BOSTON — Bariatric surgery may resolve symptoms of polycystic ovary syndrome in obese women with the condition, Dr. Héctor Escobar-Morreale reported at the annual meeting of the Androgen Excess Society.
“In some women, the syndrome is so driven by insulin resistance that it may resolve completely with weight loss,” said the endocrinologist, of the Hospital Ramón y Cajal in Madrid.
Among women seeking weight-loss advice at his endocrinology practice, Dr. Escobar-Morreale found a PCOS prevalence of 28%, more than five times the prevalence among lean women in Madrid. This discovery prompted him to examine the prevalence of the disorder among 36 obese women referred for bariatric surgery, and to also track the effect of surgically induced weight loss on their symptoms.
In this group of women, 17 (47%) were diagnosed with PCOS according to the 1990 National Institutes of Health criteria. Follow-up data at 1 year were available on 12 of them.
By 12 months, the women had lost an average of 41 kg and their hirsutism had resolved. Significant decreases were noted in their sex steroid levels: Total testosterone dropped from a mean of 69 ng/dL to 19 ng/dL, free testosterone from 1.6 to 0.3 ng/dL, androstenedione from 4.1 to 1.5 ng/dL, and dehydroepiandrosterone sulfate from 2,000 to 795 ng/dL.
Insulin sensitivity returned to normal and regular menstruation was restored. Among 10 women who were tested, all had hormonal evidence of ovulation.
Of course, Dr. Escobar-Morreale said, bariatric surgery is a serious proposal and is indicated only for morbidly obese patients who have repeatedly failed to lose weight through caloric restriction and lifestyle modification. In fact, he said, one of the PCOS patients died from postoperative surgical complications.
“Lifestyle modification should be attempted first,” he said. “But we already know that only about 20% of patients achieve success, which we define as at least a 10% weight loss that's maintained for at least 1 year. That's not very good.”