Obese women often stop getting their periods, but new research suggests weight-loss surgery can help regulate their monthly cycles, while also stemming excessive hair growth and skin problems that often accompany significant weight gain.
"Obesity is a huge problem," said study author Chandhana Paka, a fellow in minimally invasive gynaecological surgery at Stanford University School of Medicine. "We wanted to see if bariatric surgery [weight-loss surgery] was a solution to helping restore menstruation in morbidly obese women whose periods have become irregular or disappeared."
She said hormonal changes that occur when women reach a high body-mass index (BMI) - production of more male hormones, for example - can lead to menstrual disturbances. BMI is a calculation based on weight and height.
How the study was done
Paka, who was a resident at St. Luke's-Roosevelt Hospital Center in New York City when she conducted the study in 2008 and 2009, and her colleagues were scheduled to present their research this week at the annual meeting of the American College of Obstetricians and Gynecologists, in San Diego.
For the study, the scientists monitored 126 women planning to undergo bariatric surgery, which involves reducing stomach size to help patients cut back on food intake in order to reach a healthy weight.
The women were between 18 and 49 years old, and not yet in perimenopause, the time approaching menopause. Their average age was 39, Paka said.
The average BMI of the study participants was 46, well over the normal range of about 18 to 24, said Paka. Prior to surgery, 52% said they had regular periods; 39% reported irregular periods and 22% reported no periods.
Twelve months after surgery, Paka said, the average BMI was down to 33, and 99% who had previously reported irregular menses had started having regular periods again. Close to 82% of previously amaenorrheic women (those having no periods at all) had started having regular menses, too.
What the study found
"We saw women who within a month after surgery were having their periods again. The majority of obese women who had irregular or no menstruation before surgery reported regular monthly periods after surgery," said Paka. "We were surprised to see how fast that can happen."
She said many also experienced a reduction in excess hair growth, hair loss (alopecia), acne, and a skin condition called acanthosis nigricans - a darkening that can appear in the folds of the skin, around the neck and underarms, for example.
Dr Thomas Price, an associate professor of reproductive endocrinology and fertility at Duke University Medical Center in Durham, NC, said the findings aren't surprising.
"All of the results are easily explainable by the hormone changes associated with weight loss," he said. He explained that as weight loss occurs, hormonal balance improves.
Problems with a high BMI
Price said the study doesn't touch on the other health problems associated with a high BMI. "It doesn't get into the increase in hypertension that goes along with obesity, the increase in arthritis because of trauma to the joints, the increase in sleep apnea that can lead to hypertension and heart disease. The risk for endometrial cancer goes up. There's no joking around with the risks associated with obesity," he said.
"There is not a downside to weight loss through bariatric surgery," Price added, but he noted that women wishing to get pregnant should discuss how long to wait post-surgery before trying to conceive. Sometimes a year's wait is recommended, he said. He also said health insurance doesn't always cover the procedure.
Paka pointed out that bariatric surgery is not necessarily a solution for overweight women with fertility issues, but it's one avenue women can discuss with their obstetricians. Diet and exercise are always an ideal approach to weight reduction, Paka added.
She said an obstetrician/gynecologist is often the only physician a woman sees regularly, and preventive care - which includes helping patients reach a healthy weight - needs to be tackled by the OB/GYN.
"If the gynaecologist is the gatekeeper of a woman's health, that means it's our responsibility to say, 'Hey, you're having some problems with your weight. Are you exercising enough? Are you eating well?' said Paka. But sometimes so many illnesses are occurring at the same time, she added, "that though I don't think it should be what we run to, bariatric surgery is an option that needs to be available."
Data and conclusions presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.
Why do we get periods?
The U.S. National Library of Medicine has more about weight-loss surgery.
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