Polycystic Ovarian Syndrome and Laparoscopic Metabolic Surgery

By Dr. Atul N.C. Peters in Metabolic And Bariatric Surgery

Oct 29 , 2021 | 1 min read

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder affecting young women. It is more common in obese as 60% of PCOS women are obese.

Many ladies with PCOS have hypertension, dyslipidaemia, obesity, insulin and glucose abnormalities, and ultimately Metabolic Syndrome.

Ladies who have a higher incidence of insulin resistance develop Type 2 diabetes mellitus which in turn leads to Metabolic Syndrome. Criteria to define Metabolic Syndrome include at least 3 of the following:

Central Obesity
Elevated Triglycerides
Decreased HDL
Hypertension
Elevated Fasting Blood Glucose

Although diet and exercise, “lifestyle modifications”, are first line therapy for overweight women, most studies show limited ability to lose large amounts of excess body weight greater than 10 kg. Surgical weight loss has been an effective option for many years but is still unrecognised in most parts of the world.
The most common procedures performed are laparoscopic gastric bypass and laparoscopic sleeve gastrectomy (LSG), all over the world. Several studies have found improvements in sex hormone profiles and the resolution of PCOS following bariatric surgery. For instance, 16 obese women who underwent bariatric surgery demonstrated improvement in ovary function, when compared to 14 normal weight subjects. Many studies done world over have confirmed the benefit of losing weight in PCOS. Normalising of menstrual regularity has been confirmed after bariatric surgery; also sexual function improves greatly in women after surgery. A study on patients with PCOS followed up over 9 years found improvement in PCOS symptoms (menstrual cycle improved in 82%, hirsutism in 29% and diabetes in 78%) and successful conception in those attempting pregnancy. In a study of 110 young Italian women, who were previously unsuccessful at becoming pregnant, 60 conceived after postoperative weight loss. In addition to the overwhelming evidence of benefits after surgery, studies also show that patients experience
emotional, body image and quality of life improvements after bariatric surgery.

Laparoscopic Bariatric surgery has nowadays become the best tool for managing metabolic syndrome in young obese female presenting with PCOS. Laparoscopic Bariatric surgery should be considered along with other medical and lifestyle alterations as first line therapy in PCOS women with obesity and Metabolic Syndrome.

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