Obesity and Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a chronic endocrine disorder that affects women of reproductive age and is associated with infertility, hyperandrogenism, hirsutism, metabolic disorders including type 2 diabetes mellitus, and psychologic issues. Approximately 80% of PCOS patients are overweight or obese, particularly abdominal obesity. Although PCOS is an independent factor, obesity exaggerates all the reproductive, metabolic, and psychologic features related to PCOS. The underlying insulin resistance that is greater in PCOS for any given body mass index (BMI) compared with BMI-matched controls likely mediates this. Weight loss is the cornerstone for treatment in obese PCOS patients. A modest weight loss of less than 10% has been shown to improve ovulation, infertility, androgen levels, insulin resistance, and dyslipidemia in women with PCOS. Lifestyle modification (diet and exercise) is the first treatment step, followed by medical, and, potentially, surgical treatment. Pharmacologic therapy has proved disappointing in treating obesity associated with PCOS, because only orlistat is currently available. In women with PCOS, orlistat has shown to reduce both total testosterone levels and insulin resistance by inducing weight loss; however, its associated gastrointestinal side effects limit its value. Although metformin improves insulin resistance in PCOS, its effect on weight is controversial. Future medical therapy may involve glucagon-like peptide-1 analogues that reduce weight, and data suggest a concomitant improvement in menstrual cycles, ovulation rate, hyperandrogenism, and insulin sensitivity. Bariatric surgery in morbidly obese PCOS patients is effective, leading to marked weight reduction with improvement in hyperandrogenemia, insulin resistance, and hirsutism, with subsequent improvement in menstrual cycles and ovulation.