In recent years it has become clear that PCOS is closely related to a problem with insulin. Insulin is a hormone released from the pancreas after a meal and it allows the organs of the body to take up energy in the form of glucose. In PCOS there is a 'resistance' of cells in the body to insulin, so the pancreas makes more insulin to try and compensate. The excessively high levels of insulin has an effect on the ovary, preventing ovulation and causing a rise in androgen (testosterone) levels.
One study found that 30% of slim women with PCOS have insulin resistance, however it affects as many as 75% of those who are overweight. This explains why overweight women with PCOS are more likely to suffer with excessive hairiness and infertility related to not ovulating.
Longer-term risks of PCOS
The long-term risks of PCOS are related to both the insulin problem and the high androgen levels. High levels of insulin are associated with an increased risk of developing type II diabetes may require strict diet control or possibly tablet medication. 25-35% of overweight PCOS women show signs of this by their 30's and it probably becomes more common in the 40's and beyond. A blood test can check for diabetes.
The hormone changes described increase the chance of developing high blood pressure and high cholesterol levels, both of which can lead to a greater risk of heart disease. You should have a lipid and cholesterol screen at some point if you have PCOS to check for this.
Metabolic syndrome is the name given to women who have a combination of risk factors that put them at higher risk of serious complications in the future. The metabolic syndrome is said to be present if you have three or more of the following five findings:
- waist circumference more than 88cm
- raised triglycerides (>1.7 mmol/l)
- lowered HDL cholesterol (<1.3 mmol/l)
- high blood pressure (>=130/85)
- an abnormal glucose test
Irregular or infrequent periods over a long period of time lead to an increased risk of cancer of the lining of the uterus (endometrial cancer). This is, in part, due to high levels of the hormone oestrogen, which over-stimulates the lining of the uterus. Absence of ovulation, and the resulting progesterone deficiency, also adds to this risk.
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