The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis

Abstract

Bariatric surgery has been proven to be a successful management strategy for morbid obesity, but limited studies exist on its effect on polycystic ovary syndrome (PCOS). A comprehensive search of electronic databases was completed. Meta-analysis was performed on PCOS, hirsutism, and menstrual irregularity outcomes following bariatric surgery. Thirteen primary studies involving a total of 2130 female patients were identified. The incidence of PCOS preoperatively was 45.6 %, which significantly decreased to 6.8 % (P < 0.001) and 7.1 % (P < 0.0002) at 12-month follow-up and study endpoint, respectively. The incidences of preoperative menstrual irregularity and hirsutism both significantly decreased at 12-month and at study end follow-up. Bariatric surgery effectively attenuates PCOS and its clinical symptomatology including hirsutism and menstrual irregularity in severely obese women.

Bariatric Surgery, Polycystic Ovary Syndrome, and Infertility

“…PCOS is very common in this patient group. A recent meta-analysis has shown that PCOS decreases significantly after bariatric surgery from 45.6% preoperatively to 6.8% at 1 year postoperatively [14]. …”

“…Historically, epidemiological studies have suggested that the rapid weight loss in the first year or two after bariatric surgery may increase women's chance of conception. While the incidence of PCOS decreases significantly after surgery [14], there are very few studies assessing fertility before and after bariatric operations. At present, there is no consensus on the role of such surgery in the management of infertility and whether surgery can also be beneficial in women who have a BMI of under 40 kg/m 2 .…”

Polycystic ovary syndrome: a common reproductive syndrome with long-term metabolic consequences

“…Interestingly, a systematic review including 13 primary studies found that the incidence of PCOS was reduced from 45.6% to 7.1% after bariatric surgery. 105 The screening and management of metabolic abnormalities is particularly relevant in those women with PCOS who are planning a pregnancy or undergoing fertility treatment. Women with PCOS are at increased risk of different complications including gestational diabetes and pre-eclampsia.…”

Cardiometabolic Risk in PCOS: More than a Reproductive Disorder

“…Studies of morbidly obese women undergoing bariatric surgery suggest that dramatic weight loss can result in resolution of both the reproductive and metabolic features of the PCOS phenotype in this subset of patients [74, 75]. In addition, a longitudinal study found that treatment with hypocaloric diet and metformin resulting in even less dramatic weight loss resulted in improvements in measures of insulin sensitivity, androgen concentrations, hirsutism scores, and menstrual cyclicity [76].…”