OR15-04 Impact of Metabolic Surgery on PCOS, Irregular Menses, and Hyperandrogenism during Adolescence

Abstract Disclosure: M.R. Gaddam: None. S. Jang: None. H. Vanden Brink: None. S. Ha: None. T. Jenkins: None. J.R. Ryder: None. T. Inge: None. L.C. Torchen: None. Objective: Studies in adult women with polycystic ovary syndrome (PCOS) who undergo metabolic surgery (MBS) suggest that PCOS symptoms of hyperandrogenism (HA) and irregular menses (IR) often resolve following post-surgical weight loss. However, there is little available evidence on reproductive outcomes in adolescents following MBS. This study investigates the pre-surgical prevalence, weight loss trajectories, and reproductive outcomes of PCOS as well as isolated IR or HA in adolescents undergoing MBS. We assess whether pre-surgical PCOS status is associated with differences in reduction in body mass index (BMI) or timing of BMI nadir, as well as reproductive outcomes following surgery. Methods: We used data from the Teen-LABS longitudinal adolescent bariatric cohort for analyses. Reproductive phenotype data was available on 155 girls prior to MBS. PCOS was defined by IR and clinical or biochemical HA. Girls with isolated IR or HA were categorized as PCOS risk (PR). Girls with neither IR or HA were categorized as normal (NL). Outcomes included reduction in BMI, the time to BMI nadir, and changes in PCOS symptoms (IR or HA) assessed at 1-year post-surgery, BMI nadir, and peak BMI following weight regain. Maximum post-surgical follow-up time was 120 months. Timepoints at which adolescents were taking medications known affect PCOS symptomology were excluded from the analysis. Group differences were evaluated using the Kruskal-Wallis test, while descriptive statistics captured subgroup prevalence and characteristics. Results: Prior to MBS, 23.8% had PCOS, 53.5% PR, and 22.8% NL. BMI reduction at weight nadir was comparable across groups (PCOS -16.7±6.0 kg/m2; PR -16.6±6.8 kg/m2; NL -15.2±6.4 kg/m2; p = 0.52). Time to BMI nadir was also similar (PCOS 47.5±36.0; PR 38.8±34.4; NL: 37.61±37.6 months; p = 0.47). At 1 year, 41% of PCOS participants at baseline had improvement in HA or IR (improvement), 23% had normalization of HA and IR (remission), and 35% experienced persistence of both. In those with PR at baseline, 36% improved and 61% had persistence. At BMI nadir, 58% of PCOS at baseline improved, 11% had remission, and 32% persisted, while PR at baseline showed 29% improvement, 59% persistence, and 12% worsening. At peak BMI following weight regain, 33% with PCOS at nadir improved and 67% were stable. For those with PR at nadir, 15% improved, 65% persisted, and 20% worsened. Conclusion: Girls with PCOS or PR had BMI reduction comparable to reproductively normal girls following bariatric surgery. The majority of PCOS had an improved reproductive phenotype at BMI nadir, but rates of remission were lower than the nearly 80% remission rates reported in adult women with PCOS following MBS. These preliminary findings warrant further investigation into contributing factors, such as metabolic, hormonal, and psychosocial influences that may moderate the relationship between PCOS and MBS response. Presentation: Sunday, July 13, 2025