There are links between polycystic ovary syndrome, weight loss surgery and getting pregnant.
Polycystic ovary syndrome (sometimes known by its acronym, PCOS) is an often-frustrating condition many women face. Some women with this syndrome also become obese, which brings with it further health difficulties. But weight loss surgery may be an effective treatment and provide a solution.
Question: What is this illness?
Answer: Polycystic ovary syndrome is a hormonal imbalance. The exact cause isn’t completely understood, but it’s associated with obesity, and it’s certainly associated with insulin resistance as well as hyperandrogenism, which means just an increase of hormones that is abnormal.
Q: Can weight loss surgery help?
A: Up to 80% of patients who should undergo weight loss surgery are women, and up to 50% of those have polycystic ovary syndrome. So it’s a common disorder. This condition is associated with infertility. Medical or surgical weight loss improves fertility for many women who participate in those treatments.
Q: Why is that?
A: It’s poorly understood, but the thought is that the adipose tissue — the fatty tissue — actually converts estrogen into more of an androgen (a type of hormone associated with male characteristics). You’ll see that one of the signs of the disease is kind of dark hair growing on the face and chin. You can also get thinning of hair, abnormal menses (menstrual cycles) or the lack of having periods. With the reduction of adipose tissue (fat) then you start improving your hormonal cycle back to normal levels. Up to 70% of women who were not having normal periods before surgery will develop normal periods after surgery. This can happen really quickly, too, up to the month after weight loss surgery to treat polycystic ovary syndrome. A lot of the women are surprised that they are now fertile when they hadn’t been before.
Q: Should women be concerned about getting pregnant soon after weight loss surgery?
A: Some women who were not fertile before can develop fertility rapidly after surgery. We usually recommend waiting 12 to 18 months after bariatric surgery before trying to become pregnant. The thought is that you’re going into breakdown state when you’re losing weight, and then to add on top of it that you’re growing another body, we worry about the micronutrient deficiencies and those kinds of things. We like to get your body into more of a steady state before you add on to it the changes of pregnancy.
Q: So it’s safe to become pregnant after surgery, just not right away.
A: Data on this is really hard to interpret because none of this is a randomized control trial per se. There are plenty of women who call the clinic and say, “I’m pregnant and I’m three months outside of surgery! What do I do?” The answer is, it really needs to be individualized care. We need to monitor you really closely for nutrient deficiencies, and follow you for the typical complications of bariatric surgery, things like dehydration and ulcers. We need to be aware of that; we have to make sure medications that you’re taking are at the appropriate levels. You just need close follow-up. So yes, we believe it is safer outside of the 18-month term but if it happens, we have to be monitoring and careful.
Q: Is there certain birth control recommended during that 12- to 18-month period?
A: We usually recommend that if you want to use a hormonal form of birth control that you avoid an oral hormonal form (the pill) — especially if you’ve had a malabsorptive procedure. We’re not certain that you’re going to get the level of hormones from the pill that you need to provide adequate contraception. So either use a barrier method or non-oral medication: things like Depo (Depo-Provera hormone injection), implants or injections; the Nuvaring; patches — patches might also be a little bit difficult to interpret. Use something that’s not oral, or use a barrier method (such as condoms, contraceptive sponge, cervical cap and/or a diaphragm).
Q: What about additional pregnancies after the first one, post-surgery?
A: One of the things obesity is associated with is increased pregnancy complications. It can be things like gestational diabetes, preeclampsia (pregnancy-related high blood pressure), the baby being large or small for gestational age. After the 12 to 18 months after bariatric surgery, a lot of these complications are treated or improved — hypertension, diabetes. It looks like it’s probably safer and healthier to wait that long. But we have seen a number of successful pregnancies sooner after bariatric surgery.
Q: Can you share success stories of women who struggled with polycystic ovary syndrome, and how weight loss surgery helped them?
A: Some patients have said after surgery, “I wanted a family, I wanted to become pregnant and I couldn’t before surgery.” So many patients have been able to achieve this, and that’s really a gratifying part of this job, to be able to get birth announcements from these patients.
The Vanderbilt Surgical Weight Loss program offers advanced care to help you lose weight and improve your overall health. If you’ve been unable to reach a healthy weight with nutritional and lifestyle improvements alone, surgery might be a better and safer option for achieving your weight loss goals. The team will work with you to develop a personalized care plan combining surgery, nutrition, exercise and psychological support.