Obesity and PCOS, polycystic ovarian syndrome
If women are obese, a fasting lipid profile as well as a glucose tolerance test should be performed. For women who are diagnosed with polycystic ovarian syndrome and are overweight, the first line therapy for management of the condition is weight loss.
The best diet and exercise regimens have not been standardized, although a low calorie diet with reduction of carbohydrate intake and increased physical activity are recommended. For women who are morbidly obese, there is a strong recommendation to consider the use of bariatric surgery. The ideal amount of weight loss is unknown, but clinically significant improvements in the condition has been reported with as little as a 5% decrease in overall body weight.
In most cases, treatment of the obese PCOS patient should precede ovulation induction.
Concurrent medications used to treat polycystic ovarian syndrome include insulin-sensitizing agents such as metformin. The use of metformin should be restricted to patients with demonstrated glucose intolerance. Decisions about continuing metformin during pregnancy should be left to obstetricians who are providing prenatal care. These decisions should be based on the careful evaluation of the risks and benefits – both to the patient as well as to her fetus. Almost all patients with PCOS will require treatment with some type of ovulation induction medication (clomiphene citrate or gonadotropin therapy) in addition to metformin in order to achieve ovulation and pregnancy.