PCOS and Obesity: Exploring the Problems and The Solutions

Obesity is something about which we have all heard of once in our life. In Pakistan, there is a general stigma that surrounds it and very few people prefer to talk about it. This is why most of us are unfamiliar with the common risk factors associated with obesity such as; type 2 diabetes, sleep apnea, coronary artery disease (CAD), high blood pressure and cancer. However, even fewer know that women who are affected by obesity are also the most likely to counter reproductive problems like polycystic ovarian syndrome (PCOS).

What is PCOS?

PCOS is amongst the most common hormonal disorders in women of reproductive age. It usually affects 5 to 10 percent of the female population. Women with PCOS tend to have irregular menstrual bleeding and undergo various difficulties to get pregnant. PCOS occurs when levels of hormones are abnormal and out of range. The name; in general, “polycystic ovarian syndrome” refers to the development of small cysts along the outer edge of the enlarged ovaries of women who suffer from this condition.

The Relationship Between PCOS and Obesity

The underlying relationship between PCOS and obesity is immensely complicated. Symptoms of polycystic ovarian syndrome begin for some females soon after they start on their period. Women with PCOS usually produce excessive insulin, and the insulin they produce does not do the work as intended. The inability of insulin to function as designed normally is one of the main reasons why women with PCOS gain weight or have an unusually hard time shedding this weight. For certain others, PCOS develops later in life, followed by substantial weight gain. It is clear that women under the effect of obesity lean towards a greater risk for PCOS and women with PCOS have a greater risk for obesity.

Symptoms of PCOS in Women Suffering from Obesity

The main symptoms of PCOS in women suffering from obesity are severe acne, discolouration of skin in certain areas, growth of facial hair due to hormonal imbalance, infertility, and a perceptively negative body image leading to depression. Moreover, women tend to undergo severe pain and cramps during their cycle and ultimately bariatric surgery has been proven to highlight significant results. These results have helped eradicate 90% of the above symptoms and helped women towards a healthy life. 

 

How do PCOS and Obesity Cause Infertility?

Obesity is a major factor in issues of subfertility and is one of the most major risk factors during a pregnancy. Obesity; during a pregnancy, can cause stillbirth (i.e. fetal loss), poor perinatal outcomes such as premature babies and birth defects (congenital malformations).

Increased BMI can double the miscarriage rate of women suffering from obesity, as compared to women with a normal BMI. 

Obesity can cause a systemic inflammation due to interaction between the immune cells in adipose tissue and adipocytes, resulting in the release of free fatty acids (FFA) and cytokines. These FFA can increase reactive oxygen species (ROS) and cause dysfunction of the oocyte’s mitochondria and endoplasmic reticulum. These oocytes may not form viable embryos or implants.

It also affects implantation by an endometrial effect and it can cause increased endometrial polyps in obese women with PCOS.

 

Recommended Treatments For Women Suffering with Obesity 

 

•  Bariatric Surgery 

Studies conducted by John Hopkins show that obesity and PCOS independently and collectively can lead to metabolic syndrome. These studies also highlighted that bariatric surgery has led to a significant decrease in the BMI of PCOS patients. The peak weight loss usually occurs 6 to 12 months after surgery. After this weight loss, most women reported results which showed the dissolution of metabolic syndrome and a substantial decrease in the pain suffered by women. Bariatric surgery can also lead to the decline in the need for medicines for hypertension and dyslipidemia.

Bariatric surgery is usually for women that suffer from PCOS and have a BMI between 27-32.5 kg/m2. Moreover, women with a preoperative BMI of >37.5 kg/m2 lose body weight upwards or 20-60kg in the first 12 months. . After the surgery, women are instructed to delay conception for at least 1 year. This enables the body to counter any nutritional deficiencies.

2. Traditional Treatment  

When dealing with women suffering from obesity the dietary restriction is followed by a recommendation of 800 kcal/day, although this is not preferred beyond a time period of 12 weeks. Metformin facilitates weight loss by suppressing appetite,however, it is usually not recommended.

Although, traditional treatment does have some setbacks as studies have proven that this usually doesn’t help with infertility. This also doesn’t help with the excruciating pain that women with PCOS undergo. 

However, the bottomline is that; for patients suffering from obesity. It is impossible to lose weight with just exercise and diet. Without bariatric surgery, the weight loss will be negligible and can be easily regained. 

 

Conclusion

PCOS is the leading hormonal disorder in women of reproductive age. It is also amongst the leading causes of infertility and subfertility in the population of those who struggle with obesity. Bariatric surgery is the paramount option for lasting weight loss in obese individuals. Moreover, studies conducted by NCBI, NIH show that bariatric surgery reduces BMI; levels of obesity, and reduces the incidence of comorbidities. The bypass surgery was most effective with patients achieving weight loss to a normal level. Patients found improvement and/or resolution of pre-existing cardiac issues, high cholesterol, high blood pressure, Type 2 diabetes, and sleep apnea.

 

However, people still continue to pose doubts about whether bariatric surgery can cure PCOS or not. Bariatric surgery aids in losing effective weight in a shorter time period. Patients are also able to reduce and decrease the presence of metabolic syndrome and help in improving insulin resistance. Conclusively, decrease of hyperandrogenism and its related manifestations aid in restoring regular menstrual cycles and aids in successful pregnancies in patients previously struggling with infertility. Ultimately, keeping the results in mind, it’s time that we shed the stigma aside and consider bariatric surgery as a treatment option for  women suffering from obesity with PCOS. In our country the use of bariatric surgery to tackle the issue of infertility caused by PCOS is still taboo. We need to understand that its stigmatisation has led to the underutilisation of a method that continues to show promising results in the cure for PCOS and the issues caused by it. All things considered, bariatric surgery has led to the restoration of regular menstrual cycles and ovulation in 17; out of the 17 women involved in a study published in The Journal of Clinical Endocrinology & Metabolism. 

Here, at Doctor Obesity Clinic, we work towards helping those who are in need of it. We provide state of the art technology to help tackle the issues caused by Obesity. For Women suffering from obesity and its effects such as those of PCOS and infertility. Suffering from Obesity is nothing to be ashamed about, we strive to eradicate its effects and help you towards a healthier life. Bariatric surgery might seem like a scary option but it doesn’t have to be.