Polycystic Ovary Syndrome (PCOS) - What Happens

What Happens

Polycystic ovary syndrome (PCOS) is a group of health problems linked to a woman's out-of-balance hormones. Common symptoms of PCOS include irregular periods, infertility, repeat miscarriages, male-pattern hair loss, male-type facial and body hair, acne, and obesity. PCOS raises your risks for serious health problems, including high blood pressure (hypertension), heart disease, diabetes, and uterine (endometrial) cancer.

Reproductive problems

Hormone imbalances linked to PCOS cause several types of pregnancy problems and related problems, including:

• Infertility. This happens when the ovaries are not releasing an egg every month.
• Repeat miscarriages. This is thought to be because of high insulin levels and may be prevented with an insulin-lowering medicine called metformin.²
• Gestational diabetes during pregnancy. This risk is greater in women with PCOS than in women who ovulate regularly.
• Precancer of the uterine lining (endometrial hyperplasia). This can happen when you don't have regular menstrual cycles, which normally build up and "clear off" of the uterine lining every month. It can be prevented with birth control pills.
• Uterine (endometrial) cancer. Risk during the reproductive years is 3 times greater in women with PCOS than in women who ovulate monthly.⁷
• Possible breast cancer or ovarian cancer. Women with PCOS seem to have increased rates of cancer. Experts do not know whether this is linked to PCOS, infertility treatments, or other PCOS-related problems like obesity or diabetes.³

Some women with PCOS who successfully become pregnant go on to have ovulating menstrual cycles after pregnancy. Regular ovulation cycles are likely to improve PCOS symptoms and to greatly reduce risks of long-term health problems.

You may have more regular menstrual cycles as you near menopause. The reason for this is not known. But your history of PCOS may still increase your long-term risk of high blood pressure (hypertension), heart disease, diabetes, or endometrial cancer.

Problems with insulin and sugar metabolism

Your body uses sugar, or glucose, for energy. Insulin helps your body use glucose, as well as store it for future use. With PCOS, the body can have a problem with using insulin. This is called insulin resistance. Weight gain, lack of physical activity, or pregnancy can make insulin resistance worse.

In up to 40% of women with PCOS, insulin resistance makes it hard for the body to use sugar energy (glucose intolerance).³ This leads to a buildup of insulin and glucose in the body. High insulin levels play a part in many PCOS problems. High glucose is sometimes called prediabetes.

Up to 10% of women with PCOS have type 2 diabetes by the time they reach age 40.³

Serious health problems caused by insulin resistance include:

• Metabolic syndrome. This disorder includes high blood pressure, high triglycerides, low HDL ("good") cholesterol, high blood sugar, and too much fat around the waist. Metabolic syndrome increases your risks of heart attack, stroke, and diabetes.
• Gestational diabetes during pregnancy.
• Obesity.

Heart and blood circulation problems

It is possible that high insulin from PCOS makes heart and blood vessel problems worse.³ These problems include:

• Hardening of the arteries (atherosclerosis).
• Coronary artery disease and heart attack. Some studies have shown that heart attack risk may be increased by as much as 7 times in women with PCOS compared with women who don't have PCOS.⁸
• High blood pressure.
• High cholesterol.
• Stroke.

Breathing/sleep problems

Women with PCOS have a higher risk of breathing problems while sleeping (obstructive sleep apnea). This is linked to both obesity and insulin resistance.³