Predicting Menstrual Recovery After Laparoscopic Sleeve Gastrectomy in Polycystic Ovary Syndrome Women With Obesity

Abstract Objectives: To investigate the recovery of menses in polycystic ovary syndrome (PCOS) women with obesity after laparoscopic sleeve gastrectomy (LSG), and to explore the predictors for menstrual recovery. Methods: A total of 88 PCOS patients with obesity and 76 control patients with obesity aged 18-45 years were enrolled between May 2013 and December 2020. Preoperative clinical characteristics, metabolic parameters and sex hormones were collected. Postoperative menstrual status, body weight and use of oral contraceptives were obtained through telephone follow-up. Results: Patients with PCOS were followed up for at least six months after surgery, and the mean follow-up time was 3.23 years. About 24.66% of patients with PCOS started their first menstruation after LSG within 7 days, and 79.52% patients had regular menstruation at six months after LSG. In logistic regression analyses, duration of PCOS ≤4.5 years (P=0.007), number of preoperative menstruation per year >4.0 times/year (P=0.045), homeostatic model assessment of insulin resistance (HOMA-IR) ≤7.3 (P=0.020) and total testosterone (TT) ≤1.5 nmol/L (P=0.029) at baseline were significantly associated with menstrual resumption in PCOS patients within 6 months after LSG. After adjusting confounders, combination of four clinical indices at baseline could effectively predict menstrual recovery in PCOS patients within 6 months after LSG (AUC=0.837, [95%CI: 0.735-0.939], P<0.001). Conclusion: Overall, the combination of PCOS duration, menstruations per year, HOMA-IR and TT at baseline could be used as an effective tool for the prediction of menstrual recovery in PCOS patients within 6 months after LSG, which can be applied in preoperative evaluation.