Women with PCOS are at higher risk for several other health conditions, some of them serious. These conditions, while common in women with PCOS, are not considered symptoms of PCOS. Doctors usually treat the associated conditions in addition to treating PCOS. Conditions commonly associated with PCOS are described below.
Type 2 diabetes
Heart disease and high blood pressure (cardiovascular disease)
Obstructive sleep apnea
Insulin is a hormone that helps move sugar (glucose) from the bloodstream into cells to use as energy. Glucose in the blood is the body's main source of fuel. When cells don't respond to insulin, the level of glucose in the blood rises. In addition, the level of insulin goes up as the body produces more and more of it to try to get glucose into the cells.
High levels of insulin can increase appetite and lead to weight gain.1 In addition:
- Too much glucose and insulin in the blood can lead to serious health conditions, including metabolic syndrome and type 2 diabetes.
- A symptom of PCOS called acanthosis nigricans (pronounced ay-kan-THOE-sis NY-grih-kanz)—patches of thickened, dark, velvety skin—is associated with insulin resistance.1
- Too much insulin increases the production of androgens by the ovaries.2 Having abnormally high androgens causes many of the symptoms of PCOS.
- About 50% to 70% of women with PCOS have insulin resistance.3
This syndrome occurs when the body is not able to balance all the chemicals and processes it needs to create and use energy. Its features include insulin resistance, high blood sugar, obesity, high cholesterol, and high blood pressure.
- Metabolic syndrome increases the risk for diabetes and heart disease.
- Insulin resistance increases the production of androgens.
- About one in three women with PCOS also has metabolic syndrome.1
Type 2 Diabetes
In people with diabetes, the body has stopped producing insulin or does not use it properly. As a result, the glucose level in the blood rises, but the cells don't get the glucose they need for energy. If the blood glucose level is high for prolonged periods of time or on a regular basis, the condition is called diabetes.
- If not managed, diabetes can cause serious damage to the kidneys and can lead to blindness, nerve damage, and hearing loss.4
- Type 2 diabetes also increases the risk for heart disease and high blood pressure.
- More than 50% of women with PCOS will have either type 2 diabetes or prediabetes (impaired glucose tolerance) before age 40.5
Obesity is a condition in which the body stores more fat than is healthy based on a person's height and body type. Obesity in women with PCOS may result from imbalanced hormone levels, increased deposition of fat due to higher insulin levels, metabolic dysfunction (problems with how the body stores and uses energy), or a combination of these factors.
- Obesity can lead to serious health problems, including diabetes, heart disease, and high blood pressure.
- As many as 80% of women with PCOS are obese.1
Heart Disease and High Blood Pressure (Cardiovascular Disease)
Cardiovascular disease includes a range of different conditions:
- Coronary artery disease
- This is a narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart.
- Coronary artery disease can lead to heart attack, heart failure, or an irregular heartbeat, also called an arrhythmia (pronounced uh-RITH-mee-uh).6
- Atherosclerosis (pronounced ath-uh-roh-skluh-ROH-sis), or hardening of the arteries
- Women with PCOS have high levels of low-density lipoprotein (LDL), sometimes called "bad" cholesterol, and low levels of high-density lipoprotein (HDL), sometimes called "good" cholesterol. Both problems are linked to atherosclerosis.2
- High blood pressure
- Women with PCOS are at increased risk for high blood pressure.7
- High blood pressure can increase the risk of stroke. During a stroke, the blood vessels that carry blood to the brain are blocked or broken open so that oxygen and other essential factors are not delivered to the brain cells. Stroke can cause serious disability and even death.8
- Cardiomyopathy (pronounced kahr-dee-oh-mahy-OP-uh-thee)
- With this condition, the heart muscle becomes larger, thick, and hard, making the heart less able to pump blood to the body.9
Several factors related to PCOS, including insulin resistance, metabolic syndrome, and obesity, increase a woman's risk of cardiovascular disease.1
Heart disease is the leading killer of women in the United States,5 and several studies have found that women with PCOS are at increased risk for cardiovascular disease.10 Doctors should regularly screen PCOS patients for their risk of heart disease.11
Obstructive Sleep Apnea
Obstructive (pronounced uhb-STRUHKT-ihv) sleep apnea (pronounced AP-nee-uh) occurs when a person's airway becomes too narrow during sleep. When people sleep, the muscles that keep the airway open relax. In some people, the relaxed muscles allow the airway to narrow or close for a short time. As a result, breathing stops for several seconds. Often, when the person starts breathing again, he or she makes a snorting or choking sound.
- Sleep apnea increases the risk of high blood pressure, heart attack, obesity, and diabetes.12
- Women with PCOS are at much higher risk for obstructive sleep apnea than are other women.13 This risk is even higher among women with PCOS who are obese.
Women with PCOS are more likely to have mood disorders, such as depression or anxiety, or to engage in out-of-control (or binge) eating. Certain features of PCOS may contribute to the increased risk of mood disorders. For example:
- Abnormal levels of androgens and other hormones are related to mood disorders.2
- Obesity is linked to mood disorders as well as to abnormal hormone levels. Studies show that the risk of mood disorders is even greater among women with PCOS who are also obese.2,14
Inflammation is the body's normal protective response to infection or injury. However, inflammation is also involved in several dangerous conditions, such as hardened arteries, which are a major risk factor for heart attack and stroke. Some evidence suggests that women with PCOS experience long-term, low-level inflammation.
Currently, it's not clear whether this inflammation results from obesity and metabolic dysfunction, which are also common among women with PCOS, or whether it is an independent symptom of the disorder. It's also not clear whether chronic, low-level inflammation might have long-term health consequences for women with PCOS. Ongoing research on these questions should help to clarify the role of inflammation in PCOS.15
- American College of Obstetricians and Gynecologists (ACOG). (2011). Polycystic ovary syndrome. Retrieved May 10, 2012, from http://www.acog.org/~/media/For%20Patients/faq121.pdf?dmc=1&ts=20120510T1116545699 (PDF - 274 KB) [top]
- Ehrmann. D. A. (2005). Polycystic ovary syndrome. New England Journal of Medicine, 352, 1223–1236. [top]
- Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology, 7, 219–231. [top]
- American Diabetes Association. (n.d.). Living with diabetes: Complications. Retrieved February 16, 2012, from http://www.diabetes.org/living-with-diabetes/complications [top]
- Lorenz, L. B., & Wild, R. A. (2007). Polycystic ovarian syndrome: An evidence-based approach to evaluation and management of diabetes and cardiovascular risks for today's clinician. Clinical Obstetrics and Gynecology, 50, 226–243. [top]
- National Heart, Lung, and Blood Institute (NHLBI). (2011). What is coronary heart disease? Retrieved January 31, 2012, from http://www.nhlbi.nih.gov/health/health-topics/topics/cad [top]
- Hunter, M. H., & Sterrett, J. J. (2000). Polycystic ovary syndrome: It's not just infertility. American Family Physician, 62, 1079–1088, 1090. [top]
- NHLBI. (2011). What is a stroke? Retrieved December 22, 2011, from http://www.nhlbi.nih.gov/health/health-topics/topics/stroke [top]
- NHLBI. (2011). What is cardiomyopathy? Retrieved December 22, 2011, from http://www.nhlbi.nih.gov/health/health-topics/topics/cm [top]
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to the polycystic ovary syndrome. Fertility & Sterility, 81, 19–25. [top]
- ACOG. (2009). Polycystic ovary syndrome. Practice Bulletin 108. Washington, DC: ACOG. [top]
- NHLBI. (2010). What is sleep apnea? Retrieved December 22, 2011, from http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea [top]
- Fogel, R. B., Malhotra, A., Pillar, G., Pittman, S. D., Dunaif, A., & White, D.P. (2001). Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism, 86, 1175–1180. [top]
- Barry, J. A., Kuczmierczyk, A. R., & Hardiman, P. J. (2011). Anxiety and depression in polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction, 9, 2442–2451. [top]
- Duleba, A. J. & Dokras A. (2012). Is PCOS an inflammatory process? Fertility & Sterility, 97 (1), 7-12. [top]