PCOS is the abbreviation for “Polycystic Ovary Syndrome.” This hormonal condition affects more than 10% of younger women in the U.S., and PCOS is the most common cause of female infertility. PCOS nearly always comes with excess fat storage and insulin resistance, so PCOS is definitely “in the wheelhouse” of bariatric surgery because it has a strong positive impact on weight and insulin resistance.
More about PCOS – women affected by PCOS usually have irregular/absent menses and difficulty with conception. The ovaries are often enlarged (average about twice normal size) with multiple cysts that may be related to abnormal hormone production. If PCOS patients do happen to become pregnant, they have significantly higher rates of pregnancy complications such as pre-eclampsia and their babies have higher rates of birth defects. There are often signs of excess androgen (male-type) hormones such as testosterone, and women with PCOS often have some male-pattern hair growth (facial hair, sternal hair, etc.) or loss of hair on the head in a male pattern. About 50% of women with PCOS also suffer from obesity, and even non-obese patients usually have excess fat storage in the central part of their body. Not surprisingly, Insulin Resistance (which often leads to diabetes) is present in most women with PCOS. Women with PCOS have significantly elevated risk of endometrial cancer, and cardiovascular disease including heart attacks or strokes. Researchers do not know what is the underlying cause of PCOS.
Treatment strategies for PCOS – the first-line treatment for PCOS is weight loss. Even a 5% weight loss through diet/exercise has been shown to increase fertility rates, but there has been a shift away from this strategy in fertility clinics because diet/exercise have been shown not to be sustainable through pregnancy, and women with PCOS who become pregnant after diet/exercise weight loss have a very high rates of pregnancy complications. Some symptoms of PCOS such as menstrual irregularity and perhaps some abnormal hair growth may be controlled with administration of birth control pills, and early-stage insulin resistance may be improved with diabetes medication such as metformin. However, medication treatment does not correct the underlying hormone abnormalities and does not stop progression of the disease.
Bariatric surgery effects on PCOS – given that non-surgical treatment strategies are rarely fully effective, for many PCOS patients it is logical to consider more intensive treatment using a bariatric operation such as a gastric bypass or a gastric sleeve. The good news about bariatric surgery in San Antonio in the treatment of PCOS is that the bariatric operations lead to very significant weight loss and the operations have a direct positive impact on the insulin resistance which seems to be a key feature of PCOS. About 80% of bariatric surgery patients have full correction of their insulin resistance and diabetes. About 75% of patients who had unsuccessful fertility treatment before bariatric surgery are able to conceive successfully. About 50% have full correction of abnormal hair distribution. Most of these benefits show up within the first 3 months after surgery, then the patient and her bariatric team need to work together for life to maintain this healthier metabolic balance.
CAUTION – it’s really important avoid becoming pregnant during the rapid weight loss phase after bariatric surgery because of uncertainty about mom’s physical ability to provide all the resources needed for healthy development of the baby. Women who have been infertile for years prior to their bariatric operation may become fertile in only a few months after their bariatric operation, so even if they are not in the habit of using birth control it is really important to use reliable birth control after bariatric surgery. There is no nationally-agreed guideline on how long to wait to become pregnant after bariatric surgery, but our practice has had good success in recommending an 18-month gap between the bariatric operation and attempts to become pregnant. Of course, it’s also important for mom to take her vitamins without fail and for us to check her labs for vitamin/nutrition levels before pregnancy. Our practical experience with pregnancy after bariatric surgery by the leading weight loss center in San Antonio has been fantastic – as a practice we have seen more than 200 healthy babies born to our bariatric surgical patients!