Dealing with PCOS post WLS

on 7/15/15 9:48 am

This will be cross posted to the PCOS forum and general discussion.

I am writing with a heavy heart today because the PCOS I struggle with is fighting back and now my hormonal battle just got more complex.

Prior to surgery, I took Metformin and hormones to help with PCOS. I got WLS because beyond the ~20 lb loss from the metformin, I was unable to lose weight despite a low carb diet and exercising hard at the gym. 

I went off the meds and hormones for over 1 year 7 months.  Around March 2015, my endocrinologist declared my labs were normal and congratulated me for beating PCOS. I was happy but kind of had to wonder as I was still having acne, darkened skin, and hair issues..but maybe it really was something in my heritage/family tree (i.e. just being a hairy woman).

Unfortunately, despite eating low carb and a low GI diet, my Hb A1C is 5.5 (it is in the upper limit of normal; the upper threshold is 5.6). Thank god for the vets that tell people to eat protein forward/ low carb. Had I NOT been eating this way, I would certainly have been in the pre-diabetic range or at least in the "monitor closely stage".

My free and bound testerone is also high.

So now I am back on metformin.  Interestingly, Metformin seems to absorb better and have a better bioavailablity AFTER RNY as compared to non-RNY patients. So this may be the ONE drug on the planet that does better after WLS.

Effect of Gastric Bypass Surgery on the Absorption and Bioavailability of Metformin

Raj S. Padwal, MD, MSC,1 Raniah Q. Gabr, MSC,2 Arya M. Sharma, MD, PHD,1 Lee-Ann Langkaas, LPN,3 Dan W. Birch, MD,4 Shahzeer Karmali, MD,4 and Dion R. Brocks, PHD2     What I am most worried about is the progesterone and other hormones I am going to have to take. Prior to surgery, an oral birth control would have handled it. NOw, my endo is referring me to a gynocologist to get it all figured out (along with preventing pregnancy ).   It would have been easier to have a "remedy" (there is no remedy for this) to combat these symptoms had I had the slee***** WLS. To be clear, I do not regret RNY. I Love my surgery. But alternatively, it makes the treatment "landscape" so much more complicated and limiting.   While resolution of PCOS MAY occur, I knew going in it wasn't 100% thing.  I was really pleased to be PCOS free for a few months.   But I am scared and disappointed too.  I WI**** could have gone away forever, hence the disappointment.  I am scared because the last time I had a flare up, I could gain 7 lbs a week WHILE on a diet. I am afraid that I will regain my weight and have no mechanism to get it off. LIke I used my one nuke (WLS), I dont have anymore weapons in my arsenal beyond anorexia, but anorexia isn't a sane, normal option is it.   Sometimes, I really really hate my body and how it turns against me.   That is it. -SS

RNY Surgery: 12/31/2013; 

Current weight (2/27/2015) 139lbs, ~14% body fat

Three pounds below Goal!!! Yay !  

on 9/1/15 11:01 am
RNY on 04/15/15

I had my surgery on April 15/15.  I am down 92 pounds from my heaviest and 62 pounds since surgery.  I too have PCOS.  My GP recently took me off of the Metformin that I had been using for years to help control my PCOS.  He felt with all this weight loss, I didnt need it anymore.  Now I have suddenly gained 2.5 pounds in spite of eating exactly as I should and exercising.  I only get between 500-600 calories a day, and eat high protein (80-90g), low carb and low fat.  I also get between 45-60 min of exercise a day.  I am not pre menstrual.  I'm not sure what is happening.  DO you think this could be from going off the metformin?  Will it level out and start losing again?  Any suggestions?  I am only 4 and a half months out and have at least 45 pounds more to lose to get to the high end of BMI. I am feeling discouraged and would love some feedback.  Thank you.

Referral from GP- Jan 15/14, W.L.S. Orientation @ H.R.R.H.- June 30/14, Sleep Study- Apr 19/14, 1st Appt. with Surgeon (Dr Klein)- Sept 11/14, Appt. with Internist (Dr. Glazier)- Oct 7/14, Appt. with R.N./S.W./D.- Nov 18/14, 2nd Appt. with Surgeon (Dr. Klein)- Jan 5/15 , Optifast Start Date- Apr 1/15, PATTS- Mar 31/15, RNY Surgery Date- Apr 15/15

Highest Weight-278lbs, Optifast Start Weight- 257lbs, Surgery Day Weight- 248lbs, Goal Weight- 140lbs


on 9/1/15 12:35 pm

I can honestly say- I dont know.

I am stuck feeling "low" and having to eat a bit of carb at various times throughout the day to stop being foggy and having slurred speach. It really has stalled my weightloss. I am stuck at 142 and would like to get back to 139.


If you felt that it helped you...I would ask to be put back on it..but monitor your BS carefully!  I temporarily "won" the battle with PCOS but it rallied and I am back on metformin.  I am not happy about it.

RNY Surgery: 12/31/2013; 

Current weight (2/27/2015) 139lbs, ~14% body fat

Three pounds below Goal!!! Yay !  

on 10/25/15 8:47 pm

Yes it could be! Time will tell, monitor your blood sugars real tight, keep close records of diet/exercise/ all that enable wt loss. Give it two weeks, if no change...have hormones checked for PCOS "flare" for lack of a better word... Might want to do this thru GYN. Instead of wt loss surgeon or GP

on 9/4/15 3:55 am

Post op I still take a small amount of met, and diane-35, spironolactone.  If I did not I am sure I would be having the same hair issues as you.  This surgery does not cure PCOS but it does provide a tool to help manage some symptoms.  I went off met entirely for the first 6 months but was put back on a small dose just in case it would help with weight loss.  I would have loved a cure but it did not happen and that is ok.  I too worry about gaining back weight quickly, I could easily gain 20lbs in a month when it was at its worse, and that is while eating healthfully and exercising.  I had anorexia too, and bulimia, so desperate to keep my weight down, don't go there, it causes lots of other problems in the long run, if you feel you slipping ask your doctor for help with it.

on 9/16/15 7:17 am
RNY on 09/23/15 with

I too have PCOS and Diabetes. I have not had surgery yet but was hoping that PCOS would be cured. :( I was wondering if after having the surgery (I know more than 18 months out) if anyone who could not get pregnant before was able to know. I have been married 12 years and really was hoping by year 15 we would have a baby, after this surgery. I also wanted to see if the facial hair at least slows down at all. All my doctors ever put me on was 1500 ER metformin, obviously that helps sugar level and pre-diabetes, but nothing else. Any good news from anyone??


on 10/25/15 8:58 pm

The metformin is key for PCOS control. Some people are able to get pregnant without help..Facial hair does slow, but from the metformin..There is a herb used in Vietnam for this condition...It was used for one of their .a book ..something"________From the vault". have to do a search.

on 10/23/15 10:58 pm

Don't have "a heavy heart, " because you require medication to control blood sugar and PCOS.. Since you gained control of the PCOS,for a time, there is the expectation that with careful diet and tight medication compliance, It can happen again. I also can not take any extra hormones, due to other issues... at least PCOS is one thing that does resolve with menopause... for me that time is near. I still have lots of extra hair growth and the mustache, and I also have issues with blood sugar stability. So do remember , You are not the only one in this game... You are not alone.

on 4/25/18 2:28 pm, edited 4/25/18 7:29 am

Look online for Nature Way DIM, HELPS!

Read on Amazon for the reviews

SW / CW / GW 292 / 188 / 174 - Height 5'7, Size 10