Skip to main content Accessibility help
×
Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-27T19:13:15.795Z Has data issue: false hasContentIssue false

Chapter 18 - The Long-Term Health Consequences of Polycystic Ovary Syndrome

Published online by Cambridge University Press:  13 May 2022

Gabor T. Kovacs
Affiliation:
Monash University, Melbourne, Australia
Bart Fauser
Affiliation:
University Medical Center, Utrecht, Netherlands
Richard S. Legro
Affiliation:
Penn State Medical Center, Hershey, PA, USA
Get access

Summary

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. It has been known for some time as a both a reproductive and a metabolic disorder but more recently, mainly as a result of large longitudinal population-based studies, is becoming recognized as a complex multisystem disorder with comorbidities and long-term health implications. PCOS is associated not only with reproductive and metabolic features but also with cardiovascular abnormalities, psychological illness and endometrial cancer. Data are also emerging about possible long-term health consequences for the offspring of women with PCOS. Their children are more likely to be obese with metabolic disorders and are more likely to develop neurodevelopmental or psychiatric disorders. In this chapter, the long-term health consequences of PCOS for women and their offspring are described, together with a discussion on how they should best be managed.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Azziz, R. et al., Positions statement: Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006; 91(11): 42374245.CrossRefGoogle ScholarPubMed
Diamanti-Kandarakis, E. and Dunaif, A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33(6): 9811030.Google Scholar
March, W. A., et al., The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25(2): 544551.Google Scholar
Teede, H. J., et al., Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018; 33(9): 16021618.Google Scholar
Reaven, G. M., Banting Lecture 1988:. Role of insulin resistance in human disease. Diabetes, 1988; 37(12): 15951607.Google Scholar
Stepto, N. K., et al., Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod 2013; 28(3): 777784.Google Scholar
Robinson, S., et al., Postprandial thermogenesis is reduced in polycystic ovary syndrome and is associated with increased insulin resistance. Clin Endocrinol (Oxf) 1992; 36(6): 537543.Google Scholar
Cassar, S., et al., Insulin resistance in polycystic ovary syndrome: A systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod 2016; 31(11): 26192631.Google Scholar
Abbott, D. H., Dumesic, D. A. and Franks, S. Developmental origin of polycystic ovary syndrome: A hypothesis. J Endocrinol 2002; 174(1): 15.Google Scholar
Diamanti-Kandarakis, E. and Papavassiliou, A. G. Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol Med 2006; 12(7): 324332.Google Scholar
Teede, H. J., et al., Insulin resistance, the metabolic syndrome, diabetes, and cardiovascular disease risk in women with PCOS. Endocrine 2006; 30(1): 4553.Google Scholar
Rimmer, M., et al., Metabolic inflexibility in women with polycystic ovary syndrome: A systematic review. Gynecol Endocrinol 2020; 36(6): 501507.Google Scholar
Robinson, S., et al., The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries. Clin Endocrinol (Oxf), 1993; 39(3): 351355.CrossRefGoogle ScholarPubMed
Rice, S., et al., Impaired insulin-dependent glucose metabolism in granulosa-lutein cells from anovulatory women with polycystic ovaries. Hum Reprod 2005; 20(2): 373381.Google Scholar
Willis, D., et al., Modulation by insulin of follicle-stimulating hormone and luteinizing hormone actions in human granulosa cells of normal and polycystic ovaries. J Clin Endocrinol Metab 1996; 81(1): 302309.Google ScholarPubMed
Richter, E. A., et al., Effect of exercise on insulin action in human skeletal muscle. J Appl Physiol 1989; 66(2): 876885.Google Scholar
Holte, J., et al., Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 1995; 80(9): 25862593.Google ScholarPubMed
Moran, L. J., et al., Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2010; 16(4): 347363.CrossRefGoogle ScholarPubMed
Rubin, K. H., et al., Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017; 102(10): 38483857.CrossRefGoogle Scholar
Bodmer-Roy, S., et al., Pregnancy outcomes in women with and without gestational diabetes mellitus according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Obstet Gynecol 2012; 120(4): 746752.Google Scholar
Apridonidze, T., et al., Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(4): 19291935.Google Scholar
Recabarren, S .E., et al., Metabolic profile in sons of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2008; 93(5): 18201826.Google Scholar
Doherty, D. A., et al., Implications of polycystic ovary syndrome for pregnancy and for the health of offspring. Obstet Gynecol 2015; 125(6): 13971406.Google Scholar
Gambineri, A., et al., Obesity and the polycystic ovary syndrome. Int J Obes Relat Metab Disord 2002; 26(7): 883896.Google Scholar
Yildiz, B. O., Knochenhauer, E. S. and Azziz, R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab 2008; 93(1): 162168.Google Scholar
Talbott, E., et al., Coronary heart disease risk factors in women with polycystic ovary syndrome. Arterioscler Thromb Vasc Biol 1995; 15(7): 821826.Google Scholar
Taponen, S., et al., Hormonal profile of women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland birth cohort 1966 study. J Clin Endocrinol Metab 2003; 88(1): 141147.Google Scholar
Pasquali, R., Obesity and androgens: Facts and perspectives. Fertil Steril 2006; 85(5): 13191340.Google Scholar
Teede, H. J., et al., Longitudinal weight gain in women identified with polycystic ovary syndrome: Results of an observational study in young women. Obesity (Silver Spring), 2013; 21(8): 15261532.Google Scholar
Koivuaho, E., et al., Age at adiposity rebound in childhood is associated with PCOS diagnosis and obesity in adulthood-longitudinal analysis of BMI data from birth to age 46 in cases of PCOS. Int J Obes (Lond) 2019; 43(7): 13701379.CrossRefGoogle ScholarPubMed
Robinson, S, Chan, SP, Spacey, S, Anyaoku, V, Johnston, DG, Franks, S. Postprandial thermogenesis is reduced in polycystic ovary syndrome and is associated with increased insulin resistance. Clin Endocrinol (Oxf). 1992 Jun;36(6):537–43.Google Scholar
Siemienowicz, K., et al., Insights into manipulating postprandial energy expenditure to manage weight gain in polycystic ovary syndrome. iScience 2020; 23(6): 101164.Google Scholar
Diamanti-Kandarakis, E., Role of obesity and adiposity in polycystic ovary syndrome. Int J Obes (Lond) 2007; 31 (Suppl 2): S813.Google Scholar
Dunaif, A., et al., Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol Metab 2001; 281(2): E392E399.CrossRefGoogle ScholarPubMed
Hudecova, M., et al., Prevalence of the metabolic syndrome in women with a previous diagnosis of polycystic ovary syndrome: Long-term follow-up. Fertil Steril 2011; 96(5): 12711274.Google Scholar
Schmidt, J., et al., Cardiovascular disease and risk factors in PCOS women of postmenopausal age: A 21-year controlled follow-up study. J Clin Endocrinol Metab 2011; 96(12): 37943803.Google Scholar
Clark, A. M., et al., Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 1998; 13(6): 15021505.Google Scholar
Clark, A. M., et al., Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 1995; 10(10): 27052712.CrossRefGoogle ScholarPubMed
Lim, S. S., et al., The effect of obesity on polycystic ovary syndrome: A systematic review and meta-analysis. Obes Rev, 2013 14(2): 95109.CrossRefGoogle ScholarPubMed
Legro, R. S., Obesity and PCOS: Implications for diagnosis and treatment. Semin Reprod Med 2012; 30(6): 496506.Google Scholar
Moran, L. J., et al., Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88(2): 812819.Google Scholar
Crosignani, G., et al., Overweight and obese anovulatory patients with polycystic ovaries: Parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod 2003; 18(9): 19281932.Google Scholar
Jakubowicz, D. J. and Nestler, J. E. 17 alpha-Hydroxyprogesterone responses to leuprolide and serum androgens in obese women with and without polycystic ovary syndrome offer dietary weight loss. J Clin Endocrinol Metab 1997; 82(2): 556560.Google Scholar
Benito, E., et al., Fertility and pregnancy outcomes in women with polycystic ovary syndrome following bariatric surgery. J Clin Endocrinol Metab 2020; 105(9): 18.CrossRefGoogle ScholarPubMed
Wilson, W., Abbott, R. D. and Castelli, W. P. High density lipoprotein cholesterol and mortality: The Framingham Heart Study. Arteriosclerosis 1988; 8(6): 737741.Google Scholar
Bass, K. M., et al., Plasma lipoprotein levels as predictors of cardiovascular death in women. Arch Intern Med 1993; 153(19): 22092216.Google Scholar
Legro, R. S., Kunselman, A. R. and Dunaif, A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 2001; 111(8): 607613.CrossRefGoogle ScholarPubMed
Talbott, E., et al., Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: Results of a case-control study. J Clin Epidemiol 1998; 51(5): 415422.Google Scholar
Wild, S., et al., Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: A retrospective cohort study. Clin Endocrinol (Oxf) 2000; 52(5): 595600.CrossRefGoogle ScholarPubMed
Wild, R. A., et al., Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1985; 61(5): 946951.Google Scholar
Pirwany, I. R., et al., Lipids and lipoprotein subfractions in women with PCOS: Relationship to metabolic and endocrine parameters. Clin Endocrinol (Oxf) 2001; 54(4): 447453.CrossRefGoogle ScholarPubMed
Ollila, M. M., et al., Weight gain and dyslipidemia in early adulthood associate with polycystic ovary syndrome: Prospective cohort study. J Clin Endocrinol Metab 2016; 101(2): 739747.Google Scholar
Couto Alves, A., et al., Metabolic profiling of polycystic ovary syndrome reveals interactions with abdominal obesity. Int J Obes (Lond) 2017; 41(9): 13311340.Google Scholar
Clements, M. K., et al., FMRFamide-related neuropeptides are agonists of the orphan G-protein-coupled receptor GPR54. Biochem Biophys Res Commun 2001; 284(5): 11891193.Google Scholar
Diamanti-Kandarakis, E., et al., Pathophysiology and types of dyslipidemia in PCOS. Trends Endocrinol Metab 2007; 18(7): 280285.CrossRefGoogle ScholarPubMed
Ollila, M. E., et al., Self-reported polycystic ovary syndrome is associated with hypertension: A Northern Finland birth cohort 1966 study. J Clin Endocrinol Metab 2019; 104(4): 12211231.Google Scholar
Ollila, M. M., et al., Effect of polycystic ovary syndrome on cardiac autonomic function at a late fertile age: A prospective Northern Finland Birth Cohort 1966 study. BMJ Open 2019; 9(12): e033780.Google Scholar
Pierpoint, T., et al., Mortality of women with polycystic ovary syndrome at long-term follow-up. J Clin Epidemiol 1998; 51(7): 581586.CrossRefGoogle ScholarPubMed
Wild, R. A., et al., Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95(5): 20382049.Google Scholar
Park, J. G., Ramar, K., and Olson, E. J., Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clin Proc 2011; 86(6): 549554.Google Scholar
Fogel, R. B., et al., Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2001; 86(3): 11751180.Google Scholar
Vgontzas, A. N., et al., Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: Role of insulin resistance. J Clin Endocrinol Metab 2001; 86(2): 517520.Google Scholar
Andersen, M. L. and Tufik, S. The effects of testosterone on sleep and sleep-disordered breathing in men: Its bidirectional interaction with erectile function. Sleep Med Rev 2008; 12(5): 365379.Google Scholar
Tasali, E., et al., Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96(2): 365374.Google Scholar
McEvoy, R. D., et al., CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 2016; 375(10): 919931.CrossRefGoogle ScholarPubMed
Hu, X., et al., The role of continuous positive airway pressure in blood pressure control for patients with obstructive sleep apnea and hypertension: A meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich) 2015; 17(3): 215222.Google Scholar
Jonas, D. E., et al., Screening for obstructive sleep apnea in adults: Evidence report and systematic review for the US Preventive Services Task Force. JAMA 2017; 317(4): 415433.Google Scholar
Himelen, M. J. and Thatcher, S. S. Depression and body image among women with polycystic ovary syndrome. J Health Psychol 2006; 11(4): 613615.CrossRefGoogle Scholar
Cooney, L. G., et al., High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod 2017; 32(5): 10751091.Google Scholar
Shi, X., et al., Co-involvement of psychological and neurological abnormalities in infertility with polycystic ovarian syndrome. Arch Gynecol Obstet 2011; 284(3): 773778.Google Scholar
Hollinrake, E., et al., Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007; 87(6): 13691376.Google Scholar
Karjula, S., et al., Psychological distress is more prevalent in fertile age and premenopausal women with PCOS symptoms: 15-Year follow-up. J Clin Endocrinol Metab 2017; 102(6): 18611869.Google Scholar
Drosdzol, A., Skrzypulec, V. and Plinta, R. Quality of life, mental health and self-esteem in hirsute adolescent females. J Psychosom Obstet Gynaecol 2010; 31(3): 168175.Google Scholar
Bazarganipour, F., et al., Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. Iran J Reprod Med 2013; 11(10): 829836.Google Scholar
Dokras, A., et al., Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: Systematic review and meta-analysis. Fertil Steril 2012; 97(1): 225–30.e2.CrossRefGoogle ScholarPubMed
Cesta, C. E., et al., Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology 2016; 73: 196203.Google Scholar
Dokras, A., et al., Androgen Excess- Polycystic Ovary Syndrome Society: Position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 2018; 109(5): 888899.Google Scholar
Karjula, S., et al., Population-based data at ages 31 and 46 show decreased HRQoL and life satisfaction in women with PCOS symptoms. J Clin Endocrinol Metab 2020; 105(6).Google Scholar
Månsson, M., et al., Women with polycystic ovary syndrome are often depressed or anxious: A case control study. Psychoneuroendocrinology 2008; 33(8): 11321138.Google Scholar
Karacan, E., et al., Body satisfaction and eating attitudes among girls and young women with and without polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2014; 27(2): 7277.Google Scholar
Dashti, S., et al., Sexual dysfunction in patients with polycystic ovary syndrome in Malaysia. Asian Pac J Cancer Prev 2016; 17(8): 37473751.Google ScholarPubMed
Eftekhar, T., et al., Sexual dysfunction in patients with polycystic ovary syndrome and its affected domains. Iran J Reprod Med 2014; 12(8): 539546.Google Scholar
Pastoor, H., et al., Sexual function in women with polycystic ovary syndrome: A systematic review and meta-analysis. Reprod Biomed Online 2018; 37(6): 750760.Google Scholar
Janssen, O. E., et al., Mood and sexual function in polycystic ovary syndrome. Semin Reprod Med 2008; 26(1): 4552.Google Scholar
Elsenbruch, S., et al., Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88(12): 58015807.Google Scholar
Ercan, C.M., et al., Sexual dysfunction assessment and hormonal correlations in patients with polycystic ovary syndrome. Int J Impot Res 2013; 25(4): 127132.CrossRefGoogle ScholarPubMed
Drosdzol, A., et al., Quality of life and marital sexual satisfaction in women with polycystic ovary syndrome. Folia Histochem Cytobiol 2007; 45 (Suppl 1): S93S97.Google Scholar
Hahn, S., et al., Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome. Eur J Endocrinol 2005; 153(6): 853860.Google Scholar
Chen, X., et al., Association of polycystic ovary syndrome or anovulatory infertility with offspring psychiatric and mild neurodevelopmental disorders: A Finnish population-based cohort study. Hum Reprod 2020; 35(10): 23362347.Google Scholar
Speert, H., Carcinoma of the endometrium in young women. Surg Gynaecol Obstet 1949; 88(3): 332336.Google Scholar
Dahlgren, E., et al., Endometrial carcinoma; ovarian dysfunction: A risk factor in young women. Eur J Obstet Gynecol Reprod Biol 1991; 41(2): 143150.CrossRefGoogle ScholarPubMed
Charalampakis, V., et al., Polycystic ovary syndrome and endometrial hyperplasia: An overview of the role of bariatric surgery in female fertility. Eur J Obstet Gynecol Reprod Biol 2016; 207: 220226.Google Scholar
Hardiman, P. Pillay, O. C., and Atiomo, W. Polycystic ovary syndrome and endometrial carcinoma. Lancet, 2003; 361(9371): 18101812.Google Scholar
Chittenden, B. G., et al., Polycystic ovary syndrome and the risk of gynaecological cancer: A systematic review. Reprod Biomed Online 2009; 19(3): 398405.Google Scholar
Barry, J. A., Azizia, M. M. and Hardiman, J. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2014; 20(5): 748758.Google Scholar
Coulam, C. B., Annegers, J. F. and Kranz, J. S. Chronic anovulation syndrome and associated neoplasia. Obstet Gynecol 1983; 61(4): 403407.Google Scholar
Furberg, A. S. and Thune, I. Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer 2003; 104(6): 669676.CrossRefGoogle Scholar
Weiderpass, E., et al., Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 2000; 11(2): 185192.Google Scholar
Harris, H. R. and Terry, K. L. Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: A systematic review. Fertil Res Pract 2016; 2: 14.Google Scholar
Chu, D., et al., Effect of metformin use on the risk and prognosis of endometrial cancer: A systematic review and meta-analysis. BMC Cancer 2018; 18(1): 438.Google Scholar
Brinton, L. A., et al., Fertility drugs and endometrial cancer risk: Results from an extended follow-up of a large infertility cohort. Hum Reprod 2013. 28(10): 28132821.Google Scholar
Azziz, R., et al., Polycystic ovary syndrome. Nat Rev Dis Primers 2016; 2: 16057.Google Scholar
Teede, H., Deeks, A., and Moran, L., Polycystic ovary syndrome: A complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010; 8: 41.Google Scholar
Cortón, M., et al., Differential gene expression profile in omental adipose tissue in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2007; 92(1): 328337.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×