Managing weight issues in women with PCOS

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Obesity in the setting of polycystic ovary syndrome (PCOS) can be challenging to treat, according to a presentation at the 2019 American College of Obstetricians and Gynecologists annual clinical and scientific meeting in Nashville.

“However, obese women with irregular cycles do not always have polycystic ovary syndrome,” said Christina Boots, MD, an assistant professor of reproductive, endocrinology and infertility at Northwestern University in Chicago. “There can certainly be other reasons for anovulation. Therefore, it is really important that we do not judge the book by its cover, per se, before investigating a bit further.”

For instance, women with obesity can have hypothalamic dysfunction that is not related to PCOS.

A full two-thirds of reproductive-aged women in the United States are overweight and one-third of them are obese. In addition, between 10% and 15% of reproductive-aged women have PCOS, with a preponderance among obese women.

PCOS is a complex endocrinologic disorder with a broad diagnostic spectrum. “Lots of women fall into these criteria,” said Dr. Boots, including some women with normal body mass index (BMI). These women with lean PCOS have high androgens levels and are more prone to gain weight than those without PCOS.

Risk factors affecting long-term health, such as diabetes, also are similar in lean and obese women with PCOS. 

Women who are obese or overweight should be treated with sensitivity, empathy, thoughtfulness and support. “Definitely weight loss can be effective in improving some of their outcomes, such as menstrual cycles and hyperandrogenism, that go along with PCOS,” Dr. Boots told Contemporary OB/GYN. “But in addition to merely losing weight, there is a healthier version of overweight by focusing on healthy nutrition and physical exercise, In other words, not all obese is unhealthy. There is a way to be healthy and overweight at the same time.”

Concentrating on small steps toward improvement can reap meaningful benefits. “Every decision made to decrease the amount of white carbohydrates eaten as opposed to a multigrain or a smaller portion size contributes in helping to optimize reproductive health,” she said.

In reality, healthy nutrition is not a complicated concept, according to Dr. Boots. “Half of your plate should be vegetables and the other half lean meats and/or multigrain,” she said. “In contrast, French fries, white potatoes, white pasta, and white rice provide no added health value and can hurt our insulin resistance, so try to cut those out.”

Losing a mere 5% to 10% of body weight will help some obese women with PCOS to regain their menstrual cycles and may result in pregnancy.

“Although studies conclude that physical activity and exercise are not as important as diet in the action of weight loss, they are paramount in maintaining any weight loss,” Dr. Boots said. “In short, we need to change the whole culture around eating and exercise.”

Physical activity can start as modest as using a standing desk, taking the stairs instead of the elevator or walking around the block after dinner.

Other ways to help these women lose weight is by setting up an appointment with a nutritionist or perhaps a psychologist. “We know that PCOS and obesity, independently, increase the risk of depression, anxiety and issues with body image,” Dr. Boots said. “It is important that we are empathetic about the struggles these women endure and that we are here to help them. We just want them to be healthy.”

Disclosures:

Dr. Boots reports no relevant financial disclosures.