Polycystic ovary syndrome and endometrial hyperplasia: an overview of the role of bariatric surgery in female fertility

Research output: Contribution to journalReview articlepeer-review

Authors

Colleges, School and Institutes

External organisations

  • Birmingham Heartlands Hospital, Birmingham, UK.
  • Institute of Metabolism and Systems Research (IMSR)
  • Department of Diabetes and Endocrinology
  • Birmingham Women's Hospital

Abstract

One of the most effective methods to tackle obesity and its related comorbidities is bariatric surgery. Polycystic ovary syndrome (PCOS) and endometrial hyperplasia (EH), which are associated with increased risk of endometrial carcinoma, have been identified as potentially new indications for bariatric surgery.

PCOS is the most common endocrine disorder in women in the reproductive age and is associated with several components of the metabolic syndrome such as obesity, insulin resistance and hypertension. EH is a pre-cancerous condition which arises in the presence of chronic exposure to estrogen unopposed by progesterone such as both in PCOS and obesity.

The main bariatric procedures are Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. These procedures are well established and when correctly selected and performed by experienced bariatric surgeons, they can achieve significant weight loss and remission of obesity related co-morbidities.

Studies have shown that bariatric surgery can play an important role in the management of patients with PCOS and improve fertility. Similarly, bariatric surgery has a positive effect on endometrial hyperplasia, making surgically induced weight loss a potentially attractive option for endometrial cancer prevention and treatment.

Obesity has an adverse impact on spontaneous pregnancy, assisted reproduction methods and feto-maternal outcomes. After bariatric surgery obese women with subfertility can achieve spontaneous pregnancy. However, while bariatric surgery reduces the risk of pre-eclampsia and gestational diabetes, there is an increased risk of small for gestational age and possible increased risk of stillborn or neonatal death.

In this article we will review the evidence regarding the use of bariatric surgery as a treatment modality in patients with PCOS and EH. We also provide an overview of the common bariatric procedures.

Details

Original languageEnglish
Pages (from-to)220-226
Number of pages7
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Volume207
Early online date17 Oct 2016
Publication statusPublished - 1 Dec 2016

Keywords

  • Bariatric surgery, Obesity, Endometrial hyperplasia, Polycystic ovary syndrome (PCOS)