PCOD and Obesity

The polycystic ovary syndrome (PCOS) is a condition characterized by hyperandrogenism and chronic oligo-anovulation. However, many features of the metabolic syndrome are inconsistently present in the majority of women with PCOS. Approximately 50% of PCOS women are overweight or obese and most of them have the abdominal phenotype. Obesity may play a pathogenetic role in the development of the syndrome in susceptible individuals. In fact, insulin possesses true gonadotrophic function and an increased insulin availability at the level of ovarian tissue may favour excess androgen synthesis. Obesity, particularly the abdominal phenotype, may be partly responsible for insulin resistance and associated hyperinsulinemia in women with PCOS. Therefore, obesity-related hyperinsulinemia may play a key role in favouring hyperandrogenism in these women. Other factors such as increased estrogen production rate, increased activity of the opioid system and of the hypothalamic-pituitary-adrenal axis, decreased sex hormone binding globulin synthesis and, possibly, high dietary lipid intake, may be additional mechanisms by which obesity favours the development of hyperandrogenism in PCOS. Irrespective of the pathogenetic mechanism involved, obese PCOS women have more severe hyperandrogenism and related clinical features (such as hirsutism, menstrual abnormalities and anovulation) than normal-weight PCOS women. This picture tends to be more pronounced in obese PCOS women with the abdominal phenotype.

Body weight loss is associated with beneficial effects on hormones, metabolism and clinical features. A further clinical and endocrinological improvement can also be achieved by adding insulin-sensitizing agents and/or antiandrogens to weight reduction programmes. These obviously emphasize the role of obesity in the pathophysiology of PCOS.

The relationship between PCOS and obesity is a complicated one. Experts still are not certain whether PCOS makes it easier for a woman to put on weight, or if the extra weight causes a woman to develop PCOS. Not all women who have PCOS are obese, and not all obese women have PCOS. Studies are still necessary to sort out this relationship.

Every woman’s metabolism is unique. Our bodies process fats, calories and sugar differently. This is true of women with PCOS as well. Many women with PCOS eat a healthy diet and exercise religiously, but still have a problem with weight. Obviously, this is not a simple issue of caloric intake and lack of adequate activity. There is something about the way that their bodies process the food and calories that they consume which makes it difficult for them to maintain a healthy weight. This is incredibly frustrating. Some researchers have theorized that this phenomenon is a result of insulin resistance, which is very common in women with PCOS.

What Does Insulin Resistance Have To Do With It?
Insulin is a hormone produced by beta cells in the pancreas in response to levels of glucose in the blood. When there is glucose that is not being used, insulin stimulates the storage of glucose in the liver and muscle cells as glycogen, a more complex carbohydrate molecule. Once the maximum amount of glycogen has been reached, insulin next converts excess glucose into fat. Excess fat, of course, leads to excess weight.

Insulin resistance is frequently associated with PCOS; some studies suggest that as many as 70% of women with PCOS are affected by this issue. This occurs when the body has consistently high levels of sugar. The pancreas needs to secrete greater and greater amounts of insulin in order to keep blood sugar regulated. Eventually, the cells no longer respond to insulin and glucose begins to build up in the blood, leading to diabetes.

Will Losing Weight Improve Fertility or Other PCOS Symptoms?
Studies have shown that as little as a 10% weight reduction can be effective in restoring regular ovulation and menses. This can help reduce the level of androgens in your body and may even help reduce your symptoms and make infertility treatment more effective. Regular exercise has also been shown to reduce symptoms of depression and improve the quality of your sleep as well.

Weight Management in Women With PCOS
Lifestyle changes are your first option for weight loss. Make exercise a priority by scheduling 30 minutes to walk each day for 4 to 5 days every week. Cut back or eliminate simple sugars and eat lots of fruits, vegetables, lean protein and whole grains. Be mindful of how you are preparing your food -– bake or broil instead of frying, and be sparing of oil or butter, for example. Try having a salad or a big glass of water 15 minutes before each meal –- it may help fill you up so you eat less.

If you have made these changes and have been unsuccessful, you may consider taking medication or having gastric bypass surgery as an aid to your weight loss plan. Currently, a variety of weight loss supplements and diet drugs are available over the counter. Prescription medications such as Meridia and Orlistat have been successful for many women with a lot of weight to lose. However, you should not take any prescription or over-the-counter supplements without discussing it with your doctor first due to the risk of health problems associated with these drugs.

It is extremely important to talk not only to your family practitioner but also a specialist in weight loss about the risks and benefits of taking medication or having gastric bypass surgery. Many options are available, and you should find the one best suited for you and your situation.