HEALTH RISKS ASSOCIATED WITH PCOS
IF PCOS WERE just about acne and a few missing periods, then it would not be so bad. Unfortunately, PCOS is associated with many health concerns, reproductive as well as general.5 The reproductive issues include
·anovulatory cycles,
·infertility,
·disorders of pregnancy, and
·fetal concerns.
Other significant health concerns include
·cardiovascular disease,
·non-alcoholic fatty liver disease (NAFLD),
·sleep apnea,
·anxiety and depression,
·cancer,
·type 2 diabetes, and
·metabolic syndrome.
These are some of the deadliest conditions in the world, including the top two causes of death in America, cardiovascular disease and cancer. PCOS is not merely a nuisance; it is an important warning of risk. For this reason, it’s worth taking a look at each of these conditions in more detail to try to understand their link with PCOS.
Reproductive concerns
» Anovulatory cycles
Most women with PCOS suffer from infrequent or absent menstrual periods, mostly caused by anovulatory cycles (ovulation is missed). PCOS accounts for 80 percent of cases of anovulation leading to infertility.6
» Infertility
If you do not ovulate, you can’t conceive: no egg, no baby. Anovulatory cycles account for approximately 30 percent of visits to an infertility clinic, mostly due to PCOS. The Australian Longitudinal Study on Women’s Health, a community-based survey of young women, found that a heartbreaking 72 percent of women with PCOS considered themselves infertile, compared with only 15 percent without PCOS. However, women with PCOS usually have difficulty conceiving rather than being completely infertile. The use of fertility hormones in the PCOS group was almost double that of the non-PCOS group. That is, the 5.8 percent of women identified as having PCOS constituted a whopping 40 percent of those seeking fertility treatments. Obviously, PCOS contributes heavily to overall use of costly fertility treatment.7
The financial costs of infertility are depressing. Costs in the United States range from relatively inexpensive hormonal treatments (approximately US$50 per treatment cycle) to very expensive in vitro fertilization (IVF), which in 2005 was estimated to cost upward of US$6000 to $10,000 per round of treatment. With millions of women suffering from PCOS, the total cost for infertility treatment alone in the United States is an estimated US$533 million.8
The possibility of being unable to conceive a child can cause severe anxiety. Celebrity chef Jamie Oliver and his wife, Jools, have spoken openly about their struggle with PCOS. They now have five children. Jools went through many rounds of hormonal treatments, and even one round of IVF, but at least two of their children were conceived spontaneously. Fertility medications such as clomiphene have been relatively successful at inducing ovulation. However, these treatments often have serious side effects—physical, psychological, and financial. While clomiphene may help women get pregnant, the PCOS-related reproductive problems don’t stop there.
» Disorders of pregnancy
Losing a pregnancy can be absolutely devastating, especially if it was difficult to conceive in the first place. Spontaneous abortions occur in an estimated one-third of women with PCOS. Studies suggest that PCOS is associated with up to twice the rate of miscarriage.9
Rates of all pregnancy-related complications are increased among women with PCOS. Gestational diabetes, pregnancy-induced hypertension, and pre-eclampsia risks are approximately tripled. Risk of preterm birth is increased by an estimated 75 percent when compared with women in general or women who have overcome PCOS.10 Women with PCOS are more likely to deliver by cesarean section, which itself comes with complications.
Fertility treatments may double the risk of multiple pregnancies, with all their attendant complications. Pregnancy with twins, for example, has up to 10 times the risk of the babies being small for gestational age at birth and six times the risk of delivering prematurely.11
» Fetal concerns
Babies of mothers with PCOS may be large for their gestational age, since hyperinsulinemia (excess insulin in the blood) is associated with increased nutrient availability. Both small and large gestational age at birth are associated with admissions to the neonatal intensive care unit (NICU), stillbirths, and perinatal mortality (infant death in the first week after birth)12 as well as metabolic complications (type 2 diabetes, obesity, and hypertension) later in life.13 Hyperinsulinemia in utero may affect the child’s intellectual and psychomotor development too.14
Associated health conditions
» Cardiovascular disease
Some studies estimate that women with PCOS may have seven times the risk of developing cardiovascular disease over women without PCOS.15 Large epidemiological studies like the Nurses’ Health Study, which comprised 82,439 women, found a correlation between irregular menses (as a proxy for possible PCOS) and a higher risk of heart disease during 14 years of follow-up.16 Although one study showed no risk,17 a 2010 consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society estimated the increased risk at 70 to 95 percent.18
PCOS is a marker of greater cardiovascular risk. The association with type 2 diabetes, obesity, and cholesterol problems accounts for much of the heightened risk. Insulin resistance develops in 40 percent of women with PCOS19 and typically gets worse with age. Women with PCOS also tend to have poor cholesterol panels. Since cardiovascular disease is already the leading cause of death in older women, this effect is especially concerning.
» Non-alcoholic fatty liver disease
The most common form of liver disease in the world, non-alcoholic fatty liver disease (NAFLD) affects an estimated 30 percent of the general population. The liver is an organ that should not normally store fat: fat should be stored in fat cells. Excessive alcohol consumption is a common cause of fat accumulation in the liver, but this can also happen in people who drink minimal alcohol. For many years, one of the leading causes of liver failure (cirrhosis) was termed “cryptogenic,” which means “from unknown cause.”20 Now we know that cryptogenic cirrhosis was largely due to undiagnosed fatty liver disease. Patients with NAFLD have an estimated 2.6 times the risk of death compared with the general population, and the disease is intimately linked to type 2 diabetes and metabolic syndrome.
The first case linking PCOS and NAFLD was reported in the medical literature in 2005.21 A 24-year-old woman diagnosed with PCOS but otherwise healthy was investigated because her bloodwork showed evidence of liver damage. A long needle was inserted into her liver and a biopsy taken. Under the microscope, to everybody’s surprise, the pathology showed severe fatty infiltration.
Since then, many other studies have confirmed the tight correlation between the two diseases. Women with PCOS have two-and-a-half times the prevalence
