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Obesity Surgery

, Volume 26, Issue 1, pp 111–118 | Cite as

Roux-en-Y Gastric Bypass Surgery in Patients with Polycystic Ovary Syndrome and Metabolic Syndrome

  • Sahruh TurkmenEmail author
  • Alebtekin Ahangari
  • Torbjörn Bäckstrom
Original Contributions

Abstract

Background

We aimed to evaluate the impact of Roux-en-Y gastric bypass (RYGB) surgery on metabolic syndrome-related variables in obese women with polycystic ovarian syndrome (PCOS).

Methods

Thirteen obese women with PCOS (Rotterdam criteria) who met the International Diabetes Federation criteria for metabolic syndrome and who qualified for RYGB were enrolled. Clinical examinations included ovarian ultrasonography and measurement of waist, hip, body mass index and blood pressure. Venous blood samples were taken at the visit before surgery to measure triglyceride, high-density lipoprotein, low-density lipoprotein, fasting glucose, glycated haemoglobin (HbA1c), serum progesterone, allopregnanolone, total testosterone and sex hormone-binding globulin (SHBG) levels. Six months after surgery, patients underwent the same examinations and provided blood samples to analyse the same variables.

Results

At 6 months after surgery, the metabolic syndrome-related variables improved in all patients, except in six patients with anovulatory menstrual cycles who still satisfied the criteria for metabolic syndrome. The metabolic variables normalised and serum progesterone and allopregnanolone levels increased in seven patients with ovulatory cycles. Testosterone and SHBG normalised in all patients at 6 months after surgery. Serum HDL and diastolic blood pressure did not change after surgery. Correlations were found among testosterone, progesterone, allopregnanolone, lipoproteins, triglyceride, fasting glucose and HbA1c levels, which was interpreted as progesterone and its metabolite allopregnanolone may contribute to metabolic abnormalities.

Conclusions

In PCOS patients, normalisation of metabolic dysfunction may be incomplete by 6 months after RYGB surgery, and the start of ovulatory menstrual cycles may indicate normalisation of metabolic dysfunction.

Keywords

Polycystic ovarian syndrome Metabolic syndrome Roux-en-Y gastric bypass Progesterone Allopregnanolone 

Notes

Acknowledgments

The authors thanks research nurse Maria Elander for her help with this study. This study was supported by Forskning & Utveckling (FOU), Landstinget Västernorrland.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1–13.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Spritzer PM. Polycystic ovary syndrome: reviewing diagnosis and management of metabolic disturbances. Arq Bras Endocrinol Metabol. 2014;58:182–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Escobar-Morreale HF. Polycystic ovary syndrome: treatment strategies and management. Expert Opin Pharmacother. 2008;9:2995–3008.PubMedCrossRefGoogle Scholar
  4. 4.
    Panidis D, Farmakiotis D, Rousso D, et al. Obesity, weight loss, and the polycystic ovary syndrome: effect of treatment with diet and orlistat for 24 weeks on insulin resistance and androgen levels. Fertil Steril. 2008;89:899–906.PubMedCrossRefGoogle Scholar
  5. 5.
    Vrbikova J, Cifkova R, Jirkovska A, et al. Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Hum Reprod. 2003;18:980–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Escobar-Morreale HF, San Millan JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab. 2007;18:266–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Diamanti-Kandarakis E. Role of obesity and adiposity in polycystic ovary syndrome. Int J Obes. 2007;31(2):S8–S13. discussion S31-2.CrossRefGoogle Scholar
  8. 8.
    Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med. 2006;119:812–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Vaggopoulos V, Trakakis E, Chrelias C, et al. Comparing classic and newer phenotypes in Greek PCOS women: the prevalence of metabolic syndrome and their association with insulin resistance. J Endocrinol Invest. 2013;36:478–84.PubMedGoogle Scholar
  10. 10.
    Carmina E, Napoli N, Longo RA, et al. Metabolic syndrome in polycystic ovary syndrome (PCOS): lower prevalence in southern Italy than in the USA and the influence of criteria for the diagnosis of PCOS. Eur J Endocrinol. 2006;154:141–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;15:CD003641.Google Scholar
  12. 12.
    Malik SM, Traub ML. Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World J Diabetes. 2012;3:71–9.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Perez-Torres I, Guarner V, El Hafidi M, et al. Sex hormones, metabolic syndrome and kidney. Curr Top Med Chem. 2011;11:1694–705.PubMedCrossRefGoogle Scholar
  14. 14.
    Alemany M. Steroid hormones interrelationships in the metabolic syndrome: an introduction to the ponderostat hypothesis. Hormones. 2012;11:272–89.PubMedCrossRefGoogle Scholar
  15. 15.
    Netjasov AS, Vujovic S, Ivovic M, et al. Relationships between obesity, lipids and fasting glucose in the menopause. Srp Arh Celok Lek. 2013;141:41–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Golden SH, Kim C, Barrett-Connor E, et al. The association of elective hormone therapy with changes in lipids among glucose intolerant postmenopausal women in the diabetes prevention program. Metabolism. 2013;62:1313–22.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Moran LJ, Teede HJ, Noakes M, et al. Sex hormone binding globulin, but not testosterone, is associated with the metabolic syndrome in overweight and obese women with polycystic ovary syndrome. J Endocrinol Invest. 2013;36:1004–10.PubMedGoogle Scholar
  18. 18.
    Prior JC, Elliott TG, Norman E, et al. Progesterone therapy, endothelial function and cardiovascular risk factors: a 3-month randomized, placebo-controlled trial in healthy early postmenopausal women. PLoS One. 2014;9:e84698.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Kalkhoff RK. Metabolic effects of progesterone. Am J Obstet Gynecol. 1982;142:735–8.PubMedGoogle Scholar
  20. 20.
    Holmberg E, Backstrom T, Johansson M, et al. Allopregnanolone induces a diurnally dependent hyperphagic effect and alters feeding latency and duration in male Wistar rats. Acta Physiol (Oxf). 2013;208:400–9.CrossRefGoogle Scholar
  21. 21.
    Genazzani AD, Strucchi C, Luisi M, et al. Metformin administration modulates neurosteroids secretion in non-obese amenorrhoic patients with polycystic ovary syndrome. Gynecol Endocrinol. 2006;22:36–43.PubMedCrossRefGoogle Scholar
  22. 22.
    Alberti K, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med. 2006;23:469–80.PubMedCrossRefGoogle Scholar
  23. 23.
    Rotterdam EA-SPcwg, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.CrossRefGoogle Scholar
  24. 24.
    Consultation W. Definition, diagnosis and classification of diabetes mellitus and its complications: Part 1. Diagnosis and classification of diabetes mellitus. Geneva: Wold Health Organization; 1999 [publ. no. WHO/NCD/NCS/99.2].Google Scholar
  25. 25.
    Timby E, Balgard M, Nyberg S, et al. Pharmacokinetic and behavioral effects of allopregnanolone in healthy women. Psychopharmacology (Berl). 2006;186:414–24.CrossRefGoogle Scholar
  26. 26.
    Purdy RH, Moore Jr PH, Rao PN, et al. Radioimmunoassay of 3 alpha-hydroxy-5 alpha-pregnan-20-one in rat and human plasma. Steroids. 1990;55:290–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Toaff R, Toaff ME, Peyser MR. Infertility following wedge resection of the ovaries. Am J Obstet Gynecol. 1976;124:92–6.PubMedGoogle Scholar
  28. 28.
    Legro RS, Dodson WC, Gnatuk CL, et al. Effects of gastric bypass surgery on female reproductive function. J Clin Endocrinol Metab. 2012;97:4540–8.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Jamal M, Gunay Y, Capper A, et al. Roux-en-Y gastric bypass ameliorates polycystic ovary syndrome and dramatically improves conception rates: a 9-year analysis. Surg Obes Relat Dis. 2012;8:440–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:77–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Shirling D, Ashby JP, Baird JD. Effect of progesterone on lipid metabolism in the intact rat. J Endocrinol. 1981;90:285–94.PubMedCrossRefGoogle Scholar
  32. 32.
    Khokha R, Huff MW, Wolfe BM. Divergent effects of d-norgestrel on the metabolism of rat very low density and low density apolipoprotein B. J Lipid Res. 1986;27:699–705.PubMedGoogle Scholar
  33. 33.
    Chen FP, Lee N, Soong YK. Changes in the lipoprotein profile in postmenopausal women receiving hormone replacement therapy. Effects of natural and synthetic progesterone. J Reprod Med. 1998;43:568–74.PubMedGoogle Scholar
  34. 34.
    Melcangi RC, Panzica GC. Allopregnanolone: state of the art. Prog Neurobiol. 2014;113:1–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Turkmen SAL, Cengiz Y. Effects of Roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome. Gynecol Endocrinol. 2014;24:1–5.Google Scholar
  36. 36.
    Turkmen S, Backstrom T, Wahlstrom G, et al. Tolerance to allopregnanolone with focus on the GABA-A receptor. Br J Pharmacol. 2011;162:311–27.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Genazzani AD, Chierchia E, Rattighieri E, et al. Metformin administration restores allopregnanolone response to adrenocorticotropic hormone (ACTH) stimulation in overweight hyperinsulinemic patients with PCOS. Gynecol Endocrinol. 2010;26:684–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Linn ES. Clinical significance of the androgenicity of progestins in hormonal therapy in women. Clin Ther. 1990;12:447–55.PubMedGoogle Scholar
  39. 39.
    Spellacy WN, Buhi WC, Birk SA. Carbohydrate and lipid metabolic studies before and after one year of treatment with ethynodiol diacetate in “normal” women. Fertil Steril. 1976;27:900–4.PubMedGoogle Scholar
  40. 40.
    Spellacy WN, Buhi WC, Birk SA. Prospective studies of carbohydrate metabolism in “normal” women using norgestrel for eighteen months. Fertil Steril. 1981;35:167–71.PubMedGoogle Scholar
  41. 41.
    Coviello AD, Legro RS, Dunaif A. Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab. 2006;91:492–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Haffner SM, Kushwaha RS, Foster DM, et al. Studies on the metabolic mechanism of reduced high density lipoproteins during anabolic steroid therapy. Metabolism. 1983;32:413–20.PubMedCrossRefGoogle Scholar
  43. 43.
    Elbers JM, Asscheman H, Seidell JC, et al. Long-term testosterone administration increases visceral fat in female to male transsexuals. J Clin Endocrinol Metab. 1997;82:2044–7.PubMedGoogle Scholar
  44. 44.
    Lima MM, Pareja JC, Alegre SM, et al. Acute effect of Roux-en-Y gastric bypass on whole-body insulin sensitivity: a study with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95:3871–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Sahruh Turkmen
    • 1
    • 2
    Email author
  • Alebtekin Ahangari
    • 2
  • Torbjörn Bäckstrom
    • 2
  1. 1.Department of Clinical Science, Obstetrics & Gynaecology, Sundsvalls Research UnitUmeå UniversityUmeåSweden
  2. 2.Department of Clinical Science, Obstetrics & Gynaecology, Umeå Neurosteroid Research CenterUmeå UniversityUmeåSweden

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