3 most common procedures performed are laparoscopic adjustable gastric banding (LAGB), laparoscopic roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG). Studies show that there are similar differences in weight loss when comparing LRYGB and LSG and higher weight loss is noted in LSG when compared to LAGB.

LSG involves the surgical removal of about two-thirds of the stomach, which leads to a decrease in appetite and the person feeling fuller faster, which then leads to weight loss.

What to expect after surgery

Following bariatric surgery, Body Mass Index (BMI) and excess body weight decrease. One study conducted on women with PCOS revealed that PCOS does not negatively affect weight loss after sleeve gastrectomy because when comparing women with PCOS with non-PCOS women following surgery, no significant differences in weight loss were noted.

Bariatric surgery leads to weight loss which can then lead to improvements in glucose abnormalities, dyslipidemia, and hypertension have been noted. Not only does research suggest that bariatric surgery could be an effective treatment for PCOS and MS, but it is also suggested that it could help to prevent MS and related cardiovascular disease.

Action Steps: “Consider bariatric surgery as a possible therapy for PCOS especially if lifestyle and medical interventions have not been successful for you”

Can bariatric surgery resolve PCOS?

Many studies show that bariatric surgery can have a positive effect on reproduction. Research shows that modest weight loss can increase the odds of spontaneous ovulation and that bariatric surgery has been shown to improve menstrual irregularities.

Another noted improvement is that PCOS women also have lower levels of androgen following surgery.

One example of a study that supports this was a small study conducted by Escobar-Morreale HF Et al. This study found that 70.5% of women regained normal menstrual function and 83% had spontaneous ovulation within 26 months following bariatric surgery.

70.5% of women regained normal menstrual function and 83% had spontaneous ovulation within 26 months following bariatric surgery.

Studies are still being conducted on the specific effect of bariatric surgery on fertility treatment and it is not recommended as a fertility treatment alone. A large retrospective study found that out of 110 obese patients that were suffering from infertility prior to surgery, 69 of them became pregnant following bariatric surgery.

This study identifies that a 5 kg/m2 drop or reduction of BMI within 2.5 years following surgery is a significant indicator of fertility. This means that if someone has a BMI of 45 kg/m2 at the time of surgery, then within the next 2.5 years their BMI needs to be less than or equal to 40 kg/m2.

The study conducted in 2018 by Dilday et al. showed that many patients became pregnant following sleeve gastrectomy including ones that had never previously had children. This study suggests that the sleeve gastrectomy is not only effective for weight loss in PCOS patients with obesity, but it may also increase fertility.

Is it safe to get pregnant after surgery?

So now that we have established that bariatric surgery could help to improve fertility… you may be wondering if it is safe to get pregnant following surgery. Research suggests that yes, it is safe to get pregnant following bariatric surgery.

It is recommended that pregnancy be avoided in the first 12-18 months following surgery due to the significant weight loss and metabolic changes that are occurring. Due to a woman having low fertility prior to surgery, the use of contraceptives may be needed following surgery as spontaneous pregnancies can occur early on as fertility improves.

It is important to be aware of risk factors related to pregnancy post-bariatric surgery. One study revealed that of 298 deliveries from women post-bariatric surgery, there were higher incidences of macrosomia (babies that are larger than normal), hypertension, diabetes, and cesarean delivery.

However, it is important to note that these are risk factors related to obesity and pregnancy and the women in this study were still obese on average following surgery.

There was no noted increase in the rates of postpartum bleeding, infection, and fetal death occurring after 20 weeks. Another study found that bariatric surgery reduced gestational diabetes but did not decrease hypertensive disorders in pregnancy.

In summary: PCOS and bariatric surgery

Today the parameters for bariatric surgery are expanding and now include PCOS. If you are obese and have PCOS then you should consider bariatric surgery as a treatment option. Bariatric surgery has been shown to have beneficial effects on weight, MS, and fertility.

If you are trying to get pregnant following bariatric surgery, it is important to let your body adjust following the surgery before trying to conceive.