Women with polycystic ovary syndrome (PCOS) are at higher risk for several other health conditions, some of them serious.
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.
- More than one-half 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.
- The American College of Obstetricians and Gynecologists estimates that about one in three women with PCOS also has metabolic syndrome1 .
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 one-half of women with PCOS will have either type 2 diabetes or prediabetes (impaired glucose tolerance) before their early 40s.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.
- The majority of women with PCOS have obesity.1
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 (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.
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:
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). (2015). Polycystic ovary syndrome. Retrieved May 20, 2016, from http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS
- Ehrmann, D. A. (2005). Polycystic ovary syndrome. New England Journal of Medicine, 352(12), 1223–1236.
- Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology, 7(4), 219–231. Retrieved August 26, 2016, from http://www.nature.com/nrendo/journal/v7/n4/full/nrendo.2010.217.html
- American Diabetes Association. (n.d.). Living with diabetes: Complications. Retrieved May 23, 2016, from http://www.diabetes.org/living-with-diabetes/complications
- 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(1), 226–243.
- National Heart, Lung, and Blood Institute (NHLBI). 2015). What is coronary heart disease? Retrieved May 23, 2016, from https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease
- Hunter, M. H., & Sterrett, J. J. (2000). Polycystic ovary syndrome: It's not just infertility. American Family Physician, 62(5), 1079–1088, 1090.
- NHLBI. (2015). What is a stroke? Retrieved May 23, 2016, from https://www.nhlbi.nih.gov/health-topics/stroke
- NHLBI. (2015). What is cardiomyopathy? Retrieved May 23, 2016, from https://www.nhlbi.nih.gov/health-topics/cardiomyopathy
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility & Sterility, 81(1), 19–25.
- ACOG. (2009; reaffirmed 2015). Polycystic ovary syndrome. Practice Bulletin 108. Washington, DC: ACOG.
- NHLBI. (2012). What is sleep apnea? Retrieved May 23, 2016, from http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea
- 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(3), 1175–1180.
- 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, 26(9), 2442–2451.
- Duleba, A. J., & Dokras A. (2012). Is PCOS an inflammatory process? Fertility & Sterility, 97(1), 7–12. Retrieved August 26, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245829/