Daniel Skubleny1, Noah J Switzer, MD1, Richdeep S Gill, MD, PhD, FRCSC1, Mark Dykstra, MD1, Xinzhe Shi, MPH2, Christopher de Gara, MD, FRCSC1, Daniel W Birch, MD, FRCSC1, Shahzeer Karmali, MD, MPH, FRCSC1. 1University of Alberta, 2Centre for the Advancement of Minimally Invasive Surgery
Introduction. Polycystic ovary syndrome (PCOS) is a common comorbidity found in obese women of reproductive age. It is associated with significant clinical manifestations of menstrual irregularities, infertility and androgen excess. Bariatric surgery has been widely proven to be a successful management strategy for morbid obesity and metabolic syndrome, but limited studies exist on its effect on PCOS. To our knowledge, we are the first to systematically review the literature and perform a meta-analysis on the impact of bariatric surgery on PCOS.
Methods. A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science and the Cochrane Library) using search terms “bariatric*, sleeve gastrectomy, gastric band*, or gastric bypass” AND “polycystic ovary syndrome, polycystic ovar*, or PCOS” was completed. All randomized controlled trials, non-randomized comparison study, and case series with greater than 5 patients were included. All human studies limited to English were included. The reference list of included studies was also checked to identify missing studies in the primary search. 593 titles were identified through primary search and 311 titles or abstracts were screened after removing duplicates. Meta-analysis was performed on polycystic ovary syndrome, hirsuitism and menstrual irregularity outcomes following bariatric surgery, but was not performed on infertility due to the limited studies available.
Results. 13 primary studies involving a total of 2130 female patients were identified. Overall preoperative mean BMI was found to be 48.1 kg/m2, which improved to 33.6 kg/m2 post-operatively. The incidence of PCOS preoperatively was 45.6%, which significantly decreased to 6.8% (P < 0.01) and 7.1% (P < 0.01) at 12-month follow up and study endpoint respectively. 56.2% of patients reported preoperative menstrual irregularity, which improved significantly following surgery, with the incidence decreasing to 7.7% (P < 0.01) and 7.1%(P < 0.01) at 12-month follow up and study endpoint respectively. The incidence of hirsuitism preoperatively was 67.0%, which decreased significantly postoperatively to 38.6% at 12-month follow up (P = 0.03) and further to 32.0% at study end (P < 0.01). Preoperative infertility rate was reported as 15.6% (n=2), which dropped to 1.6% (n=1) postoperatively at the study endpoint.
Conclusion. Bariatric surgery effectively resolves PCOS and its clinical symptomatology including hirsuitism and menstrual irregularity in obese women. More primary studies with a specific focus placed on PCOS and bariatric surgery are required to further reinforce this finding.