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Medical management and surgery for weight loss |
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Weight loss reduces insulin resistance and can therefore improve the symptoms of PCOS that are associated with insulin resistance (high androgen levels, menstrual irregularity, lack of ovulation and risk factors for type 2 diabetes and cardiovascular disease). Weight loss is best achieved through a combination of lifestyle changes (ideally diet, physical activity and behavioral change). (See Lifestyle Management)
In rare instances where it is not possible to achieve weight loss through lifestyle change, weight loss medications or surgery are alternative options.
Weight loss medications In PCOS, there are a number of small research studies assessing the effect of weight loss drugs (orlistat or sibutramine). These treatments showed similar changes in androgen levels when compared to the oral contraceptive pill or metformin, but greater improvements in some other factors such as weight or insulin. As yet, there is no evidence that these weight loss medications are any better than other medical or lifestyle treatments. They are generally expensive, only work whilst being taken, lead only to small weight loss and have side effects. As such they are not an alternative to improved lifestyle.
Surgical weight loss
There are two main types of weight loss surgery:
- Gastric bypass – where a smaller stomach pouch is made from the stomach and the intestine joined to it (fairly major operation)
- Gastric banding - where the size of the stomach is reduced by a band around the upper part of the stomach (minor procedure done via keyhole surgery)
The effect of obesity surgery has also been assessed in PCOS. While this improves menstrual regularity, natural conception, excess hair (hirsutism), androgen levels and insulin resistance, this is a surgical procedure with potential post-operative complications. It is also expensive and whilst covered in part by private health insurance, it is very rarely available in public hospitals in Australia.
Weight loss surgery should only be considered for women who fit all of the following criteria:
- Are very obese (BMI >35 or 40)
- Have obesity-related conditions including diabetes, high blood pressure or arthritis
- Have been unsuccessful losing weight with alternative treatments
However, for women in these categories, gastric banding does result in sustained and significant weight loss in the majority of those who have the procedure.
Content updated July 31, 2009
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