Efficacy of Bariatric Surgery in the Treatment of Women With Obesity and Polycystic Ovary Syndrome

Abstract

Objective To determine the difference in efficacy between drug and bariatric surgery therapy for women with obesity and polycystic ovary syndrome (PCOS). Design Prospective non-randomized trial. Methods A total of 90 women aged 18–40 years with body mass index (BMI) ≥ 27.5 kg/m 2 and waist circumference ≥85 cm fulfilling the 2011 Chinese diagnostic criteria for PCOS were enrolled and 81 subjects completed this study. In the drug group, patients were administered metformin and an oral contraceptive containing ethinyl-estradiol and cyproterone acetate for the first 6 months, and metformin alone for the second 6 months. In the surgical group, patients underwent laparoscopic sleeve gastrectomies. The follow-up time was 12 months. The main outcome was set as the complete remission of PCOS requiring six consecutive regular menstruation or spontaneous pregnancy. Results Median BMI at endpoint was 30.1 kg/m 2 in the drug group and 23.7 kg/m 2 in the surgical group, complete remission rate was 15% and 78%, respectively. Except endpoint BMI, no difference was observed in free androgen index, ovarian morphology, homeostasis model assessment for insulin resistance, and total weight loss between remission and non-remission patients. Logistic regression analyses also revealed that the final BMI was the major factor influencing the remission of PCOS. The cut-off points of the final BMI were 27.5 kg/m 2 for the drug group and 26 kg/m 2 for the surgical group. Overall, nearly 95% of patients with an endpoint BMI below the cut-off values achieved complete remission. Conclusion Complete remission of PCOS in patients with obesity depends on the final BMI after weight loss. Thus, bariatric surgery should be prioritized for these patients.

Impact of bariatric surgery on anthropometric, metabolic, and reproductive outcomes in polycystic ovary syndrome: a systematic review and meta‐analysis

“…In the single non-randomized trial, participants receiving surgery achieved significantly better anthropometric outcomes compared to pharmacotherapy (i.e., metformin and combined oral contraceptive pill), including final weight (65. compared with the pharmacotherapy group at baseline. In this study, Hu et al 14 found that bariatric surgery was more effective than pharmacotherapy for reducing fasting glucose, fasting insulin, triglycerides, LDL-C, HbA1C, total testosterone, and SHBG. There were no significant differences in total cholesterol or HDL-C between groups.…”

“…Study characteristics are summarized in Table 1. The single nonrandomized trial 14 women with PCOS as well between women with and without PCOS.…”

“…The number of women with PCOS included in each study ranged from 6 to 83 with the mean age ranging from 24 to 37 years. The Rotterdam criteria were used to diagnose PCOS in nine studies, [14][15][16][17][19][20][21][22][23] and the original NIH criteria were used in one study. 18…”

A bibliometric and visual analysis of obesity and polycystic ovary syndrome from 2012 to 2022

“…According to Fatemeh et al (41), PCOS may reduce the occurrence of silent coronary artery disease in a population-based cohort study. Compared with metformin, bariatric surgery should be prioritized for patients with obesity and PCOS in a Chinese prospective nonrandomized trial (42). In these studies, researchers were able to identify the research hotspots, which may shape future research directions.…”

Simplify your approach to the diagnosis and treatment of PCOS

“…For patients with PCOS and a body mass index (BMI) ≥ 35 kg/m 2 , bariatric surgery often results in sufficient weight loss to resolve the patient's hyperandrogenism and oligo-ovulation, restoring spontaneous ovulatory cycles. 24 In a study of more than 1,000 patients with: PCOS; mean BMI, 44 kg/m 2 ; mean age, 31 years who were followed post-bariatric surgery for 5 years, > 90% of patients reported reductions in hirsutism and resumption of regular menses. 25 For patients with PCOS seeking fertility, bariatric surgery often results in spontaneous pregnancy and live birth.…”