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Polycystic ovary syndrome - Management
Basis for recommendation
Advise weight loss if appropriate
- It is estimated that 40–50% of women with polycystic ovary syndrome (PCOS) are obese [Lobo and Carmina, 2000]. Obesity worsens insulin resistance and increases the risk of Type 2 diabetes and cardiovascular disease. Unfortunately, weight loss is difficult to achieve.
- Weight gain is associated with worsening of symptoms, whereas weight loss may improve the endocrine and metabolic profile [Balen, 2000].
- Limited evidence from small randomized controlled trials and a within-group comparison study suggests that even moderate weight loss can lead to an improvement in hyperinsulinism and hyperandrogenism.
- Good evidence from a Cochrane systematic review and small prospective studies suggests that weight reduction in infertile obese women with PCOS improves ovulation and the chances of pregnancy.
- Expert opinion from a textbook is that if more than 5% of body weight can be lost, there is an excellent chance of restoring menstrual regularity, and an increased incidence of pregnancies has been reported [Balen and Glass, 2005].
Use of orlistat and sibutramine
- Guidelines from the Royal College of Obstetricians and Gynaecologists recommend the use of either of these drugs, as they may reduce body weight and hyperandrogenism in women with PCOS [RCOG, 2007].
- Very limited evidence from a small randomized controlled trial and two small prospective studies suggests that orlistat and sibutramine may reduce body weight and hyperandrogenism in women with PCOS.
Use of bariatric surgery
- This intervention is suggested in guidelines from the Royal College of Obstetricians and Gynaecologists for selected women with morbid obesity [RCOG, 2007]. A small prospective non-randomized study followed up 12 of an original cohort of 17 women with PCOS and morbid obesity who had undergone bariatric surgery. The mean weight loss was 41 +/– 9 kg, and menstrual cycle regularity was restored in all 12 women. In one woman, diabetes and dyslipidaemia resolved, and in another woman, the diabetes reverted to glucose intolerance. However, one of the women undergoing bariatric surgery died of post-operative complications [Escobar-Morreale et al, 2005].
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