For many women with polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of childbearing age, losing weight can be a persistent struggle. In the U.S., around 60% of women with PCOS are obese, compared to 35% of women in the general population with obesity, putting them at a higher risk for obesity related health conditions such as diabetes, high blood pressure, high cholesterol, heart disease, and uterine cancer. Women with PCOS have higher levels of androgens, or male hormones, and are less sensitive to insulin or are insulin resistant, making it challenging to manage weight.
For patients with PCOS, bariatric surgery can be an effective treatment for not only weight gain but also for PCOS symptoms, as it can help regulate hormones and improve issues like irregular periods and infertility.
The Connection Between PCOS and Weight Gain
PCOS creates a hormonal environment that encourages weight gain and makes weight loss difficult. The adipose (fat), muscle and liver cells in women with PCOS do not respond well to insulin (which is what is referred to as insulin resistance) in other words its efficiency in driving sugar into the cells goes down – leading to higher blood sugar levels. Insulin resistance causes insulin and sugar, or glucose, to build up in the bloodstream. The pancreas compensates for this by producing more insulin which in turn binds to ovarian receptors stimulating them to produce androgens. Moreover, pituitary gland in PCOS patients also produces more luteinizing hormone (LH) which also stimulates the ovaries to produce more androgens. Insulin resistance decreases liver’s production of a protein (sex-hormone binding globulin) that binds the androgens which in turns leads to higher levels of circulating free androgens Elevated androgen levels lead to symptoms like acne, irregular periods, body hair growth and weight gain.
Since the weight gain is triggered by male hormones, and men tend to store excess weight in the abdomen, women with PCOS might notice fat accumulating within the abdomen (“android” or man-like obesity) and around abdominal organs – also referred to “visceral” adiposity, instead of it accumulating underneath the skin (subcutaneous fat deposit) around their hips and thighs (“Gynoid” or women-like obesity).
Visceral or intra-abdominal adiposity carries a higher risk because it is more inflammatory than subcutaneous fat which is relatively inert in comparison. Unlike subcutaneous fat, visceral fat drains into the portal vein, allowing inflammatory agents (interleukin-6 (IL-6), tumor necrosis factor-alpha and others) to go directly into the liver, causing fatty liver, and increasing the risk for heart disease. That is why visceral fat is also referred to as metabolically active “Sick Fat” that causes adiposopathy (dysfunctional fat), leading to insulin resistance, hypertension, and diabetes [Insert reference: https://pubmed.ncbi.nlm.nih.gov/36575472/]
How Weight Loss Surgery Can Improve PCOS Symptoms
Weight loss surgery (or Bariatric Surgery) improves PCOS symptoms by promoting significant weight loss and thereby improving metabolic function. When a patient loses a significant amount of weight after surgery, it increases their insulin sensitivity and helps balance hormones. It can reduce androgen levels and alleviate symptoms like acne, excess hair growth and reduce the risk of health issues such as metabolic sydnrome, hypertension, high cholesterol and type 2 diabetes.
Bariatric surgery for PCOS benefits reproductive health, making menstrual cycles regular and increasing fertility.
Symptoms of PCOS and related complications were alleviated after bariatric surgery. In addition, with significant improvement sex hormones, glucose and lipid metabolism in patients with PCOS after bariatric surgery.[Insert reference: https://pubmed.ncbi.nlm.nih.gov/34006495/]
Who Is a Good Candidate for PCOS Weight Loss Surgery?
Suitable candidates for PCOS related weight loss surgery include those with a body mass index (BMI) of over 35 or those with a BMI over 30 with serious health issues like poorly controlled hypertension despite optimal medical management or obstructive sleep apnea, elevated cholesterol, fatty liver disease, disabling degenerative disease involving weight bearing joints (e.g. knees, hips or spine), heart disease & pulmonary hypertension. Many insurance companies also cover bariatric surgery for those with a BMI over 30 with type 2 diabetes that is not well controlled with medical treatments and lifestyle changes. Patients will need to review their insurance plans to ensure eligibility.
To determine if a patient is a suitable candidate for weight loss surgery, they will typically undergo a thorough assessment by a multidisciplinary team . This process will ensure they are prepared for the necessary long-term lifestyle changes to maintain their weight loss.
Common Bariatric Surgery Options for PCOS
There are many weight loss surgery options available for people with PCOS, such as:
Vertical Sleeve Gastrectomy
Also known as gastric sleeve surgery, vertical sleeve gastrectomy is one of the most common weight loss surgeries. During the procedure, nearly 90% of the stomach is removed. Gastric sleeve PCOS surgery reduces the size of the stomach to limit food intake, but the stomach functions normally.
One randomized control trial (RCT) in obese women (BMI >35) with PCOS showed that bariatric surgery was 2.5x more effective than medical care in inducing spontaneous ovulation in women with PCOS, obesity, and irregular, infrequent (oligomenorrhea) or no menstruation (amenorrhea), enhancing the prospects of spontaneous fertility in those with PCOS. [Insert reference: https://pubmed.ncbi.nlm.nih.gov/38782004/]
Duodenal Switch (DS) and the Single Anastomosis Duodenal-Ileal (SADI or SIPS)
These advanced surgeries deliver some of the best weight loss long-term by combining a sleeve gastrectomy with intestine re-arrangement which helps induce satiety, improves gut-brain signaling and creates a ceiling on how much of the consumed calories are absorbed. As one of the most powerful metabolic weight reduction operation, the duodenal switch can lead to significant and long-lasting weight reduction, which is crucial for relieving PCOS symptoms.
Duodenal switch (DS) surgery is highly effective for PCOS patients with severe obesity, by inducing substantial weight loss that is 3-5x what can be achieved through medications and life-style changes alone and roughly twice the weight loss from a VSG or gastric bypass. The DS is highly effective at reversing metabolic syndrome components frequently associated with PCOS, including insulin resistance, hypertension, and high cholesterol. Weight loss from this surgery improves insulin sensitivity, reduces excess androgens (hyperandrogenism), restoring sex hormonal balance which in turn results in regular menstruation and ovulation leading to higher chance of pregnancy and boosts fertility rates with many patients achieving successful pregnancies within 1–1.5 years post-surgery. This surgery is also associated with a > 90% remission rate for type 2 diabetes along with significant improvements/ resolution in other weight-related conditions, such as hypertension and , sleep apnea.. [
Gastric Bypass
Gastric bypass works by altering the stomach and small intestine. It decreases calorie absorption and promotes a sense of satiety by restricting the amount of food that can be consumed. The surgery involves creating a small stomach pouch while bypassing the top one-fourth of the small intestine.
For people with PCOS, gastric bypass may lead to significant weight loss while improving metabolic issues like insulin resistance. Gastric bypass PCOS surgery can ultimately lead to better hormonal balance, more regular menstrual cycles and improved fertility.
Adjustable Gastric Banding
Also known as Lap-Band® surgery, this surgery places an inflatable band around the top of the stomach, creating resistance to the food stream and leading to a feeling of fullness with small amounts of food. There is no intestinal rearrangement, and weight loss is achieved by restricting the amount of food consumed.
Many people view adjustable gastric banding as a potential treatment for PCOS-related insulin resistance — it may improve insulin sensitivity by reducing the body’s fat content. It may also improve hormonal imbalances, menstrual irregularities and fertility, making it a suitable option for some people with PCOS.
The Patient Journey at Center for Weight Loss Surgery
At the Center for Weight Loss Surgery, patients with PCOS considering bariatric surgery will undergo the following process to see if it is a good option for them:
- Initial consultation either in-person or virtuallyStarting the process at home through a virtual consultationmakes the process simpler and more convenient. At the Center for Weight Loss Surgery, we offer HIPAA-compliant telehealth consultations, where patients can discuss their options with a healthcare provider and determine the type of weight losssurgery that best meets their needs.
- Testing and education: Patients undergo lab work, imaging and further consultations to address their nutritional behavioral change needs.
- Surgery and recovery: Most patients return home on the day of surgery and are then seen regularly for follow-up care.
- Long-term support: We are committed to our patients’ long-term health and well-being, providing comprehensive long-term care and support. This includes nutritional and educational guidance, as well as psychological support, to aid in recovery and ensure success.
Take the Next Step Toward Managing Your PCOS
For women with PCOS, managing weight can feel challenging. Fortunately, there are various types of bariatric surgery available that may alleviate your symptoms and help you sustain weight loss. At the Center for Weight Loss Surgery, our experienced practitioners will guide you through your surgery options and help you find the right one that addresses your exact needs.
We offer virtual initial consultations and weight loss treatments tailored to your health concerns and weight loss goals. You can appreciate the convenience of doing most of the pre-surgical program virtually.
Schedule a consultation with our experienced clinicians today to learn how bariatric surgery can help with your PCOS. Our team is here to answer your questions and guide you on your journey to better health.
