PCOS Risks: Polycystic Ovary Syndrome Is Linked to a Host of Health Issues (Women's Health Matters article) (Web resource; WHM resource) Author: Patricia Nicholson Organization: Women's College Hospital, Women's Health Matters Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. It’s a condition linked to many other health issues, from infertility and obesity to heart disease and insulin resistance. Endocrine disorders affect the body’s network of hormone-secreting (endocrine) glands. Between five and 10 per cent of women have PCOS, says Dr. Sheila Laredo, an endocrinologist at Women’s College Hospital in Toronto who presented a talk at the hospital on PCOS and related health risks on March 3, 2010. There are a number of definitions for PCOS, but the most common is known as the Rotterdam criteria: to be diagnosed with PCOS, a woman must have at least two out of the following three criteria, with no other explanation for the symptoms: irregular or infrequent periods hyperandrogenism (high male hormones) or evidence of high male hormones such as hirsutism (excess body hair in ‘male pattern’ areas such as the chin and upper lip) enlarged ovaries with multiple cysts confirmed by ultrasound examination Despite the name, the ‘cysts’ involved in PCOS are, in fact, enlarged follicles on the ovary – not actually cysts, Dr. Laredo said. ‘Even though we call them cysts, they’re not, they’re follicles,’ she said. PCOS is the most common cause of irregular periods, Dr. Laredo said. In fact, it’s a good bet that if a woman has irregular (as opposed to absent) periods, she has PCOS. ‘If she has some periods and they’re irregular, the chances of her having PCOS are about 90 per cent.’ Irregular periods are defined as less often than every 35 days on average, or less than eight to 10 periods a year. Not just cosmetic Hirsutism is one of the defining characteristics of PCOS. About half of women who have hirsutism have PCOS. Of the three defining characteristics of PCOS, hirsutism might seem like the one with the least impact. However, its effects can be significant. ‘It’s important that we see it not just as a cosmetic problem, because we know it’s associated with lower quality of life scores, both on physical and mental health scales, with lower sense of self worth, and poorer sexual satisfaction,’ Dr. Laredo said. Hirsutism is associated with anxiety issues and social phobias. Women may be anxious about telling their partners that they have this condition, or worry about keeping it private in work settings. Dr. Laredo explained that some women with hirsutism carry a razor in their handbag to deal with ‘five o’clock shadow’ in case they have to stay late at work. ‘So it really affects their day-to-day functioning,’ she said. But the most important thing about hirsutism as a feature of PCOS is its link to insulin resistance, a condition that impairs the body’s ability to regulate blood sugar and which can be a precursor to Type 2 diabetes. Women with PCOS can have any combination of the three diagnostic criteria (irregular periods, hirsutism, polycystic ovaries), so not all PCOS patients have hirsutism. However, the women that do have hirsutism are the most likely to be insulin resistant. Dr. Laredo says PCOS, like diabetes, is a ‘triple threat’ when it comes to dyslipidemia (abnormal levels of fats, such as cholesterol, in the blood). PCOS patients tend to have high triglycerides and low HDL (good cholesterol). Even if their levels of LDL (bad cholesterol) aren’t excessive, PCOS patients usually have a type of smaller, denser LDL particles that are associated with insulin resistance and linked to heart disease. Heart risks A study looking at cardiovascular disease in women with irregular periods suggests a link between PCOS and heart disease. Women with irregular periods had 50 per cent higher risk of coronary heart disease, and 88 per cent higher risk of fatal coronary heart disease, compared to women with regular cycles. Even after taking into consideration factors such as BMI and blood pressure, women with irregular cycles had an increased risk of heart disease. Dr. Laredo noted that because the vast majority of women with very irregular periods do in fact have PCOS, this increased risk for heart disease could be a feature of PCOS. Risk of sleep apnea is also very high in women with PCOS. ‘Their relative risk is about 30-fold compared to the general population,’ Dr. Laredo said. ‘One in six women with PCOS has sleep apnea, and very often severely.’ Although high BMI is a risk factor for sleep apnea, women with PCOS had high rates of sleep apnea even when BMI was accounted for. Sleep apnea risk also appeared to be linked to insulin resistance. PCOS may also increase the risk of developing endometrial cancer. In a study that compared women with endometrial cancer to women from the same clinic who were being treated for benign conditions, premenopausal women who had cancer had a far greater likelihood of having PCOS than those with benign conditions. These results suggest that PCOS may be greatly overrepresented among premenopausal endometrial cancer patients. A comparison could not be made among postmenopausal women because PCOS is difficult to identify after menopause. Fertility problems are common among PCOS patients. Dr. Laredo noted that between one-quarter and one-third of women who present to fertility clinics have PCOS. When they do get pregnant, they are more likely to develop obstetrical risks, including miscarriage, preterm birth, stillbirth, gestational diabetes, pre-eclampsia and delivery problems such as the baby’s shoulders becoming stuck in the birth canal. While some of these outcomes are probably related to BMI, research has shown that even after taking BMI into consideration, women with PCOS still had an increased risk of pregnancy-induced hypertension and gestational diabetes. Bulimia is also much more common in women with PCOS. About 6 per cent of PCOS patients have bulimia, compared to about 1 per cent of other women. ‘If you look at women with bulimia, the inverse also holds true: women who have bulimia are more likely to have PCOS as well,’ Dr. Laredo said. It’s not known which direction this association works in: whether disordered eating contributes to PCOS, or whether PCOS contributes to the eating disorder. Quality of life Given the host of complications and related conditions linked to PCOS, it’s not surprising that PCOS patients tend to have a lower quality of life than other women. Weight problems, obesity and fertility problems contribute to this. But depression is also much more common in women with PCOS than in the general population, even after adjusting for factors such as infertility. Depression can worsen problems with insulin resistance, diabetes and obesity because depression reduces the ability to undertake lifestyle interventions, such as exercise, that might help reduce the impact of those issues. Dr. Laredo stressed that PCOS is more than irregular cycles and excess body hair. Its association with conditions ranging from insulin resistance to sleep apnea make it a health issue that needs careful attention and further research. ‘We really should be thinking of not just the periods and the cosmetic symptoms, but about what underlies it and what the other risks are,’ she said. Version française :  Cliquez ici pour voir la description en français Purpose:  Consumer information/support; Health information Information Source:  Hospital/Clinic Geographic Origin:  Canada Language of Resource:  English Groups:  Adult women Last Reviewed by Women's Health Matters:  March 17, 2010