Efficacy of Bariatric Surgery in the Treatment of Women With Obesity and Polycystic Ovary Syndrome

Abstract

Context: The comparative effectiveness of drugs and surgical therapy for women with obesity and polycystic ovary syndrome (PCOS) has not been systematically compared.

Objective: We aimed to determine the difference in efficacy between drug and bariatric surgery therapy for women with obesity and PCOS.

Methods: This prospective nonrandomized trial enrolled 90 women aged 18 to 40 years with body mass index (BMI) ≥ 27.5 kg/m2 and waist circumference ≥ 85 cm and fulfilling the 2011 Chinese diagnostic criteria for PCOS; 81 subjects completed the study. In the drug group, patients were administered metformin and an oral contraceptive containing ethinyl-estradiol and cyproterone acetate for the first 6 months, and metformin alone for the second 6 months. In the surgical group, patients underwent laparoscopic sleeve gastrectomies. The follow-up period was 12 months. The main outcome was the complete remission of PCOS, requiring 6 consecutive regular menstruation cycles or spontaneous pregnancy.

Results: Median BMI at endpoint was 30.1 kg/m2 in the drug group and 23.7 kg/m2 in the surgical group; complete remission rate was 15% and 78%, respectively. Except endpoint BMI, no difference was observed in free androgen index, ovarian morphology, homeostasis model assessment for insulin resistance, and total weight loss between remission and nonremission patients. Logistic regression analyses also revealed that the final BMI was the major factor influencing the remission of PCOS. The cutoff points for the final BMI were 27.5 kg/m2 for the drug group and 26 kg/m2 for the surgical group. Overall, nearly 95% of patients with an endpoint BMI below the cutoff values achieved complete remission.

Conclusion: Complete remission of PCOS in patients with obesity depends on the final BMI after weight loss. Thus, bariatric surgery should be prioritized for these patients.

Keywords: TWL; bariatric surgery; obesity; polycystic ovary syndrome; weight loss.

Figure 1.

Flowchart of the study participants.

Figure 2.

Changes in clinical and hormonal indicators. (A) Weight, (B) BMI, (C) SHBG, (D) FAI, (E) MaxOV, and (F) the percentage of patients with over 12 follicles. Abbreviations: BMI, body mass index; FAI, free androgen index; MaxOV, maximum ovarian volume; SHBG, sex hormone–binding globulin.

Figure 3.

Subgroup analysis of the endpoint. (A) The proportion of patients in remission or nonremission. Comparison of patients in or out of remission regarding (B) BMI, (C) FAI, (D) MaxOV, and (E) the percentage of patients with over 12 follicles. (F) The proportion of patients menstruating each month during the follow-up. (G) Kaplan-Meier curves for the cumulative proportion of patients with regular menstruation. Abbreviations: BMI, body mass index; FAI, free androgen index; MaxOV, maximum ovarian volume.

Figure 4.

ROC curve for the drug and surgical groups. (A) Drug group, (B) Surgical group. As a reference, a curve with an AUC of 0.5 has been plotted (dashed line). Abbreviations: AUC, area under the curve; ROC, receiver operating characteristic.

Figure 5.

Subgroup analysis based on the cutoff values. Comparison of patients over the cutoff value of BMI in the drug group for (A) complete remission rate, (B) TWL, (C) FAI, (D) MaxOV, and (E) the percentage of patients with over 12 follicles, and in the surgical group for (F) complete remission rate, (G) TWL, (H) FAI, (I) MaxOV, and (J) the percentage of patients with over 12 follicles. Abbreviations: BMI, body mass index; FAI, free androgen index; MaxOV, maximum ovarian volume; TWL, total weight loss.