The Impact of Obesity on Ovulation and the Menstrual Cycle
The impact of obesity on ovulation and the menstrual cycle was documented as early the 1600s. It was a classification of women who reported obesity, prolonged or no menstrual cycles and hyperandrogenism (excessive body hair). In these women who were obese and had hyperandrogenism, approximately 50% did not have a regular menstrual cycle. This report may be one of the first demonstrations of the effect of obesity on reproduction. We now know this condition to be polycystic ovarian syndrome (PCOS).
Weight and Irregular Menstrual Cycles
One of the fundamental biologic issues is how the body sees and utilizes glucose (sugar). If the body believes it to be in a state of starvation (inflammation), it will slow metabolism, and try to release more insulin. Insulin is a bridge that allows glucose (food) from outside the cells, into the cells where they can function. If this pathway is impaired, more insulin can be produced but the cells continue to starve, sending distress signals to the brain. Metabolism continues to slow and the weight gain continues.
This weight gain promotes menstrual cycle irregularity. The prevalence of more erratic cycles and extended cycles increase with increasing BMIs. The body fat distribution in PCOS is also key with PCOS women demonstrating more abdominal fat.
How To Improve Ovulation
Improved ovulation rates and return to menstrual regularity is associated with modest weight loss in women with PCOS. Part of this return to cycle regulation with weight loss is founded in the changes in reproductive hormones. The hormones primarily affected are LH (leutenizing hormone), which when expressed at higher, sustained levels, negatively effect the menstrual cycle, but also promote higher circulating androgens. Androgens are the male hormone and are responsible for excessive facial and body hair as well as male-patterned baldness.
For many women, it remains an uphill battle. This inflammation drives weight gain, which makes it seemingly impossible to lose. Metabolically, the body responds to distress signals which manifest in menstrual cycle irregularities. Without ovulation, there is not chance of pregnancy. PCOS is the hamster wheel of reproduction. It is here we try to help the launch from this wheel with dietary modifications such as keto-based approaches, the use of metformin and other weight loss strategies that are consistent with the body’s metabolic language.
At Fertility Centers of New England, patients come to us because they are struggling with infertility and/or miscarriages. If you have more questions about the impact of obesity on ovulation and the menstrual cycle or treatment options for polycystic ovarian syndrome (PCOS), please contact us for a free consultation.
*Your consultation is FREE if you don’t have infertility insurance coverage.