Bariatric Surgery Can Improve Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) affects millions of women worldwide.¹

Over the past few decades, it has become apparent that PCOS is a reproductive issue as well as a complex hormonal and metabolic condition that carries with it weight gain, insulin resistance, and fertility challenges. It can be even more complex in populations who are overweight or obese.

For those considering bariatric surgery, there may be light at the end of the tunnel.

The Link Between PCOS and Obesity

PCOS is a disorder in which the body produces higher-than-normal levels of androgens (e.g., testosterone), creating a hormone imbalance. This imbalance can cause ovarian cysts, disrupt ovulation, and lead to irregular menstrual cycles. While PCOS can affect women of all body types, research shows that it’s amplified by obesity.

Studies estimate that between 38% and 88% of women with PCOS are overweight or obese, depending on the population studied.² Obesity exacerbates core features of PCOS, including insulin resistance, hyperandrogenism, and reproductive dysfunction. Insulin resistance causes the pancreas to produce more insulin, which in turn stimulates the ovaries to produce more testosterone. Elevated testosterone disrupts normal ovulation, contributing to irregular periods and difficulties conceiving.³

PCOS and Weight Loss Surgery

Weight loss surgery can be transformative in more ways than one, including a positive influence on PCOS and fertility. A reduction in body weight from procedures like gastric bypass or sleeve gastrectomy is one side of the coin. On the other side is improvement in obesity-related comorbidities that favorably modify insulin sensitivity, normalize hormone levels, and restore ovulation. Even modest weight loss, at least 5% or more, can improve menstrual regularity and increase the likelihood of conception in women with PCOS.⁴

Bariatric surgery can reverse hormonal dysregulation, sometimes quite rapidly and within months of surgery. Insulin levels begin to drop, and the body’s response to glucose improves. As insulin resistance decreases, the overproduction of ovarian androgens diminishes, restoring hormonal balance. Menstrual cycles tend to become more regular, and fertility can skyrocket, so much so that contraceptive use is a major conversation in the pre-op phase.

Weight loss surgery is not a cure for PCOS – it addresses obesity-driven aspects of the condition, but underlying genetic or hormonal factors might still require ongoing management. Post-operative lifestyle modifications, including balanced nutrition and regular physical activity, are also critical for long-term success with weight loss, hormone regulation, and future pregnancies.

Importance of Birth Control Post-Op

Because fertility can improve rapidly after weight loss surgery, healthcare providers strongly recommend avoiding pregnancy for 12 to 18 months post-procedure, and sometimes up to 24 months.

Most post-op weight loss happens in the two years following surgery. Your body is also adjusting to significant metabolic changes and absorbing fewer calories, increasing your risk of nutrient deficiencies that can affect both maternal and fetal health.

Using effective contraception is essential. Non-oral contraceptives, like IUDs, implants, patches, rings, or injections, are more reliable post-surgery than oral routes. That’s because changes to the digestive system can prevent birth control pills from entering the bloodstream at effective rates.

Many experts recommend using two forms of birth control, hormone-based and secondary (e.g., condoms and diaphragms), to ensure protection while your body stabilizes. During this period, many patients notice increased energy, improved confidence, and a renewed sense of vitality, which can make intimacy more enjoyable. You can embrace these positive changes safely and prepare for pregnancy when the timing is right with some proactive family planning.

PCOS and GLP-1 Medications

GLP-1 is a naturally occurring hormone within the digestive tract that helps regulate blood sugar, slow gastric emptying, and promote a sense of fullness. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are another tool in the arsenal for managing obesity, either before surgery to optimize weight and metabolic health, or afterward in select patients needing additional support.

GLP-1 RAs may also influence reproductive hormones. Animal studies suggest they can stimulate gonadotropin-releasing hormone (GnRH) release, enhance luteinizing hormone (LH) secretion, and support ovarian follicle maturation – mechanisms that could help improve menstrual regularity and fertility in women with PCOS.⁴

However, GLP-1 medications are not recommended as safe during pregnancy. Discontinuation before conception is required, as exposure has been linked to higher risks of excess gestational weight gain, preterm delivery, gestational diabetes, and hypertensive disorders of pregnancy.⁵

GLP-1 RAs represent a promising complement, or in some cases, a bridge, to bariatric surgery. But because of these risks, women planning pregnancy must coordinate closely with their healthcare team to time discontinuation safely while still reaping preconception benefits.

The Road Ahead

Deciding to pursue bariatric surgery is a choice that touches nearly every part of your life.

Before surgery, many women with PCOS and obesity face a complex interplay of metabolic challenges: insulin resistance, elevated androgens, irregular cycles, and fertility struggles. These issues often exist alongside comorbidities like type 2 diabetes, high blood pressure, sleep apnea, and cardiovascular risks. It’s a lot to navigate, and the path forward can feel overwhelming.

That’s where a thoughtful, in-depth conversation with a weight loss specialist like Dr. Higa can make all the difference. By exploring your health history, goals, and concerns with a trusted provider, you can develop a roadmap that addresses both the immediate weight loss benefits of surgery and the long-term management of conditions such as PCOS.

Understanding and talking through what life will look like after surgery, including how your body will respond to changes in nutrition, metabolism, and hormone balance, infuses clarity and confidence into the next phase of your life, including a future pregnancy. For those considering expanding their family, these discussions are essential.

If you’re ready to explore the full picture of life before and after surgery, schedule a consultation with Dr. Higa today.

1. World Health Organization. (2026, January 22). Polycystic ovary syndrome. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome.
2. Barber, T. M., Hanson, P., Weickert, M. O., & Franks, S. (2019). Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical medicine insights. Reproductive health, 13, 1179558119874042. https://doi.org/10.1177/1179558119874042.
3. Kim, J. J. (2024). Obesity and Polycystic Ovary Syndrome. Journal of Obesity & Metabolic Syndrome, 33(4), 289–301. https://doi.org/10.7570/jomes24035.
4. Monney, M., Mavromati, M., Leboulleux, S., & Gariani, K. (2025). Endocrine and metabolic effects of GLP-1 receptor agonists on women with PCOS, a narrative review. Endocrine Connections, 14(5), Article e240529, e240529. Retrieved Feb 1, 2026, from https://doi.org/10.1530/EC-24-0529.
5. Maya, J., Pant, D., Fu, Y., James, K., Batlle, C., Hsu, S., Soria-Contreras, D. C., Shook, L. L., Mow, C., Hivert, M.-F., Thaweethai, T., & Powe, C. E. (2025). Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation. JAMA, 334(24). https://doi.org/10.1001/jama.2025.20951.