PCOS and Gastric Bypass Surgery: Will Surgery Help?

PCOS and Gastric Bypass Surgery: Will Surgery Help?

PCOS, or Polycystic Ovary Syndrome, is a condition commonly found in overweight women. While the exact cause of PCOS is unknown, studies have indicated that weight loss can play a significant role in the treatment of PCOS. Can gastric bypass help with PCOS?

What Is PCOS?

PCOS is a condition where the ovaries produce an abnormal amount of androgens, or male sex hormones. While all women have small amounts of androgens, the increased presence of these hormones restricts ovulation and interrupts the menstrual cycle. Oligomenorrhea (infrequent periods) leads to ovarian cysts and infertility. Women with metabolic issues such as insulin resistance and obesity are more likely to have PCOS.

Why Is PCOS Commonly Found in Obese Women?

Women who are overweight or obese tend to have metabolic dysfunction, resulting in insulin resistance and diabetes mellitus. Rising insulin levels in the body can trigger higher levels of male sex hormones.

Weight gain has been found to aggravate PCOS symptoms, whereas weight loss has ameliorated hormonal and metabolic imbalances, thus relieving symptoms. Women who struggle to lose weight have difficulty managing their PCOS symptoms given the relationship between PCOS and insulin.

What Are the Symptoms Of PCOS and How Is It Diagnosed?

Symptoms of PCOS may include:

  • Absence of periods, irregular periods or light periods
  • Enlarged ovaries or cystic ovaries
  • Infertility
  • Weight gain, especially around the abdomen
  • Excessive body hair found on the chest, abdomen and back (hirsutism)
  • Thinning hair or male-pattern baldness
  • Acne or oily skin
  • Presence of skin tags on the neck and armpits
  • Dark or thickened skin patches on the back of the neck, under the breasts or in the armpits
physical exam
Meet with your doctor if you are concerned about symptoms of PCOS.

To determine whether or not you have PCOS, your healthcare provider will conduct a review of your medical history and symptoms, and will perform a physical exam that may include a pelvic exam, ultrasound and blood tests.

Treatment of PCOS

Multiple studies have indicated that weight loss can treat many, or all, of the symptoms of PCOS, and can even help improve fertility. Increased exercise and dietary improvements are one of the first recommendations for treatment of PCOS.

woman on scale
Weight loss is one of the main recommendations for treatment in women with PCOS.

PCOS is also frequently treated with medication to help manage symptoms. Birth control pills, diabetes medication and medications to manage hair loss or acne are sometimes prescribed for patients not wanting to get pregnant. For patients planning to get pregnant, medication therapy aims at increasing ovulation.

Weight Loss Helps Improve PCOS But I Can’t Lose the Weight

Lifestyle modifications, such as adhering to a healthy diet and increasing activity, are recommended in women with PCOS. However, some women find that they are unable to lose weight despite dieting and exercise. It is important to discuss your weight loss goals with your physician if you find that you have tried and failed to lose weight through lifestyle changes.

Weight loss surgery (bariatric surgery) is an option for some women who are unable to lose weight, or for women who have serious health problems due to obesity. Your physician may recommend gastric bypass surgery as an option to help with weight loss.

What Is Gastric Bypass Surgery?

Gastric bypass surgery is a form of bariatric surgery in which a surgeon changes the anatomy of the stomach to limit the amount of food that one can intake, as well as the amount of nutrient absorption that occurs with eating.

surgery
Gastric bypass surgery may be an option for patients who have had difficulty losing weight with lifestyle modifications.

The most common type of gastric bypass surgery is called the Roux-en-Y (roo-n-y), where the surgeon cuts the stomach into a walnut-sized pouch. The resulting pouch can hold only about one ounce of food, which is a significant decrease from a non-modified stomach, which holds about 3 pints of food.

Then the surgeon directly attaches a part of the small intestine to the pouch so that food immediately enters the middle portion of the small intestine. The result of this modification is that food intake is limited to a very small portion and much less absorption of nutrients occurs.

Will Gastric Bypass Help My PCOS?

Now that we have explored that gastric bypass leads to weight loss, the question remains whether gastric bypass will treat PCOS. As many women with PCOS are overweight, and many women have seen improvement or resolution of PCOS symptoms with weight loss, your physician may recommend bariatric surgery to help decrease conditions associated with obesity, including PCOS.

weight loss tape
There are different types of weight loss surgery. Talk to your physician about what procedure may be best for you.

What Do Studies Say About PCOS Before And After Gastric Bypass?

Multiple reviews of studies involving patients who underwent gastric bypass demonstrate a significant improvement in some or all of the symptoms associated with PCOS. In a study of 24 women with PCOS and obesity, weight loss from gastric bypass surgery caused significant improvement in clinical problems related to PCOS.

Prior to gastric bypass surgery, all the women in the study were of reproductive age, were oligomenorrheic (infrequent periods), and 23 of the women had hirsutism. Within a few months after gastric bypass surgery, all women had normal menstrual cycles and most of the women with hirsutism saw significant improvement. Five of the women in the study were also able to conceive without the help of clomiphene, a medication that helps to improve chances of fertility.

pregnancy
Many women with PCOS experience difficulty conceiving. With resolution of PCOS, some patients have been able to conceive without fertility medication.

Gastric bypass has demonstrated significant improvement in metabolic dysfunction including insulin resistance and diabetes, which helps normalize the levels of male sex hormones that are increased in women with PCOS. The improvement of metabolic dysfunction for gastric bypass also improves other conditions associated with obesity including high blood pressure, dyslipidemia, coronary artery disease and risk for cardiac events.

couple
Discuss your options with your physician to see if gastric bypass can help treat PCOS.

Find Out if Gastric Bypass Surgery Is an Option for You

If you are overweight or obese, have struggled with weight loss despite making lifestyle changes, and have PCOS, gastric bypass may be an option for you. Discuss PCOS and gastric bypass surgery with your physician to see if gastric bypass will help you in achieving your health goals.

Julia Rae Walker, RN, BSN, BA

Author

Julia is an experienced critical care nurse with a background in pediatric and adult patient populations. Her passion is helping patients maximize their quality of life.

Gintas Antanavicius, MD, FACS, FASMBS

Medical Reviewer

Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.