PCOS and health risks
If you have been living with PCOS for a while now, you may have started to wonder whether the effects of PCOS are limited to irregular periods, and those pesky skin and hair concerns. How will the disease progress as you grow older? Does it have any implications on your pregnancy health? What additional health risks should one be aware of and manage? While the answers to these questions may not be pleasant to hear, it's important to be aware of the prognosis of PCOS to take better charge of your long-term health.
You may have heard about how PCOS can lead to infertility, miscarriage, or complications during pregnancy. However, this syndrome is not limited to fertility problems. According to a scientific study published in the Journal of Clinical Endocrinology & Metabolism, polycystic ovary syndrome (PCOS) also carries cardiovascular and metabolic risks, which can lead to hospitalization.
Research has also shown that women with the disorder have an increased risk of developing nonalcoholic fatty liver disease (NAFLD), heart problems, diabetes, reproductive problems, or even cancer of the endometrium (layer of tissue that lines the uterus).
When we eat carbohydrates, the pancreas must produce insulin to regulate the sugar (glucose) in the blood to produce energy or store it for future use. Insulin allows sugar to enter the cell to produce energy.
Girls and women with PCOS often develop insulin resistance, which usually stimulates the pancreas to produce more insulin than normal. The increase in insulin can lead to weight gain, a factor in the development of the disease, and type 2 diabetes.
Insulin resistance is a failure of the body to use sugar properly and consequently, a higher level of sugar is found in the blood. This resistance directly promotes the development of type 2 diabetes, the most common form of diabetes.
Thus, weight gain, high BMI, insulin resistance, are some factors that contribute to the risk of PCOS women (1 in every 2 women) being diagnosed with type 2 diabetes by the age of 40. Compared to ones without this condition, women with PCOS are more prone to developing gestational diabetes.
A cascading effect
A high insulin level can then cause the ovaries to secrete more androgens, causing problems with hair growth, acne, hair loss, fat storage, and therefore a risk of being overweight. The excess of insulin in the blood will block ovulation and thus prevent the natural phenomenon of progesterone production which is essential to the menstrual cycle. High insulin level also leads to a darkening of the skin on the neck and underarms of some women, signs associated with type 2 diabetes.
There are broadly two kinds of cardiovascular risk factors: family history of cardiovascular diseases and factors such as age, and sex. The other kind, however, is something that can be managed or reduced by acting on these risk factors. These include smoking, diabetes, hypertension, excess cholesterol, being overweight, or living a sedentary lifestyle.
Metabolic disorders are common in women with PCOS and symptoms include being overweight, high cholesterol, high blood pressure, and insulin resistance/diabetes. Each of these symptoms increases the risk of heart disease. Another factor for increased cardiovascular risks among women with PCOS is an increased BMI as well as an increased waist circumference.
Being aware of heart risks means that women with PCOS can take the right measures and delay the development of cardiovascular diseases. Small, healthy changes in your daily routine can lower your risk of heart diseases.
Endometrial cancer is considered to be hormone-dependent cancer, notably linked to the activity of estrogen that stimulates the multiplication of specific cells. The endometrium, which has numerous receptors for these hormones, is very sensitive to estrogen stimulation.
Thus, the more a woman is exposed to a large quantity of estrogen or the longer she is exposed to it, the more the multiplication of cells will be stimulated. In general, high and/or prolonged exposure to estrogen is a risk factor for endometrial cancer–for example, estrogen-only hormone replacement therapy, early puberty, late menopause, and anovulation.
Endometrial cancer can be one of the complications of PCOS. Irregular periods over a long period of time can lead to the thickening of the lining of the uterus and the development of cancer cells. This can take years to develop though and so the risk of developing endometrial cancer increases with age.
Physical activity and combined estrogen-progestin oral contraceptives (birth control pills containing estrogen and progesterone) are protective agents for endometrial cancer.
Nonalcoholic fatty liver disease (NAFLD)
NAFLD is a complication of metabolic syndrome. It is established when the patient has at least three of the following conditions: diabetes, obesity, high blood pressure, elevated triglycerides, and low HDL cholesterol.
Among PCOS patients, obesity, particularly central adiposity, and insulin resistance are considered to be the principal causes of NAFLD. It is highly advisable to undergo NAFLD screening if you have any of these conditions along with PCOS.
Besides this, high levels of testosterone also significantly increased the risk of fatty liver disease, even in women who were at a normal healthy weight.
Mitigating health risks
- Increase your fiber intake
Eating more fiber can help you control your blood sugar and lower your cholesterol. Plus, fiber makes you feel full, so you'll tend to eat less. It can help you control your weight. Aim for 21 to 25 grams per day. Here are some high-fiber foods to try:
- Fruit - especially berries, pears, oranges, figs, and kiwi fruit
- Vegetables - especially peas, spinach, squash, and broccoli
- Whole grains - like oats, brown rice, whole wheat, quinoa, barley, and buckwheat
- Legumes - like lentils, chickpeas, soybeans and kidney beans
- Nuts and seeds - like almonds, flaxseeds, sunflower seeds
2. Opt for the right fats
Excessive consumption of saturated and trans fats can lead to weight gain, high blood pressure, and high cholesterol. Limit your intake of foods that contain saturated and trans fats. To replace these bad fats, choose small amounts of the healthy unsaturated fats found in vegetable oils such as sesame seed and olive oil, and nuts. Aim for a total of 30 mL to 45 mL of healthy fats per day (2 to 3 tbsp).
A healthy lifestyle is essential and remains the best way to fight health risks and symptoms associated with PCOS.
- reduce sugar consumption, favor a low-carbohydrate diet
- work on the intestinal flora with the help of probiotics
- practice intermittent dieting, which will allow you to regulate your insulin and improve your glucose metabolism with more stable blood sugar levels
- Metformin, a drug that reduces insulin (not to be taken without a doctor's prescription)
- Practicing a sports activity on a regular basis to improve the overall health
- losing weight will also lead to an improvement in your general wellbeing
- Chandrasekaran, S., & Sagili, H. (2018). Metabolic syndrome in women with polycystic ovary syndrome. The Obstetrician & Gynaecologist, 20(4), 245-252.
- Richard S. Legro, Silva A. Arslanian, David A. Ehrmann, Kathleen M. Hoeger, M. Hassan Murad, Renato Pasquali, Corrine K. Welt, Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 12, 1 December 2013, Pages 4565–4592, https://doi.org/10.1210/jc.2013-2350
- Scicchitano, P., Dentamaro, I., Carbonara, R., Bulzis, G., Dachille, A., Caputo, P., Riccardi, R., Locorotondo, M., Mandurino, C., & Matteo Ciccone, M. (2012). Cardiovascular Risk in Women With PCOS. International journal of endocrinology and metabolism, 10(4), 611–618. https://doi.org/10.5812/ijem.4020
- Vassilatou E. (2014). Nonalcoholic fatty liver disease and polycystic ovary syndrome. World journal of gastroenterology, 20(26), 8351–8363. https://doi.org/10.3748/wjg.v20.i26.8351