EXECUTIVE SUMMARY
Women diagnosed with polycystic ovary syndrome (PCOS) face an elevated risk of developing heart disease, diabetes, mental health conditions, reproductive disorders, and cancer of the lining of the uterus.
• PCOS is a common cause of infrequent bleeding and is the most common endocrinopathy of reproductive-age women. Five million U.S. women might be affected.
• Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS.
Women diagnosed with polycystic ovary syndrome (PCOS) face an elevated risk of developing heart disease, diabetes, mental health conditions, reproductive disorders, and cancer of the lining of the uterus than healthy women, a new study indicates.1
PCOS is a common cause of infrequent bleeding and is the most common endocrinopathy of reproductive-age women.2 Between one in 10 and one in 20 women of childbearing age has PCOS. Five million U.S. women might be affected.3
Polycystic ovary syndrome occurs when a woman’s body generates higher than normal levels of testosterone and other androgen hormones. This hormone imbalance can cause irregular or absent menstrual periods, infertility, weight gain, acne, excess hair on the face and body, or thinning hair on the scalp.
PCOS has “profound implications” for a women’s reproductive health as well as her long-term risk of chronic illness, said study lead author, Roger Hart, MD, MRCOG, FRANZCOG, CREI, in a statement accompanying the study’s publication. “Our study indicates women who have PCOS have twice as many hospital admissions as women without the condition,” said Hart, professor of reproductive medicine at the University of Western Australia and medical director of Fertility Specialists of Western Australia, both in Perth. “Additional health care resources should be directed to address the risks facing this population.”
For the population-based retrospective cohort study, researchers examined records for 2,566 women ages 15 and older who were diagnosed with PCOS during a hospital visit in Western Australia between 1997 and 2011. These records were compared to hospitalization records for 25,660 women of similar ages, who were identified using voter registration records. Scientists tracked the hospitalization records until the women reached a median age of 35.8.
Women who were diagnosed with PCOS were more likely to be hospitalized for reasons unrelated to reproductive health or injury than their counterparts. Women who had PCOS were more likely to have miscarriages, ectopic pregnancies, and other gynecological conditions. These same women also had a higher rate of endometrial cancer, findings indicate.1
Women diagnosed with PCOS were hospitalized more often for mental health disorders than other study participants. Diagnosis of PCOS also was associated with a higher risk of late onset diabetes, high blood pressure, heart disease, asthma, and musculoskeletal disorders.1
“We found women who have PCOS are particularly prone to developing metabolic and cardiovascular disease,” said Hart. “Since only 25% of the women we studied were older than 40, we anticipate the rate of diagnosis would rise as these women continue to age.”
Guidance issued in 2013 by the Endocrine Society directs providers to use the Rotterdam criteria for diagnosing PCOS, which calls for presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries.4
Establishing a diagnosis of PCOS can be problematic in adolescents and menopausal women, the guidance notes. Hyperandrogenism is central to the presentation in adolescents, while there is no consistent phenotype in postmenopausal women, it notes. Providers should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease in their evaluation of women with PCOS.4 Obesity is a common feature of PCOS. The prevalence of obesity is 50% overall.5
Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS, the guidance advises. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS.4
While estrogen/progestin contraceptives provide benefits in terms of menstrual dysfunction and prevent endometrial hyperplasia and endometrial cancer, there are women who can’t remember to take pills or who have reasons to avoid pills, says Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta. Menstrual dysfunction and endometrial carcinoma also are prevented by the levonorgestrel intrauterine device (Mirena LNG IUD, Bayer Healthcare Pharmaceuticals, Wayne, NJ). However, switching from combined pills to an LNG IUD might cause acne to become worse, he notes.
“On occasion, women with PCOS who have an LNG IUD in place and experience a return of acne may be placed on a very low-dose combined pill to improve their acne,” says Hatcher. “The most common reason a woman with PCOS is using an LNG IUD is because she wants the greater effectiveness of the device.”
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Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. J Clin Endocrinol Metab 2014; doi: 10.1210/jc.2014-3886.
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Nelson AL, Baldwin SB. Menstrual disorders. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
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U.S. Department of Health and Human Services. Office of Women’s Health. Polycystic Ovary Syndrome (PCOS). Accessed at http://1.usa.gov/1zMqyaL.
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Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2013; 98(12):4565-4592.
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Fritz MA, Speroff L. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.
