Obesity and Gynecology

Description

Obesity and Gynecology, Second Edition, presents updated chapters on a variety of topics, ranging from adolescent obesity, contraception, assisted reproduction and sexual dysfunction, to bariatric surgery and improving semen parameters. The prevalence of obesity in men and women continues to dramatically increase around the world. Obesity presents specific challenges in relation to male and female infertility and general gynecology. Patients who are obese require specific considerations and knowledge. Cover Obesity and Gynecology Copyright Dedication Contents List of contributors About the editors Preface—obesity in gynaecology Section 1: Obesity and adolescence 1 Obesity and the onset of adolescence Obesity in childhood and adolescence: definition Obesity in childhood and adolescence: incidence Obesity in children and adolescents: etiology Obesity and puberty: pathophysiology Obesity and pubertal development Obesity in childhood and adolescence: clinical manifestation Obesity in children and adolescents: counseling Obesity in children and adolescents: management References 2 Obesity in adolescence Introduction Prevalence of childhood obesity: a global perspective Obesity and the pubertal transition Factors affecting childhood and adolescent obesity Adolescent obesity—adverse outcomes General Psychological effects The metabolic syndrome Polycystic ovarian syndrome in adolescence Obstetric outcomes in obese adolescents The impact of childhood and adolescent obesity on adult health Management principles Prevention Lifestyle interventions Drugs Surgery Management of polycystic ovarian syndrome in adolescence Combined oral contraceptive pills Insulin sensitizers Psychological morbidity Conclusion References 3 Obesity in polycystic ovary syndrome and infertility Introduction Obesity and infertility—possible mechanisms Hyperandrogenism Hypersecretion of luteinizing hormone Hyperinsulinemia Adipokines Leptin Adiponectin Interleukin-6 Plasminogen activator inhibitor type-1 Resistin Tumor necrosis factor-α Ghrelin Other biomarkers Impact of obesity on infertility treatment Diet Lifestyle Bariatric surgery Clomiphene citrate Aromatase inhibitors Follicle-stimulating hormone . Laparoscopic ovarian drilling Insulin sensitizers In vitro fertilization References Section 2: Contraception 4 Obesity and sexual health Introduction Obesity and sexual behavior Obesity and sexual function Obesity and sexual health outcomes Conclusion References 5 Obesity and contraception Introduction Risks of obesity in pregnancy Classification of obesity based on body mass index Potential concerns with obesity and contraception Obesity and contraceptive efficacy Mechanisms by which obesity could potentially affect contraceptive efficacy Evidence (or lack of) for contraceptive efficacy in overweight or obese women Contraceptives and weight gain: myth or truth? Potential mechanisms by which contraceptives can cause weight gain COCs and weight gain POCs and effect on weight Safety of hormonal contraceptives in obese women Obesity, contraception, and cardiovascular disease Obesity, contraception, and venous thromboembolism Obesity, contraception, and cancer Contraceptive issues after bariatric surgery Intrauterine contraceptive devices in obese women Sterilization procedures in obese women References 6 Contraceptive choices for women before and after bariatric surgery Introduction—Bariatric Surgery Long acting contraceptives Copper intrauterine device Levonorgestrel containing intrauterine device Progesterone-only implant Progesterone-only injection Oral hormonal contraception Progestogen-only pill Safety and health benefits Contraceptive patch and ring Barrier method Emergency contraception References 7 Long-term contraceptive care in obese and superobese women Introduction Combined hormonal contraceptives Copper intrauterine device Efficacy Health risks Side effects Additional health benefits Contraindications Limitations of use Practical issues in obese women Levonorgestrel-containing intrauterine systems Efficacy Health risks Side effects Health benefits Safe prescribing Summary Etonogestrel-releasing implant Progestogen implants Efficacy Health risks Side effects Health benefits Practical issues Contraindications Safe prescribing Special consideration Summary References Section 3: Male and female Infertility 8 Obesity and hirsutism Introduction Obesity and ovarian function Obesity and androgen production Hirsutism Obesity and polycystic ovarian syndrome The role of adrenal androgens in obese women with hirsutism Management of hirsutism associated with obesity The hair cycle Clinical assessment of hirsutism Treatment Conclusion References 9 Obesity and female infertility Introduction Epidemiology Transgenerational inheritance Pathophysiological basis of infertility in obese women Obesity and reproductive functions Adipose tissue and adipokines Leptin Adiponectin Interleukin-6 Plasminogen activator inhibitor type 1 Tumor necrosis factor-α The clinical effects of obesity on female infertility Effect on the hypothalamic–pituitary–ovarian axis Effects on the oocyte Effects on the embryo Effect on the endometrium Challenges of managing obese women Treatment options Weight loss Physical activity Dietary factors Bariatric surgery Barriers to weight loss in infertile women Conclusion References 10 Obesity and recurrent miscarriage Introduction Obesity and miscarriage Obesity and recurrent miscarriage Polycystic ovarian syndrome Ovarian dysfunction Endometrial changes in obesity Immunological factors WARNING!!! DUMMY ENTRY Leptin Male obesity and recurrent miscarriage Management Conclusion References 11 Obesity and assisted reproduction Introduction Prevalence of obesity in the assisted reproduction sector Evidence of reduced fertility in the obese Cycle effects Specific issues relating to assisted reproduction treatment Effects on the oocyte Effects on embryos Effects on the endometrium Rationale for the use of assisted reproduction Practical management of obese women undertaking assisted reproduction treatment Patient selection Stimulation regimes Monitoring of stimulation Clinical procedures Egg collection Embryo transfer hCG trigger Luteal support Effect of obesity on the results of assisted reproduction treatment Pregnancy rate Miscarriage rate Live birth rate Safety issues for mothers and offspring Ethical issues relevant to access to services Conclusion References Further reading 12 Obesity and sexual dysfunction in men Physiology of sexual function Sexual Dysfunction Sex Drive Obesity related sexual dysfunction Sexual dysfunction and obesity-related comorbidities Hypertension Peripheral vascular disease Coronary artery disease Diabetes mellitus Evaluation—General considerations Evaluation of sexual function Multidisciplinary approach to treatment Weight management Pharmacological therapy Penile intracavernosal injection therapy Penile prosthesis Testosterone replacement therapy Prevention References 13 Male obesity—impact on semen quality Introduction Impact on semen quality Sperm concentration and count Sperm motility Sperm morphology Combined semen parameters Sperm DNA damage Etiological theories Endocrine theory Genetic theory Sexual dysfunction theory Testicular hyperthermia theory Reactive oxygen species theory Treatment Conclusion References 14 Evidence-based assisted reproduction in obese women Introduction Impaired ovarian folliculogenesis Embryo development Altered endometrial receptivity Obesity and in vitro fertilization Obesity and frozen-thawed embryo transfer Obesity and intrauterine insemination Conclusion References 15 Obesity, bariatric surgery, and male reproductive function Introduction Bariatric surgical techniques Sleeve gastrectomy Gastric bypass Gastric banding Biliopancreatic diversion Endoluminal procedures Pathophysiology in obesity Hypothalamic–pituitary–gonadal axis Leydig cell function Obesity and spermatogenesis Obesity and Sertoli cell function Obesity and erectile dysfunction Transgenerational epigenetic effects Practical considerations References 16 Medical interventions to improve outcomes in infertile obese women planning for pregnancy Introduction Impact of high body mass index on fertility and pregnancy Lifestyle interventions to improve outcomes in infertile obese women planning for pregnancy Dietary interventions Diet Role of exercise Weight-loss medications and fertility outcomes Metformin Sibutramine Orlistat Liraglutide Barriers to weight loss Conclusion References 17 Surgical interventions to improve fertility potential in obese men and women Introduction Obesity and fertility Nonsurgical management of obesity Bariatric surgery as a weight loss measure Types of bariatric surgery The impact of bariatric surgery on fertility Bariatric surgery and polycystic ovarian syndrome The potential of bariatric surgery for a negative impact on fertility Pregnancy after bariatric surgery Assisted reproduction after bariatric surgery Obesity in the male Conclusion References Section 4: General Gynaecology 18 Obesity and gynecology ultrasound Key points Introduction Pelvic ultrasound Transabdominal approach Transvaginal approach Transrectal approach Transperineal approach Ultrasound settings Ergonomic considerations Clinical applications Miscarriage Polycystic ovarian syndrome and infertility Endometrial hyperplasia and endometrial cancer Ovarian cancer Cervical cancer Pelvic floor dysfunction Conclusion Acknowledgments References Further reading 19 Obesity and menstrual disorders Introduction Abnormal uterine bleeding—Causes PALM-COEIN Classification Polyps Malignancy and hyperplasia Ovulatory dysfunction The endometrium Polycystic ovary syndrome Obesity in the absence of polycystic ovary Summary Acknowledgments References 20 Incontinence and pelvic organ prolapse in the obese woman Introduction Incidence and prevalence Normal bladder function and causes of incontinence in women Urodynamic stress incontinence Detrusor overactivity Obesity and urinary incontinence Obesity and fecal incontinence Obesity and prolapse Weight loss and the effects upon continence and prolapse Continence and prolapse surgery in the obese woman Conclusion References 21 Urinary and fecal incontinence in obese women Introduction—epidemiology Urinary incontinence Anal incontinence Epidemiological data in obese populations Pathophysiology of incontinence in the obese population Urinary incontinence Anal incontinence Outcomes of incontinence procedures in obese women Urinary incontinence Anal incontinence Incontinence symptoms following weight loss Urinary incontinence Anal incontinence Conclusion References 22 Role of obesity in cancer in women Overview Epidemiologic evidence for links between obesity and cancer Cancers unique to or more common in women Potential mechanisms for oncogenesis Clinical implications for prevention and treatment of cancer in obese patients Summary and ongoing needs for research References 23 Obesity and breast cancer Epidemiology Pathogenetic mechanisms Sex hormones Hyperinsulinemia Adipokines Chronic inflammation Microbiome Diagnosis Therapy Surgery Radiotherapy Chemotherapy Endocrine Prognosis References 24 Obesity and female malignancies Introduction Epidemiology Obesity and endometrial cancer Obesity and breast cancer Obesity and ovarian cancer Obesity and cervical cancer Mechanisms relating obesity to female malignancies Effect of obesity on management of female malignancies Future directions References 25 Challenges in gynecological surgery in obese women Introduction Indications for surgery Risk of obese women undergoing surgery Physiological changes in the obese patients Preoperative evaluation Equipment and general considerations Anesthetic challenges Thromboprophylaxis Intraoperative challenges Laparoscopic surgery Open abdominal surgery Postoperative issues Medicolegal implication Conclusion References 26 Laparoscopic and robotic surgery in obese women Introduction Physiological changes in (obese) surgical patient Cardiovascular alterations Respiratory function Effects of CO2 pneumoperitoneum Gastrointestinal changes Renal function Venous stasis Drug pharmacology Immune system Benefits of minimally invasive surgery Technological features Indications Minimally invasive surgery and obesity: laparoscopy–robotics Alternatives for class III (morbidly) obese patients Cost-effectiveness Complications Preoperative preparation General considerations Pulmonary and cardiovascular assessment Additional considerations Intraoperative considerations Theatre staff, operating room, and equipment Patient positioning Medication Surgical technical diligence Entry techniques Port placement Exposure Surgical considerations Postoperative considerations Conclusion References 27 Obesity and venous thromboembolism Introduction The interplay between obesity and venous thromboembolism risk Hormonal contraception Hormonal contraception and venous thromboembolism risk Obesity and contraceptive efficacy Contraception and the fear of weight gain Weight-loss treatment and contraception Guideline recommendations Hormone replacement therapy Assisted conception Gynecological surgery Gynecological cancer Conclusion References 28 Obesity and cardiovascular disease in reproductive health Introduction Risk assessment in obese individuals The significance of adipose distribution Pathogenesis of visceral obesity Lipid metabolism in nonpregnant obese women Cardiac adaptation to obesity Lipid metabolism in pregnant obese women Gynecology practice Maternal obesity and in utero programing for cardiovascular disease Interventions to address obesity in reproductive health Physical activity Medical treatment Surgical treatment Interventions to improve outcomes in pregnancy Weight management Bariatric Surgery Conclusions References 29 Female obesity and osteoporosis Introduction Normal bone metabolism Epidemiology of osteoporosis Relationship between fat and bone: epidemiologic and clinical observations Diabetes mellitus treatment and osteoporosis Beta-cell hormones (pancreatic hormones) Adipocyte hormones Obesity of the bone Clinical and diagnostic implication of the concept-obesity of bone Treatment implications of the concept-obesity of the bone Bariatric surgery and bone health Management after Roux-en-Y gastric bypass Pragmatic approach for obese women What a physician should advise to an obese woman? Conclusion Conflict of interest References Future research 30 Obesity, menopause, and hormone replacement therapy Introduction The menopausal obesity: role of estrogens Obesity, lifestyle intervention, and hormone replacement therapy Emerging menopausal therapies Conclusion Conflict of interest References 31 Obesity and chronic pelvic pain Introduction Obesity and pain physiology The genetics of obesity and chronic pain The psychological impact of obesity and chronic pelvic pain The impact of obesity on the assessment of chronic pelvic pain The impact of obesity on the treatment of women with chronic pelvic pain The impact of obesity on the surgical management of women with chronic pelvic pain Obesity and endometriosis Obesity and adenomyosis Obesity and abdominal myofascial pain syndrome Obesity and nongynecological causes of chronic pelvic pain Conclusion References 32 Obesity and clinical psychosomatic women’s health Introduction Why are mind–body approaches likely to be of benefit in the management of obese patients?—an analysis Section 1: menstrual problems and obesity Pathophysiology of psychosomatic menstrual issues Psychosomatic insights into menstrual presentations in the obese The clinical psychosomatic approach and the patients’ perspective Clinical psychosomatic gynecological referrals for menstrual irregularities Clinical psychosomatic angles to menstrual irregularities, premenstrual syndrome, and polycystic ovarian syndrome Polycystic ovarian syndrome and obesity—an increasing clinical psychosomatic conundrum Section 2: infertility/subfertility and clinical psychosomatic aspects Successes/failures in conceiving, distress, and obesogenic behavior Section 3: physical, mental, and sexual violence with obesity in migrants The clinical psychosomatic aspect of gender-related violence Characteristics of hospital catchment area where patients resided Section 4: obesity and severe pelvic/perineal dysfunction The clinical psychosomatic viewpoint Section 5: psychosomatic impact of gynecological tumors in the obese The global disease burden of endometrial cancer/malignancy The etiopathogenesis of endometrial cancer Preventing/treating obesity to prevent endometrial cancer Conclusions References 33 Obesity and psychosexual disorders Biological and psychological mechanism Normal sexual functio Effect of cardiovascular disease on sexual function Mechanism and effect of obstructive sleep apnea Polycystic Ovarian syndrome Impaired body image References 34 Professionally responsible clinical management of obese patients before and during pregnancy Introduction Professional ethics in obstetrics The ethical concept of medicine as a profession The ethical principle of beneficence The clinical ethical concept of medically reasonable clinical management The ethical principle of respect for autonomy The professional virtue of compassion The professional virtue of self-effacement Compassion and self-effacement considered together Professional ethics in clinical practice with obese patients before and during pregnancy The role of directive counseling or making recommendations The role of shared decision-making The role of preventive ethics in preconception counseling The role of ethically justified “nudging” patients toward more healthy eating habits Responsibly managing the strong responses that obese patients can evoke Conclusion References Index Back Cover