Obesity and weight loss in polycystic ovary syndrome

Polycystic ovary syndrome and fat distribution: the central issue?

This review discusses the role of central obesity in polycystic ovary syndrome. There is increasing evidence that intraabdominal or visceral fat is either causative or a very early effect of polycystic ovary syndrome. The clinical implications of this are discussed. The simplest technique for assessing visceral fat and monitoring treatment is to measure waist circumference rather than waist:hip ratio or body weight. Weight loss is an effective treatment even where there is only a very modest reduction. The key element in lifestyle modification is regular exercise.

Effect of long-term naltrexone treatment on endocrine profile, clinical features, and insulin sensitivity in obese women with polycystic ovary syndrome

OBJECTIVE

Evaluation of clinical and endocrine effects of naltrexone administration in obese women with PCOS.

DESIGN

Open, controlled, clinical study.

SETTING

Department of Reproductive Medicine and Child Development, Section of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.

PATIENT(S)

Ten PCOS women were studied.

INTERVENTION(S)

Women were treated with naltrexone (50 mg/day) for 6 months.

MAIN OUTCOME MEASURE(S)

Body mass index and the menstrual cyclicity during naltrexone treatment were assessed. Basal levels of LH, FSH, 17beta-estradiol (E(2)), 17-hydroxyprogesterone, total and free T, androstenedione, dehydroepiandrosterone sulfate, cortisol, sex hormone-binding globulin were evaluated before treatment and every 3 months. Progesterone levels were measured in the luteal phase during the sixth month. Gonadotropin response to GnRH administration (10 microg) and a 75-g oral glucose tolerance test were performed before and every 3 months.

RESULT(S)

Body mass index significantly decreased from 29.94 +/- 1.04 to 26.07 +/- 0.81 during treatment. The menstrual cyclicity improved in 80% of PCOS women: the mean cycle length was 40-360 days before treatment and ranged between 25 and 120 days and 28-120 days after 3 and 6 months of treatment. Plasma levels of free T, androstenedione, dehydroepiandrosterone sulfate, and cortisol significantly decreased. Fasting glucose-to-insulin ratio improved in women with insulin resistance.

CONCLUSION(S)

Naltrexone may have a beneficial effect on the clinical and endocrine-metabolic disturbances of obese PCOS women. Whether these effects are the consequences of weight loss or are due to changes in opioidergic tone is debatable.