A 5 to 10 per cent weight loss could help improve health issues associated with PCOS, according to gynaecologist Tan Thiam Chye
Weight and polycystic ovary syndrome are closely associated, with each influencing the other. PHOTO: GETTY IMAGES
Weight gain and obesity, irregular menstrual cycles, acne and infertility are some signs and symptoms of polycystic ovary syndrome, or PCOS. Data from the World Health Organization (WHO) suggests that approximately 116 million women (3.4 per cent) are affected by PCOS globally and around 10 to 15 per cent of women in Singapore have this condition.
The exact cause for PCOS is unknown, says Dr Tan Thiam Chye, consultant obstetrician and gynaecologist at Mount Elizabeth Novena Hospital. What doctors do know is that it is a metabolic condition caused by high insulin resistance and related to increased levels of the male hormone androgen.
The excess androgen can also lead to excessive facial and body hair, thinning of hair on the head, deepening of the voice, and decreased breast size, notes Dr Tan. Very often, there are no symptoms at all, which means the condition can go undiagnosed well into adulthood.
In recent years, the correlation between PCOS and excessive weight ( a body mass index of 25 and above) has also come to the forefront, notes Dr Tan, highlighting the importance of weight loss to effectively manage this condition.
The link between PCOS and weight
While a few factors can contribute to PCOS, such as genetics, high levels of insulin or insulin resistance, PCOS and weight are closely intertwined, with each influencing the other.
Dr Tan explains: “Just like it is hard to determine which came first, the chicken or the egg, doctors have not determined definitively if PCOS causes metabolic issues or vice versa. However, we know with certainty that weight gain and obesity worsen PCOS and cause irregular periods.”
For those with excess weight around the waistline, this could contribute to insulin resistance and impair the body’s ability to effectively use insulin. This, in turn, could further promote weight gain and metabolic issues, hindering weight-loss efforts, and even heightening the risk of Type 2 diabetes.
Adds Dr Tan: “Diabetes and endometrial (womb) cancer risk are increased in those with PCOS in the long term, and we monitor for these two conditions closely.”
The silver lining? Even a 5 to 10 per cent weight loss can improve ovulation, fertility and menstrual cycles in those who have PCOS, according to studies, says Dr Tan.
How is PCOS diagnosed?
According to Dr Tan Thiam Chye, PCOS can be diagnosed clinically with blood tests and/or a pelvic ultrasound.
“The ultrasound will show small cysts in one or both ovaries, also known as polycystic ovaries. Blood tests will show hormonal imbalance and high anti-mullerian hormone (AMH) levels,” he explains.
These cysts are fluid-filled sacs of immature eggs that were not ovulated due to elevated levels of male sex hormones.
Strategies for weight management
As weight loss is an important aspect of PCOS management, diet combined with exercise is important.
Prioritise whole foods such as whole grains, lean proteins, fruits, vegetables and healthy fats, advises Dr Tan. These are nutrient-dense and provide essential vitamins and minerals while promoting fullness.
Limit processed foods and added sugars as these can contribute to weight gain and insulin resistance, he adds.
Include cardiovascular exercises to elevate the heart rate and burn calories through activities such as brisk walking, running, cycling and swimming. Strength training also helps to build lean muscle mass that can increase one’s resting metabolism.
Stress can also impact hormonal balance and exacerbate PCOS symptoms, cautions Dr Tan, who recommends meditation, deep breathing exercises, and making self-care a priority.
When the symptoms of PCOS are severe, medical intervention is sometimes needed.
Dr Tan explains: “Key-hole surgery (laparoscopy) and ovarian drilling (removal of the ovarian cysts) can help to rectify the polycystic ovaries. This has been shown to improve ovulation in 80 per cent after surgery.
“Ovulation medications can also improve fertility, as can hormonal medications. There are also pills to regulate menses. Metformin helps to reduce insulin resistance and improve menstrual cycles and ovulation.”
There is a new class of medication called glucagon-like peptide-1 receptor agonists (GLP-1 RAs) that may be effective in reducing weight in women with PCOS with a body mass index of above 27 kg/m2 by 5 to 10 per cent in 16 weeks, he says.
These findings are based on a 2022 study1 conducted by the Woman’s Hospital Research Center in Louisiana, in the United States, and supported by global healthcare company Novo Nordisk.
The 32-week survey included 82 women, who were obese and had PCOS, aged 18 to 45. Some were randomly assigned to take GLP-1RA once daily with lifestyle interventions, while the others were given a placebo.
The study found that more than half the participants in the group who took GLP-1RA once a day with lifestyle interventions achieved at least a 5 per cent weight reduction. This was 75 per cent higher compared with the participants who were on the placebo.
“GLP-1RAs support weight loss by reducing hunger and increasing satiety – food intake decreases as a result,” explains Dr Tan. “This treatment significantly improves the regularity of periods in women with PCOS.
“Menses occurrence was also significantly increased with significant reduction in the amount of excess male sex hormones being produced, and the GLP-1RA also improved blood glucose levels.”
Patients may experience some common side effects such as nausea, vomiting, diarrhoea and constipation.
Dr Tan cautions that the GLP-1 class of drugs is not recommended for those who have a personal or family history of medullary (soft-tissue) thyroid cancer, multiple endocrine neoplasia (tumours), are allergic to any ingredients in the drug, are pregnant, or trying to conceive.
“We have seen improvements in PCOS patients with proper weight management. Ultimately, it’s up to you to take charge of your health, so speak with a doctor first about the best course of treatment,” advises Dr Tan.
1Liraglutide 3 mg on weight, body composition, and hormonal and metabolic parameters in women with obesity and polycystic ovary syndrome: a randomized placebo-controlled-phase 3 study Elkind-Hirsch KE, Chappell N, Shaler D, Storment J, Bellanger D. Liraglutide 3 mg on weight, body composition, and hormonal and metabolic parameters in women with obesity and polycystic ovary syndrome: a randomized placebo-controlled-phase 3 study. Fertil Steril. 2022;118(2):371-381. doi:10.1016/j.fertnstert.2022.04.027