The Long-Term Health Effects of PCOS: Everything You Need to Know
If you’ve been diagnosed with PCOS, you may have already been informed that there are several long-term health effects that are related to the condition. This doesn’t mean you will go on to develop all or any of them. It simply means your risk of developing them is higher than someone who doesn’t have PCOS.
That said, it’s important to understand what these long-term risks are, and to know the signs and symptoms to look out for. This way ensure that if you do develop a complication of PCOS, the earlier you’re treated for it, the better the outcome. Your doctor or specialist should also monitor you for the early symptoms of PCOS-related conditions. This is important even after the menopause, when certain PCOS symptoms may disappear or become milder, as some of the long-term risks may affect you in later life.
Research into PCOS is evolving rapidly, and scientists are still discovering more about the long-term complications associated with it. In this article, we’ve collated a rundown of what we know so far, including what you should look out for and whether there are any self-help measures you could make that may be useful.
According to the most recent estimates, up to 70 percent of women with PCOS are thought to be affected by insulin resistance.i Insulin resistance means your body’s tissues are resistant to the effects of insulin, the hormone produced by the pancreas to control your blood sugar levels. If your body is resistant to insulin, your pancreas compensates by producing more and more insulin to keep your blood glucose normal.
However, high levels of insulin can make your ovaries produce too much testosterone. High levels of testosterone play a part in several PCOS symptoms including irregular periods, excess facial or body hair, oily skin and acne. It can also lead to weight gain, which can make your body produce even more insulin (indeed being overweight or obese is thought to be a cause of insulin resistance).
What to look out for: Insulin resistance doesn’t usually produce any symptoms initially, and it’s possible to be affected by it for years without knowing it. At this point, the only way to find out if you’re insulin resistant is to have your blood glucose levels tested. If you have PCOS, it’s a good idea to ask your GP to check your blood glucose levels regularly.
Some people with insulin resistance may develop acanthosis nigricans. This is a skin condition that produces brown or black patches of hyperpigmentation in places such as the folds of the neck, under the arms and the groin.
What can you do? Eating a healthy balanced diet may be helpful, particularly if you try to base your meals around foods that have a low glycaemic index (GI). This measures carbohydrates on a scale of 0 - 100 based on how quickly and how much they raise your blood glucose levels after eating. Low-GI foods, which have a rating of 55 or lower, are digested more slowly, so your blood glucose level rises gradually. This means your pancreas doesn’t have to produce as much insulin as when you eat foods with a high GI.
Staying physically active may also help counteract the effects of insulin resistance, and is recommended for women with PCOS. Studies suggest that exercise increases insulin sensitivity, and some experts believe it’s an essential tool for treating and preventing insulin resistance.ii
Type 2 diabetes
If you have insulin resistance, you also have a higher-than-normal risk of developing type 2 diabetes. Your risk of developing diabetes is also higher if you’re aged 40 or older, if you have relatives with diabetes, if you had gestational diabetes (diabetes during pregnancy) or if you are obese (if your body mass index is 30 or higher).
Type 2 diabetes develops when your pancreas doesn’t produce enough insulin to control the amount of glucose in your blood, or when your body’s cells don’t react to insulin – or a combination of the two. This means glucose stays in your blood and isn’t used by your cells to produce energy.
What to look out for: Diabetes symptoms can develop gradually, which means many people are affected for some time before they’re diagnosed. Once it has progressed, diabetes can cause symptoms such as being thirsty all the time, being constantly tired, losing weight for no reason and passing large amounts of urine. Other possible symptoms include blurred vision and recurring infections.
What can you do? Making lifestyle changes to reduce your risk of insulin resistance may help prevent type 2 diabetes. This means eating a healthy balanced diet, doing lots of regular exercise and – if you’re overweight or obese – taking steps to lose weight.
PCOS is one of the most common causes of infertility in women, and according to the NHS, many women only discover they have PCOS while having problems trying to get pregnant.iii This is because PCOS can cause infrequent ovulation or an absence of ovulation, which means having irregular or non-existent periods.
Some women with PCOS also experience an increased risk of pregnancy problems such as preeclampsia (high blood pressure in pregnancy), gestational diabetes (diabetes in pregnancy), and a higher risk of having a premature birth. But this doesn’t mean that getting pregnant is impossible. Here’s how to optimise your fertility with PCOS.
What to look out for:
If your PCOS symptoms include irregular or absent periods, you may need one or more treatments to help you get pregnant and have a healthy pregnancy. There are medicines that can help you to ovulate, or your doctor or fertility specialist may recommend taking the contraceptive pill for a while to help regulate your hormone levels before you start trying for a baby.
What can you do?
If you’re overweight or obese, losing weight could help rebalance your hormones and regulate your cycle. This may increase your chances of getting pregnant. However, this may be easier said than done, as many women with PCOS find it difficult to lose weight, despite their best efforts. A generally healthy lifestyle may also boost your fertility, so try to eat as healthily as possible, take regular exercise and if you have type 2 diabetes, aim to take all possible steps to keep it under control.
Meanwhile, when you do become pregnant it’s important to be monitored throughout your pregnancy for preeclampsia and gestational diabetes.
Some women with PCOS produce higher-than-normal levels of oestrogen, which can lead to a condition called endometrial hyperplasia. This is where the lining of the uterus (the endometrium) becomes too thick. This can happen if you have infrequent or no periods, as the endometrial lining can build up without being shed sufficiently.
However, endometrial hyperplasia may increase your risk of developing endometrial cancer (also known as cancer of the womb or cancer of the uterus) in later life.
What to look out for:
Abnormal bleeding is the most common symptom of endometrial hyperplasia and endometrial cancer.
What can you do?
The good news is your risk of endometrial cancer can be reduced by having progestogen-based treatments to regulate your periods. These treatments include the contraceptive pill, progestogen tablets or a progestogen-releasing coil.
Being very overweight is thought to increase your risk of endometrial hyperplasia, so taking steps to manage your weight if you need to may be helpful.
Women with PCOS may also have a higher risk of other established cardiovascular risk factors, including high blood pressure and high cholesterol.iv There’s also some evidence that women with PCOS may have compromised endothelial function (the endothelium is the inner lining of blood vessels), which is an early marker of cardiovascular disease.v
What to look out for:
If you have PCOS it’s important to have regular heart health checks, including blood pressure and cholesterol monitoring. Your doctor should be routinely assessing your cardiovascular risk factors, particularly if you’ve also been diagnosed with insulin resistance or type 2 diabetes.
What can you do?
It is recommended that you follow a healthy balanced diet, stop smoking and exercise regularly.vi This means eating a healthy balanced diet that’s low in saturated fat and salt and being as physically active as possible.
Studies suggest women with PCOS have a much higher risk of having obstructive sleep apnoea than those without PCOS.vii Sleep apnea causes interrupted breathing during sleep, which can lead to daytime fatigue and sleepiness as well as increase your risk of developing a number of conditions including high blood pressure, irregular heartbeat and type 2 diabetes.
One study even suggests women with PCOS are 30 times more likely to suffer from sleep-disordered breathing than those who don’t have PCOS – and that insulin resistance is linked with sleep apnea more strongly than being overweight or obese, or having high testosterone levels.viii
What to look out for: You may not notice the signs of sleep apnoea yourself, but someone else who’s with you while you sleep may have spotted one of the following:
Noisy and laboured breathing
Gasping or snorting interrupting your breathing
What can you do?
Sleep apnoea needs medical treatment, so see your GP if you think you may be affected. There are also some things you can do to reduce your risk of developing it, including losing weight if necessary, avoiding alcohol (especially in the evening), giving up smoking and avoiding using sleeping tablets and tranquilisers. If sleep apnea has you feeling constantly exhausted, here are some ways to boost your energy levels with PCOS.
Symptoms of PCOS can affect your self-esteem and confidence, they can also lead to mental health problems such as depression, anxiety and mood swings. One study claims women with PCOS may have significantly higher levels of psychological distress than the general population.ix Another report suggests women with PCOS are also more likely to develop eating disorders and sexual and relationship problems.x
What to look out for: According to the National Institute for Health and Care Excellence, guidelines for screening for psychological issues – especially depression – include asking the following two questions:
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?
If you answer ‘yes’ to one or both questions, speak to your GP or specialist about having a mental health assessment.xi
What can you do? If you’re having mental wellbeing problems, your healthcare team can suggest treatments that may be helpful, such as cognitive behavioural therapy or other forms of counselling. There are also lots of things you can do to help yourself if your mood is low, including getting plenty of exercise (as physical activity helps produce feel-good hormones in your brain); eating a healthy balanced diet with lots of mood-boosting foods such as unrefined carbs, fruit, vegetables and oily fish; talking to someone you trust about your feelings; and limiting the amount of alcohol you drink.
You can find more information on how to manage PCOS in the long-term on our hub.
Marshall, J.C., Dunaif, A. (2012 Jan). All Women With PCOS Should Be Treated For Insulin Resistance. Fertil Steril. 97(1); 18-22. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/
Borghouts, L.B., Keizer, H.A. (2000 Jan). Exercise and insulin sensitivity: a review. Int J Sports Med. 21(1):1-12. Available online: https://www.ncbi.nlm.nih.gov/pubmed/10683091
NHS. Polycystic ovary syndrome page. [Date accessed 19/03/2018]. Available online: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/
Dokras, A. (2008 Jan). Cardiovascular disease risk factors in polycystic ovary syndrome. Semin Reprod Med. 26(1):39-44. doi: 10.1055/s-2007-992923. Available online: https://www.ncbi.nlm.nih.gov/pubmed/18181081
Sprung, V.S., et al. (2013 Mar). Endothelial function measured using flow-mediated dilation in polycystic ovary syndrome: a meta-analysis of the observational studies. Clin Endocrinol (Oxf). 78(3):438-46. Available online: https://www.ncbi.nlm.nih.gov/pubmed/22775449?dopt=Abstract
American Heart Association. (July 2015). Lifestyle changes for preventing a heart attack. [Date acessed 19/03/2018]. Available online: http://www.heart.org/HEARTORG/Conditions/HeartAttack/LifeAfteraHeartAttack/Lifestyle-Changes-for-Heart-Attack-Prevention_UCM_303934_Article.jsp#.Wq-fQJPFJhE
PCOS Awareness Association. (2017). PCOS and Sleep Apnea. [Date acessed 19/03/2018]. Available online: http://www.pcosaa.org/pcos-and-sleep-apnea/
Vgontzas, A.N., et al. (2001 Feb). Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 86(2):517-20. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11158002
McCook, J.G., et al. (2015 Jul). Differential Contributions of Polycystic Ovary Syndrome (PCOS) Manifestations to Psychological Symptoms. J Behav Health Serv Res. 42(3):383-94.
Himelein, M.J., Thatcher, S.S. (2006 Nov). Polycystic ovary syndrome and mental health: A review. Obstet Gynecol Surv. 61(11):723-32. Available online: https://www.ncbi.nlm.nih.gov/pubmed/17044949
National Institute for Health and Care EXCELLENCE. Common mental health problems: identification and pathways to care. (2018). [Date accessed 19/03/2018] Available online: https://www.nice.org.uk/guidance/cg123/chapter/key-priorities-for-implementation