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| |    Medical Risks of Polycystic Ovarian Syndrome (PCOS) How some treatments can prevent long-term complications by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Polycystic ovarian syndrome (PCOS) is caused by a complex hormonal imbalance and is distinguished, in part, by irregular ovulations or the absence of ovulation. Chronic anovulation is another medical term for this syndrome, in which the hormone estrogen is present without the balancing effects of the hormone progesterone, which is normally produced by the ovary after an egg is released. Over time, women with untreated chronic anovulation are at risk for excessive menstrual bleeding (to the point of hemorrhage), infertility, diabetes, hypertension, cardiovascular disease, and uterine cancer. Hemorrhage Women and girls with PCOS have ovaries that either don't release eggs at all or that only do so infrequently. This usually leads to abnormal menstrual cycles. Some women with chronic anovulation don't bleed at all, while others may bleed irregularly. When menstrual bleeding occurs, it's due to structural instability of the uterine lining, where the lining of the uterus gets so thick that parts start to shed on their own, rather than from the hormonal cycle that typically occurs in women each month. This may lead to bleeding that is irregular, extremely heavy, and prolonged. Protracted or heavy bleeding can in turn lead to iron deficiency and low blood counts (anemia). Sometimes the bleeding can be so severe that blood transfusion is required. To prevent hemorrhaging, women with PCOS can periodically take progesterone-like medications (progestins) or oral contraceptive pills. Uterine cancer The hormonal imbalance of PCOS leads to constant stimulation of the uterine lining by the hormone estrogen without the balancing effects of the hormone progesterone. Over years, this can progress to overgrowth (or hyperplasia) of the uterine lining, which can proceed to endometrial cancer. To prevent cancer, women with PCOS who are not trying to get pregnant should take birth control pills or receive periodic progestin treatment. Fertility issues Women with PCOS who sometimes ovulate may end up conceiving without specific treatment. For overweight women with PCOS, a modest loss of just 5 to 10 percent of body weight may be enough to restart ovulation. There is some evidence that treatment with diabetes medications like metformin (see below) may help women with PCOS to get pregnant. However, many women with PCOS will require fertility drugs to stimulate ovulation. Some physicians offer a procedure called ovarian drilling, which punctures the ovarian cysts and jump-starts ovulation. While this treatment is effective for some women, the long-term effects on the ovaries aren't known. Many fertility specialists are waiting for more research before offering this treatment to their patients. If you have PCOS and are trying to get pregnant, talk to your practitioner about how long you should try before it would be appropriate to start treatment. Also, keep in mind that although many women with PCOS don't ovulate at all, some women with this diagnosis have been known to conceive when they least expect it--so don't rely on it as a birth control method! Diabetes and insulin resistance Some women and girls with PCOS have insulin resistance, meaning that they have to produce greater than normal amounts of the hormone insulin to keep their blood sugar under control. If the insulin production can't keep up with the body's need, diabetes can develop. The cause-and-effect relationships between insulin resistance, hypertension, heart disease, and PCOS are not completely understood. New research indicates that for some women, taking an insulin-sensitizing agent like metformin (Glucophage) can lead to ovulation and successful pregnancy. Currently this treatment is considered unnecessary for girls and women with PCOS who are not trying to conceive. For overweight women and girls with PCOS, simply losing weight can diminish many of these long-term risks. There is a lot of research going on in this area. Your doctor can tell you which options might be helpful in your situation.
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