Is PCOS a comorbidity for weight loss surgery?

Written on April 19, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• What is PCOS?
• PCOS treatment options
• Obesity and PCOS
• Comorbidities for weight loss surgery
• PCOS could be a comorbidity for weight loss surgery
• Discuss with your healthcare provider
• Related content

What is PCOS?

Polycystic ovary syndrome, or PCOS, is a common cause of infertility in women and people assigned female at birth.[1-3] The condition impacts 6% to 12% of women of reproductive age in the United States, though PCOS is a lifelong health condition. [1] It is also a leading cause of fertility issues in this population.[3]

Causes of PCOS

PCOS is a complex disorder, and the exact cause is unknown; however, higher than normal androgen hormone levels have a role. [1,3] Other conditions and factors associated with PCOS are obesity, family history, and insulin resistance. [1,3] Obese women and those with a family member with PCOS or type 2 diabetes are likelier to have PCOS. Though obesity is associated with PCOS, the relationship is complicated and still not very clear.[1] Additionally, insulin resistance related to being overweight, regardless of the cause (unhealthy diet, lack of exercise, or family history), is also a factor in PCOS. [1] Insulin resistance is when the body’s cells no longer respond well to insulin. [4,5] Insulin's function is to facilitate the transportation of sugar or glucose into the body's cells. Insulin resistance is associated with PCOS and can also lead to type 2 diabetes.

PCOS symptoms

PCOS involves a set of symptoms caused by abnormal hormone levels that affect people assigned female at birth. PCOS signs can vary from obvious to highly vague, and some people may only experience one symptom while others may have multiple. Your healthcare provider may diagnose you with PCOS if you have at least two of these three symptoms [1,4]:

• Lack of ovulation leading to irregular menstrual periods or no periods at all
• High levels of androgen hormones contributing to an excess of body and facial hair, or thinning scalp hair
• Abnormal growths on ovaries; previously believed to be fluid-filled sacs called cysts, current evidence suggests the growths are underdeveloped ovarian follicles

Additional PCOS symptoms include acne, hair growth, darkened skin in body creases, unpredictable periods, oily skin, and weight gain.[1,5]

PCOS treatment options

The initial therapeutic option for PCOS is weight loss through lifestyle modifications.[3] Changes in diet to include healthy, well-balanced meals with increased physical activity are central to helping decrease body weight and can contribute to managing other health issues.[1] Therapy for PCOS also includes hormone modulator medications and laparoscopic ovarian drilling.[3] Treatment takes into consideration PCOS symptoms, along with other health conditions, and whether pregnancy is part of the overall goal for the individual.[5]

Obesity and PCOS

Obesity and being overweight is common in PCOS. About 4 in 5 women with PCOS are obese.[5] Weight loss in those who are overweight may help regulate the menstrual cycle; even a small amount of weight loss may be helpful. Losing weight can also improve cholesterol and insulin levels and help control hair growth and acne symptoms. [3,5] Reduced body weight can improve response to ovulatory induction and hormonal treatments in PCOS.[3]

Comorbidities for weight loss surgery

Weight loss surgery is effective for obesity therapy and has positive implications for obesity-related comorbidities.[5-7] If you are obese and other weight loss therapies have proven unsuccessful, then surgery for weight loss may be an option for you. If you are considering therapeutic options to lose weight, consult your healthcare provider for the best approach based on your medical history, comorbid conditions, and health goals.

Weight loss surgery is recommended as part of management for obesity and the presence of various comorbidities as follows[6,7]:

• Body Mass Index (BMI) of 40 kg/m^2 or more without any coexisting medical conditions
• BMI greater than or equal to 35 kg/m^2 and one or more comorbidities (such as type 2 diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, non-alcoholic fatty liver disease, GERD, asthma, venous stasis disease, or severe urinary incontinence)
• BMI of 30 to 34.9 kg/m^2 with diabetes or metabolic syndrome

PCOS could be a comorbidity for weight loss surgery

Weight loss surgery, such as bariatric surgery, has been used to help treat PCOS; however, it is not currently recognized as a first-line treatment for PCOS.[3] Additionally, PCOS alone is not considered a main comorbidity for weight loss surgery.[6,7] Since weight loss has implications for improved insulin resistance, androgen levels, and menstrual cycles, weight loss surgery has the potential to be a treatment option for PCOS.[3,6,7] More studies are still needed to establish PCOS as a leading comorbidity for weight loss surgery. [3,6,7]

Discuss with your healthcare provider

If you have concerns about your menstrual cycles or are having difficulty getting pregnant, it’s important to speak with your healthcare provider. It is also essential to consult with your clinician if you are considering weight loss surgery to discuss the potential benefits and risks and explore all therapeutic options.

Everlywell provides access to Weight Care+, a telehealth option that allows you to discuss your weight loss goals and condition with a certified clinician from the comfort of your own home. You can partner with a healthcare provider and get support to optimize your care plan.

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References

1. PCOS (polycystic ovary syndrome) and diabetes. Centers for Disease Control and Prevention. URL. Published December 30, 2022. Accessed April 11, 2023.
2. What causes PCOS? Eunice Kennedy Shriver National Institute of Child Health and Human Development. URL. Accessed April 11, 2023.
3. Lee R, Joy M C, Jose MT, Elshaikh AO, Shah L, Cancarevic I. A review of the impact of bariatric surgery in women with polycystic ovary syndrome. Cureus. 2020;12(10):e10811. doi: 10.7759/cureus.10811. URL.
4. Polycystic Ovary Syndrome (PCOS). Eunice Kennedy Shriver National Institute of Child Health and Human Development. URL. Accessed April 11, 2023.
5. Polycystic ovary syndrome (PCOS). American College of Obstetricians and Gynecologists. URL. Accessed April 11, 2023.
6. Stahl JM, Malhotra S. Obesity surgery indications and contraindications. 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. URL.
7. Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875-E891. doi: 10.1503/cmaj.191707. URL.