Long-term Health Concerns of PCOS
What are the long-term health risks associated with PCOS?
PCOS is associated with increased risk for endometrial hyperplasia, endometrial cancer,
insulin resistance, type II diabetes, high blood pressure, high cholesterol, and heart
disease.
What kind of monitoring is recommended?
Even if pregnancy is not desired, women with PCOS should be sure to have their blood
sugar, insulin, cholesterol and triglycerides checked once per year. Those who are also
hypothyroid should also monitor TSH to make sure medications are working properly.
What is endometrial hyperplasia and how can risk be reduced?
Endometrial hyperplasia is a thickening of the endometrium with the finding of abnormal
cells a pre-cancerous condition. It is diagnosed through an endometrial biopsy where
a thin catheter is threaded through the cervix and a small sample of the lining is
removed. A pathologist reviews the tissue and results are not available immediately. The
key to reducing risk is to make sure to have some kind of "bleed" in which the lining
of the uterus is shed at least every 3 months, preferably more often. This can be
accomplished through the use of birth control pills or progesterone/progestins for
period induction.
What can be done to reduce the risk of endometrial cancer?
The primary way to reduce the risks of cancer is to have regular menses one way or
another. Whether it be through the use of oral contraceptive, progesterone or progestins
for period induction, or otherwise regulating hormone levels so that one doesn't go
longer than a couple of months without shedding the uterine lining. There is no
guaranteed way to prevent cancer, but one can minimize the risk.
What if induction of menses fails?
If using progesterone or progestin (Provera, Aygestin, and Cycrin) after a negative
pregnancy test fails to induce menstruation, one should have a second pregnancy test
before further treatment. It may be that the lining was not thick enough to shed, in
which case using estrogen followed by progesterone/progestin, or birth control pills,
may work for bringing on a period.
What are insulin resistance, diabetes, and the other impairments of insulin and glucose
metabolism?
One of the complicating factors of understanding the blood sugar and insulin issues
associated with PCOS is all the different names out there. Below is a brief description
tf the various terms and there is more information under the insulin connection section.
Insulin Resistance is when a fasting insulin level is greater than 10 mIU/ml. There are
some other testing methods used. Some would say a fasting glucose:insulin ratio less
than 4.5:1 indicates insulin resistance. Another method is doing a glucose tolerance
test and checking insulin along with blood sugar. If the insulin level at 2 hours is 5
times the fasting level, insulin resistance is diagnosed. The most common testing is
the fasting level. Central obesity is considered a risk factor for insulin resistance.
Hyperinsulinemia is when insulin levels are high in relation to glucose levels. It goes
along with insulin resistance. Hyperinsulinemia in PCOS correlates with increased
cardiovascular risk independent of obesity.
Impaired Fasting Glucose is when the fasting glucose level is greater than or equal to
110 and less than 126 mg/dl. This level may signal insulin resistance and is a future
risk factor for diabetes.
Impaired Glucose Tolerance is when a person has a 2-hour glucose tolerance test result
greater than or equal to 140 but less than 200 mg/dl (some would suggest lowering the
upper limit to 180). This indicates a future risk factor for diabetes.
Diabetes is when a person has a fasting blood sugar equal to or greater than 126 mg/dl,
or a 2-hour GTT level greater than or equal to 200 mg/dl dl (some would suggest
lowering the upper limit to 180). This should be confirmed by a second test.
What can be done to reduce the risk of type II diabetes?
The best way to reduce the risk of type II, non-insulin dependant (NIDDM) diabetes
mellitus is through careful food choices, exercise, and weight loss in overweight
individuals. Insulin-sensitizing medication may also help prevent or delay the onset of
diabetes. These medications can increase the likelihood of pregnancy, and may reduce
effectiveness of oral contraceptives, so precautions should be taken by anyone not
wishing to get pregnant.
What are normal levels for cholesterol and triglycerides?
The table below includes standard fasting levels. The LDL cholesterol target level is
reduced in those who have risk factors. With one risk factor, the target is less than
160 mg/dl, with 2 factors the target is less than 130 mg/dl, and those with heart
disease have a target level less than 100. Insulin resistance, diabetes, obesity, and
family history are some of the risk factors, so those with PCOS should have a target
range of less than 130.
Cholesterol and Triglycerides
Type Normal Borderline High High Very High Low
Total Cholesterol < 200 mg/dl 200-239 mg/dl 240+ mg/dl
HDL Cholesterol > 35 mg/dl < 35
LDL Cholesterol < 160 mg/dl
Triglycerides < 200 mg/dl 200-400 mg/dl 400-1000 mg/dl 400-1000 mg/dl
What can be done to help improve cholesterol and triglycerides?
The best way to improve levels is through diet, exercise and weight loss for those who
are overweight. In some cases, medications may be used to lower cholesterol levels, but
those attempting pregnancy should not use these. Exercise can be particularly
beneficial as it can help increase good cholesterol and helps the body metabolize sugar.
What is dyslipidemia?
Dyslipidemias are disorders of lipoprotein metabolism, including lipoprotein
overproduction or deficiency. These disorders may be manifested by elevation of the
serum total cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides
concentrations, and a decrease in the high-density lipoprotein (HDL) cholesterol
concentration.
What is hyperlipidemia?
Hyperlipidemia is an elevation of lipids (fats) in the bloodstream. These lipids
include cholesterol, cholesterol esters (compounds), phospholipids and triglycerides.
What can be done about high blood pressure now and in the future?
This again is an area where diet, exercise and weight reduction in overweight
individuals may help lower blood pressure and perhaps lessen the need for medication.
Research also suggests that lowering salt intake and increasing consumption of foods
containing certain minerals, such as potassium and magnesium, can help. There are many
prescription medications that can be used to lower blood pressure as well, including
diuretics, beta blockers, and calcium channel blockers. Anyone who is trying to get
pregnant should discuss which medications are safest with their physician, and try to
get good control on safe medications before attempting a pregnancy.
What can be done to reduce the risk of heart disease?
Reducing heart disease risk follows the same pattern for reducing insulin resistance,
balancing cholesterol, and lowering blood pressure it all involves managing PCOS to
minimize current symptoms and attempt to delay or prevent worsening of the underlying
conditions that lead to heart disease. This can be done through careful food choices,
exercise, weight loss in overweight individuals, and through careful selection of
medications.
