2023 Health Alert: PCOS and Obesity Are on the Rise

Regarding women’s health, the intersection of Polycystic Ovary Syndrome (PCOS) and obesity presents a profound challenge, demanding keen attention to both. Today, PCOS alone spans a staggering range of 3.7 to 22.5% in India and 6 to 26% worldwide. This is why the significance of polycystic ovary syndrome cannot be overstated. 

PCOS, a multifaceted endocrine disorder, affects millions of women globally, affecting their reproductive health and overall well-being. PCOS is characterised by a range of symptoms, including irregular menstrual cycles, excessive hair growth, and the formation of ovarian cysts. However, one of the most insidious aspects of PCOS lies in its link to obesity.

A bidirectional relationship exists between these two conditions, where PCOS can contribute to weight gain, and obesity can exacerbate the symptoms and complications of PCOS.

As we delve deeper into the connection between PCOS and obesity, this blog aims to dissect these three aspects mainly:

1. What is PCOS, and what are its symptoms?
2. How are PCOS and obesity related?
3. What are the effective treatments for PCOS and obesity?

Understanding PCOS

Polycystic Ovary Syndrome, often called PCOS, is a complex hormonal disorder that predominantly affects people with ovaries, typically during their reproductive years. It involves several key aspects of hormonal regulation and can lead to various symptoms and health challenges.

What happens when you have polycystic ovarian syndrome?

The key cause of polycystic ovary syndrome is a disruption in the normal hormonal balance, particularly insulin and sex hormones like oestrogen and testosterone. This disruption can affect the way the ovaries function.

In normal conditions, the ovaries release an egg every month as part of the menstrual cycle. These eggs develop within structures called follicles. A select few follicles are nurtured monthly, growing larger daily until one fully matures. This mature follicle then releases an egg in a process known as ovulation.

In women with PCOS, the usual sequence of events encounters some hitches. Genetic factors, environmental influences, and poor lifestyle choices can cause your body’s intricate hormonal orchestra to play out of tune.

While one of the most common hormonal disorders, here’s the science behind polycystic ovary syndrome and its symptoms like weight gain, insulin resistance, etc.

Insulin is a hormone which helps your cells to utilise sugar for energy. In polycystic ovary syndrome, your insulin doesn’t work as effectively as it should. As a result, your body responds by producing more insulin.

The excess insulin signals the ovaries to produce more androgens, male hormones. These androgens interfere with the usual development of follicles. Instead of one follicle maturing and releasing an egg, multiple follicles start developing but don’t complete the process.

These immature follicles, often termed cysts, gather in the ovaries and potentially give the appearance of multiple cysts (hence the term “polycystic ovaries”). Since these follicles don’t mature and release eggs as they should, the body experiences reproductive and metabolic abnormalities, like the menstrual cycle becoming irregular or stopping.

The disbalance of hormones in women with PCOS also leads to other complications, such as insulin sensitivity which indirectly leads to impaired glucose tolerance, cardiovascular disease, metabolic dysfunction and other risks.

Symptoms of PCOS

The hormonal imbalances in polycystic ovarian syndrome can lead to a range of symptoms and health concerns, including:

1. Irregular Menstrual Cycles: Due to disrupted follicle development, ovulation might not occur regularly. This can lead to irregular or absent periods.
2. Difficulty Getting Pregnant or Reproductive Dysfunction: Irregular ovulation can make conceiving harder.
3. Hirsutism: Elevated androgen levels can cause excessive hair growth in the face, chest, and back areas.
4. Scalp Hair Thinning: The excess androgen levels can also cause excessive hair growth in areas like the face, chest, and back in women with PCOS.
5. Acne and Oily Skin: Androgens can also stimulate the sebaceous glands in the skin, leading to increased oil production and acne.
6. Weight Gain: Insulin resistance can make you at a higher risk of weight gain, and you can also face difficulty in losing weight.
7. Acanthosis Nigricans (Darkened Skin Patches): Skin areas like the neck, armpits, or groyne become darker and thicker.
8. Insulin Resistance: Higher insulin levels due to reduced insulin sensitivity, potentially leading to prediabetes or type 2 diabetes.
9. Metabolic Concerns: Insulin resistance can increase the risk of type 2 diabetes and other metabolic syndrome in women with PCOS.

Breaking Down Obesity

Obesity is a medical condition characterised by the excessive accumulation of body fat caused due to various factors, which can negatively affect health. To measure obesity, healthcare professionals often use the Body Mass Index (BMI) tool. BMI considers both your weight and height and estimates your body fat levels. It’s a simple formula: weight in kilograms divided by height in metres squared.

Think of body mass index to determine whether your weight is appropriate for your height. If your BMI falls into the higher ranges, it suggests that you have excess body fat, which can cause chronic diseases if not addressed immediately.

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Understanding the Connection Between PCOS and Obesity

PCOS and obesity are two complex medical conditions that often coexist and interact intricately. To understand the bidirectional relationship, whether PCOS causes obesity or vice versa, it is important to understand the science behind both conditions. The role of insulin resistance and hormonal imbalances is crucial for a comprehensive grasp of how these conditions influence each other and impact overall health. 

First, let’s explore epidemiological and genetic interlinks between PCOS and Obesity:

Epidemiological Links: Epidemiological studies have consistently demonstrated a strong association between PCOS and obesity. Around 38–88% of women with PCOS are obese. Conversely, obesity can increase the risk of having PCOS by a staggering 2.4 to 7.5 times. This connection is not merely coincidental; it reflects a bidirectional relationship where each condition can exacerbate the other. Adolescents and women of reproductive age are particularly susceptible to this duo, and the prevalence tends to increase.

Genetic Ties: Peering beneath the surface, it’s evident that genetics contribute significantly to this intricate interplay. Family studies have indicated a hereditary component in both PCOS and obesity. When you dive deeper, you encounter the role of certain genes, such as those related to insulin resistance, a hallmark of both conditions. These genes are akin to signposts directing us toward a shared genetic foundation.

PCOS Leading to Obesity

As discussed previously, when someone has polycystic ovarian syndrome, their ovaries might produce higher levels of androgens (male hormones) than usual. This hormonal imbalance can lead to irregular periods, fertility issues, and the development of cysts on the polycystic ovaries. It can also affect how the body uses insulin, a hormone that helps regulate blood sugar levels. Insulin resistance can lead to higher blood sugar levels and an increased risk of developing type 2 diabetes.

Now, how does this relate to obesity? And more importantly, can PCOS cause obesity? 

Well, yes, insulin resistance can contribute to weight gain. When the body doesn’t respond effectively to insulin, it compensates by producing more insulin. This excess insulin can promote fat storage and make it harder for the body to use stored fat as energy. This can lead to weight gain, especially around the abdomen. Additionally, the hormonal imbalances in PCOS can increase appetite and make it challenging to manage cravings, further contributing to weight gain.

Now, let’s dissect how PCOS can contribute to obesity

1. Hormonal Imbalance and Insulin Resistance: As stated previously, in polycystic ovary syndrome, there is an imbalance in hormones, particularly higher levels of the male sex hormones or androgens, such as testosterone. This hormonal imbalance can lead to insulin resistance, where the body’s cells become less responsive to the effects of insulin, a hormone that regulates blood sugar. Insulin resistance can result in higher levels of insulin in the blood. Increased insulin levels can stimulate the body to store more fat, especially in the abdominal area.

2. Appetite Regulation Disruption: PCOS can affect the brain’s regulation of appetite. Insulin resistance and hormonal imbalances might lead to increased cravings and appetite. This can cause individuals with PCOS to consume more calories than their bodies need, contributing to weight gain.

3. Metabolic Changes: Research suggests that PCOS may be associated with a slower metabolic rate. This means the body burns fewer calories at rest, making it easier to gain weight and harder to lose it.

4. Inflammation: PCOS is linked to a low-grade state of inflammation in the body. This inflammation can interfere with the body’s ability to process nutrients and contribute to weight gain.

The connection between inflammation and weight gain often leads to questions like, “Is it harder to lose weight with PCOS?” as individuals seek to understand the role of inflammation in their struggle to manage weight.

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Obesity Leading to PCOS

Conversely, obesity can also play a role in developing and worsening PCOS. Epidemiological studies have shown a strong association between PCOS and obesity. The prevalence of PCOS is higher among women with obesity than those without.

Excess body fat can lead to more inflammation and further disrupt insulin sensitivity. This can exacerbate the insulin resistance already seen in PCOS. Disrupted insulin signalling can worsen hormonal imbalances, leading to increased androgen production, irregular periods, and other PCOS symptoms.

Furthermore, obesity can influence the communication between hormones regulating the menstrual cycle and ovary function. Adipose tissue (fat cells) can release hormones and chemicals that interfere with the normal hormonal balance, contributing to developing PCOS-like symptoms.

Obesity can also influence the development and exacerbation of PCOS through the following mechanisms. This helps you understand why obesity is common in PCOS:

1. Insulin Resistance and Hormonal Imbalance: Excess body fat, especially around the abdomen, can lead to insulin resistance. Insulin resistance, in turn, can disrupt the normal balance of hormones in the body, including those involved in the ovaries. This disruption can lead to irregular menstrual cycles, ovulation problems, and the development of PCOS.

2. Inflammation: Obesity triggers chronic inflammation in the body. This inflammation can affect the ovaries’ function and hormone regulation, increasing the risk of PCOS.

3. Leptin Resistance: Leptin is a hormone that plays a role in regulating appetite and metabolism. In obesity, the body might become resistant to the effects of leptin. This resistance can lead to overeating and weight gain. Leptin resistance can also contribute to hormonal imbalances associated with PCOS.

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4. Ovarian Dysfunction: Obesity can directly impact ovarian function. The excess fat tissue produces hormones that can disrupt the ovaries’ normal hormone production and ovulation process, contributing to the development of PCOS.

5. Hypothalamic-Pituitary Effects: Obesity can influence the hypothalamic-pituitary axis, crucial in regulating reproductive hormones and the menstrual cycle. The interactions between obesity and this axis contribute to the development and exacerbation of PCOS through the following mechanisms:

• GnRH Dysregulation: Gonadotropin-releasing hormone (GnRH) is released from the hypothalamus and stimulates the pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In obese women, there can be disruptions in the secretion of GnRH, which can affect the release of FSH and LH. This disruption contributes to the irregular menstrual cycles seen in PCOS.
• LH and FSH Imbalance: There is often an elevated LH-to-FSH ratio in PCOS, which can disrupt normal ovulation. Obesity can exacerbate this imbalance, as excess body fat can contribute to elevated LH levels. Women diagnosed with PCOS also undergo blood tests that measure levels of several hormones, including LH and FSH, to exclude potential causes of menstrual abnormalities or androgen excess.
• Altered Feedback Loop: Obesity-associated hormonal changes can disrupt the feedback loop between the ovaries, hypothalamus, and pituitary gland. This can lead to a self-perpetuating cycle of hormonal imbalances, further exacerbating PCOS symptoms. 

Diagnosis and Treatment of PCOS and Obesity

Diagnostic Options for PCOS

These are some of the ways by which polycystic ovarian syndrome can be diagnosed:

Pelvic Exam 

A pelvic exam is a medical procedure in which a doctor examines your reproductive organs, which include the uterus, ovaries, and surrounding structures. This examination is conducted to identify any abnormalities, masses, growths, or changes in these organs. By doing so, the healthcare provider can gain insight into your reproductive health and assess whether any physical changes indicate conditions like PCOS or other underlying concerns that align with the diagnostic criteria.

Blood Tests

Blood tests are crucial in diagnosing PCOS, obesity-related issues, and metabolic dysfunction. These tests measure various hormone levels in your blood. Hormones are chemical messengers that control numerous bodily functions, including your menstrual cycle, metabolism, and the development of male-like traits. By analysing hormone levels, healthcare professionals can rule out other potential causes of menstrual irregularities or excessive androgen levels that can mimic the symptoms of PCOS.

Also, blood tests may include assessments of fasting cholesterol and triglyceride levels, which are vital components of the diagnostic criteria. These measurements provide valuable information about your cardiovascular health, which can be impacted by obesity, a common condition that often coexists with PCOS. 

Moreover, a glucose tolerance test evaluates how your body responds to sugar (glucose). This test helps assess your susceptibility to insulin resistance, a metabolic syndrome commonly associated with PCOS and obesity. Insulin resistance can contribute to hormonal imbalances and further complicate the symptoms of PCOS.

Ultrasound

An ultrasound is a diagnostic imaging technique that utilises sound waves to create images of your internal structures. In the context of PCOS and obesity, a specific type of ultrasound known as transvaginal ultrasound is employed. This involves inserting a wand-like device, called a transducer, into the vagina. The transducer emits sound waves that bounce off your ovaries and surrounding tissues, producing detailed images on a computer screen.

Ultrasound helps healthcare providers visualise the appearance of your ovaries and assess the thickness of the uterine lining. In women with PCOS, the ovaries might appear enlarged and contain multiple small follicles, fluid-filled sacs that can contribute to hormonal imbalances. Furthermore, the ultrasound helps exclude other conditions that might resemble PCOS, such as ovarian tumours or cysts, aiding in accurate diagnosis.

Diagnostic Options for Obesity

While the above are some of the diagnoses options for PCOS, for obesity, the following diagnoses methods are used: 

BMI Index

For most adults, having a BMI of 18.5 to 24.9 is considered a healthy weight. A BMI of 25 to 29.9 is considered overweight, and a BMI over 30 is considered obese. 

Blood tests

More often than not, obesity is also due to genetic conditions – like insulin resistance and blood pressure. Patients are also often asked to undergo these examinations to rule out underlying conditions of obesity.

Treatment Options for PCOS

While there is no permanent cure for PCOS in women, here are some ways to control the symptoms of polycystic ovarian syndrome.

Lifestyle Modifications

Lifestyle modifications are the foremost treatment strategy for individuals with polycystic ovary syndrome and obesity. This approach involves targeted changes in daily habits, particularly focusing on exercise and weight management. The significance of this approach stems from its capacity to enhance insulin sensitivity, a crucial aspect of PCOS management.

Statistics from many studies reveal that lifestyle adjustments exhibit notable efficacy. For instance, 44% to 57% of women with PCOS witness improvements in their menstrual cycles or ovulation patterns following these changes, often accompanied by subsequent weight loss. 

Medications

Oral Contraceptives

Oral contraceptives, commonly known as birth control pills, are a type of medication that contains synthetic versions of female hormones, oestrogen, and progesterone. . By introducing these synthetic hormones, oral contraceptives help regulate the menstrual cycle, reducing the irregularity of periods, a common symptom of polycystic ovarian syndrome. 

They also work to decrease the luteinizing hormone and lower the levels of androgens, which can alleviate symptoms such as acne and excess hair growth. The combined effect of hormonal regulation aids in managing PCOS-related symptoms. 

Please note that it’s important to consult a healthcare professional before starting any hormonal treatment, as a contraceptive choice should be personalised based on individual health considerations.

Anti-Androgen Medications

Anti-androgen medications, like spironolactone, target the overproduction of androgens in individuals with polycystic ovarian syndrome. Spironolactone is a drug that was originally developed to treat conditions involving excess fluid retention and high blood pressure. However, due to its anti-androgenic properties, it has found use in managing PCOS-related symptoms. Regular use of this medication under the supervision of a healthcare professional, can lead to visible improvements in skin health and the reduction of unwanted hair growth.

Insulin Sensitizers (Metformin, Thiazolidinedione)

Insulin sensitizers are medications primarily used to manage insulin resistance, a common feature of PCOS. Metformin is a weight loss medication known for its use in diabetes management. In PCOS, insulin resistance can exacerbate hormonal imbalances and contribute to weight gain. Metformin helps improve insulin sensitivity, allowing cells to respond more effectively to insulin’s actions. 

By addressing insulin resistance, metformin can aid in regulating hormonal imbalances associated with PCOS, leading to improved menstrual regularity and potentially supporting weight loss efforts. Other insulin sensitisers like thiazolidinediones (glitazones) can also manage insulin resistance in PCOS, although their use may be more limited due to potential side effects. 

Note: A healthcare professional should prescribe and monitor these weight loss medications to ensure their appropriate use and benefits.

Treatment options for obesity

Since we know that obesity can also cause PCOS, here are some treatment options for obesity: 

Lifestyle modification

One of the first steps towards recovery and achieving weight reduction is adopting a healthy lifestyle and starting a regular physical activity regime. 

Weight management programs

These are weight loss programs for obese and overweight women. These programs, like Elevate Now, diagnose obesity and offer a doctor-led sustainable weight loss plan. 

Medical weight loss pills

When healthy eating and weight management programs are insufficient, doctors can prescribe medicines or pills to help with weight loss. These medicines help you regain control of your body weight and achieve sustainable weight loss. One such example is Ozempic which can help obese and overweight people undergo sustainable weight loss.

Please note that these medicines should only be taken under the guidance of your doctor, who will diagnose the underlying issue and then prescribe medications best suited for you.

Weight loss surgery

Bariatric surgery, commonly referred to as weight loss surgery, is a procedure that restricts the amount of food a person can comfortably consume or inhibits the body’s absorption of food and calories. In some cases, it performs both functions. 

This surgery is not a simple solution to weight loss; it is a significant procedure with potentially serious risks. Following the operation, those who have undergone the surgery must modify their eating habits and control their food intake, or they may face health issues.

On the other hand, nonsurgical methods may not always be effective in assisting those with obesity to lose weight and minimise associated health risks. 

Various types of weight loss surgeries are available, including:

• Gastric Bypass Surgery: A surgeon forms a small pouch at the stomach’s top, connecting it directly to the small intestine. This causes food and liquids to pass through the pouch and into the intestine, skipping most of the stomach. It’s also referred to as Roux-en-Y gastric bypass (RYGB) surgery.
• Laparoscopic Adjustable Gastric Banding (LAGB): A band divides the stomach into two pouches in this method.
• Gastric Sleeve Surgery: A portion of the stomach is removed during this procedure, leading to rapid weight loss.
• Biliopancreatic Diversion with Duodenal Switch: This technique involves the removal of most of the stomach.

Overall, bariatric surgery is a complex and individualised approach to weight loss, requiring significant lifestyle changes and careful consideration of potential risks and benefits.

Bottom Line

As discussed in this blog, it becomes evident that these two conditions, polycystic ovary syndrome and Obesity, share a complex interplay. Obesity can exacerbate polycystic ovary syndrome symptoms, while PCOS might contribute to weight gain.

There are medications and other hormonal treatments to manage the symptoms of polycystic ovary syndrome. And, if you have obesity which is the cause of your polycystic ovary syndrome, then it is important to lose weight and control your body mass index. This will help reduce the polycystic ovary syndrome symptoms.

To ensure that you don’t have PCOS and obesity, here are some habits that you can implement:

• Maintain a healthy lifestyle
• Reduce the intake of processed foods
• Exercise as much as you can, especially for obese women with PCOS
• Try and improve body fat distribution with the help of weight management strategies
• Obese women with polycystic ovary syndrome might also require medications that will help with reproductive abnormalities and sustained weight loss

To conclude, this journey towards well-being is not solely about shedding weight or treating PCOS; it’s a profound transformation that underscores the pivotal significance of lifestyle, diet, and physical activity in steering us towards lasting health and vitality.

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