Polycystic Ovary Syndrome
PCOS is one of the most common causes of infertility due to anovulation, which leads to obesity from hyperandrogenism and insulin-resistance or metabolic syndrome . Some studies have found a higher incidence of PCOS among women with type 1 and type 2 diabetes. Many times the condition is misdiagnosed or overlooked.
PCOS occurs when excessive male hormone is produced in the ovaries, throwing off the balance of hormones that causes a regular menstrual cycle. Common symptoms are weight gain, acne, and hair growth on the face, chest, and abdomen. The cause of PCOS is unknown but family history may be involved.
PCOS, also known as Stein-Leventhal syndrome, is an endocrine disorder that affects how a woman’s ovaries function. Cysts develop on the ovaries and the ovary does not regularly release eggs while hyperandrogenism, or excess male hormone, disrupts the normal ovulation process . Adolescent and young women who have irregular menstrual cycles and do not ovulate are inclined to gain weight and should be assessed for PCOS. Since there is no cure, medication and lifestyle changes can begin early to offset weight problems.
PCOS affects 5%—10% women of reproductive age and up to 50% of them become diabetic or prediabetic before they reach the age of 40 . Dr. Evanthia Diamanti-Kandarakis, Endrocrine Section First Department of Medicine, Medical School, University of Athens, Greece says women with PCOS may have beta cells already prone to dysfunction and insulin resistance just aggravates the problem .
Many women with PCOS have had a weight problem their entire life while others indicate it was a sudden onset. Metformin has become a treatment of choice since it may enhance tissue sensitivity to insulin. The effectiveness of metformin rests in its capacity to suppress glucose production by the liver and decrease insulin resistance in the muscle .
Metabolic disturbances are common in women with PCOS and obesity is the major link with diabetes, hypertension, and low-grade inflammation. Preventative measures of diet, exercise, and smoking cessation for weight loss are difficult to achieve with hormonal imbalance so bariatric surgery can reduce risks of morbid obesity in PCOS [78-80]. PCOS is also associated with insulin resistance and metabolic syndrome according to Caserta et al.  and it is necessary to treat excess adiposity and the insulin resistance in order to prevent cardiovascular disease.
Gastric bypass surgery achieved significant reduction in BMI, testosterone, blood glucose, and lipid metabolism in PCOS cases  and sleeve gastrectomy resolved endocrine mechanisms in a woman who did not respond to insulin sensitizing drugs for treatment of her PCOS .
A meta-analysis of 13 studies involving 2,130 female patients with PCOS has shown bariatric surgery to be a successful management strategy for morbid obesity but limited data exists on the effectiveness in symptom management of PCOS . Barber and Dimitriadis  make the association of PCOS with obesity based on genetic studies and suggest dietary modifications and exercise are important in weight loss maintenance.
Improved eating behavior for management of clinical symptoms of PCOS is stressed in two studies reviewing the need for lifestyle modification to improve success in not only weight loss but fertility and hormone levels [86,87]. Using a low-glycemic diet is important for symptom management.