Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

The weight is over; overcoming severe hyperandrogenism in PCOS (#586)

Madeleine Haygarth 1 , Ee Mun Lim 1
  1. Sir Charles Gairdner Hospital, Perth, WA, Australia

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A 25-year-old female presented with clinical and biochemical hyperandrogenism, with associated marked increased testosterone of 13 nmol/L. Her history included obesity (BMI 36 kg/m²) and poorly controlled type 2 diabetes. She presented with facial hirsutism, progressive weight gain, and secondary amenorrhea. Elevated androgens were noted at diagnosis (Table 1). After exclusion of other causes, she was diagnosed with polycystic ovarian syndrome (PCOS) based on the Rotterdam criteria. Treatments for hyperandrogenaemia were initiated with no significant improvement (Table 2) and both pharmacological and non-pharmacological measures to obtain weight loss had been unsuccessful. She underwent Omega Loop gastric bypass in February 2021, losing 30 kg in one year, with resultant drastic improvement in hyperandrogenism (Graph 1) and resumption of menses. She naturally conceived and delivered a healthy baby in 2023 and remains off treatment with stable weight and normal androgen levels. 

Polycystic ovary syndrome affects 5-20% of premenopausal women and is a leading cause of anovulatory infertility. It is characterized by hyperandrogenism, polycystic ovaries, and oligomenorrhea. Obesity is common in PCOS, with >50% of patients affected. This exacerbates hyperandrogenism and metabolic issues including type 2 diabetes. Increased adiposity enhances ovarian androgen production and decreases SHBG, raising free testosterone. Management involves both lifestyle and pharmacological measures. Weight loss of 5-10% can significantly improve metabolic and reproductive outcomes, reducing serum testosterone and restoring ovulatory cycles. Bariatric surgery offers sustained weight loss, significantly improving hormonal and metabolic abnormalities, resolving menstrual disturbances, and enhancing fertility. Studies show that bariatric surgery can lead to substantial reductions in insulin resistance and androgen levels, often resulting in the complete resolution of PCOS features and improved reproductive outcomes. 

Take-home

Severe hyperandrogenaemia in PCOS is rare.  

Obesity exacerbates the endocrine and metabolic abnormalities associated with PCOS 

Weight loss can significantly lower serum testosterone levels in obese women with PCOS. 

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