Dr. Sophia Yen, MD

Despite the name, not everyone with polycystic ovarian syndrome develops cysts on their ovaries. It is also possible to have ovarian cysts without having PCOS. The symptoms of polycystic ovarian syndrome are actually related to insulin resistance, a condition where the insulin made by the body is not effectively recognized by the cells. This causes the pancreas to release higher levels of insulin in order to keep blood sugar levels stable, and the excess insulin interferes with hormone production in the pituitary and ovaries, causing the PCOS symptoms.

The symptoms of PCOS include:

• Weight gain
• Acne
• Facial or body hair
• Thinning head hair
• Missing or irregular periods
• Infertility

PCOS is a syndrome, which means that if patients have PCOS, they might not have each and every symptom. Even a few of them might be enough to have physicians check for polycystic ovarian syndrome. A doctor might perform an exam and order blood tests to measure hormone levels.

Treatment for PCOS may include:

• Insulin sensitizers, which help the body use insulin more effectively, lowering hormone levels. The most commonly used insulin sensitizer is metformin.
• Weight loss. Being overweight does not cause PCOS, and PCOS can make losing weight difficult. Still, weight loss can improve symptoms for many women.
• Birth control pills to regulate menstruation and sometimes reduce symptoms such as acne.
• Fertility medications, especially medications to stimulate ovulation such as clomiphene.
• Anti-androgen medications, which work to treat symptoms such as acne and facial hair.
• Low-carb diets, which work similarly to insulin sensitizers to lower hormone levels and help reduce weight.
• Ovarian drilling or resectioning, surgical procedures sometimes performed if infertility is a persistent problem. These procedures open up the wall of the ovary to temporarily make ovulation more likely.

Polycystic ovarian syndrome is one of the most common endocrine disorders affecting women. Left untreated, it can increase the risk of diabetes, heart disease, and certain cancers. Fortunately there are many good treatment options available.

By far the most common of the gastric bypass surgeries is called Roux-en-Y. During this surgery, part of the stomach and small intestine are detached from the gastrointestinal tract, in order to make the tract smaller. The surgeon divides the stomach into two parts. The working stomach, at the end of the esophagus, is now tiny - only the size of a walnut. This makes patients feel full after eating a small amount of food. Then the small intestine is also divided, and after bypassing a section of the small intestine to reduce food absorption, the intestine is attached to the small stomach pouch. The patient now has a working stomach and intestine like before, only much smaller.

Because gastric bypass is used to treat extreme obesity, it can reduce the risk of some of the problems associated with obesity. Gastric bypass can help treat or reduce the risk for such conditions as heart disease, high blood pressure, sleep apnea, and type 2 diabetes. However, it is a major surgery and also carries risks itself. Any surgery can lead to infection, bleeding, or blood clots, and weight loss surgery in particular carries risks of leaks in the gastrointestinal system, malnutrition, bowel obstructions, and vomiting.

Typically patients are considered candidates for gastric bypass surgery if they have a BMI greater than 40, or sometimes if they have a BMI between 35 and 40 but are suffering from obesity-related illnesses such as diabetes. The outlook is generally good, with most patients losing between 50-75% of their excess weight in 1-2 years. However, patients must follow strict diet guidelines so that the stomach can heal, starting with no food at all, then followed by a liquid diet for some time. For many severely obese patients who have tried strict diets before without success, gastric bypass surgery is the tool that allows them to finally achieve their weight loss and health goals.