The Lifestyle Fertility link: How Obesity is driving PCOS and Infertility in Young Women - Dr Sanjay Patil

Women and Modern Lifestyle

The modern lifestyle has led to a significant increase in overweight and obesity issues, jumping 2.5-fold from 6% to 15% over the last 40 years. Along with an increase in sedentary habits, screen time, and the need to balance work with family, women are often left with little time for regular physical activity, balanced nutrition, and adequate sleep.

In some cases, chronic stress and irregular routines may also contribute to unhealthy coping behaviors such as smoking or alcohol use, disrupting metabolic and hormonal balance.

These patterns are a contributing factor to obesity and even play a significant role in the development and progression of certain disorders. One such condition closely linked to metabolic and hormonal imbalances is polycystic ovarian syndrome, or PCOS, and it is often a key driver of infertility.

Obesity as a PCOS Trigger

PCOS is a hormonal condition affecting up to 10% of women of reproductive age, who experience irregular periods, heightened androgens, and ovaries filled with small, immature follicles. As a result, there is an increase in androgen levels, leading to acne, excessive hair growth, weight gain, and infertility.

In all this, obesity plays a major role as it triggers insulin resistance. 50% to 80% of PCOS patients experience comorbid obesity, often from insulin resistance, wherein their cells ignore insulin, leading to a spike in blood sugar and fat storage.

From there begins the vicious cycle of obesity through adipokine production by subcutaneous and visceral fat in the body. While there is a lack of clarity as to how insulin resistance originates in PCOS, there is evidence that obesity augments it.

Hidden Comorbidities in PCOS

Obesity, leading to a higher prevalence of PCOS in women, also results in additional weight gain, increasing the burden of comorbidities.

Obstructive sleep apnea (OSA), affects almost 2.2% women who suffer from recurrent episodes of complete or partial obstruction of the airway, leading to intermittent hypoxia and chronic sleep loss (Sleep Medicine Reviews, 2024). While PCOS raises the risk of OSA and weight gain, OSA disrupts hormones and boosts insulin resistance, further fueling PCOS.

These factors are not just physical, as they affect the body as well as the mind. Up to 40% of PCOS patients face depression, anxiety, and an overall negative body image. Their self-esteem is also at risk of being lowered due to these attributes that make them feel isolated and cause further hindrance in adopting healthy lifestyle changes.

In addition to this, conditions like hypothyroidism (underactive thyroid gland) and hyperprolactinemia (abnormal levels of prolactin hormone in blood) also coexist with PCOS.

Prolactin affects PCOS by inhibiting ovulation due to changes in the balance of follicle-stimulating and luteinizing hormones and increased dehydroepiandrosterone from the adrenal glands, which is a causative factor for infertility in women.

Targeted Treatment through Lifestyle Changes

Obesity and PCOS management require a more holistic approach; one that starts with treating the root cause of it. For hypothyroidism, thyroxine is used to treat and restore thyroid balance. For higher prolactin or hyperprolactinemia, cabergoline helps normalize hormones.

Apart from this, certain lifestyle changes such as a low glycemic diet, eating on time, adequate sleep, regular exercise, and medications targeted to insulin resistance, like metformin or myoinositol, are suggested.

For treating irregular periods in PCOS, cyclical oral contraceptives help regulate cycles while curbing androgens. Counselling tackles mental health, boosts body confidence, and aids in the continuity of healthy habits. These measures have shown considerable success in improving insulin sensitivity, metabolic and reproductive health, and menstrual cyclicality in women.

Overall, obesity triggered by lifestyle changes can adversely affect other functions of the body, causing conditions like PCOS.

But these conditions need to be treated holistically, and in time, lest they may lead to a higher risk of infertility, diabetes, high blood pressure, and cardiovascular disease. Even a little shift in one’s daily routine can have a lasting impact on improving metabolic and reproductive health in women.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.