Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women aged 15-49 years. Contrary to what many people think, PCOS affects more than fertility: Women with PCOS are at a higher risk for certain serious conditions than women without PCOS. It is recommended that women with PCOS are accurately assessed for long-term health risks associated with the syndrome, and to have a good schedule in place on how to monitor for these conditions.
Conditions Associated with PCOS
The understanding of PCOS has evolved over the years. Once regarded as a gynecological problem, it is now known that it goes beyond reproductive signs and symptoms.1 Because it is a highly inherited disorder, it is likely that you have a sister or a female relative with the same condition. However, no two cases of PCOS are the same. Some women will have mild symptoms. Others will have to deal with all the classic features, including hirsutism, irregular or missed periods, acne, scalp hair loss, and difficulty becoming pregnant.2
Studies suggest that women with PCOS have a significantly increased risk of developing abdominal obesity, type 2 diabetes, and heart diseases.3 It is also associated with the worsening of fertility and pregnancy outcomes as well as endometrial cancer. However, researchers are yet to clarify if PCOS is a causative factor per se or if obesity and other factors play a role.4
PCOS is a systemic disorder, which means it affects your whole body: your skin, your gut, your heart, your mind, your metabolism, and your immune system. It is vital that you understand how the syndrome can increase your risk for other conditions that may have lifelong consequences. To get more information about the long-term complications of PCOS and how to best monitor your health, ask your healthcare provider.
Subfertility (reduced fertility) and infertility are common reproductive problems associated with PCOS. The overproduction of the male hormone testosterone causes an imbalance in other sex hormones, so the ovaries may only infrequently release eggs. Although your chances of becoming pregnant are reduced with PCOS, it is not a substitute for contraceptives.5 You may still get pregnant with or without treatment.
Almost half of women with PCOS are obese.6 Fats often accumulate around the midsection. Obese women are more likely to have severe symptoms than lean women with PCOS.7 With or without obesity, women with PCOS are more likely to have upper body fat distribution, resulting in an apple-shaped body, which is associated with an increased risk of diabetes and heart disease.
Researchers point to insulin resistance and hyperandrogenism as the causes of obesity in PCOS. However, obesity itself causes insulin resistance and raises diabetes risk. Note that insulin resistance occurs also in lean women with PCOS.8 Having insulin resistance and hyperinsulinemia (excess insulin in the blood) can lead to increased production of androgens in the ovaries, making PCOS symptoms worse.
Women with PCOS have a higher risk of developing type 2 diabetes.9 The average age for women with PCOS who were diagnosed with diabetes was 31 years. For those without PCOS, the average age was 35 years. High body mass index and high glucose and triglyceride levels are associated with the development of diabetes. Official guidelines recommend that women with PCOS should be screened for impaired glucose tolerance and diabetes.
A recent study suggests that young women with PCOS have an increased risk of heart disease.10 Overweight or obesity, diabetes, and high blood pressure are common in PCOS and are all risk factors for heart disease and stroke. But the good news is that you have a good chance of reducing your risk for heart disease by following a heart-healthy lifestyle. That is eating a balanced diet with more fruits and vegetables and engaging in regular physical activity.
A study by the University of Chicago revealed that obstructive sleep apnea is associated with PCOS.11 The authors suggest screening for sleep apnea in women with PCOS, as it may be a contributory factor in the development of metabolic and cardiovascular diseases. Low estrogen levels, excess androgen, and visceral fat (belly fat) could be involved in the increased risk of sleep apnea in PCOS.
Anxiety and depression are two of the most common disorders associated with PCOS. Hormonal imbalance, particularly abnormal levels of androgens,12 and obesity13 may contribute to the increased risk of mood disorders. Studies show that anxiety and depression are more common in women with PCOS who are also obese.
It appears that women with PCOS are at increased risk of developing endometrial cancer.14 The endometrium is the lining of the uterus that undergoes monthly buildup to prepare for a potential pregnancy. The thickened tissue is shed during menstruation if no pregnancy occurs. Women with PCOS often have infrequent or nonexistent periods, so the thickened endometrial lining is not sufficiently shed. As it continues to build up, it increases your risk of endometrial cancer.
PCOS can lead to an increased risk for a number of serious long-term complications. In order to minimize your risks to develop future conditions, you need the help of a dedicated team of healthcare providers trained to deal with all the aspects of PCOS. Together with your PCOS care team, you can determine the best plan forward for your current symptoms, and monitor for long-term complications and associated conditions.
- Dapas M, Lin FTJ, Nadkarni GN, et al. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLoS Med. 2020;17(6):e1003132. Published 2020 Jun 23. doi:10.1371/journal.pmed.1003132
- Barbieri R, Ehrmann D. UpToDate. Uptodate.com. https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics. Published 2019.
- Srabani Mukherjee. Polycystic Ovary Syndrome. Intech; 2012.
- Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health. 2015;7:745-763. Published 2015 Jul 31. doi:10.2147/IJWH.S70314
- Health Risks Associated with PCOS – UChicago Medicine. Uchicagomedicine.org. https://www.uchicagomedicine.org/conditions-services/endocrinology-metabolic-disorders/polycystic-ovary-syndrome/pcos-risk. Published 2018.
- Carmina E, Lobo RA. Polycystic Ovary Syndrome (PCOS): Arguably the Most Common Endocrinopathy Is Associated with Significant Morbidity in Women. The Journal of Clinical Endocrinology & Metabolism. 1999;84(6):1897-1899. doi:10.1210/jcem.84.6.5803
- Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the Polycystic Ovary Syndrome: a consensus statement by the Androgen Wxcess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95(2):2038–2049.
- Stepto NK, Cassar S, Joham AE, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod. 2013;28(3):777–784.
- Rubin KH, Glintborg D, Nybo M, Abrahamsen B, Andersen M. Development and Risk Factors of Type 2 Diabetes in a Nationwide Population of Women With Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism. 2017;102(10):3848-3857. doi:10.1210/jc.2017-01354
- Oliver-Williams C, Vassard D, Pinborg A, Schmidt L. Risk of cardiovascular disease for women with polycystic ovary syndrome: results from a national Danish registry cohort study. Eur J Prev Cardiol. 2020. doi:10.1177/2047487320939674.
- Tasali E, Van Cauter E, Ehrmann DA. Polycystic Ovary Syndrome and Obstructive Sleep Apnea. Sleep Med Clin. 2008;3(1):37-46. doi:10.1016/j.jsmc.2007.11.001
- Ehrmann DA. Polycystic Ovary Syndrome. New England Journal of Medicine. 2005;352(12):1223-1236. doi:10.1056/nejmra041536
- Barry JA, Kuczmierczyk AR, Hardiman PJ. Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction. 2011;26(9):2442-2451. doi:10.1093/humrep/der197
- Ding DC, Chen W, Wang JH, Lin SZ. Association between polycystic ovarian syndrome and endometrial, ovarian, and breast cancer: A population-based cohort study in Taiwan. Medicine (Baltimore). 2018;97(39):e12608. doi:10.1097/MD.0000000000012608